Borderline Personality Disorder in Clinical Practice: study

Limitations and Potential Objections
The data from this study, like the data from a number of studies from our laboratory (e.g., references 22, 25, 27, 29), point to the potential utility of practice research network methods in research on personality disorders. The convergence of multiple informants would clearly be ideal (although most studies of psychopathology rely on a single observer—the patient—by means of either self-report or structured interviews); however, data from experienced clinical observers who interact with the patient over time and hence can provide a longitudinal portrait provide a complementary standpoint to that typically seen in psychiatric research.

Another set of limitations concerns the makeup of the current sample. Psychologists were disproportionately represented in the sample, relative to psychiatrists (80% and 20%, respectively), and the overall response rate was relatively low, compared to our previous studies. Although we cannot be sure that some unknown bias was not introduced by clinicians’ decisions to participate or not participate, the data provided by psychologists and by psychiatrists did not show any pattern of differences in this or any of our prior studies using this method, despite substantially different response rates, and our findings converged with those of research from medical centers that used completely different sampling methods. The similarities in these findings suggest that such biases are not likely substantial. Limiting the study to patients in psychotherapy also introduced the possibility that we were oversampling higher-functioning borderline personality disorder patients. However, the data suggested otherwise: The majority of the borderline personality disorder patients in the study reported histories of psychiatric hospitalizations, suicide attempts, and self-injurious behavior, and their average GAF score (mean=47.64, SD=9.68) indicated serious impairment. Finally, male and non-Caucasian borderline personality disorder patients are understudied groups, and broader sampling, including oversampling to maximize representativeness of the population, would strengthen future investigations.


Received Jan. 13, 2003; revision received Feb. 17, 2004; accepted May 19, 2004. From Cambridge Hospital/Harvard Medical School; and the Departments of Psychology and Psychiatry and Behavioral Sciences, Emory University. Address correspondence and reprint requests to Dr. Zittel Conklin, The Cambridge Hospital, Macht Building, 1493 Cambridge St., Cambridge, MA 02139; .(JavaScript must be enabled to view this email address) (e-mail); or Dr. Westen, Departments of Psychology and Psychiatry and Behavioral Sciences, Emory University, 532 North Kilgo Circle, Atlanta, GA 30322; .(JavaScript must be enabled to view this email address) (e-mail). Preparation of this manuscript was supported in part by NIMH grants MH-62377 and MH-62378 to Dr. Westen and by a grant from the Fund for Psychoanalytic Research of the American Psychoanalytic Association to Dr. Zittel Conklin. Presented in part at the 2nd Annual Meeting of the National Institute of Mental Health and Borderline Personality Disorder Research Foundation, Minneapolis, May 30–June 1, 2002. The authors thank the 117 clinicians who donated up to 4 hours of their time to participate in the study.


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Carolyn Zittel Conklin, Ph.D., and Drew Westen, Ph.D.
Am J Psychiatry 162:867-875, May 2005
American Psychiatric Association

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