A proposed severity classification of borderline symptoms using the borderline symptom list (BSL-23)

Abstract

Background: The Borderline Symptom List (BSL-23) is a well-established self-rating instrument to assess the severity of borderline typical psychopathology. However, a classification of severity levels for the BSL-23 is missing. Methods: Data from 1.090 adults were used to develop a severity classification for the Borderline Symptom List (BSL-23). The severity grading was based on the distribution of the BSL-23 in 241 individuals with a diagnosis of BPD. Data from three independent samples were used to validate the previously defined severity grades. These validation samples included a group of treatment seeking patients with a diagnosis of BPD (n = 317), a sample of individuals with mental illnesses other than BPD (n = 176), and a healthy control sample (n = 356). The severity grades were validated from comparisons with established assessment instruments such as the International Personality Disorders Examination, the Structured Clinical Interview for DSM-IV, the global severity index of the Symptom Checklist (GSI, SCL-90), the Global Assessment of Functioning (GAF), and the Beck Depression Inventory (BDI-II). Results: Six grades of symptom severity were defined for the BSL-23 mean score: none or low: 0-0.3; mild: 0.3-0.7; moderate: 0.7-1.7; high: 1.7-2.7; very high: 2.7-3.5; and extremely high: 3.5-4. These grades received consistent empirical support from the independent instruments and samples. For instance, individuals with a severity grade of none or low were virtually free from diagnostic BPD-criteria, had a GSI below the normative population, and a high level of global functioning corresponding to few or no symptoms. Severity grades indicating high to extremely high levels of BPD symptoms were observed at a much higher rate in treatment-seeking patients (70.0%) than in clinical controls (17.6%) and healthy controls (0.0%). The BSL-23 score that best separated treatment-seeking BPD patients and clinical controls was 1.50, whereas the clearest discrimination of BPD patients and healthy controls was found at a score of 0.64. Conclusions: The grades of BPD-specific symptom severity derived from the distribution of the BSL-23 scores received consistent empirical validation from established assessments for psychopathology. Future studies should expand this validation by including additional instruments e.g., to assess self-esteem, loneliness, connectedness, and quality of life.

Loneliness, Social Isolation and Their Difference: A Cross-Diagnostic Study in Persistent Depressive Disorder and Borderline Personality Disorder

“…Depressive symptoms were more prevalent in both patient groups than in their matched HC, and BPD patients had higher BDI-II scores than PDD patients but did not differ in the observer-rated measure (MADRS, see Tables 1 , 2 ). Similarly, both patient groups reported higher borderline symptom scores than their matched HC (BSL-23), with a significant difference between PDD and BPD patients, i.e., moderate scores in PDD and high scores in BPD ( 67 ).…”

Latent Profiles of Patients with Borderline Pathology Based on the Alternative DSM-5 Model for Personality Disorders

“…The BSL-23 covers DSM Section II BPD diagnostic criteria (e.g., affective instability, suicidality, transient psychotic symptoms) in addition to other affective experiences typical of borderline pathology (e.g., proneness to shame, self-criticism, loneliness, mistrustfulness, and helplessness), which should provide a large span of borderline pathology clinical presentations. The severity grades proposed by Kleindienst et al [43] received robust empirical support from established assessments for psychopathology across three independent samples. Items are scored on a ve-point Likert scale.…”

“…Patients were rst asked to complete a computerized self-report battery of questionnaires, and then took part in a clinical interview led by one of the team's psychologist, who produced a detailed evaluation report. In line with the objectives of the present study, a total of 211 patients [1] (133 women, M age = 33.66, SD = 10.97) were selected based on the presence of at least moderate borderline pathology according to cutoffs recently proposed by Kleindienst et al [43] for the short version of the Borderline Symptom List ( [44]; see below). According to the proposed grades of borderline symptom severity, 26.5% had a moderate level of pathology (score 0.7-1.7; n = 56), 40.8% had a high level of pathology (1.7-2.7; n = 86), 25.1% had a very high level of pathology (2.7-3.5; n = 53), and 6.6% had an extremely high level of pathology (3.5-4; n = 14).…”

Mentalization and interpersonal problems in borderline personality disorder (BPD) traits

“…proneness to shame and self-disgust and problems with trust) and, (4) the experiences of clinical experts and individuals with BPD (Kleindienst et al, 2020).…”

“…The degree of symptom severity for BPD is represented by the following mean scores : none or low : 0-0.3 ; mild: 0.3-0.7; moderate: 0.7-1.7; high: 1.7-2.7; very high: 2.7-3.5; and extremely high: 3.5-4. The authors of the BSL-23 established six categories of symptom severity and validated their classification cut offs with other established assessments of BPD and functioning (Kleindienst et al, 2020). Internal consistency for the BSL-23 is excellent as Cronbach's α ranges from .94 to .97; Bohus et al, 2009).…”