Nikolaus Kleindienst1, Martin Jungkunz2,3, Martin Bohus2,4. 1. Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, J5, D-68159 Mannheim, Germany / Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany. nikolaus.kleindienst@zi-mannheim.de. 2. Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, J5, D-68159 Mannheim, Germany / Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany. 3. National Center for Tumor Diseases, Section for Translational Medical Ethics, Heidelberg University Hospital, Heidelberg, Germany. 4. McLean Hospital, Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: The Borderline Symptom List (BSL-23) is a well-established self-rating instrument to assess the severity of borderline typical psychopathology. However, a classification of severity levels for the BSL-23 is missing. METHODS: Data from 1.090 adults were used to develop a severity classification for the Borderline Symptom List (BSL-23). The severity grading was based on the distribution of the BSL-23 in 241 individuals with a diagnosis of BPD. Data from three independent samples were used to validate the previously defined severity grades. These validation samples included a group of treatment seeking patients with a diagnosis of BPD (n = 317), a sample of individuals with mental illnesses other than BPD (n = 176), and a healthy control sample (n = 356). The severity grades were validated from comparisons with established assessment instruments such as the International Personality Disorders Examination, the Structured Clinical Interview for DSM-IV, the global severity index of the Symptom Checklist (GSI, SCL-90), the Global Assessment of Functioning (GAF), and the Beck Depression Inventory (BDI-II). RESULTS: Six grades of symptom severity were defined for the BSL-23 mean score: none or low: 0-0.28; mild: 0.28-1.07; moderate: 1.07-1.87; high: 1.87-2.67; very high: 2.67-3.47; and extremely high: 3.47-4. These grades received consistent empirical support from the independent instruments and samples. For instance, individuals with a severity grade of none or low were virtually free from diagnostic BPD-criteria, had a GSI below the normative population, and a high level of global functioning corresponding to few or no symptoms. Severity grades indicating high to extremely high levels of BPD symptoms were observed at a much higher rate in treatment-seeking patients (70.0%) than in clinical controls (17.6%) and healthy controls (0.0%). The BSL-23 score that best separated treatment-seeking BPD patients and clinical controls was 1.50, whereas the clearest discrimination of BPD patients and healthy controls was found at a score of 0.64. CONCLUSIONS: The grades of BPD-specific symptom severity derived from the distribution of the BSL-23 scores received consistent empirical validation from established assessments for psychopathology. Future studies should expand this validation by including additional instruments e.g., to assess self-esteem, loneliness, connectedness, and quality of life.
BACKGROUND: The Borderline Symptom List (BSL-23) is a well-established self-rating instrument to assess the severity of borderline typical psychopathology. However, a classification of severity levels for the BSL-23 is missing. METHODS: Data from 1.090 adults were used to develop a severity classification for the Borderline Symptom List (BSL-23). The severity grading was based on the distribution of the BSL-23 in 241 individuals with a diagnosis of BPD. Data from three independent samples were used to validate the previously defined severity grades. These validation samples included a group of treatment seeking patients with a diagnosis of BPD (n = 317), a sample of individuals with mental illnesses other than BPD (n = 176), and a healthy control sample (n = 356). The severity grades were validated from comparisons with established assessment instruments such as the International Personality Disorders Examination, the Structured Clinical Interview for DSM-IV, the global severity index of the Symptom Checklist (GSI, SCL-90), the Global Assessment of Functioning (GAF), and the Beck Depression Inventory (BDI-II). RESULTS: Six grades of symptom severity were defined for the BSL-23 mean score: none or low: 0-0.28; mild: 0.28-1.07; moderate: 1.07-1.87; high: 1.87-2.67; very high: 2.67-3.47; and extremely high: 3.47-4. These grades received consistent empirical support from the independent instruments and samples. For instance, individuals with a severity grade of none or low were virtually free from diagnostic BPD-criteria, had a GSI below the normative population, and a high level of global functioning corresponding to few or no symptoms. Severity grades indicating high to extremely high levels of BPD symptoms were observed at a much higher rate in treatment-seeking patients (70.0%) than in clinical controls (17.6%) and healthy controls (0.0%). The BSL-23 score that best separated treatment-seeking BPD patients and clinical controls was 1.50, whereas the clearest discrimination of BPD patients and healthy controls was found at a score of 0.64. CONCLUSIONS: The grades of BPD-specific symptom severity derived from the distribution of the BSL-23 scores received consistent empirical validation from established assessments for psychopathology. Future studies should expand this validation by including additional instruments e.g., to assess self-esteem, loneliness, connectedness, and quality of life.
Authors: Martin Bohus; Matthias F Limberger; Ulrike Frank; Alexander L Chapman; Thomas Kühler; Rolf-Dieter Stieglitz Journal: Psychopathology Date: 2007-01-11 Impact factor: 1.944
Authors: Nicolas Rüsch; Klaus Lieb; Ines Göttler; Christiane Hermann; Elisabeth Schramm; Harald Richter; Gitta A Jacob; Patrick W Corrigan; Martin Bohus Journal: Am J Psychiatry Date: 2007-03 Impact factor: 18.112
Authors: Martin Bohus; Nikolaus Kleindienst; Matthias F Limberger; Rolf-Dieter Stieglitz; Melanie Domsalla; Alexander L Chapman; Regina Steil; Alexandra Philipsen; Martina Wolf Journal: Psychopathology Date: 2008-11-20 Impact factor: 1.944