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Vol. 40, No. 2, 2007
Issue release date: February 2007
Editor's Choice -- Free Access
Psychopathology 2007;40:126–132
(DOI:10.1159/000098493)

Psychometric Properties of the Borderline Symptom List (BSL)

Bohus M.a · Limberger M.F.a · Frank U.b · Chapman A.L.c · Kühler T.d · Stieglitz R.-D.e
aDepartment of Psychosomatics and Psychotherapy, Central Institute of Mental Health Mannheim, Mannheim, and bDepartment of Psychology, Albert Ludwig University Freiburg, Freiburg, Germany; cDepartment of Psychology, Simon Fraser University, Burnaby, B.C., Canada; dPsychiatric-Psychotherapeutic Hospital for Women Meissenberg, Zug, and eUniversity Psychiatric Outpatient Department, Basel, Switzerland
email Corresponding Author

Abstract

Background: The Borderline Symptom List (BSL) was developed as a self-rating instrument to specifically quantify borderline-typical symptomatology. The items are based on the criteria of the DSM-IV, the Diagnostic Interview for Borderline Personality Disorder – revised version, the opinions of clinical experts and borderline patients. The psychometric properties and validity of the BSL have been investigated in several studies. Sampling and Methods: A total of 380 borderline patients and 204 healthy controls scored the items. A factor analysis of the BSL items suggests the following subscales: ‘self-perception’, ‘affect regulation’, ‘self-destruction’, ‘dysphoria’, ‘loneliness’, ‘intrusions’ and ‘hostility’. Results: Theinternal reliability as well as the test-retest reliability within 1 week are high. Different aspects of validity (e.g. comparison between groups) provide favorable results. Pre-post comparisons after 3 months of dialectical behavioral treatment reveal a significant reduction of the total score and of 5 of the 7 subscales. Conclusions: This indicates that the BSL is sensitive to therapeutically induced change of borderline-typical impairment.


 goto top of outline Key Words

  • Borderline personality disorder
  • Borderline Symptom List (BSL)
  • Quantitative assessment

 goto top of outline Abstract

Background: The Borderline Symptom List (BSL) was developed as a self-rating instrument to specifically quantify borderline-typical symptomatology. The items are based on the criteria of the DSM-IV, the Diagnostic Interview for Borderline Personality Disorder – revised version, the opinions of clinical experts and borderline patients. The psychometric properties and validity of the BSL have been investigated in several studies. Sampling and Methods: A total of 380 borderline patients and 204 healthy controls scored the items. A factor analysis of the BSL items suggests the following subscales: ‘self-perception’, ‘affect regulation’, ‘self-destruction’, ‘dysphoria’, ‘loneliness’, ‘intrusions’ and ‘hostility’. Results: Theinternal reliability as well as the test-retest reliability within 1 week are high. Different aspects of validity (e.g. comparison between groups) provide favorable results. Pre-post comparisons after 3 months of dialectical behavioral treatment reveal a significant reduction of the total score and of 5 of the 7 subscales. Conclusions: This indicates that the BSL is sensitive to therapeutically induced change of borderline-typical impairment.

Copyright © 2007 S. Karger AG, Basel


 goto top of outline References
  1. Lieb K, Zanarini MC, Schmahl CG, Linehan MM, Bohus M: Borderline personality disorder. Lancet 2004;364:459–461.

    External Resources

  2. Skodol AE, Gunderson JG, McGlashan TH, Dyck IR, Stout RL, Bender DS, Grilo CM, Shea MT, Zanarini MC, Morey LC, Sanislow CA, Oldham JM: Functional impairment in patients with schizotypal, borderline, avoidant or obsessive-compulsive personality disorder. Am J Psychiatry 2002;159:276–283.
  3. American Psychiatric Association: Practice guideline for the treatment of patients with borderline personality disorder: introduction. Am J Psychiatry 2001;158:2.
  4. Bender DS, Dolan RT, Skodol AE, Sanislow CA, Dyck IR, McGlashan TH, Shea MT, Zanarini MC, Oldham JM, Gunderson JG: Treatment utilization by patients with personality disorders. Am J Psychiatry 2001;158:295–302.
  5. Zanarini MC, Frankenburg FR: Attainment and maintenance of reliability of axis I and II disorders over the course of a longitudinal study. Compr Psychiatry 2001;42:369–374.
  6. Zanarini MC, Frankenburg FR, Sickel AE, Yong L: The Diagnostic Interview for DSM-IV Personality Disorders. Belmont, McLean Hospital, Laboratory for the Study of Adult Development, 1996.
  7. Loranger AW, Sartorius N, Andreoli A, Berger P, Buchheim P, Channabasavanna SM, Coid B, Dahl AA, Diekstra RFW, Ferguson B, Jakobsberg L, Mombour W, Pull C, Ono Y, Regier DA: Deutschsprachige Fassung der International Personality Disorder Examination (IPDE). Genf, WHO, 1998.
  8. First MB, Spitzer RL, Gibbon M, Williams JBW: User’s Guide for the Structured Clinical Interview for DSM-IV personality disorders (SCID-II). Washington, American Psychiatric Press, 1996.
  9. Pfohl B, Blum N, Zimmerman M: Structured Interview for DSM-IV Personality. Washington, American Psychiatric Press, 1997.
  10. Dittmann V, Ermer A, Stieglitz RD: Diagnostik von Persönlichkeitsstörungen; in Stieglitz RD, Baumann U, Freyberger HJ (eds): Psychodiagnostik in Klinischer Psychologie, Psychiatrie und Psychotherapie (Psychodiagnostics in Clinical Psychology, Psychiatry and Psychotherapy). Stuttgart, Thieme, 2001.
  11. Zanarini MC, Gunderson JG, Frankenburg FR, Chauncey DL: The revised diagnostic interview for borderlines: discriminating BPD from other axis II disorders. J Personal Disord 1989;3:10–18.
  12. Baron M: Schedule for Interviewing Borderlines. New York, New York State Psychiatric Institute, 1981.
  13. Perry JC: The Borderline Personality Disorder Scale (BPD Scale). Cambridge, Cambridge Hospital, 1982.
  14. Kernberg OFC: The structural diagnosis of borderline personality organization; in Hartcollis P (ed): Borderline Personality Disorders. New York, International University Press, 1977, pp 78–121.
  15. Conte HR, Plutchik R, Karasu TB, Jerrett I: A self-report borderline scale: discriminative validity and preliminary norms. J Nerv Ment Dis 1980;168:428–435.
  16. Zanarini MC: Zanarini rating scale for borderline personality disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology. J Personal Disord 2003;17:233–242.
  17. Arntz A, van den Hoorn M, Cornelis J, Verheul R, van den Bosch WMC, de Boer SF: Reliability and validity of the borderline personality disorder severity index. J Personal Disord 2003;17:45–59.
  18. Bohus M, Limberger MF, Frank U, Sender I, Gratwohl T, Stieglitz RD: Entwicklung der Borderline-Symptom-Liste (Development of the borderline symptom list). Psychother Psychosom Med Psychol 2001;51:201–211.
  19. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The mini international neuropsychiatric interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59:22–33.
  20. Bohus M, Haaf B, Stiglmayr CE, Pohl U, Boehme R, Linehan MM: Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder: a prospective study. Behav Res Ther 2000;38:875–887.
  21. Bohus M, Haaf B, Simms T, Limberger MF, Schmahl CG, Unckel C, Lieb K, Linehan MM: Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behav Res Ther 2004;42:487–499.
  22. Beck AT, Ward CH, Mendelson M, Mock H, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.
  23. Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
  24. Laux L, Glanzmann P, Schaffner P, Spielberger CD: State-Trait-Angstinventar (STAI). Weinheim, Beltz, 1981 (German version of Spielberger CD, Gorsuch RL, Lushene RE: STAI, Manual for the State-Trait-Anxiety Inventory. Palo Alto, Consulting Psychologists Press, 1970).
  25. Spielberger CD: State-Trait-Anger-Expression-Inventory (STAXI). Odessa, Psychological Assessment Resources, 1988.
  26. Freyberger HJ, Spitzer C, Stieglitz RD: Fragebogen zu dissoziativen Symptomen (FDS): Ein Selbstbeurteilungsverfahren zur syndromalen Diagnostik dissoziativer Phänomene. Berne, Huber, 1999 (German adaptation of Bernstein EM, Putnam FW: Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986;174:727–735).
  27. Linehan MM, Comtois K: Lifetime Parasuicide Count. Unpublished manuscript, 2004.
  28. Derogatis LR: SCL-90-R: Administration, Scoring and Procedures. Manual II. Towson, Clinical Psychometric Research, 1977.
  29. Gunderson JG, Zanarini MC: Revised Diagnostic Interview for Borderlines (DIB-R). Boston, Harvard Medical School, , 1992.
  30. Bernstein EM, Putnam FW: Development, reliability and validity of a dissociation scale. J Nerv Ment Dis 1986;174:727–735.
  31. Franke G: Symptom-Checkliste (SCL-90-R). Göttingen, Beltz, 1995.
  32. Briggs SR, Cheek JM: The role of factor analysis in the development of an evaluation of personality scales. J Pers 1986;54:106–148.

    External Resources

  33. Lineham MM: Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, Guildford Press, 1993.
  34. Stieglitz RD: Diagnostik und Klassifikation psychischer Störungen (Diagnostics and Classification of Mental Disorders). Göttingen, Hogrefe, 2000.
  35. Fahrenberg J: Die Freiburger Beschwerdenliste (FBL). (The Freiburg Complaint List). Göttingen, Hogrefe, 1994.

 goto top of outline Author Contacts

Prof. Dr. M. Bohus
Department of Psychosomatics and Psychotherapy
Central Institute of Mental Health, J 5
DE–68159 Mannheim (Germany)
Tel. +49 621 1703 4001, Fax +49 621 1703 4005, E-Mail martin.bohus@zi-mannheim.de


 goto top of outline Article Information

M.B. and M.F.L. contributed equally to the article.

Received: May 2, 2005
Accepted after revision: February 13, 2006
Published online: January 11, 2007
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 5, Number of References : 35


 goto top of outline Publication Details

Psychopathology (International Journal of Descriptive and Experimental Psychopathology, Phenomenology and Psychiatric Diagnosis)

Vol. 40, No. 2, Year 2007 (Cover Date: February 2007)

Journal Editor: Akiskal, H.S. (San Diego, Calif.)
ISSN: 0254–4962 (Print), eISSN: 1423–033X (Online)

For additional information: http://www.karger.com/PSP


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Background: The Borderline Symptom List (BSL) was developed as a self-rating instrument to specifically quantify borderline-typical symptomatology. The items are based on the criteria of the DSM-IV, the Diagnostic Interview for Borderline Personality Disorder – revised version, the opinions of clinical experts and borderline patients. The psychometric properties and validity of the BSL have been investigated in several studies. Sampling and Methods: A total of 380 borderline patients and 204 healthy controls scored the items. A factor analysis of the BSL items suggests the following subscales: ‘self-perception’, ‘affect regulation’, ‘self-destruction’, ‘dysphoria’, ‘loneliness’, ‘intrusions’ and ‘hostility’. Results: Theinternal reliability as well as the test-retest reliability within 1 week are high. Different aspects of validity (e.g. comparison between groups) provide favorable results. Pre-post comparisons after 3 months of dialectical behavioral treatment reveal a significant reduction of the total score and of 5 of the 7 subscales. Conclusions: This indicates that the BSL is sensitive to therapeutically induced change of borderline-typical impairment.



 goto top of outline Author Contacts

Prof. Dr. M. Bohus
Department of Psychosomatics and Psychotherapy
Central Institute of Mental Health, J 5
DE–68159 Mannheim (Germany)
Tel. +49 621 1703 4001, Fax +49 621 1703 4005, E-Mail martin.bohus@zi-mannheim.de


 goto top of outline Article Information

M.B. and M.F.L. contributed equally to the article.

Received: May 2, 2005
Accepted after revision: February 13, 2006
Published online: January 11, 2007
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 5, Number of References : 35


 goto top of outline Publication Details

Psychopathology (International Journal of Descriptive and Experimental Psychopathology, Phenomenology and Psychiatric Diagnosis)

Vol. 40, No. 2, Year 2007 (Cover Date: February 2007)

Journal Editor: Akiskal, H.S. (San Diego, Calif.)
ISSN: 0254–4962 (Print), eISSN: 1423–033X (Online)

For additional information: http://www.karger.com/PSP


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Lieb K, Zanarini MC, Schmahl CG, Linehan MM, Bohus M: Borderline personality disorder. Lancet 2004;364:459–461.

    External Resources

  2. Skodol AE, Gunderson JG, McGlashan TH, Dyck IR, Stout RL, Bender DS, Grilo CM, Shea MT, Zanarini MC, Morey LC, Sanislow CA, Oldham JM: Functional impairment in patients with schizotypal, borderline, avoidant or obsessive-compulsive personality disorder. Am J Psychiatry 2002;159:276–283.
  3. American Psychiatric Association: Practice guideline for the treatment of patients with borderline personality disorder: introduction. Am J Psychiatry 2001;158:2.
  4. Bender DS, Dolan RT, Skodol AE, Sanislow CA, Dyck IR, McGlashan TH, Shea MT, Zanarini MC, Oldham JM, Gunderson JG: Treatment utilization by patients with personality disorders. Am J Psychiatry 2001;158:295–302.
  5. Zanarini MC, Frankenburg FR: Attainment and maintenance of reliability of axis I and II disorders over the course of a longitudinal study. Compr Psychiatry 2001;42:369–374.
  6. Zanarini MC, Frankenburg FR, Sickel AE, Yong L: The Diagnostic Interview for DSM-IV Personality Disorders. Belmont, McLean Hospital, Laboratory for the Study of Adult Development, 1996.
  7. Loranger AW, Sartorius N, Andreoli A, Berger P, Buchheim P, Channabasavanna SM, Coid B, Dahl AA, Diekstra RFW, Ferguson B, Jakobsberg L, Mombour W, Pull C, Ono Y, Regier DA: Deutschsprachige Fassung der International Personality Disorder Examination (IPDE). Genf, WHO, 1998.
  8. First MB, Spitzer RL, Gibbon M, Williams JBW: User’s Guide for the Structured Clinical Interview for DSM-IV personality disorders (SCID-II). Washington, American Psychiatric Press, 1996.
  9. Pfohl B, Blum N, Zimmerman M: Structured Interview for DSM-IV Personality. Washington, American Psychiatric Press, 1997.
  10. Dittmann V, Ermer A, Stieglitz RD: Diagnostik von Persönlichkeitsstörungen; in Stieglitz RD, Baumann U, Freyberger HJ (eds): Psychodiagnostik in Klinischer Psychologie, Psychiatrie und Psychotherapie (Psychodiagnostics in Clinical Psychology, Psychiatry and Psychotherapy). Stuttgart, Thieme, 2001.
  11. Zanarini MC, Gunderson JG, Frankenburg FR, Chauncey DL: The revised diagnostic interview for borderlines: discriminating BPD from other axis II disorders. J Personal Disord 1989;3:10–18.
  12. Baron M: Schedule for Interviewing Borderlines. New York, New York State Psychiatric Institute, 1981.
  13. Perry JC: The Borderline Personality Disorder Scale (BPD Scale). Cambridge, Cambridge Hospital, 1982.
  14. Kernberg OFC: The structural diagnosis of borderline personality organization; in Hartcollis P (ed): Borderline Personality Disorders. New York, International University Press, 1977, pp 78–121.
  15. Conte HR, Plutchik R, Karasu TB, Jerrett I: A self-report borderline scale: discriminative validity and preliminary norms. J Nerv Ment Dis 1980;168:428–435.
  16. Zanarini MC: Zanarini rating scale for borderline personality disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology. J Personal Disord 2003;17:233–242.
  17. Arntz A, van den Hoorn M, Cornelis J, Verheul R, van den Bosch WMC, de Boer SF: Reliability and validity of the borderline personality disorder severity index. J Personal Disord 2003;17:45–59.
  18. Bohus M, Limberger MF, Frank U, Sender I, Gratwohl T, Stieglitz RD: Entwicklung der Borderline-Symptom-Liste (Development of the borderline symptom list). Psychother Psychosom Med Psychol 2001;51:201–211.
  19. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The mini international neuropsychiatric interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59:22–33.
  20. Bohus M, Haaf B, Stiglmayr CE, Pohl U, Boehme R, Linehan MM: Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder: a prospective study. Behav Res Ther 2000;38:875–887.
  21. Bohus M, Haaf B, Simms T, Limberger MF, Schmahl CG, Unckel C, Lieb K, Linehan MM: Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behav Res Ther 2004;42:487–499.
  22. Beck AT, Ward CH, Mendelson M, Mock H, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.
  23. Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
  24. Laux L, Glanzmann P, Schaffner P, Spielberger CD: State-Trait-Angstinventar (STAI). Weinheim, Beltz, 1981 (German version of Spielberger CD, Gorsuch RL, Lushene RE: STAI, Manual for the State-Trait-Anxiety Inventory. Palo Alto, Consulting Psychologists Press, 1970).
  25. Spielberger CD: State-Trait-Anger-Expression-Inventory (STAXI). Odessa, Psychological Assessment Resources, 1988.
  26. Freyberger HJ, Spitzer C, Stieglitz RD: Fragebogen zu dissoziativen Symptomen (FDS): Ein Selbstbeurteilungsverfahren zur syndromalen Diagnostik dissoziativer Phänomene. Berne, Huber, 1999 (German adaptation of Bernstein EM, Putnam FW: Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986;174:727–735).
  27. Linehan MM, Comtois K: Lifetime Parasuicide Count. Unpublished manuscript, 2004.
  28. Derogatis LR: SCL-90-R: Administration, Scoring and Procedures. Manual II. Towson, Clinical Psychometric Research, 1977.
  29. Gunderson JG, Zanarini MC: Revised Diagnostic Interview for Borderlines (DIB-R). Boston, Harvard Medical School, , 1992.
  30. Bernstein EM, Putnam FW: Development, reliability and validity of a dissociation scale. J Nerv Ment Dis 1986;174:727–735.
  31. Franke G: Symptom-Checkliste (SCL-90-R). Göttingen, Beltz, 1995.
  32. Briggs SR, Cheek JM: The role of factor analysis in the development of an evaluation of personality scales. J Pers 1986;54:106–148.

    External Resources

  33. Lineham MM: Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, Guildford Press, 1993.
  34. Stieglitz RD: Diagnostik und Klassifikation psychischer Störungen (Diagnostics and Classification of Mental Disorders). Göttingen, Hogrefe, 2000.
  35. Fahrenberg J: Die Freiburger Beschwerdenliste (FBL). (The Freiburg Complaint List). Göttingen, Hogrefe, 1994.