McLean Screening Instrument for BPD (MSI-BPD)

Assessments

Description
The MSI-BPD is a 10-item self-report instrument used to screen for borderline personality disorder (BPD; Zanarini et al., 2003) in youth (15 years of age or greater; Chanen et al., 2008; Noblin et al., 2013; van Alebeek et al., 2017) or adults. Screening for BPD is an important consideration given it is a significant public health problem that is under recognised and underdiagnosed in clinical practice (Zimmerman & Balling, 2021) and for patients diagnosed with BPD, the lag between initial treatment seeking and the correct diagnosis is often more than 10 years (Magnavita et al., 2010). As BPD is associated with high rates of self-harm, suicide attempts, and death by suicide in adults and adolescents, screening and assessment of BPD is an important clinical intervention (Boylan et al., 2019). The MSI-BPD is based on a subset of the questions that comprise the borderline module of the Diagnostic Interview for DSM-IV Personality Disorders or DIPD-IV (Zanarini, et al., 2003) and is a well-validated and widely-used screener for BPD (Zimmerman & Balling, 2021). The ten items of the MSI-BPD are written such that a positive response indicates the presence of BPD symptoms. Each item of this instrument is rated on a dichotomous scale with 1 corresponding to “present” and 0 corresponding to “absent” and all items are written such that a positive responses indicate the presence of BPD symptoms.

Validity and Reliability
The MSI-BPD has illustrated satisfactory reliability and validity (Zanarini et al., 2003) with a Cronbach alpha of 0.78. Gardner and Qualter (2009) found that the MSI-BPD correlated highly with other BPD screening tools in a mixed community and student sample, and reported that confirmatory factor analysis suggested that the MSI-BPD is an appropriate measure for assessing BPD as a global construct. The past empirical evidence has suggested the score of greater than or equal to 7 as a useful clinical cutoff score in screening for BPD among adults (Zanarini et al., 2003) with a sensitivity of 81% and specificity of 89%. However, a review of the literature by Zimmerman & Balling (2021) for over 1,473 subjects determined that a 90% sensitivity (higher sensitivity is important for a screening test) requires a cutoff score slightly lower than 7. Although there was no definitive recommendation for what that score should be, they found that various studies required a cutoff score of 5 or 6 to reach the 90% sensitivity level (Zimmerman & Balling, 2021). Noblin et al. (2013) also found that a lower cutoff (5.5 or greater) might be beneficial for use with adolescents. A sample of 235 US university students (55% female: mean age = 18.5) provided normative data for the MSI-BPD, with a mean score of 4.83 and standard deviation of 2.64 (Klonsky & Glenn, 2009).

Interpretation
The total score ranges from 0 to 10, with a score greater than or equal to 7 being above the cutoff for Borderline Personality Disorder (Zanarini et al., 2003). If the client scores 5 or 6, then further evaluation for BPD is recommended (Zimmerman & Balling, 2021). Scores of 4 or less indicates the level of symptoms are not consistent with BPD. A percentile is also presented, which compares the respondent’s scores to a normative sample of university students. A percentile rank close to 50 indicates that the individual’s score is typical compared to the normative sample. A percentile of 75, for example, indicates that the respondent scored higher than 75% of people in the normative sample.

Developer
Zanarini, M. C., Vujanovic, A. A., Parachini, E. A., Boulanger, J. L., Frankenburg, F. R., & Hennen, J. (2003). A screening measure for BPD: the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Journal of Personality Disorders, 17(6), 568–573. https://doi.org/10.1521/pedi.17.6.568.25355

Number Of Questions
10

References
Boylan, K., Chahal, J., Courtney, D. B., Sharp, C., & Bennett, K. (2019). An evaluation of clinical practice guidelines for self-harm in adolescents: The role of borderline personality pathology. Personality Disorders, 10(6), 500–510. https://doi.org/10.1037/per0000349 Chanen, A. M., Jovev, M. J., Djaja, D., McDougall, E., Yuen, H. P., Rawlings, D., & Jackson, H. J. (2008). Screening for borderline personality disorder in outpatient youth. Journal of Personality Disorders, 22(4), 353–364. https://guilfordjournals.com/doi/abs/10.1521/pedi.2008.22.4.353 Gardner, K., & Qualter, P. (2009). Reliability and validity of three screening measures of borderline personality disorder in a nonclinical population. Personality and Individual Differences, 46, 636-641. https://doi.org/10.1016/j.paid.2009.01.005 Klonsky, E. D., & Glenn, C. R. (2009). Assessing the functions of non-suicidal self-injury: Psychometric properties of the Inventory of Statements About Self-injury (ISAS). Journal of Psychopathology and Behavioral Assessment, 31(3), 215–219. https://doi.org/10.1007/s10862-008-9107-z Magnavita, J. J., Critchfield, K. L., Levy, K. N., & Lebow, J. L. (2010). Ethical considerations in treatment of personality dysfunction: Using evidence, principles, and clinical judgement. Professional Psychology: Research and Practice, 41, 64–74. Noblin, J. L., Venta, A., & Sharp, C. (2014). The validity of the MSI-BPD among inpatient adolescents. Assessment, 21(2), 210–217. https://doi.org/10.1177/1073191112473177 van Alebeek, A., van der Heijden, P. T., Hessels, C., Thong, M.S.Y., & van Aken, M. (2017). Comparison of three questionnaires to screen for borderline personality disorder in adoles- cents and young adults. European Journal of Psychological Assessment, 33, 123–128. Zimmerman, M., & Balling, C. (2021). Screening for Borderline Personality Disorder with the McLean Screening Instrument: A Review and Critique of the Literature. Journal of Personality Disorders, 35(2), 288–298. https://doi.org/10.1521/pedi_2019_33_451

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