> ## 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.
# MSI-BPD — McLean Screening Instrument for Borderline Personality Disorder
> A ten-item yes/no screen for probable borderline personality disorder, positive at 7, with a self-harm and suicide-attempt item that flags on its own.
The MSI-BPD is a ten-question yes/no screen for probable borderline
personality disorder. It takes about a minute, and it exists to answer
one question: does this presentation warrant a proper structured
interview?
## What it measures
The nine DSM-IV borderline criteria, mapped onto ten items — the
self-harm and suicidal-behaviour criterion gets its own question, which
is why there are ten items for nine criteria.
The items cover unstable relationships, deliberate self-harm and suicide
attempts, impulsivity, mood instability, anger, distrust, dissociation
and derealization, chronic emptiness, identity disturbance, and efforts
to avoid abandonment.
The frame is "generally … over the past 2 years (or as long as you can
remember)" — this is a trait-level screen, not a state measure.
## When to use it
* **When the presentation doesn't fit the referral.** A depression or
anxiety referral that keeps producing relationship crises, self-harm,
or abrupt treatment ruptures.
* **Before committing to a treatment model.** The answer changes whether
DBT, mentalization-based work, or schema-focused work belongs on the
table.
* **Alongside the [BSL-23](/clinical-templates/screening/bsl-23).** The
MSI-BPD screens for whether the picture is present; the BSL-23 tracks
severity over treatment. Screen once, track with the other.
* **In the assessment phase, not the crisis.** A client in acute distress
will over-endorse trait items; the screen reads more cleanly when
things are stable.
## How clients fill it
About a minute. The stem reads: "Please answer Yes or No to each of the
following questions about how you have generally been over the past 2
years (or as long as you can remember)."
All ten items carry the same two options:
* No
* Yes
## How Rivet scores it
Yes scores 1, No scores 0. The total is the count of Yes answers across
all ten items. Range: 0–10. No reverse-scored items.
Item 2 is also tracked on its own — see below.
## Score bands
| Total | Band |
| ----- | ----------------------------------------------------------------------- |
| 0–6 | Below MSI-BPD threshold |
| 7–10 | Positive screen — probable BPD, structured clinical interview indicated |
Seven is the cutoff from Zanarini 2003, which reported sensitivity of 81%
and specificity of 85% in a sample of psychiatric outpatients.
A positive screen means the structured interview is indicated — not that
the diagnosis is made. Ten yes/no questions cannot carry a personality
disorder diagnosis, and the consequences of an incorrectly applied
borderline label are large enough that this distinction matters more here
than on most measures.
## Item 2 — self-harm and suicide attempts
**Item 2 asks directly about deliberate self-harm and suicide
attempts.** A Yes on item 2 warrants a risk conversation regardless of
the total. An MSI-BPD of 4 with item 2 endorsed matters more than an
MSI-BPD of 9 with item 2 at No.
Rivet flags item 2 separately in the scoring pill when it's endorsed.
What happens next — history-taking, a
[C-SSRS](/clinical-templates/clinician-administered/c-ssrs), a
[safety plan](/clinical-templates/crisis/safety-plan), a consult — is
your clinical call.
Item 2 reads: "Have you deliberately hurt yourself physically (e.g.,
punched yourself, cut yourself, burned yourself)? Or made a suicide
attempt?"
It's a compound question covering two different behaviours with different
risk implications, and the client answers it with one word. The item
tells you to have the conversation; it doesn't tell you which of the two
they meant, how recent it was, or what the intent was. That's the
follow-up.
## Clinical change
The MSI-BPD isn't a change measure. The frame is the past two years, so
re-administering it during treatment measures very little. Screen once;
track severity with the [BSL-23](/clinical-templates/screening/bsl-23).
## When NOT to use it
* **As a diagnostic instrument.** It's a screen. The diagnosis comes from
a structured clinical interview.
* **During acute crisis.** Trait items get answered as state items when
the client is in the middle of something.
* **With adolescents, as if it were a diagnosis.** The instrument was
validated in adult psychiatric outpatients, and applying a personality
disorder label to a developing adolescent on the strength of a screen
is not defensible.
* **As a way to explain a difficult therapeutic relationship.** If the
reason you're reaching for it is that the work is hard, that's a
supervision conversation, not a screening one.
## MSI-BPD vs BSL-23
The MSI-BPD asks whether the criteria are met; the
[BSL-23](/clinical-templates/screening/bsl-23) asks how bad this week was.
Ten yes/no items mapped to the nine DSM criteria, scored against a cutoff
of 7 — that's a screen, and a positive one points to a structured clinical
interview, not to a diagnosis. The BSL-23 has no diagnostic cutoff at all
and isn't trying to have one. It tracks borderline symptom severity over
the past week, which is what you want once the formulation is settled and
you're doing DBT or similar work.
The order most practices use: MSI-BPD once, BSL-23 repeatedly.
## Is it free to use?
**Yes.** Free clinical use, and widely cited.
## Citation
Zanarini, Vujanovic, Parachini, Boulanger, Frankenburg & Hennen (2003).
*Journal of Personality Disorders,* 17: 568–573.
Free for clinical use. Rivet preserves the canonical item wording
verbatim.
## Related articles
Borderline Symptom List — the severity tracker to use once the screen
is positive.
The suicide-risk assessment to run when item 2 is endorsed.
The six-step collaborative plan that follows an actionable risk
finding.
When to screen and the risk-flag rule across measures.