The borderline syndrome. I. Testing three diagnostic systems.

Diagnostic systems require testing on several factors: reliability, comprehensiveness, concordance with established use, specificity, and validity. Three sets of diagnostic criteria for the borderline have been proposed recently: the Gunderson et al criteria, the DSM-III criteria for borderline personality (BP) disorder, and the DSM-III criteria for schizotypal personality (SP) disorder. This article reviews work to date testing these systems on these factors. New data are presented from the retrospective application of these criteria to the clinical records of 400 diagnostically heterogeneous former inpatients at Chestnut Lodge, Rockville, Md; 330 of them also received systematic follow-up by interview an average of 15 years after discharge. Results strongly supported the validity of the DSM-III division of borderline into BP and SP. Although the BP and Gunderson et al criteria demonstrated high concordance, the latter appeared to offer some slight advantages for defining BP disorder.