A new self-rated scale to measure severity and change in persons with borderline personality disorder (BPD) is described. The Borderline Evaluation of Severity Over Time (BEST) was developed to rate the thoughts, emotions, and behaviors typical of BPD. Data were collected in the course of a randomized controlled trial (RCT) of Systems Training for Emotional Predictability and Problem Solving (STEPPS) for subjects with BPD. The instrument showed moderate test-retest reliability, high internal consistency, and high discriminant validity. Its 15 separate items showed a moderate or better correlation with the total score. The BEST was also sensitive to clinical change as early as week 4 of the RCT and correlated highly with other measures of illness severity. We conclude that the new scale is both reliable and valid in measuring severity and change in persons with BPD.

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Objective Few predictors of treatment outcome or early discontinuation have been identified in persons with borderline personality disorder (BPD). Aim The aim of the study was to examine the relationship between baseline clinical variables and treatment response and early discontinuation in a randomized controlled trial of System Training for Emotional Predictability and Problem Solving, a new cognitive group treatment. Method Improvement was rated using the Zanarini Rating Scale for BPD, the Clinical Global Impression Scale, the Global Assessment Scale and the Beck Depression Inventory. Subjects were assessed during the 20 week trial and a 1-year follow-up. Results Higher baseline severity was associated with greater improvement in global functioning and BPD-related symptoms. Higher impulsivity was predictive of early discontinuation. Optimal improvement was associated with attending ≥15 sessions. Conclusion Subjects likely to improve have the more severe BPD symptoms at baseline, while high levels of impulsivity are associated with early discontinuation

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