| RPT |
.| .| Borderline Symptom List 23 - (BSL-23)| |
Questions and Answers| |
1. It was hard for me to concentrate|
<*Answer_7000*>|
2. I felt helpless|
<*Answer_7001*>|
3. I was absent-minded and unable to remember what I was actually doing|
<*Answer_7002*>|
Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>|
4. I felt disgust|
<*Answer_7003*>|
5. I thought of hurting myself|
<*Answer_7004*>|
6. I didn't trust other people|
<*Answer_7005*>|
7. I didn't believe in my right to live|
Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>|
<*Answer_7006*>|
8. I was lonely|
<*Answer_7007*>|
9. I experienced stressful inner tension|
<*Answer_7008*>|
10. I had images that I was very much afraid of|
<*Answer_7009*>|
SSN: <.Patient_SSN.>| DOB:<.Patient_Date_Of_Birth.> (<.Patient_Age.>)|
11. I hated myself|
<*Answer_7010*>|
12. I wanted to punish myself|
<*Answer_7011*>|
13. I suffered from shame|
<*Answer_7012*>|
Gender: <.Patient_Gender.>| |
14. My mood rapidly cycled in terms of anxiety, anger, and depression|
<*Answer_7013*>|
15. I suffered from voices and noises from inside or outside my head|
<*Answer_7014*>|
16. Criticism had a devastating effect on me|
<*Answer_7015*>|
17. I felt vulnerable|
<*Answer_7016*>|
18. The idea of death had a certain fascination for me|
<*Answer_7017*>|
19. Everything seemed senseless to me|
<*Answer_7018*>|
20. I was afraid of losing control|
<*Answer_7019*>|
BSL-23 TOTAL SCORE = <-BSL-23->|
21. I felt disgusted by myself|
<*Answer_7020*>|
22. I felt as if I was far away from myself|
<*Answer_7021*>|
23. I felt worthless|
<*Answer_7022*>| | |
Total scores range from 0-92. Higher scores indicate more borderline symptoms.| |
Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic purposes. Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities and
procedures.| $~
|
