Content area
Full Text
Borderline personality disorder (BPD) is a common psychiatric disorder that is often overlooked in treatment settings. This report describes the validation of a new self-report screening measure for DSM-IV BPD-the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Two hundred subjects with treatment histories whose ages ranged from 18 to 59 filled out the MSI-BPD. Each subject was then interviewed, blind to MSI-BPD results, with the BPD module of the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV; Zanarini, Frankenburg, Sickel, & Yong, 1996). Of these 200 subjects, 139 (69.5%) met DSM-IV criteria for BPD as assessed by the BPD module of the DIPD-IV and the remaining 61 subjects (30.5%) did not. Using logistic regression analyses, an MSI-BPD cutoff of 7 or more of the measure's 10 items was judged to be the best cutoff. This was so because it yielded both good sensitivity (.81; percentage of correctly identified cases) and specificity (.85; percentage of correctly identified noncases) for the diagnosis of DSM-IV BPD. Foryounger subjects, diagnostic efficiency was even greater. For example, sensitivity was .90 and specificity was .93 at a cutoff of 7 for the 63 subjects who were 25 years old or younger. The results of this study suggest that the MSI-BPD may be a useful screening instrument for the presence of DSM-IV borderline personality disorder.
Epidemiological evidence suggests that about 2% of the American adult population meets DSM criteria for borderline personality disorder (BPD; Swartz, Blazer, George, & Winfield, 1990). However, clinical experience suggests that BPD is often underdiagnosed in many treatment settings. As accurate diagnosis is the starting point of any successful treatment, the failure to correctly identify borderline patients may lead to them receiving no treatment or inappropriate and/or unnecessary treatment.
Currently, there are five reliable semistuctured diagnostic interviews for the DSM-IV personality disorders (Zimmerman, 1994). There is also a reliable self-report measure for the assessment of BPD and the other DSM Axis II disorders-the Personality Diagnostic Questionnaire (PDQ; Hyler, Skodol, Kellman, Oldham, & Rosnick, 1990). This measure, which has very high sensitivity (.98) and low specificity (.41) for the borderline diagnosis, has been the only instrument available for screening for the presence of BPD. Yet, it has an extremely high false positive rate, misidentifying almost 60% of nonborderline...