> ## Documentation Index
> Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt
> Use this file to discover all available pages before exploring further.
# BSL-23 — scoring and mean-score interpretation
> How to score the Borderline Symptom List, what the mean score means, and how to track borderline symptom severity across DBT work.
The BSL-23 is the short form of Bohus's Borderline Symptom List — the
self-report severity tracker used in DBT and similar borderline-focused
protocols to measure trajectory across treatment. It's descriptive, not
diagnostic. A high score doesn't make a BPD diagnosis; a downward trend
across sessions is the signal you're after.
Twenty-three items, one week look-back, free for academic and clinical
use under CC-BY.
## What it measures
Past-week severity of borderline-specific symptoms across seven
implicit domains:
* Self-perception
* Affect regulation
* Self-destructive impulses
* Dysphoria
* Loneliness and emptiness
* Intrusions
* Hostility
The 23 items don't map cleanly to seven distinct subscales — Bohus
designed the short form for a single severity total. Use the total
score and watch the trajectory.
## When to use it
* **Intake for borderline-focused work** to establish a severity
baseline.
* **Every 2-4 weeks during DBT or other borderline protocols** to
track trajectory.
* **Pre/post a discrete protocol phase** (DBT skills modules, brief
DBT, modified EMDR for CPTSD).
* **Outcome documentation** at discharge.
## How clients fill it out
Twenty-three items rated 0-4 (Not at all → Very strong) over the past
week. Five to seven minutes. Reading level grade 7-8.
## Scoring and severity cutoffs
Sum of all 23 items. Range 0-92.
### Bands
| Total | Band (mean equivalent) |
| ----- | ----------------------- |
| 0-12 | None to low (mean ≤0.5) |
| 13-35 | Mild (mean 0.6-1.5) |
| 36-58 | Moderate (mean 1.6-2.5) |
| 59-81 | High (mean 2.6-3.5) |
| 82-92 | Very high (mean ≥3.6) |
Bands are derived from the canonical per-item mean thresholds in
Kleindienst 2020's BSL-23 validation work — the original instrument
is sometimes interpreted on a 0-4 mean scale rather than a sum, and
the Rivet bands translate the mean cuts back to the sum scale.
### Self-harm / suicidality items
Items 5 (self-harm thoughts), 7 (right to live), 12 (self-punishment),
and 18 (fascination with death) form a separate flagged subscale. Any
score ≥ 1 on any of these surfaces a "self-harm / suicidality /
death-fascination endorsed — clinical evaluation indicated" label on
the result.
**The self-harm subscale flag is decision-support, not a complete
risk assessment.** When any of items 5, 7, 12, or 18 are
endorsed, do a direct risk conversation with the client and pair
with the C-SSRS at intake and at any inflection point. The
BSL-23 alone is not sufficient for risk stratification.
## Clinical change
BPD severity moves slowly. A 5-10 point drop across a 12-week
treatment period is in the range of effects reported in DBT outcome
literature. A one-band shift (e.g. high → moderate) over a full course
of treatment is the more clinically meaningful threshold for
documentation.
## Use note
BSL-23 is **descriptive**, not diagnostic. It tells you how severe
the borderline-spectrum experience is right now — it doesn't make a
BPD diagnosis. Positive borderline screening belongs with the
MSI-BPD or a structured clinical interview. Use BSL-23 once a
clinical frame is established to track severity over time.
## BSL-23 vs MSI-BPD
The BSL-23 is descriptive, not diagnostic, and that is a deliberate design
choice rather than a limitation. It has no cutoff that says "borderline";
it produces a severity number for the past week that you can watch move
across a course of DBT.
Screening is the [MSI-BPD](/clinical-templates/screening/msi-bpd)'s job —
ten yes/no items against the DSM criteria with a cutoff at 7, and a
positive result meaning a structured interview is warranted.
So they sit in sequence rather than competition: MSI-BPD to decide whether
this is the right formulation, BSL-23 to track it once you're working.
Using the BSL-23 as a screen would be reading a number it isn't producing.
## Is it free to use?
**Yes.** Published under a Creative Commons attribution licence by Bohus and colleagues.
## Citation
Bohus, M., Kleindienst, N., Limberger, M. F., Stieglitz, R. D.,
Domsalla, M., Chapman, A. L., Steil, R., Philipsen, A., & 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.
CC-BY academic/clinical use per Bohus 2009. Verbatim canonical
wording.
## When not to use it
* **You're doing a borderline differential** without an established
frame. Use MSI-BPD or a structured interview first.
* **The client is under 18.** BSL-23 is validated in adult samples.
* **You want a measure of emotion regulation specifically.** Use
the DERS-18 instead — BSL-23 is broader.
## Related articles
Emotion regulation difficulties — narrower than BSL-23 and
closer to the DBT skills frame.
Complex PTSD measure for clients whose presentation crosses
BPD and CPTSD.
Suicide risk screener — pair with BSL-23 when self-harm items
flag.