Borderline Symptom List 23

The Borderline Symptom List 23 (BSL-23) is a robust clinical tool developed to assess the core phenomenological experiences of borderline personality…

Questions: 23
Duration: 5 min
Original title: Borderline Symptom List 23
Adaptation: Borderline Symptom List 23
Authors: Bohus, M., Kleindienst, N., Limberger, M. F., Stieglitz, R. D., et al.
Created: 2009

The Borderline Symptom List 23 (BSL-23) is a robust clinical tool developed to assess the core phenomenological experiences of borderline personality disorder (BPD). Distilling the extensive 95-item original version into a highly efficient 23-item format, this instrument captures the acute distress and functional impairment patients experience across multiple symptomatic domains. It is specifically calibrated for adult psychiatric populations, offering a sensitive measure of symptom fluctuation over a one-week recall period.

For clinicians, the BSL-23 is invaluable for establishing a precise symptom baseline and tracking progress throughout structured interventions. Unlike broader diagnostic checklists, this scale focuses heavily on the internal, subjective distress that characterizes borderline psychopathology, from visceral self-hatred to micro-psychotic episodes. Integrating the BSL-23 alongside standardized criteria for personality disorders ensures a multidimensional clinical formulation. It is particularly responsive to targeted treatments, making it a standard monitoring tool in programs such as Dialectical Behavior Therapy and schema-focused approaches.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

1.87/ 4

The BSL-23 is a 23-item self-report questionnaire designed to assess the severity and course of symptoms specific to borderline personality disorder (such as emotional dysregulation, impulsivity, self-harming behaviors, interpersonal difficulties, and identity disturbances). It is a validated short form of the BSL-95.

0–0.28

None/Low

0.28–1.07

Mild

1.07–1.87

Moderate

1.87

1.87–2.67

High

2.67–3.47

Very High

3.47–4

Extremely High

Symptom severity category based on standard deviation units from the mean score of the calibration sample.

généralemixed · general population · Germany · n = 356 · Kleindienst et al. (2020)

1.87

M = 0.12 ± 0.17

cliniquemixed · pathology: Axis I disorders including major depressive disorder, schizophrenia, anxiety disorders, and obsessive-compulsive disorder · Germany · n = 176 · Kleindienst et al. (2020)

1.87

M = 1.08 ± 0.79

cliniquemixed · pathology: Borderline Personality Disorder (BPD) · Germany · n = 317 · Kleindienst et al. (2020)

1.87

M = 2.34 ± 0.86

For information

Cut-off≥ 1.5Responses consistent with BPD

Provides optimal discrimination between individuals with BPD and those with other clinical psychopathology.

Kleindienst et al. (2020)

Cut-off≥ 0.64Optimal discrimination from healthy controls

Provides optimal discrimination between individuals with BPD and healthy controls.

Kleindienst et al. (2020)

Scoring

Mean, total score from 0 to 4, each item is scored on a 5-point scale (from 0 to 4).

Have your patient take this test

Assign it in one click: your patient answers on their phone, you receive the score and its interpretation.

Assign this test to a patient

What the test measures

The BSL-23 quantifies the multidimensional severity of borderline pathology by sampling the most distressing subjective experiences reported by patients. Rather than mapping strictly to diagnostic criteria, it captures the raw clinical phenomenology across several core facets of the disorder.

Affective dysregulation: Evaluates rapid mood cycling, profound despair, and intense internal tension that patients struggle to modulate.
Identity and self-worth: Probes pervasive feelings of worthlessness and the toxic internal dialogue characteristic of a defectiveness schema.
Interpersonal sensitivity: Assesses extreme vulnerability to criticism, fear of abandonment, and foundational mistrust of others.
Dissociation and psychosis: Measures stress-related cognitive disruptions, auditory hallucinations, and episodes of depersonalization and derealization.
Destructive urges: Captures the cognitive preoccupation with self-harm, self-punishment, and fascination with death.

This instrument is intended for adult patients presenting with complex emotional dysregulation or suspected borderline personality organization.

When and why to use it

Clinicians deploy the BSL-23 to systematically track borderline symptom burden and guide clinical decision-making across the phases of care. Its brevity and high sensitivity to change make it an excellent tool for continuous measurement-based practice.

Intake and baseline assessment: Establishes the initial severity of borderline symptoms to determine the appropriate level of care and structural support required.
Differential formulation: Helps distinguish the pervasive identity and affective disturbances of BPD from acute mood episodes or complex PTSD, though these frequently co-occur.
Monitoring treatment trajectory: Repeated weekly or fortnightly administrations provide concrete data on whether symptom severity is responding to the current intervention.
Reviewing crisis management: Provides a structured way to evaluate coping strategy effectiveness by correlating shifts in specific scale items with skill acquisition.

Relying on the validated BSL-23 score grounds the clinical impression in objective data, helping clinicians detect subtle deteriorations before they escalate into acute behavioral crises.

Clinical library

750+ clinical tools

A library built with and for clinicians, ready to use in session and extend between appointments.

Access all the tools

Several resource types

Psychoeducation handouts

Understand at a glance

Interactive exercises

To do and fill in

Interactive programs

A structured path

Audios

Meditation and relaxation

Psychometric tests

Automatic scoring

The questions

Please follow these instructions when answering the questionnaire. In the following table you will find a set of difficulties and problems which you might have had. Please read through the items and check to what extent you have suffered from each of these problems during the course of the past week. Please answer all questions. If you had different feelings at different times, please answer with a rough average. During the course of the past week...
1. I found it hard to concentrate.
Assesses the presence of cognitive scattering and difficulty sustaining attention amidst emotional distress.
- Not at all
- A little
- Somewhat
- A lot
- All the time
2. I felt hopeless.
Probes the subjective experience of powerlessness and inability to manage one's internal or external environment.
- Not at all
- A little
- Somewhat
- A lot
- All the time
3. My mind was elsewhere and I couldn't remember what I was doing.
Evaluates transient cognitive disruptions and everyday dissociative gaps in awareness.
- Not at all
- A little
- Somewhat
- A lot
- All the time
4. I felt disgusted.
Measures a generalized sense of revulsion, a common affective baseline in severe personality pathology.
- Not at all
- A little
- Somewhat
- A lot
- All the time
5. I thought about hurting myself.
Directly assesses the cognitive preoccupation with self-directed violence and self-injury.
- Not at all
- A little
- Somewhat
- A lot
- All the time
6. I didn't trust others.
Captures the pervasive suspicion and interpersonal paranoia that often disrupts the therapeutic alliance.
- Not at all
- A little
- Somewhat
- A lot
- All the time
7. I didn't believe I had the right to live.
Probes profound invalidation of the self and passive suicidal ideation.
- Not at all
- A little
- Somewhat
- A lot
- All the time
8. I felt lonely.
Assesses the deep, unquenchable sense of isolation that persists even when the patient is not physically alone.
- Not at all
- A little
- Somewhat
- A lot
- All the time
9. I experienced a stressful internal tension.
Evaluates the somatic and psychological buildup of aversive arousal that frequently precedes impulsive behavior.
- Not at all
- A little
- Somewhat
- A lot
- All the time
10. I had images that scared me.
Probes the occurrence of intrusive, distressing visual imagery or trauma-related flashbacks.
- Not at all
- A little
- Somewhat
- A lot
- All the time
11. I hated myself.
Captures the visceral self-loathing central to the borderline identity disturbance.
- Not at all
- A little
- Somewhat
- A lot
- All the time
12. I wanted to punish myself.
Assesses the drive for self-retribution and the behavioral manifestation of severe internalized shame.
- Not at all
- A little
- Somewhat
- A lot
- All the time
13. I felt ashamed.
Evaluates the persistent, painful affect of feeling fundamentally flawed or unacceptable.
- Not at all
- A little
- Somewhat
- A lot
- All the time
14. My mood changed quickly, shifting between anxiety, anger, and sadness.
Measures the hallmark affective instability and emotional hyper-reactivity of the disorder.
- Not at all
- A little
- Somewhat
- A lot
- All the time
15. I heard voices and noises coming from inside or outside my head.
Probes stress-related pseudo-psychotic symptoms and auditory hallucinations.
- Not at all
- A little
- Somewhat
- A lot
- All the time
16. Criticism from others had a devastating effect on me.
Assesses extreme interpersonal hypersensitivity and catastrophic reactions to perceived rejection.
- Not at all
- A little
- Somewhat
- A lot
- All the time
17. I felt vulnerable.
Captures the subjective lack of emotional shielding and a pervasive sense of unsafety.
- Not at all
- A little
- Somewhat
- A lot
- All the time
18. The idea of death fascinated me.
Evaluates romanticized or preoccupying thoughts about dying, distinct from active suicidal planning.
- Not at all
- A little
- Somewhat
- A lot
- All the time
19. Everything seemed meaningless.
Probes the painful subjective emptiness and loss of existential meaning.
- Not at all
- A little
- Somewhat
- A lot
- All the time
20. I was afraid of losing control.
Assesses the patient's terror of their own behavioral unpredictability and emotional cascades.
- Not at all
- A little
- Somewhat
- A lot
- All the time
21. I felt disgusted with myself.
Captures self-directed revulsion, often linked to body image distortions or shame about past behavior.
- Not at all
- A little
- Somewhat
- A lot
- All the time
22. I felt very distant from myself.
Evaluates the presence of depersonalization and the sensation of being detached from one's own identity.
- Not at all
- A little
- Somewhat
- A lot
- All the time
23. I felt worthless.
Probes the foundational collapse of self-esteem and the enduring belief of having no value.
- Not at all
- A little
- Somewhat
- A lot
- All the time