Assessments
Appendix HSummary of outcome measures for borderline personality disorder1
| Measure | Full name | Description | Minimally important difference |
|---|---|---|---|
ALS | Affective Lability Scale | Items: 54-item self-report measure of lability of anger | NR |
Scale: 0–3 (greater affective lability) | |||
Scoring: Patients rate different features of mood instability on a 4-point Likert scale from 0 (very uncharacteristic) to 3 (very characteristic); total score is mean of all item responses divided by number of responses | |||
BIS-11 | Barratt Impulsiveness Scale | Items: 30-item self-report questionnaire designed to measure impulsivity; items describe common impulsive or nonimpulsive behaviors and preferences | NR |
Scale: 30–120 (greater impulsivity) | |||
Scoring: Each item rated on 4-point Likert scale from 1 (rarely/never) to 4 (almost always/always); overall score is calculated from the sum of the 30 items | |||
BAI | Beck Anxiety Inventory | Items: 21-item self-report measure of anxiety items | NR |
Scale: 0 (low anxiety) to 63 (score of ≥ 36 = potentially concerning levels of anxiety) | |||
Scoring: Each item rated on 4-point Likert scale from 0 (not at all bothered) to 3 (severely bothered); total score calculated by finding the sum of the 21 items | |||
BDI | Beck Depression Inventory | Items: 21-item self-report inventory that measures characteristic attitudes and symptoms of depression | 5 |
Scale: 0–63 (minimal to severe depression) | |||
Scoring: Each item rated on 4-point Likert scale from 0 (mild) to 3 (severe); total score calculated by finding the sum of the 21 items | |||
BHS | Beck Hopelessness Scale | Items: 20-item checklist that assesses negative attitudes about the future | NR |
Scale: 0–20 (score ≥ 9 associated with 11-times higher suicide rate than score ≤ 8) | |||
Scoring: Each item rated true or false; total score calculated by finding the sum of endorsed pessimistic statements and denied optimistic statements | |||
BSS | Beck Scale for Suicide Ideation | Items: 21-item self-report instrument evaluating current intensity of suicidality in past week | NR |
Scale: 0–38 | |||
Scoring: Each item consists of three options graded according to suicidal intensity on 3-point scale ranging from 0 to 2; ratings for first 19 items summed to yield total score | |||
BEST | Borderline Evaluation of Severity Over Time | Items: 15-item self-report questionnaire designed to assess change in severity of BPD during prior month | NR |
Scale: 12 (best) to 72 (worst) | |||
Scoring: Each item rated on 5-point Likert scale from 1 (none/never) to 5 (extreme/almost always); items divided among three subscales (A, B, C); total score calculated by adding together the scores of subscales A and B, then subtracting total from subscale C and adding correction factor of 15 | |||
BPDSI | Borderline Personality Disorder Severity Index | Items: 70-item semistructured clinical interview measure assessing frequency and severity of BPD-related symptoms among nine symptom areas corresponding to DSM-IV criteria | NR |
Scale: 0–90 (scores > 15 signify BPD pathology) | |||
Scoring: Each item rated on 11-point scale from 0 (never) to 10 (daily); for each DSM criterion an average score is derived (range = 0–10), with the sum of these nine scores providing the total score | |||
BSL-23 | Borderline Symptom List–23 | Items: 23-item self-report scale to assess borderline typical symptomatology | NR |
Scale: 0 (none or low) to 4 (extremely high) | |||
Scoring: Each item rated on 5-point Likert scale from 0 (not at all) to 4 (very strong); total score calculated as the sum of item response ratings divided by total number of responses | |||
BSI | Brief Symptom Inventory | Items: 53-item self-report scale derived from SCL-90-R to identify clinically relevant psychological symptoms | NR |
Scale: NR | |||
Scoring: Each item rated on 5-point Likert scale from 0 (not at all) to 4 (extremely); GSI calculated using sums for the nine symptom dimensions plus four additional items and dividing by total number of item responses, providing the mean score | |||
CGI-I | Clinical Global Impression–Improvement | Items: 1-item clinician-rated instrument to conduct global assessment of illness improvement | NR |
Scale: 1–7 | |||
Scoring: Clinician rates patient’s mental illness on a scale from 1 (very much improved) to 7 (very much worse) | |||
CGI-S | Clinical Global Impression–Severity | Items: 1 item clinician-rated instrument to conduct global assessment of illness severity | NR |
Scale: 0–7 | |||
Scoring: Clinician rates patient’s mental illness on 7-point scale: 1 (normal, not at all ill), 2 (borderline mentally ill), 3 (mildly ill), 4 (moderately ill), 5 (markedly ill), 6 (severely ill), 7 (among the most extremely ill patients); score should reflect average severity level across past 7 days | |||
CUXOS | Clinically Useful Anxiety Outcome Scale | Items: 20-item self-report measure designed to assess severity of anxiety symptoms in adults with diagnosed anxiety disorder or depression | NR |
Scale: 0–80 (< 10 nonanxious; 11–20 minimal anxiety; 21–30 mild anxiety; 31–40 moderate anxiety; 41+ severe anxiety) | |||
Scoring: There are two subscales, psychic anxiety and somatic anxiety; each item rated on 5-point Likert scale from 0 (not at all) to 4 (almost always); total score is the sum of all items | |||
CUDOS | Clinically Useful Depression Outcome Scale | Items: 18-item self-report scale to identify depression symptoms and impact | NR |
Scale: 0–72 (nondepressed 0–10; minimal depression 11–20; mild depression 21–30; moderate depression 31–45; and severe depression ≥ 46) | |||
Scoring: Each item rated on 5-point Likert scale from 0 (not at all) to 4 (almost always); total score is the sum of all items | |||
DSHI | Deliberate Self-Harm Inventory | Items: 17-item self-report measure that assesses method, frequency, and medical severity of deliberate self-harm without suicidal intent | NR |
Scale: 0–17 | |||
Scoring: Each item answered yes or no; total score is the sum of yes answers | |||
DASS | Depression, Anxiety, Stress Scale | Items: 42-item self-report questionnaire that measures depression, anxiety, and stress | NR |
Scale: 0–126 (suggested cutoffs for normal, mild, moderate, severe, and extremely severe for depression are 9, 13, 20, 27, and 42, respectively; for anxiety 7, 9, 14, 19, 42, and for stress 14, 18, 25, 33, 42) | |||
Scoring: Each item rated on 4-point Likert scale ranging from 0 to 3 for how often item has been experienced in past week; total score calculated by summing all items | |||
DERS | Difficulties in Emotion Regulation Scale | Items: 36-item self-report measure of six facets of emotion regulation | NR |
Scale: 36–180 (higher scores indicate greater degree of emotion dysregulation) | |||
Scoring: Each item rated on 5-point Likert scale from 1 (almost never) to 5 (almost always); total score calculated by summing all items | |||
DES | Dissociative Experiences Scale | Items: 28-item self-report scale to measure various types of dissociation | NR |
Scale: 0–100 (higher scores indicate greater likelihood of dissociative disorder; suggested cutoff score 45) | |||
Scoring: Each item rated from 0% of time experiencing item to 100% of time, increasing by 10% increments; mean score used as total | |||
EQ-5D | European Quality of Life–5 Dimension | Items: 5-item instrument to measure health-related quality of life in Europe | NR |
Scale: 0 (worst) to 100 (best) | |||
Scoring: Each item rated at one of three response levels: slight problems, moderate problems, extreme problems | |||
GAF | Global Assessment of Functioning | Items: 100-item clinician-rated instrument indicating overall psychosocial functioning during specified period on continuum from psychological sickness to health | NR |
Scale: 0–100 (severely impaired to extremely high functioning) | |||
Scoring: Rating can be based on many things, including interview or questionnaire; medical records; information from medical providers, caregivers, or relatives; or police or court records about violent or illegal behavior; summary score reflects level of individual’s overall functioning | |||
GAS | Global Assessment Scale | Items: 1-item clinician-rated instrument evaluating overall functioning during specified period on continuum from psychological sickness to health | NR |
Scale: 1 (hypothetically sickest) to 100 (hypothetically healthiest); scale divided into 10 equal intervals | |||
Scoring: In making a rating, lowest interval that describes subject’s functioning during the preceding week is selected; information needed to make rating can come from patient, reliable informant, or case record | |||
Ham-A | Hamilton Rating Scale for Anxiety | Items: 14-item questionnaire to assess patients’ anxiety | NR |
Scale: 0–56 (mild severity, < 17, mild to moderate severity 18–24, severe > 25) | |||
Scoring: Each item rated on 5-point Likert scale from 0 (not present) to 4 (most severe); sum of the score indicates severity of anxiety | |||
Ham-D | Hamilton Rating Scale for Depression | Items: ≥ 17-item questionnaire used to assess patients’ depression | NR |
Scale: 0–53 (0–7 considered normal; > 20 considered moderate severity) | |||
Scoring: Each item rated on 3- or 5-point Likert scale from 0 to 2 or 0 to 4; sum of the score indicates severity of depression | |||
IIP | Inventory of Interpersonal Problems | Items: 64-item self-report measure of interpersonal distress | NR |
Scale: 0–64 (higher scores indicate more interpersonal distress) | |||
Scoring: Each item rated on 5-point Likert scale from 0 (not at all) to 4 (extremely) on how much difficulty/distress it causes participants; items grouped into eight subscales | |||
LSASI | Lifetime Suicide Attempt Self-Injury Interview | Items: 20-item clinician-administered structured, face-to-face interview for assessing information regarding participant’s first, most recent, and most severe episodes of self-injury | NR |
Scale: Assessors code suicide and self-injury behaviors according to method, lethality, intent to die, and level of medical treatment received | |||
MOAS | Modified Overt Aggression Scale | Items: 20-item clinician-administered, semistructured interview designed to assess various manifestations of aggressive behavior in outpatients | NR |
Scale: 0–100 (no symptoms to severe) | |||
Scoring: Four subcomponent types of aggression are scored between 0 (no aggression) and 4, with potential cumulative score of 10 for each subcomponent, with each weighted differently; total score calculated by multiplying the sum score of each subcomponent by the weight for that category, then summing weighted scores | |||
MADRS | Montgomery-Åsberg Depression Rating Scale | Items: 10-item clinician-rated measure of severity of 10 depressive symptoms | NR |
Scale: 0–60 (0–6 defined as symptom absent; > 34 defined as severe depression) | |||
Scoring: Each item rated on a scale from 0 to 6, with 6 as most severe description of symptom; total score is the sum of scores for each item | |||
PAI | Personality Assessment Inventory | Items: 344-item self-report instrument of 22 nonoverlapping scales to assess personality and psychopathology | NR |
Scale: T scores (from ≤ 30 to ≥ 110) are provided for validity, clinical, interpersonal, and treatment amenability scales and subscales on the basis of a census matched standardization sample of 1,000 normal adults. Coefficients of fit are also available that compare scores with profiles of known clinical groups. | |||
Scoring: Each item rated from 0 (false) to 4 (very true) on 4-point Likert scale | |||
QoL | Quality of Life Index | Items: 10-item self-report instrument measuring 10 dimensions of health-related quality of life | NR |
Scale: 0–100 | |||
Scoring: Each item rated from 1 (poor) to 10 (excellent), total score summed total from each item | |||
SHI | Self-Harm Inventory | Items: 22-item self-report instrument that explores respondents’ histories of self-harm | NR |
Scale: 0–22 | |||
Scoring: Each item answered yes or no, total score summed by counting number of endorsed self-harm behaviors | |||
SDS | Sheehan Disability Scale | Items: 5-item self-rated instrument used to measure effect of individual’s symptoms on three areas | NR |
Scale: 0–30 (no symptoms to severe) | |||
Scoring: Each of three areas scored according to how much it was disrupted by symptoms (0 not at all to 10 very severely) | |||
SFQ | Social Functioning Questionnaire | Items: 8-item self-report scale to assess perceived social function | NR |
Scale: 0–24 (score >10 indicates poor social functioning) | |||
Scoring: Each item scored on 4-point scale from 0 (no/never) to 3 (severely/always); total score is the sum of all items | |||
STAXI | State-Trait Anger Expression Inventory | Items: 44-item self-report scale that assesses anger expression (which consists of anger control, anger suppression, and externally directed anger) as well as anger as a state and a trait | NR |
Scale: Total score for each scale and subscale is based on the sum of individual item scores | |||
Scoring: Each item rated on 4-point scale for frequency of exhibiting behavior (almost always, often, sometimes, almost never) | |||
STAXI-II | State-Trait Anger Expression Inventory–II | Items: 57-item self-report questionnaire that assesses anger as well as anger as a state and a trait; updated version of STAXI | NR |
Scale: T scores (from less than or equal to 20 to greater than or equal to 80) and percentiles are provided and categorized by gender for each scale and subscale. | |||
Scoring: Each item rated on 4-point scale for frequency of exhibiting behavior (almost always, often, sometimes, almost never) | |||
SBQ | Suicidal Behaviors Questionnaire | Items: 4-item self-reported measure of suicidal thoughts and behaviors | NR |
Scale: 5–19 | |||
Scoring: Each item rated on a Likert scale from 1 to 3, 5, or 6; total score is the sum of all items | |||
SASII | Suicide Attempt Self-Injury Interview | Items: 40-item semistructured interview measures frequency, intent, and medical severity of suicide attempts and NSSI acts | NR |
Scale: NSSI, ambivalent suicide attempt, nonambivalent suicide attempt, failed suicide | |||
Scoring: Assessors use six screening items, nine open-ended questions, and scores from six scales to categorize episodes | |||
SRS | Suicide Risk Scale | Items: 26-item scale to measure risk of suicide | NR |
Scale: 0–26 | |||
Scoring: Each item is answered yes or no; number of positive responses can be summed for total score | |||
SCL-90-R | Symptom Checklist-90-Revised | Items: 90-item self-report screening measure of general psychiatric symptomatology along nine symptom constructs | NR |
Scale: 0–4 | |||
Scoring: Each item scored on 5-point Likert scale from 0 (not at all bothered) to 4 (extremely bothered); GSI can be calculated as average score of the 90 items in questionnaire | |||
WHOQOL | World Health Organization Quality of Life Scale | Items: 100-item self-report questionnaire assessing quality of life through six domains | NR |
Scale: 0–100 (higher scores denote higher quality of life) | |||
Scoring: Each item rated on 5-point Likert scale from 1 (not at all) to 5 (extremely); scale has 24 facets divided unequally among six domains, each domain has a unique method of calculating mean score; domain and facet scores can be transformed to 100-point scale using this formula: TRANSFORMED SCORE = (SCORE – 4) × (100/16) | |||
ZAN–BPD | Zanarini Rating Scale for Borderline Personality Disorder | Items: Nine-item semistructured interview | NR |
Scale: 0–36 (no symptoms to severe) | |||
Scoring: Each item rated on 5-point Likert scale from 0 (no symptoms) to 4 (severe symptoms) on each of nine items corresponding to the nine DSM-IV criteria for BPD; total score is the sum of all items |
BPD = borderline personality disorder; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; GSI = Global Severity Index; NR = not reported; NSSI = nonsuicidal self-injury; SCL-90R = Symptom Checklist–90–Revised.
1Additional rating scales that can be used in adolescents include the Beck Depression Inventory for Youth, the Borderline Personality Features Scale for Children, the Children’s Global Assessment of Functioning Scale, the Millon Adolescent Clinical Inventory, the Youth Quality of Life Research Version, and the Youth Self-Report Scale (Jørgensen et al. 2021).
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The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder
November 2024
©American Psychiatric Association Publishing
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