Diagnostic tools for BPD?

[jbomba]

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Anyone have any objective instruments they use for BPD? I have read about the DIB-R but cannot find it anywhere. Anything people recommend? Bonus points if freely accessibly online. Thx.

 

[splik]

Not sure what you mean by "objective instruments". The McLean Borderline Questionnaire is a self-report measure but it is pretty decent and available online. The SCID-5-PD is the "gold standard" which you have to purchase and is for all personality disorders. Any actual structured interview instruments will not be legally available freely only as it would compromise the validity of the tool.

 

[romanticscience]

You could use these online versions of the SCID. I believe they are about $25 per test.

 

[clausewitz2]

Not sure what you mean by "objective instruments". The McLean Borderline Questionnaire is a self-report measure but it is pretty decent and available online. The SCID-5-PD is the "gold standard" which you have to purchase and is for all personality disorders. Any actual structured interview instruments will not be legally available freely only as it would compromise the validity of the tool.

Seconding the McLean, PPV above the cut-off (7 IIRC) is strong. It is free, easy, and quick.

 

[annoyedpsychiatrist]

Seconding the McLean, PPV above the cut-off (7 IIRC) is strong. It is free, easy, and quick.

i also use the mclean screen. typically if someone endorses all mclean sx strong possibility theyre BPD.

 

[comp1]

This is why I do inpatient. I need the patient to announce their diagnoses to me at introduction in some manner. The whole idea of having to bring out the SCID to clarify borderline PD seems amazingly tedious.

 

[mistafab]

The SCID is a great tool but also highlights the limitations of our current personality disorder diagnostic system.

I am at a place where we regularly administer the SCID for personality disorders. One thing you will notice right away doing it is many people will flag full diagnosis for multiple personality disorders. The other thing you will notice is the actual diagnosis may or may not line up with the actual Core Issue / Assessment that is needed for these people to improve their disorders.

In having exposure to this, it is clear to me that when dealing with personality disorders, what is more important than the diagnosis itself, is recognizing the core constructs that are disabling or causing suffering to the patient, and identifying what would be the most productive treatment modality for that patient.

I'll give an example - a loosely coherent, identity diffused patient with grossly unstable emotions and poor coping skills may be diagnosed with borderline personality disorder and benefit from DBT. A coherent, identity diffused patient with frequent dissociations but mature defenses and good coping skills may also be diagnosed with borderline personality disorder but would likely not benefit from DBT, and could do better with mentalization based therapy, transference focused therapy, or psychodynamic approaches. A SCID may label the first person as borderline full, histrionic full, and OCPD traits. And the SCID may label the second person Borderline full, avoidant full, OCPD traits. Does that really help us understand the patient? not really, and it doesn't really help identifying what treatment would work best for them.

In essence, I'm saying it's more helpful to identify if a PD is likely present, then understand what are the core issues contributing. Tailor treatment to those underlying problems, not necessarily the specific PD diagnosis.

 

[smalltownpsych]

The SCID is a great tool but also highlights the limitations of our current personality disorder diagnostic system.

I am at a place where we regularly administer the SCID for personality disorders. One thing you will notice right away doing it is many people will flag full diagnosis for multiple personality disorders. The other thing you will notice is the actual diagnosis may or may not line up with the actual Core Issue / Assessment that is needed for these people to improve their disorders.

In having exposure to this, it is clear to me that when dealing with personality disorders, what is more important than the diagnosis itself, is recognizing the core constructs that are disabling or causing suffering to the patient, and identifying what would be the most productive treatment modality for that patient.

I'll give an example - a loosely coherent, identity diffused patient with grossly unstable emotions and poor coping skills may be diagnosed with borderline personality disorder and benefit from DBT. A coherent, identity diffused patient with frequent dissociations but mature defenses and good coping skills may also be diagnosed with borderline personality disorder but would likely not benefit from DBT, and could do better with mentalization based therapy, transference focused therapy, or psychodynamic approaches. A SCID may label the first person as borderline full, histrionic full, and OCPD traits. And the SCID may label the second person Borderline full, avoidant full, OCPD traits. Does that really help us understand the patient? not really, and it doesn't really help identifying what treatment would work best for them.

In essence, I'm saying it's more helpful to identify if a PD is likely present, then understand what are the core issues contributing. Tailor treatment to those underlying problems, not necessarily the specific PD diagnosis.

Diagnosis is just one part of case formulation or case conceptualization as us psychologists like to say 😁. It is important to get this part right as it is foundational, but definitely need to look deeper and understand the person who has the disorder since they are all different. Was trying to explain how different underlying temperaments and personality traits would intersect with disorders and affect presentation and treatment yesterday with my postdoc. Then you have to look at the environmental factors and experiences that have shaped them as well. It’s why when we have the highest level of training and skill and abilities it sets us so far apart from the lower tier providers.

 

[Merovinge]

Diagnosis is just one part of case formulation or case conceptualization as us psychologists like to say 😁. It is important to get this part right as it is foundational, but definitely need to look deeper and understand the person who has the disorder since they are all different. Was trying to explain how different underlying temperaments and personality traits would intersect with disorders and affect presentation and treatment yesterday with my postdoc. Then you have to look at the environmental factors and experiences that have shaped them as well. It’s why when we have the highest level of training and skill and abilities it sets us so far apart from the lower tier providers.

Understood. Prescribe Adderall 20mg TID and Xanax 2mg TID.

 

[Stagg737]

Seconding the McLean, PPV above the cut-off (7 IIRC) is strong. It is free, easy, and quick.

i also use the mclean screen. typically if someone endorses all mclean sx strong possibility theyre BPD.

Going to push back here a bit. Even with cutoff being >7 it picks up a lot of patients with PTSD/trauma disorders who have some baseline borderline traits but would otherwise not meet full criteria once trauma is addressed. Zanarini scale is similar but only asks about symptoms within the past week. I've also seen people combined the scale and basically do a McLean with the heading "in the past (2) weeks have you experienced:" which is just even worse, lol. Not saying awful, but imo doesn't compare to taking 10-20 minutes to just run through the criteria with a decent interview.

The SCID is a great tool but also highlights the limitations of our current personality disorder diagnostic system.

I am at a place where we regularly administer the SCID for personality disorders. One thing you will notice right away doing it is many people will flag full diagnosis for multiple personality disorders. The other thing you will notice is the actual diagnosis may or may not line up with the actual Core Issue / Assessment that is needed for these people to improve their disorders.

In having exposure to this, it is clear to me that when dealing with personality disorders, what is more important than the diagnosis itself, is recognizing the core constructs that are disabling or causing suffering to the patient, and identifying what would be the most productive treatment modality for that patient.

I'll give an example - a loosely coherent, identity diffused patient with grossly unstable emotions and poor coping skills may be diagnosed with borderline personality disorder and benefit from DBT. A coherent, identity diffused patient with frequent dissociations but mature defenses and good coping skills may also be diagnosed with borderline personality disorder but would likely not benefit from DBT, and could do better with mentalization based therapy, transference focused therapy, or psychodynamic approaches. A SCID may label the first person as borderline full, histrionic full, and OCPD traits. And the SCID may label the second person Borderline full, avoidant full, OCPD traits. Does that really help us understand the patient? not really, and it doesn't really help identifying what treatment would work best for them.

In essence, I'm saying it's more helpful to identify if a PD is likely present, then understand what are the core issues contributing. Tailor treatment to those underlying problems, not necessarily the specific PD diagnosis.

Love this and emphasizes an approach of identifying and addressing specific traits that I wish was more prevalent. I did research on AMPD in residency and still am peripherally involved. We used the PAI (which is fine but not great) in addition to the SCID-IV but had developed a program that would convert the PAI into domains and some specific trait scores for the AMPD. Someone who is scoring highly for traits in the disinhibition domain may look much different and require quite a different approach than someone who mostly has dysfunction in the negative affectivity domain.

 

[smalltownpsych]

Understood. Prescribe Adderall 20mg TID and Xanax 2mg TID.

Patient satisfaction scores are high…great job! 😉

 

[OldPsychDoc]

The quivering hairs on my dorsal neck.

 

[Ceke2002]

The quivering hairs on my dorsal neck.

"Treating Psychiatrist reports strong urge to back away slowly" should totally be on the symptom list.