Self-Rating Scale Shows Acceptable Accuracy for BPD Screening

Researchers have validated the KABOSS-BD, a self-rating subscale designed to screen for borderline personality disorder in patients presenting with self-harm. The study, published in BMC Psychiatry, examined the diagnostic accuracy of this brief instrument in emergency department settings. The findings indicate that the scale demonstrates good internal consistency and acceptable diagnostic accuracy for identifying individuals with clinically diagnosed borderline personality disorder. This validation is significant because borderline personality disorder is overrepresented among individuals with deliberate self-harm, yet identifying patients who require diagnostic evaluation remains challenging in acute care environments.

The study aimed to address the difficulty of recognizing borderline personality disorder symptoms in emergency settings. Effective screening tools may facilitate earlier identification of symptoms, potentially shortening diagnostic delay and improving treatment planning. The present study sought to validate the borderline subscale of the Karolinska Affective and Borderline Symptoms Scale, known as the KABOSS-BD, as a self-rating screening tool. The researchers also sought to examine its correlation with clinical diagnosis.

Data for the analysis were collected from 671 patients who presented with self-harm, with or without suicidal intention, at emergency departments in three Swedish cities. The study population included both women and men, allowing for gender-specific analysis of the screening tool’s performance. The researchers investigated the internal validity of the KABOSS-BD and its correlation with clinically diagnosed borderline personality disorder, which is classified as Emotionally Unstable Personality Disorder in the ICD-10. The researchers also determined optimal cut-off scores for women and men for screening purposes.

The results indicated that the KABOSS-BD demonstrated good internal consistency, with a Cronbach’s alpha of 0.87. In terms of diagnostic accuracy, the scale yielded an Area Under the Curve of 0.73, which reflects acceptable performance in distinguishing between patients with and without the disorder. The overall optimal cut-off score was identified as 32, which resulted in a sensitivity of 68% and a specificity of 68%.

Gender differences emerged as a significant factor in the scale’s performance. Women consistently scored higher than men on the KABOSS-BD, suggesting that a single cut-off score may not be optimal for all patients. To address this, the researchers determined gender-specific cut-offs that improved diagnostic accuracy. For women, the scale performed optimally with a cut-off score of 33. For men, the scale performed better at a lower threshold of 26.

The study concludes that the KABOSS-BD is a suitable tool for screening borderline personality disorder in both women and men who present with suicide attempts and non-suicidal self-harm. The scale's brevity and ease of administration make it suitable for emergency settings. By potentially reducing diagnostic delay, the tool could improve treatment allocation for this high-risk population.

Subject of Research: Validation of the KABOSS-BD self-rating scale for screening borderline personality disorder in patients presenting with self-harm.

Article Title: Screening for borderline personality disorder after self-harm episodes: validation of the self-rating KABOSS-BD, the borderline subscale of the Karolinska Affective and borderline symptoms scale

Article References: Asellus, P., Doering, S., Renberg, E. S., Runeson, B., & Waern, M. (2026). Screening for borderline personality disorder after self-harm episodes: validation of the self-rating KABOSS-BD, the borderline subscale of the Karolinska Affective and borderline symptoms scale. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08832-1

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08832-1

Keywords: borderline personality disorder, self-harm, screening tool, KABOSS-BD, emergency medicine, diagnostic accuracy, mental health, psychiatry, Screening, borderline, personality, disorder