What Is the McLean Screening Instrument for BPD?

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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-BPD

Each 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-BPD

Clinicians 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 Interview

The 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 Scale

The 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-BPD

It'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 Verywell

BPD 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

  • How do I get a BPD assessment?

    The first step is to make an appointment with a licensed mental health professional, ideally one who has knowledge of and experience with BPD. Professional experience with BPD is important because the disorder can mimic and co-occur with other conditions such as bipolar disorder. They will evaluate your condition and prescribe a course of treatment.

  • How long does a BPD diagnosis take?

    BPD assessment tools themselves generally take no more than an hour to complete. However, diagnosing BPD can be tricky because it can mimic other mental health conditions, so your clinician might need more than one session to discuss your symptoms and provide a diagnosis.

  • Why does BPD require a medical diagnosis?

    A medical exam is important in any mental health diagnosis to rule out physical causes for your symptoms and to confirm the appropriateness and safety of medications your clinician might prescribe.

12 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Zimmerman M, Balling C. Screening for borderline personality disorder with the McLean screening instrument: A review and critique of the literatureJ Pers Disord. 2021;35(2):288-298. doi:10.1521/pedi_2019_33_451

  3. Patel AB, Sharp C, Fonagy P. Criterion validity of the MSI-BPD in a community sample of womenJ Psychopathol Behav Assess. 2011;33(3):403-408. doi:10.1007/s10862-011-9238-5

  4. First MB, Williams JBW, Benjamin LS, Spitzer RL. Structured Clinical Interview for DSM-5 Screening Personality Questionnaire: Designed to Be Used as a Screener for the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). American Psychiatric Association Publishing; 2016.

  5. Personality Diagnostic Questionnaire for the DSM IV and DSM 5. The Official PDQ-4 Website.

  6. Mary C. Zanarini, EdD. McLean Hospital.

  7. van Alebeek A, van der Heijden PT, Hessels C, Thong MSY, van Aken M. Comparison of three questionnaires to screen for borderline personality disorder in adolescents and young adultsEur J Psychol Assess. 2017; 33(2),123–128. doi:10.1027/1015-5759/a000279

  8. de Reus RJM, van den Berg JF, Emmelkamp PMG. Personality diagnostic questionnaire 4+ is not useful as a screener in clinical practiceClin Psychol Psychother. 2013;20(1):49-54. doi:10.1002/cpp.766

  9. Paris J. Suicidality in borderline personality disorderMedicina (Kaunas). 2019;55(6):223. doi:10.3390/medicina55060223

  10. Biskin RS, Paris J. Diagnosing borderline personality disorderCMAJ. 2012;184(16):1789-1794. doi:10.1503/cmaj.090618

  11. Zimmerman M. Screening tests are not diagnostic: A commentary on a study of electroconvulsive therapy for depressed patients with and without borderline personality disorder. J Clin Psychiatry. 2021 Mar 30;82(2):21com13909. doi:10.4088/JCP.21com13909

  12. Borderline personality disorder and bipolar disorder: What’s the difference?. NAMIi: National Alliance on Mental Illness.

Additional Reading
  • Laboratory for the Study of Adult Development. McLean Hospital (2016).

  • Zanarini MC, Vujanovic AA, Parachini EA, Boulanger JL, Frankenburg FR, Hennen J. A Screening Measure for BPD: The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Journal of Personality Disorders 17(6):568-573, 2003.

By Kristalyn Salters-Pedneault, PhD
 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.