The absence of self-harm does not preclude a diagnosis of BPD, in new findings that may have potential implications for changes to diagnostic criteria for the disorder.
Zimmerman noted the impetus for conducting the study originated with a patient he saw who had all of the features of BPD except for self-harm and suicidality. However, because she didn't have those two features, she was told by her therapist she could not have BPD.
The investigators wondered if there were other"hidden" cases of BPD that were being missed by therapists. "Given the clinical and public health significance of suicidal and self-harm behavior in patients with BPD, an important question is whether the absence of this criterion, which might attenuate the likelihood of recognizing and diagnosing the disorder, identifies a subgroup of patients with BPD who are 'less borderline' than patients with BPD who do not manifest this criterion," the investigators write.
Only one-fifth of patients with BPD presented with a chief complaint that was related to a feature of BPD and had received BPD as their principal diagnosis.
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