Tokyo psychiatrist, Dr. Douglas Berger, comments on “Update on Diagnostic Issues for Borderline Personality Disorder” by Peter Fonagy, OBE, FMedSci, FBA, PhD, Chloe Campbell, PhD, and Anthony W. Bateman, MA, FRCPsych, July 19, 2016 issue of the Psychiatric Times:

It is unclear how the proposals in this article are any more valid than the current categorical criteria. For example, the article doesn’t mention the exclusion criteria for a personality disorder when the criteria can be explained by another psychiatric disorder. For example, the trait stage of diagnosis for BPD notes 7 traits that could easily be due to a mood disorder: emotional lability, anxiousness, separation anxiety, depressivity, and/or ADHD or a manic spectrum disorder: impulsivity, risk-taking, and hostility.

Until there is a reliable biological or genetic parameter that can validly discriminate BPD from these other disorder spectrums, it seems prudent to have the modesty to admit that the diagnosis of a personality disorder, especially BPD, will still be far from a valid construct no matter how categorical or dimensional we want to make a mix of them.

Doug Berger, M.D., Ph.D.
US Board Certified Psychiatrist
Tokyo, Japan

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