Iowa Personality Disorder Screen (IPDS)

Structured interview-based methods for diagnosing Personality Disorders (PD) are considered among the best practices for diagnosing PD (Zanarini et al., 2000), but they are time consuming and involve specific training of the clinician. Therefore, several authors have advised that clinicians should first screen patients for PD to identify patients who need a more thorough evaluation (Rizeanu, 2016).

The Iowa Personality Disorder Screen (IPDS) was developed by Langbehn et al (1999) to serve as a brief interview-based measure, taking around 5 min to complete. It is an 11-item screening instrument used to evaluate whether a PD is present or absent in the psychiatric outpatient clinic setting (Langbehn et al., 1999). Most of the 11 items have follow up questions making up a total 19 possible questions. It can easily be integrated into standard diagnostic clinical interviews and initial validation research suggests that it is adequate in identifying patients requiring further evaluation to determine if they meet criteria for a personality disorder. Furthermore, a study by Trull and Armdur (2001) examined the effectiveness of the IPDS in a non-clinical sample of 103 undergraduate students and determined that it may be useful as a screening measure for PD in both clinical and nonclinical populations.

Retrospective analyses using 1,203 Structured Interview for Disorders of Personality-Revised (SIDP-R; Pfohl, Blum, Zimmerman,1995) interviews suggested that the IPDS items should provide good sensitivity and specificity (Langbehn et al., 1999). Furthermore, results from a prospective validation study, using a mixed group of 52 nonpsychotic inpatients and outpatients who were diagnosed showed that blind administration of the IPDS yielded excellent sensitivity (92%) and good specificity (79%). The IPDS shows promise as a quick PD screen for use in research settings or standard clinical interviews. Moreover, socio-demographic and psychopathological factors have been suggested to have little effect on the IPDS as screening instrument (Olssøn, Sørebø, & Dahl, 2011).

In a study by Morse and Pilkonis (2007) psychiatric and non-psychiatric samples were employed to compare the validity of three screening measures: the PD scales from the Inventory of Interpersonal Problems, a self-report version of the Iowa Personality Disorder Screen, and the self-directedness scale of the Temperament and Character Inventory. The screeners were highly correlated in a range from .71 to .77, despite their different theoretical origins. These findings suggest that the use of multiple screeners was not a significant improvement over any individual screener, and no single screener stood out as clearly superior to the others.

When using self-rating scales, clinicians should be mindful as individuals with PD see themselves in distorted ways and may not be able to give accurate accounts of their presenting difficulties (Klonsky, Oltmanns, & Turkheimer, 2002). Reports of symptoms have been shown to differ from those of their friends and families (Klonsky, Oltmanns, & Turkheimer, 2002), therefore interviews with people who know the patient well can improve the accuracy of a diagnosis.

This tool is not meant to be used as a diagnostic tool. Only a trained professional can properly diagnose a personality disorder. The formal diagnosis for a PD is ultimately a clinical decision that should be made by incorporating multiple sources and the screening measures are intended to aid clinicians in making decisions regarding identification of patients who are in need of a more thorough evaluation, but a formal diagnosis should not be given based exclusively on these data alone.
References

Langbehn DR et al. (1999). The Iowa Personality Disorder Screen: development and preliminary validation of a brief screening interview. J Pers Disord. Spring;13(1)75-89.

Morse, J. Q., & Pilkonis, P. A. (2007). Screening for Personality Disorders. Journal of Personality Disorders21(2), 179–198. http://doi.org/10.1521/pedi.2007.21.2.179

Olssen, I., Sørebø, Ø., & Dahl, A. A. (2011). A cross-sectional testing of The Iowa Personality Disorder Screen in a psychiatric outpatient setting. BMC Psychiatry11, 105. http://doi.org/10.1186/1471-244X-11-105

Pfohl, B., Blum, N., Zimmerman, M. (1995). Structured interview for DSM-IV personality SIDP-IV. Iowa City, IA. The University of Iowa.

Rizeanu, S. (2016). Screening measures for personality disorders. Romanian Journal of Experimental Applied Psychology, 7(2).

Siefert, C. J. (2010). Screening for Personality Disorders in Psychiatric Settings: Four Recently Developed Screening Measures, in Baer, L., Blais, M.A. (2010). Handbook of Clinical Rating Scales and Assessment in Psychiatry and Mental Health. N.Y: Human Press.

Trull, T.J. & Amdur, M. (2001). Diagnostic Efficiency of the Iowa Personality Disorder Screen Items in a Nonclinical Sample. Journal of Personality Disorders: Vol. 15, No. 4, pp. 351-357. https://doi.org/10.1521/pedi.15.4.351.19184

Borderline Symptom List (BSL-23)

Background

The Borderline Symptom List 23 was developed in 2009 to provide a way to quantify the symptoms experienced by people diagnosed with Borderline Personality Disorder in a quick and efficient manner (Bohus et al., 2009). It was created from the original BSL-95 which was developed in 2007, based on a sample of 379 borderline patients (Bohus et al., 2007). It is a self-report questionnaire using a Likert scale rating (0 = ‘not at all’, 1 = ‘a little’, 2 = ‘rather’, 3 = ‘much’, and 4 = ‘very strong’). It asks the patient to evaluate their symptoms for the past week in a series of 23 questions.

Although the original BSL-95 had very strong psychometric properties, the number of questions in the list was thought to be not practical in some settings and to reduce the patent burden and increase the willingness of clinicians and researches to use the tool, a brief form was created (Bohus et al., 2009).

Scoring

The BSL-23 is scored by adding the values of the items. Patients must complete at least 90% of the questionnaire for the scores to be evaluated (Mannheim, 2007). To enable the comparability with the original BSL-95 the score needs to compare the mean values of the scales. The supplement Items for assessing Behaviour is assessed in the same way, with scored being added to obtain the actual dysfunctional behaviour score. Both scores are used to monitor the severity of BPD symptoms and track the changes across time for the patient. It does not diagnose Borderline Personality Disorder.

Psychometric Properties

Research findings by Bohus et al. (2009) have found good psychometric properties for the BSL-23 which are comparable to those found longer BSL-95. There is also a high correlation between the BSL-23 and BSL-95 scores from all samples they tested (range: 0.958–0.963) Internal consistency was also high with Cronbach’s α ranging between 0.935–0.969.

Clinical Uses

The BSL-23 can be used to test the effectiveness of treatments being undertaken by the patient as it is sensitive enough to detect changes between testings (Bohus et al., 2009). The briefness of the tool allows it to be used weekly with low patient burden, compared to the BSL-95.  The tool was originally written in German and has been translated into several different languages apart from English and the psychometric properties for the translated tools are valid and have been published (Nicastro et al., 2016; Soler et al., 2013).

References

Bohus, M., Kleindienst, N., Limberger, M. F., Stieglitz, R.-d., Domsalla, M., Chapman, A. L., . . . Wolf, M. (2009). The Short Version of the Borderline Symptom List (BSL-23): Development and Initial Data on Psychometric Properties. Psychopathology, 42(1), 32-39.

Bohus, M., Limberger, M. F., Frank, U., Chapman, A. L., Kühler, T., & Stieglitz, R.-D. (2007). Psychometric Properties of the Borderline Symptom List (BSL). Psychopathology, 40(2), 126-132.

Mannheim, P. Z. (2007). Borderline Symptom List 23 (BSL-23) Analysis Information Retrieved from https://www.zi-mannheim.de/fileadmin/user_upload/downloads/forschung/PSM_downloads/BSL_23_english_scoring_06_2007.pdf

Nicastro, R., Prada, P., Kung, A.-L., Salamin, V., Dayer, A., Aubry, J.-M., . . . Perroud, N. (2016). Psychometric properties of the French borderline symptom list, short form (BSL-23). Borderline Personality Disorder and Emotion Dysregulation, 3(1), 4. doi:10.1186/s40479-016-0038-0

Soler, J., Vega, D., Feliu-Soler, A., Trujols, J., Soto, Á., Elices, M., . . . Pascual, J. C. (2013). Validation of the Spanish version of the borderline symptom list, short form (BSL-23). BMC Psychiatry, 13(1), 1317. doi:10.1186/1471-244X-13-139