Diagnostic Considerations

As many as one half of all patients with borderline personality disorder (BPD) may also meet the criteria for histrionic, antisocial, or schizotypal personality disorders. Chronic feelings of emptiness, impulsivity, self-mutilation, short-lived psychotic episodes, and manipulative suicide attempts help distinguish BPD from other personality disorders. The Gunderson Diagnostic Interview for Borderlines^[26]and the Perry Borderline Personality Disorder Scale can be helpful structured tools in the diagnosis of BPD.

Andrulonis evaluated a population of 45 children (aged 5-12 years) who met the Diagnostic and Statistical Manual, Third Edition (DSM-III) , and Gunderson criteria for BPD.^[21]The primary behaviors that differentiated these children from the control group were aggression and rage, attention-deficit/hyperactivity disorder (ADHD), excessive use of fantasy, impulsivity, and poor relationships.

Skodol et al examined data from 1996 participants in a national survey who initially had a diagnosis of major depression.^[27]These participants were then reinterviewed 3 years later to determine the persistence and recurrence of the diagnosis. The study concluded that BPD robustly predicted persistence (a finding supported by subsequent studies). Thus, personality psychopathology, most notably BPD, should be assessed in patients with major depressive disorder and should be considered as part of prognosis and treatment.

Differential Diagnoses

Child Abuse & Neglect: Posttraumatic Stress Disorder
Dissociative Identity Disorder
Pediatric Attention Deficit Hyperactivity Disorder (ADHD)
Pediatric Bipolar Affective Disorder
Posttraumatic Stress Disorder in Children

Workup

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