Assessing situational dysphoria in borderline patients: Development and preliminary validation of the Situational Dysphoria Scale (SITDS)

Objective: According to recent phenomenological literature, dysphoria is the psychopathological core of borderline personality disorder (BPD). It is a complex emotional state that consists of persistent tension, irritability, discontent and unhappiness, which is difficult to modulate and is associated with impulsivity. Under certain circumstances, this basic “kind” of dysphoria (“background dysphoria”) can be experienced differently, as “situational dysphoria”. The latter is a sense of pressure, an urge to act and a feeling of quasi-explosion that is mostly related to interpersonal triggers. The aim of this study was to present the process of developing a questionnaire for measuring situational dysphoria in BPD (the Situational Dysphoria Scale, SITDS) and test its psychometric properties. Method: The sample consisted of 105 borderline patients recruited from adult psychiatric outpatient services and residential inpatient communities. The SITDS was developed over several stages, with the initial version consisting of 58 items. In order to test convergent and discriminant validity, the SITDS was administered with four self-report instruments (Nepean Dysphoria Scale, Cynical Distrust Scale, Inventory of Interpersonal Problems-47 and Empathy Quotient) and one semi-structured interview (Borderline Personality Disorder Severity Index-IV). Results: The final version of SITDS, consisting of 24 items, was derived after conducting two factor analyses, a hierarchical cluster analysis and further refinement of the scale. It is divided into three clusters (Personal Events, Interpersonal Events and Environmental Events) and rated on three subscales (Internal Pressure, Urge to Act and Quasi-Explosion). This version of the SITDS demonstrated excellent internal consistency (Cronbach’s alpha value =.91) and a solid degree of convergent and discriminant validity. Conclusions: The study provides preliminary support for use of the SITDS in BPD. Further studies of psychometric properties of the SITDS are needed to support it as a tool for routine clinical practice.