Creation of Borderline Personality Disorder Criteria and Diagnosis

For a diagnosis of BPD, the DSM-5 requires endorsement of any 5 of the 9 possible criteria and social-occupational dysfunction.¹⁴ A summary of how each BPD criterion was operationalized in this study using the specific AUDADIS-5 questions is provided in eTable 1 in the Supplement. The NESARC-III provided 2 BPD diagnostic codes, 1 requiring reported social-occupational dysfunction for at least 1 criterion and a second requiring reported social-occupational dysfunction for at least 2 criteria. This approach has been previously questioned as being too liberal because a report of marked distress or impairment in social function is a key characteristic of personality disorders.²⁷ Thus, for this study, we created more stringent coding of each BPD criterion and the scoring of the BPD diagnosis. Specifically, we required that associated social-occupational dysfunction be reported for any specific criterion endorsed by the respondents; thus, to receive a BPD diagnosis, at least 5 criteria with associated dysfunction must have been endorsed. The NESARC-III also assessed the age when some of the BPD features began to occur; we used the same approximate time frame as the age at onset of BPD variables in our data analysis.