Approach Considerations

No laboratory tests are useful in identifying borderline personality disorder (BPD). Some BPD patients have abnormal results with dexamethasone suppression testing and with thyrotropin-releasing hormone testing; however, these findings are also present in many patients with depression. As with any thorough workup of a patient with a mood disorder, fasting glucose and thyroid function studies are usually indicated. Other laboratory tests are indicated, depending on the clinical presentation.

No diagnostic imaging studies are specific for borderline disorders in adults or children. In one small study of 20 patients with BPD, 40% of patients had abnormal, diffuse, slow activity on electroencephalography (EEG).^[13]Some patients with BPD have shortened rapid eye movement (REM) latency and sleep-continuity disturbances, but these findings are also found in a fair number of patients with depression.

Although psychological testing reveals and highlights clinical features, it does not increase diagnostic specificity. Most authors agree that patients with BPD demonstrate ordinary reasoning abilities on structured tests (eg, the Wechsler Adult Intelligence Scale [WAIS]). Abnormal processes are noted only on unstructured projective tests (eg, the Rorschach test). Projective testing highlights circumstantial reasoning and illogical and unrelated connections. In addition, responses of patients with BPD are often overwhelmingly negative.

Treatment & Management

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