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.
The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) is a 10-item self-report screening instrument for borderline personality disorder (BPD; Zanarini et al., 2003). The MSI-BPD has been validated for use with youth aged 15 years and older (Chanen et al., 2008; Noblin et al., 2013; van Alebeek et al., 2017) and adults.
Screening for BPD is an important clinical consideration given it is a significant public health problem that is under-recognised and underdiagnosed in clinical practice (Zimmerman & Balling, 2021). 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 questions from the borderline module of the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV; Zanarini et al., 2003). Each item corresponds to one of the nine DSM-5 BPD diagnostic criteria, with the exception of the paranoia/dissociation criterion which is assessed by two items, resulting in 10 items total. Items are written such that a positive response indicates the presence of BPD symptoms.
Each item is rated on a dichotomous scale with 1 corresponding to “present” and 0 corresponding to “absent”. The total score ranges from 0 to 10.
A score of 7 or greater is above the traditional cutoff for BPD screening (Zanarini et al., 2003). A score of 5 or 6 suggests BPD cannot be ruled out and further evaluation is recommended, as research indicates 19% of individuals with BPD score below 7 (Zanarini et al., 2003; Zimmerman & Balling, 2021). Scores of 4 or less indicate that symptom levels are not consistent with BPD.
A percentile is presented that compares the respondent’s score to a university sample of 235 US students (55% female; mean age 18.5 years; Klonsky & Glenn, 2009). This non-clinical comparison group had a mean score of 4.83 (SD = 2.64). A percentile rank close to 50 indicates the score is typical for this comparison sample. Percentile labels are displayed on the right side of the graph for reference.
On first administration, a bar graph displaying the total score is presented.
When the assessment is administered multiple times, a longitudinal line graph is generated to track changes in the total score over time.
Each endorsed item on the MSI-BPD corresponds to a specific DSM-5 criterion and provides clinically meaningful information for treatment planning. Clinicians are encouraged to review which items were endorsed to identify specific symptom areas that may be most relevant for intervention. The pattern of endorsed items can help guide therapeutic focus and inform case conceptualisation.
The MSI-BPD has demonstrated satisfactory reliability and validity across multiple studies (Zanarini et al., 2003; Zimmerman & Balling, 2021). The original validation study reported a Cronbach’s alpha of 0.74 and test-retest reliability of ρ = 0.72 (Zanarini et al., 2003).
Gardner and Qualter (2009) found that the MSI-BPD correlated highly with other BPD screening tools in a mixed community and student sample. Confirmatory factor analysis in that study indicated the MSI-BPD appropriately assesses BPD as a global construct.
A large-scale item response theory (IRT) analysis of 22,035 university students confirmed that the MSI-BPD is unidimensional and meets assumptions of local independence (Martin et al., 2023). This study also examined differential item functioning (DIF) across gender and found that while some items showed small gender differences in endorsement patterns, the overall effect sizes were negligible. The expected true score standardised difference at the test level was 0.05, indicating the MSI-BPD functions equivalently for men and women.
Notably, the items providing the greatest measurement information were affective lability and chronic feelings of emptiness, whilst the unstable relationships item provided the least information, possibly reflecting normative relationship instability in younger samples (Martin et al., 2023).
The past empirical evidence has suggested a score of 7 or greater as a useful clinical cutoff for screening BPD among adults (Zanarini et al., 2003) with a sensitivity of 81% and specificity of 85%. A review of the literature 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, with various studies requiring a cutoff of 5 or 6 to reach 90% sensitivity (Zimmerman & Balling, 2021). For adolescent populations, Noblin et al. (2013) found that a lower cutoff (6 or greater) may be beneficial.
Normative data for the MSI-BPD are derived from Klonsky and Glenn (2009), who administered the measure to a non-clinical sample of 235 university students in the United States (55% female; mean age 18.5 years). This sample had a mean score of 4.83 (SD = 2.64). As a non-clinical comparison group, this sample provides context for interpreting individual scores relative to a general young adult population without identified psychopathology. Percentile ranks are calculated based on this distribution, with a percentile of 50 indicating a score typical for this comparison sample.
Borderline personality disorder is more common than many realise. Research suggests that approximately 2–6% of the general adult population meets criteria for BPD, with higher rates observed in clinical settings, around 10-20% of psychiatric outpatients and 20-40% of psychiatric inpatients. BPD can emerge during adolescence, early adulthood or later in life and can affect people from all backgrounds. Despite its prevalence, BPD frequently goes unrecognised, which is one of the reasons why brief screening tools are valuable in helping to identify individuals who may benefit from further assessment.
Borderline personality disorder (BPD) is a significant public health concern that is frequently under-recognised and underdiagnosed in clinical practice. Research indicates that for patients eventually diagnosed with BPD, the average lag between first seeking treatment and receiving an accurate diagnosis is often more than 10 years. Timely screening allows for earlier identification and intervention.
Yes, the MSI-BPD has been validated for use with young people aged 15 years and older, as well as adults. Research supports early detection of BPD risk in adolescents, as early intervention can reduce the emotional, functional, and financial costs associated with the disorder.
A score at or above the clinical cut-off indicates that an individual may be experiencing symptoms consistent with BPD and warrants further evaluation, it does not constitute a diagnosis. The MSI-BPD is a screening instrument designed to identify individuals who may benefit from a more comprehensive assessment, such as a structured clinical interview. Scores in the borderline range (5–6) also warrant clinical attention.
Yes, large-scale research using item response theory analysis has confirmed that the MSI-BPD functions equivalently across gender. While some individual items show small differences in endorsement patterns between men and women at equal levels of BPD severity, for example, women may be slightly more likely to endorse items related to self-harm and affective lability, while men may be more likely to endorse anger at lower severity levels, however, the overall effect of these differences are small and the MSI-BPD is equally valid for use with both men and women.
The MSI-BPD can be used at multiple points across the clinical pathway. At intake, it helps identify individuals who may have unrecognised BPD and require comprehensive assessment. The pattern of endorsed items can also inform case conceptualisation and guide therapeutic focus, for example, prominent endorsement of items related to chronic emptiness, identity disturbance, or abandonment fears may indicate areas requiring clinical attention. When administered repeatedly over time, the MSI-BPD can help track changes in symptom presentation, though clinicians should be aware that as a screening tool with dichotomous items, it may be less sensitive to gradual change than dimensional measures of BPD severity.
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
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://doi.org/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. https://doi.org/10.1037/a0017801
Martin, J. A., Tarantino, D. M., & Levy, K. N. (2023). Investigating gender-based differential item functioning on the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD): An item response theory analysis. Psychological Assessment, 35(5), 462–468. https://doi.org/10.1037/pas0001229
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. https://doi.org/10.1027/1015-5759/a000279
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
