Diagnostic approaches to borderline personality and their relationship to self-harm behavior

OBJECT: This study was designed to explore the relationship, if any, between diagnostic approach to borderline personality disorder (BPD) and the extent of self-harm behavior among psychiatric inpatients. METHOD: Newly admitted psychiatric inpatients (N =77) were evaluated for BPD using a self-report measure, clinical diagnosis, and a DSM-IV checklist. All participants were assessed for self-harm behavior using the 22-item Self-Harm Inventory (SHI). RESULTS: Participants with a clinical diagnosis of BPD showed the highest prevalence of, and most potentially lethal, types of self-harm behavior, followed by those diagnosed as BPD by the DSM-IV checklist, and then by self-report measure. Participants diagnosed as BPD on all three measures showed the highest mean number of self-harm and potentially lethal behavior types. Prevalence and potential lethality decreased successively among those who were diagnosed as BPD on two measures versus one measure versus no diagnosis of BPD. CONCLUSION: Self-harm behavior appears to be a clinically concordant behavior type among the diagnostic approaches to BPD used in this study. Clinical diagnosis appears most sensitive to self-harm behavior, compared with self-report and DSM-IV checklist.