BPD Symptoms List

What is the BPD Symptoms List?

The Borderline Symptom List (BSL), is a self-rating instrument that can be utilized by practitioners to screen for BPD-specific symptom severity among patients. Initially, this list had 92 items that clients would complete to identify symptoms of personality disorders. To reduce patient burden and assessment time, a short version was developed by Bohus et al. (2008) that includes only 23 items (BSL-23). The previously defined severity grades were also robustly tested on over 1,000 individuals.

The results of the development and consistent empirical validation of this resource indicate that the BSL-23 is an efficient and convenient self-rating instrument with good psychometric properties comparable to those of the initial BSL-95 (Bohus et al., 2008).

This resource can be used for individuals over 18 years of age. It works to assess patients for borderline symptoms and their severity grade highlighted by the Australian BPD Foundation Limited (2018):

• Affective instability
• Suicidal behavior
• Self-mutilation ideology
• Dissociative symptoms
• Self-criticism
• Trust issues
• Emotional vulnerability
• Shame
• Self-disgust
• Loneliness
• Helplessness

How to use our BPD Symptoms List template

Implementing this resource in your practice is simple. Follow the instructions below to integrate it easily and support your clients.

Step 1: Access the BPD Symptoms List

You can access this resource through this guide by clicking on "Use template" or "Download". From here, decide whether you would prefer to use this list as an online resource for telehealth patients or if you would like to use this as a physical resource for in-person clients.

Step 2: Run through this resource with your client

Firstly, decide whether this is the appropriate tool for your client. If you choose to utilize this tool, be sure to explain what this assessment tool is trying to understand and how this can support your understanding of client symptoms. Remind your patient that this is not a diagnostic tool and cannot be used to form any clinical diagnosis. Additionally, answer any questions your client may have.

Step 3: Score the list

Once your client has completed this list, you can score their answers. A scoring interpretation is provided below in the next section and within the resource.

Step 4: Check in with your client

Once completed, your client may have questions about the list. Be sure to answer these to the best of your ability. You may also cross-check with the diagnostic BPD criteria or recommend further assessment, a diagnostic interview such as the International Personality Disorders examination (IPDE) or the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD) for further exploration.

Step 5: Store the resource

Finally, store this completed document securely for future analysis. You can rely on Carepatron to store this document confidentially with our patient record software. You may wish to revisit the completed document to track their progress.

Scoring

The average score of the 23 items (with each item scored between 0 and 4 - the proposed severity classification) is calculated by summing the individual scores and dividing by 23. Low scores indicate few or no symptoms, and severity grades indicating high or, more specifically, a score 1.50 or above suggest that the responses align with BPD. Research indicates that this threshold effectively distinguishes BPD patients from those with other psychological disorders (Kleindienst et al., 2020).

• None/Low: 0 – 0.3
• Mild: 0.3 – 1.1
• Moderate: 1.1 – 1.9
• High: 1.9 – 2.7
• Very High: 2.7 – 3.5
• Extremely High: 3.5 – 4

Based on the scores obtained from individual cases, practitioners may wish to refer clients to external resources for further assessment of borderline typical psychopathology. The list provided by Carepatron is not a diagnostic tool and should not be utilized to make clinical diagnoses.

Next steps after using the BPD Symptoms List

Once completed, the next steps after utilizing the BPD Symptoms List typically involve treatment plans. Although this is not a diagnostic tool, it can give practitioners valuable information once scored. The next steps for clients may include the following:

Further assessment

This list of symptoms can help mental health professionals decide whether external or further assessments should occur. Although this template can not be used to diagnose BPD patients, it can support further understanding of the individual's symptoms. This can also be used alongside other measures such as diagnostic interviews, tests to screen for other psychopathology such as the Beck Depression Inventory, and functioning scales such as the Global Severity Index (GSI) among others.

Education

This list can also be used to educate clients. It can support their overall understanding of how they are currently functioning. Once highlighted, they may be more able to make changes to support their overall mental health. This allows them to engage in appropriate lifestyle changes, such as therapy.

Therapy recommendations and plans

Mental health professionals may make decisions regarding the care of their clients once this list has been completed. Depending on the score obtained by each individual that this document is presented to, practitioners can make the call to refer them for external assessment for a formal diagnosis or whether they can engage in psychiatric and psychosomatic psychotherapy.

References

Australian BPD Foundation Limited. (2018). Diagnostic criteria. https://bpdfoundation.org.au/diagnostic-criteria.php

Bohus, M., Kleindienst, N., Limberger, M. F., Stieglitz, R.-D., Domsalla, M., Chapman, A. L., Steil, R., Philipsen, A., & Wolf, M. (2008). The short version of the Borderline Symptom List (BSL-23): Development and initial data on psychometric properties. Psychopathology, 42(1), 32–39. https://doi.org/10.1159/000173701

Kleindienst, N., Jungkunz, M., & Bohus, M. (2020). A proposed severity classification of borderline symptoms using the borderline symptom list (BSL-23). Borderline Personality Disorder and Emotion Dysregulation, 7, 11. https://doi.org/10.1186/s40479-020-00126-6