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Borderline Personality Disorder and High Utilization of Inpatient Psychiatric Hospitalization: Concordance Between Research and Clinical Diagnosis

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Abstract

The goals of this study were to (1) assess prevalence rates of borderline personality disorder (BPD) in public mental health patients and (2) compare research assessment rates to clinical record rates in those with and without a history of high utilization of inpatient psychiatric hospitalization. One hundred and sixty participants randomly selected from county mental health centers were fully assessed. Among the non-high utilizers, 10% met criteria for BPD on research diagnosis, 4.5% on clinical record diagnosis, and 1.5% on both. Among high utilizers, 42% met criteria for BPD on research diagnosis, 19% on clinical record diagnosis, and 19% on both. For the non-high utilizers, the sensitivity of the clinical record diagnosis (compared to the gold standard of the research diagnosis) was 15% and the specificity was 97%. For the high utilizer group, the sensitivity of the clinical record diagnosis was 45% and specificity was 100% indicating that there was never an incorrect clinical diagnosis of BPD among the high utilizers. Thus, while the specificity of the clinical record was high, the sensitivity of the clinical record diagnosis was quite low, and the clinical record greatly underestimated the prevalence of BPD in this sample. Further, since effective outpatient treatment has been developed for these expensive high utilizers with BPD, the under-recognition of BPD has significant implications for the planning of outpatient mental health services in public sector settings.

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Acknowledgments

This study was supported by grants from the National Institute of Mental Health (#MH5558701).

Conflict of Interest

Dr. Comtois provides professional training in DBT and receives compensation for these activities in addition to her salary from the University of Washington. This financial interest and the design of the study have been reviewed and approved by the University of Washington. Dr. Carmel has no conflicts of interest to report.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359911, Seattle, WA, 98104, USA

    Katherine Anne Comtois PhD, MPH & Adam Carmel PhD

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  1. Katherine Anne Comtois PhD, MPH
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  2. Adam Carmel PhD
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Correspondence to Adam Carmel PhD.

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Comtois, K.A., Carmel, A. Borderline Personality Disorder and High Utilization of Inpatient Psychiatric Hospitalization: Concordance Between Research and Clinical Diagnosis. J Behav Health Serv Res 43, 272–280 (2016). https://doi.org/10.1007/s11414-014-9416-9

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  • DOI: https://doi.org/10.1007/s11414-014-9416-9

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