title: Clinical vs. DSM diagnosis of bipolar disorder, borderline personality disorder and their co-occurrence.
abstract: OBJECTIVE
  To investigate the extent and reasons contributing to discrepancies between those receiving a DSM as against a clinical diagnosis of a bipolar disorder (BP) and/or a borderline personality disorder (BPD).
  
  
  METHODS
  We interviewed participants previously receiving a BP or BPD diagnosis, studying those who met DSM or clinical criteria for one or both conditions. We compared the numbers of participants allocated to the three diagnostic categories according to rater strategy to calculate concordance rates and determine reasons for discordance.
  
  
  RESULTS
  Rates of assignment to BP, BPD and comorbid BP/BPD varied according to the diagnostic strategy. Concordance rates were reduced as BP disorder duration criteria were relaxed, with discordance mainly arising from clinical allocation of a BP disorder for those DSM assigned as unipolar depression. Rates of BPD allocation varied marginally, with discordance mostly arising from so clinically diagnosed receiving a comorbid BP/BPD DSM diagnosis. Finally, DSM overestimated comorbidity compared with clinician diagnoses. Of central importance, not imposing the DSM duration criteria for BP did not increase the prevalence of misdiagnosing BPD, a finding at variance with the literature.
  
  
  CONCLUSIONS
  Rates and reasons for discordance between clinical and DSM diagnosis are detailed, which should assist clinical decision-making.
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Bayes
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.|Black Dog Institute, Randwick, NSW, Australia.
authors.forename: G B
authors.initials: GB
authors.lastname: Parker
mesh_terms: D001714:Bipolar Disorder / Q000175:diagnosis*; D001883:Borderline Personality Disorder / Q000175:diagnosis*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011795:Surveys and Questionnaires
keywords: bipolar disorder; borderline personality disorder; comorbidity; diagnosis