Responses to the medical review of systems: Borderline versus nonborderline patients in an internal medicine outpatient clinic

Objective: In both clinical and empirical reports, individuals with borderline personality disorder have been characterized by tendencies toward somatization. In this study, we examined the relationship between somatic symptoms, in the context of a traditional medical review of systems, and borderline personality disorder, using 2 self-report measures for this Axis II dysfunction. Method: In a cross-sectional consecutive sample of 381 internal medicine outpatients being seen predominantly by resident providers in a midsized, midwestern city in October 2010, we assessed 35 physical symptoms, which constitute 1 version of a medical review of systems, and borderline personality disorder using the Borderline Personality Disorder Scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI). Results: The total number of symptoms endorsed on the medical review of systems was positively correlated with scores on the PDQ-4 (r = 0.42, P <.001, n = 369) and scores on the SHI (r = 0.36, P <.001, n = 366). In addition, the percentages of participants with borderline personality disorder increased as the number of endorsed symptoms increased. No individual symptom, or symptom pattern, was particularly related to participants with borderline personality disorder features. Conclusions: In an internal medicine outpatient sample from a resident provider clinic, patients with borderline personality disorder characteristics endorsed significantly more physical symptoms on a medical review of systems than those without such characteristics, suggesting a somatic overlay in individuals with this Axis II disorder. No specific physical symptom pattern or cluster was evident among those with these Axis II features.