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• McLean Screening Instrument data were collected in a clinical cohort Scores were related to retrospectively-reported trauma, and time attitudes Scores were also related to variables gathered up to 20 years previously Individuals explained why they endorsed items in
interviews AbstractBorderline Personality Disorder is a severe psychiatric disorder with debilitating consequences. Screening for the disorder is problematic as symptoms overlap with other psychiatric disorders. 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. Total number of MSI items endorsed was meaningfully related to scores on emotional neglect and negative time attitudes. There was substantive overlap between MSI threshold (≥7 items) and lifetime diagnosis of a mental disorder. The stated rationale for endorsing MSI items, was less indicative of personality trait, and was related more to particular developmental periods, one-off episodes, and life-contexts. Additionally, participants conflated constructs such as emptiness with loneliness, and moodiness with general emotionality. Those meeting MSI threshold recalled more childhood emotional neglect, and were more negative about all time periods. It is apparent that scoring of the MSI is driven by prevailing life circumstances as much as enduring personality traits. KeywordsBorderline Personality McLean Screening Instrument Childhood Trauma Time Attitudes SCID-5-RV Cited by (0)© 2022 Published by Elsevier B.V. What Is the McLean Screening Instrument?The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) is a commonly used 10-item measure to screen for borderline personality disorder (BPD). Mary Zanarini, EdD, and her colleagues at McLean Hospital developed this paper-and-pencil test based on BPD diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). 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 MSI-BPDEach item in the MSI 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 MSI-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 MSI-BPDClinicians use the MSI-BPD to assess a person for BPD, sometimes in conjunction with other screening tools. Research suggests the MSI-BPD is helpful in detecting BPD in the general population, 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 BPD Screening Tools The MSI-BPD is only one of several tools that clinicians use to screen for BPD. Others
include the following. Structured Clinical InterviewThe 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. It is an update of the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). 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 ScaleThe 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 Tool 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 BPD Screening BPD 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 MSI-BPDIt's important to note that the MSI-BPD 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 MSI-BPD'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. A Word From VerywellBPD 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. Frequently Asked Questions
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Additional Reading
By Kristalyn Salters-Pedneault, PhD Thanks for your feedback! What is McLean screening instrument for borderline personality MSI?What Is the McLean Screening Instrument? The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) is a commonly used 10-item measure to screen for borderline personality disorder (BPD).
Is there a screening tool for borderline personality disorder?The screening instrument for borderline personality disorder (SI-Bord) consists of a 5-item self-reported questionnaire on the key features of BPD from the DSM-5 using a 5-point Likert scale.
What is the BPD checklist?The Criteria for a Diagnosis
Chronic feelings of emptiness. Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) Frantic efforts to avoid real or imagined abandonment.
Can a brain scan detect borderline personality disorder?Using real-time brain imaging, a team of researchers have discovered that patients with Borderline Personality Disorder (BPD) are physically unable to regulate emotion. The findings, by Harold W.
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Mclean screening instrument for borderline personality disorder pdf
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