Discordance between self-report and observer-rated psychopathology in borderline patients

The present study examined the relationship between clinically observable symptoms, as measured by the expanded Brief Psychiatric Rating Scale (BPRS), and self-reported experience, as measured by the Symptom Checklist-90-Revised (SCL-90-R), in a sample of 54 nonpsychotic, nonorganic, personality-disordered adolescent and young adult inpatients (31 with borderline personality disorder, BPD; 23 without borderline personality disorder, NBPD). Although BPD and NBPD patients were virtually indistinguishable on the BPRS, BPD patients were significantly more disturbed on numerous scales of the SCL-90-R. Of note, on similar dimensions assessed by the two instruments (e.g., Depression, Hostility), BPD patients exhibited greater pathology than NBPD patients on the SCL-90-R but not on the BPRS. Total score on the BPRS and the Global Distress Index on the SCL-90-R were significantly correlated for the NBPD group (r = .52, p < .01) but not for the BPD group (r = .27, NS). These findings provide empirical support for earlier clinical descriptions noting marked discrepancies between the superficially intact behavioral presentation and the extraordinarily chaotic inner experience of patients with borderline psychopathology.