McLean Screening Instrument For Borderline Personality Disorder

Borderline Personality Disorder is a severe psychiatric disorder with debilitating consequences. Screening for the disorder is problematic as symptoms overlap with other psychiatric disorders. This article McLean’s screening instrument for borderline personality disorder.

The McLean Screening Instrument (MSI) assesses endorsement (yes/no) of 10 symptoms, with a cut-off of seven indicating potential caseness. Participants were (N = 68) from an established clinical cohort who completed a structured clinical interview, the MSI, the Childhood Trauma Questionnaire, and the Adolescent and Adult Time Attitudes Scale. A proportion (N = 20) also completed a follow-up interview examining their rationale for endorsing MSI items. A total number of MSI items endorsed was meaningfully related to scores on emotional neglect and negative time attitudes. There was substantive overlap between the MSI threshold (≥7 items) and the lifetime diagnosis of a mental disorder.

There’s no biologically based test to definitively diagnose borderline personality disorder. However, mental health professionals often use screening instruments such as the MSI-BPD to help identify the likelihood of BPD and the need for further evaluation and treatment.

Scoring the McLean Screening Instrument for BDP

Each item in the McLean Screening Instrument for borderline personality disorder is rated as a “1” if it is present and a “0” if it is absent, and items are totaled for possible scores from 0 to 10. A score of 7 is generally considered a valid clinical cutoff, meaning that a score of 7 or higher indicates that a person likely meets the criteria for a BPD diagnosis. However, some researchers have proposed a lower cutoff.

The first eight items of the MSI-BPD represent the first eight DSM-IV/5 diagnostic criteria for BPD, while the last two items assess the final DSM-IV/5 criterion (i.e., paranoia/dissociation).

Reliability and Validity

The McLean Screening Instrument for BPD has demonstrated valid, reliable psychometric properties. It has adequate internal consistency and test-retest reliability. It has also demonstrated sensitivity and specificity for detecting borderline personality disorder when a score of 7 is used as the cutoff.

Uses for the McLean Screening Instrument for BPD

Clinicians use the MSI-BPD to assess a person for BPD, sometimes in conjunction with other screening tools. Research suggests the McLean Screening Instrument is helpful in detecting BPD in the general population,3 but more studies are needed.

The MSI-BPD test has been shown to be very effective in detecting possible BPD in people who are seeking or have a history of treatment for mental health problems.

Other Assessments for Borderline Personality Disorder

The McLean Screening Instrument for BPD is only one of several tools that clinicians use to screen for BPD. Other assessments that are used for BPD include the Structured Clinical Interview, the Personality Diagnostic Questionnaire (PDQ-4), and the Zanarini Rating Scale.

Structured Clinical Interview

The Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD) is an official diagnostic interview from the American Psychiatric Association (APA) that clinicians use to assess for personality disorders such as BPD.

This assessment for borderline personality disorder is an update of the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II).4 A mental health professional may use this screening tool to help determine a person’s diagnosis by asking questions directly related to the criteria for BPD that are listed in the DSM-5.

This screening instrument also has an optional self-reporting questionnaire with 108 questions, but not all clinicians who choose the SCID-5-PD use this.

Personality Diagnostic Questionnaire (PDQ-4)

The Personality Diagnostic Questionnaire, 4th Edition (PDQ-4) screening test consists of 99 true-or-false questions that can help screen for various personality disorders, including BPD.

Zanarini Rating Scale

The Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), also developed by Dr. Zanarini, is used for patients who have already been diagnosed with BPD to test for changes over time.

Which Assessment for BPD Is Best?

A 2017 study comparing correlations, sensitivity, and specificity among the MSI-BPD, PDQ-4, and SCID-II in adolescents and young adults showed they were equally effective in predicting a BPD diagnosis. That said, an older study concluded that the PDQ-4 resulted in a high number of false positives, and as a result, the researchers did not recommend its use as a screening tool for personality disorders in clinical practice.

Impact of Assessment for Borderline Personality Disorder

A borderline personality disorder is challenging to diagnose and treat, in part because it’s often misdiagnosed and confused with other mental health conditions such as bipolar disorder. Further complicating the issue is that BPD often exists with comorbidities, including bipolar disorder, and poses a significant risk of suicide, which makes accurate screening tools such as the MSI-BPD particularly important.

Once BPD is diagnosed, however, the clinician can develop a treatment plan to address it. This might include such targeted approaches as dialectical behavioral therapy (DBT), which has been shown to be effective for people with BPD.

Potential Pitfalls of the McLean Screening Instrument for BPD

It’s important to note that the McLean Screening Instrument for borderline personality disorder is not a diagnostic tool. Rather, it’s a screening tool that helps determine the likelihood that a person has BPD.

An actual diagnosis requires structured and semi-structured interviews and therapy, ideally with a clinician who offers a strong background in BPD diagnosis and treatment. As such, the MSI-BPD is just one of several tools used in the diagnostic process and should not be used alone for diagnosis.

Another potential problem is related to the McLean Screening Instrument’s ease of use and availability online, which could allow someone to attempt to self-screen without fully understanding its intent or the implications of the result. The test is best administered by a professional who can interpret the results and then recommend an appropriate course of action.

Lastly, assessments such as the MSI-BPD provide a picture of a person’s mental status only at a particular point in time. Astute clinicians also must take into account the person’s patterns of behavior over time.

In summary, BPD is a particularly difficult disorder to diagnose and treat. Research indicates that the MSI-BPD is one of several valuable tools in this effort, however, and takes very little time to complete. If your screening indicates the possibility of BPD, your clinician can then recommend further testing and treatment options.

I hope you find this article helpful.

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