POSTTRAUMATIC STRESS DISORDER, BORDERLINE PERSONALITY DISORDER, AND DISORDERS OF EXTREME STRESS, NOT OTHERWISE SPECIFIED; A VIGNETTE STUDY EXPLORING VA AND PRIVATE SECTOR CLINICIANS’ DIAGNOSTIC PERCEPTIONS

Due to the role of trauma in the etiology of posttraumatic stress disorder (PTSD), borderline personality disorder (BPD), and disorders of extreme stress, not otherwise specified (DESNOS), and noted similar clinical pictures, it is important to explore differential diagnosis. There is evidence that gender influences the diagnosis of PTSD and BPD and of an “anchoring effect” in which disclosure of childhood trauma early versus late in a case vignette results in more diagnoses of PTSD or BPD, respectively. Additionally, as many veterans seek care within the private sector, it is important to understand possible diagnostic differences between VA and private sector clinicians. The present study explored gender bias, the anchoring effects of placement of childhood trauma in a case, and differences between VA and private sector clinicians in the diagnosis of PTSD and BPD. A national sample of 62 VA psychologists and 87 private sector psychologists read one of four versions of a case vignette and assigned a diagnosis, diagnostic ratings, and symptom ratings. The vignettes included PTSD and BPD symptoms, and a history of childhood trauma and combat-related trauma, and the versions differed with regard to patient gender and the placement of a childhood trauma within the case. Overall, the cases tended to be seen as PTSD, with PTSD being the frequent diagnosis, followed by BPD. Gender played a role in BPD diagnoses, with the female version of the case receiving significantly more BPD diagnoses and higher BPD ratings than the male version, as hypothesized. However, gender did not influence the diagnosis of PTSD. There was little support for an anchoring effect of placement of the childhood trauma in the case. VA clinicians assigned significantly lower PTSD ratings, as predicted, but also more diagnoses of BPD than private sector psychologists. Methodological limitations of the study and implications of the results are discussed