A Systematic Review on the Reliability and Validity of Semistructured Diagnostic Interviews for Borderline Personality Disorder

By Carcone, Dean; Tokarz, Victoria L. et al. | Canadian Psychology, May 2015 | Go to article overview

A Systematic Review on the Reliability and Validity of Semistructured Diagnostic Interviews for Borderline Personality Disorder


Carcone, Dean, Tokarz, Victoria L., Ruocco, Anthony C., Canadian Psychology


Historically, formulating a diagnosis of borderline personality disorder (BPD) has been complicated by the range of diagnostic measures available. Originally conceived as a condition lying somewhere on the "borderline" between psychosis and neurosis (Kernberg, 1967), BPD has evolved into a diagnostic entity characterised by four core sectors of psychopathology: affective, interpersonal, behavioural and cognitive (Gunderson et al., 2011). In light of the significant diagnostic challenges surrounding BPD, several semistructured diagnostic interviews have been developed to assess the disorder in a more standardized manner than the unstructured clinical interview. Whereas these diagnostic instruments are in widespread use by researchers and clinicians, there are no comprehensive updated reviews on the reliability and validity of these measures. Here, the terms interview, instrument, and measure are used interchangeably. A review of these instruments is timely considering that revisions to the diagnostic criteria for BPD are being considered (for a review, see Gunderson, 2013), and comparing the effectiveness of these measures, which use different approaches to operationalize the diagnostic criteria, may be useful. Furthermore, these measures continue to serve as the most highly regarded and widely used when diagnosing the disorder.

In a review on instruments to diagnose personality disorders based on the third and revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980, 1988), Reich (1989) concluded that these measures required additional testing to support their validity and reliability (especially test-retest reliability) and to understand discrepancies in diagnoses made using different instruments. While emphasising the strengths of these instruments in terms of their interrater reliability, Zimmerman (1994) cautioned against interpreting test-retest reliability coefficients for measurements of DSM-III and DSM-III-R BPD because agreement in diagnoses over time appeared to decrease with increasing duration of the test-retest interval. Zimmerman also questioned the validity of personality disorder diagnoses made according to these instruments. He also highlighted the scarcity of research investigating the prognostic value and predictive validity of these diagnoses, which respectively refer to whether a diagnosis is beneficial to a patient and clinicians, and how it may be used to predict future symptoms, diagnoses, or aspects of life. More recently, Biskin and Paris (2012) commented that the accurate assessment of BPD using structured interviews is critical because the disorder may be frequently misdiagnosed and that informing patients about their BPD diagnosis can lead to favourable outcomes. Considering that experts in the field view BPD as the most frequently diagnosed personality disorder in clinical practice (Mullins-Sweatt, Bernstein, & Widiger, 2012), an updated comprehensive review of diagnostic interviews for BPD may provide clarity on the relative strengths and weaknesses of these instruments.

In the current article, we present a systematic review on the reliability and validity of semistructured diagnostic interviews for BPD. There are many perspectives on how to organise concepts of reliability and validity in psychological assessment (e.g., Borsboom, Mellenbergh, & van Heerden, 2004; Carmines & Zeller, 1979; Sechrest, 1984). We structured this review according to the preponderance of research available on specific topics for the diagnostic interviews considered. This included research on three forms of reliability- interrater, test-retest, and internal consistency-and three aspects of validity-convergent, discriminant, and criterion-related. Reliability refers to the dependability of a measure (i.e., freedom from measurement error; see Streiner, 2004). For this review, interrater reliability concerns the level of agreement between two or more raters with the same individual using the same diagnostic instrument. …

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