Construct Validity of the McLean Screening Instrument for Borderline Personality Disorder in Two Singaporean Samples

This study examined the construct validity of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) in a consecutive sample of adult psychiatric patients (n = 128) and a separate sample of undergraduate students (n = 289) in Singapore. Participants were administered the MSI-BPD and other measures assessing related symptoms of BPD. Patients were also administered a semistructured interview by interviewers blind to their MSI-BPD scores. Confirmatory factor analyses revealed a unique three-factor solution, consisting of affect dysregulation, self-disturbances, and behavioral and interpersonal dysregulation. In both samples, the MSI-BPD demonstrated good internal consistency and convergent validity. The measure also showed good discriminant validity and predictive accuracy (AUC = .82), with an optimal cut-off score of 7.5. Overall, the findings suggest that BPD is a valid and coherent clinical construct in Singapore, and point to the need to further clarify the presentation and etiology of BPD in this cultural context.

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Supplemental Material for Elaborating on the Construct Validity of the Minnesota Borderline Personality Disorder Scale (MBPD): A Multi-Sample, Longitudinal Examination

Psychological Assessment ◽

10.1037/pas0000061.supp ◽

2015 ◽

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Construct Validity ◽

Borderline Personality ◽

Longitudinal Examination

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Development and validation of a screening instrument for borderline personality disorder (SI-Bord) for use among university students

BMC Psychiatry ◽

10.1186/s12888-020-02807-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Trustsavin Lohanan ◽

Thanakorn Leesawat ◽

Tinakon Wongpakaran ◽

Nahathai Wongpakaran ◽

Nuntaporn Karawekpanyawong ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

University Students ◽

Predictive Value ◽

Demographic Data ◽

Intraclass Correlation ◽

Screening Instrument ◽

Borderline Personality ◽

Youden Index ◽

Operating Characteristics

Abstract Background 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. This study investigated its validity and reliability in screening for BPD in university students. Methods A cross-sectional study was conducted on a sample of university students in Thailand between November and December 2019. An online assessment gathered demographic data and results from the SI-Bord, the Perceived Stress Scale-10 (PSS-10) and the Patient Health Questionnaire-9 (PHQ-9). Participants whose SI-Bord scores were ≥ 1 were randomly selected to be interviewed and assessed for a BPD diagnosis by four psychiatrists using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) as a reference point. An intraclass correlation coefficient (ICC) of 0.925 (95% CI, 0.805–0.979) ensured inter-rater reliability between the four psychiatrists. The diagnostic sensitivity and specificity of the SI-Bord, as compared to that of the SCID-II, were determined to indicate the cut-off score. The Receiver Operating Characteristics (ROC) was analyzed to evaluate its diagnostic accuracy. Results The study included 342 students aged 18–25 years (the mean age was 20.25 ± 1.4 years), 80.4% of whom were female. Among the 68 participants selected for an online interview, 16 were diagnosed with BPD. The cut-off score of the SI-Bord was > 9, as suggested by the Youden index, yielding a sensitivity of 56.3% and a specificity of 92.3%. It had a positive predictive value of 69.2% and negative predictive value of 87.3%. The SI-Bord had adequate discriminative power between cases and non-cases of BPD, with the area under the ROC curve being 0.83. Cronbach’s alpha for the SI-Bord was 0.76, indicating acceptable internal consistency. The SI-Bord score was positively correlated to PHQ-9 and PSS-10 scores (r = 0.67 and r = 0.69, p < 0.001, respectively) and negatively correlated to MSPSS (r = − 0.50, p < 0.001). The prevalence of BPD in the sample was 6.4%, according to the cut-off score > 9. Conclusion The SI-Bord demonstrated good reliability and validity for screening BPD in university students. However, a study in non-Thai and other population groups should be warranted.

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Screening for Borderline Personality Disorder With the McLean Screening Instrument: A Review and Critique of the Literature

Journal of Personality Disorders ◽

10.1521/pedi_2019_33_451 ◽

2019 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Mark Zimmerman ◽

Caroline Balling

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

High Sensitivity ◽

Screening Instrument ◽

Borderline Personality ◽

Self Report ◽

Cutoff Score ◽

Cutoff Scores ◽

Diagnostic Detection

Borderline personality disorder (BPD) is underdiagnosed in clinical practice. One approach towards improving diagnostic detection is the use of screening questionnaires. It is important for a screening test to have high sensitivity because the more time-intensive/expensive follow-up diagnostic inquiry will presumably only occur in patients who are positive on the initial screen. The most commonly studied self-report scale specific for BPD is the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). We summarize the performance of the scale across studies, examine the performance of the scale using different cutoff scores, and highlight the approach used by investigators in recommending a cutoff score. Most studies of the scale have taken a case-finding approach in deriving the cutoff score on the scale instead of a screening approach. For the purposes of screening, it may be more appropriate for the cutoff score on the MSI-BPD to be less than the currently recommended cutoff of 7.

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