Disorders of Extreme Stress, Not Otherwise Specified, Posttraumatic Stress Disorder, and Borderline Personality Disorder: A Vignette Study Exploring Clinicians' Diagnostic Perceptions

Abstract

Research suggests that some individuals who suffer invasive, early childhood trauma develop significant character pathology, and may meet the criteria for both Posttraumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD). Trauma researchers have proposed a new diagnostic category for these individuals, called Disorders of Extreme Stress, Not Otherwise Specified (DESNOS), also known as Complex PTSD. The present study compared clinicians’ symptom ratings for two case vignettes to determine if DESNOS was a better description of the cases than PTSD, BPD, or comorbid PTSD/BPD. Additionally, potential sex bias in diagnosis was examined by manipulating the sex of the client in the vignette, and examining effects of participant sex. A national sample of 123 licensed psychologists completed the study online. The participants read both vignettes, rated the symptoms in each case, and assigned a diagnosis. The hypothesis that DESNOS would receive higher mean symptom ratings than PTSD, BPD, or comorbid PTSD/BPD was not supported. PTSD and BPD each received higher mean symptom ratings than DESNOS in Vignette A, but in Vignette B there were no significant differences in the symptom ratings. The hypothesis that sex of the client in the vignette would influence the diagnosis of BPD was not supported in Vignette A, but was supported in Vignette B, in which all BPD diagnoses were assigned to the female case. The hypothesis that female participants would endorse higher PTSD diagnostic ratings than would male participants was not supported. However, female participants assigned higher PTSD symptom ratings, and endorsed more of the symptoms of PTSD for Vignette A than did male participants, suggesting that the women attended more to the trauma history in the case. Overall, the study provided limited support for the construct of DESNOS. Limitations of the methodology, implications of the findings, and directions for future research are discussed.