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Mental health claims are often difficult to assess because of the uncertainty of the illness trajectory. Mental health claims involving personality disorders are some of the most challenging to assess, for both insurance analysts and independent reviewers. This article focuses on borderline personality disorder, what it is and is not, its most common iterations in disability claims, cases in which it may cause impairment, and signs of impairment on the basis of the diagnosis.
Personality disorders are generally not believed to cause impaired functioning that results in lost work time. This is because, by definition, personality disorders have an onset in adolescence or early adulthood and are "an enduring pattern of inner experience and behavior . . ." (American Psychiatric Association [APA], 2000 , p. 689). Personality disorders, Axis II disorders, differ from Axis I disorders in that Axis I disorders can, theoretically, be diagnosed at any point in an individual's life. They differ from major depressive disorder (MDD) in that MDD is not required, by definition, to be "enduring"--MDD can be treated and can remit. A personality disorder is a long-standing (e.g., potentially existing for decades) pattern of behavior (APA, 2000 ). Theoretically, if an individual with a personality disorder was able to work at age 20, he or she should also be able to work at age 30 or 40. However, this logic does not always hold true. Personality disorders, including borderline personality disorder, are covered under the Americans with Disabilities Act.
The 10 personality disorders are divided into three general clusters corresponding to their type or commonalities: Cluster A (paranoid, schizoid, and schizotypal), Cluster B (antisocial, borderline, narcissistic, and histrionic), and Cluster C (avoidant, dependent, and obsessive-compulsive) (APA, 2000 ). Everyone has some maladaptive personality traits that manifest in stressful situations but are not pathological. Also, at some point, almost everyone has exhibited traits of all of these disorders. However, not everyone has these diagnoses. For example, someone experiencing the end of a relationship may be emotionally labile, vacillating between feelings of love and feelings of hate for the other person. This individual does not have a personality disorder because this is not an enduring pattern of experience and behavior, but rather a normal response to a stressful...