Clinical staging and risk profiling in borderline personality disorder: An evaluation of reliability and clinical utility

To address the need for a more dynamic assessment of the progress and severity of borderline personality disorder (BPD), as well as associated treatment needs, various models of clinical staging and risk profiling have been proposed. Clinical staging involves estimating disorder severity along a continuum, whereas risk profiling predicts progression across stages using known risk factors. This study examines these models' reliability and clinical utility in predicting dosage (total registered units of direct patient contacts) and outcome for BPD patients. We used anonymized information from patient records of 128 patients treated for (subthreshold) BPD in the Netherlands ( M age = 30.51, SD = 11.85; range: 14-61 years). After establishing interrater reliability, a retrospective analysis of routine clinical data was used to examine the relationship between two clinical staging models and one risk profile model on total treatment dosage and outcome. The results showed that staging models and risk profiles could be reliably assessed and that patients in earlier stages required less treatment and achieved better outcomes compared with later stages. However, the contribution of risk profiling was minimal and insignificant. Furthermore, results suggest that the transition from Stage 1 to Stage 2 represents a critical turning point in BPD progression and underscores the importance of early intervention. Despite limitations, clinical staging models explained significant variance in treatment dosage and symptom reduction, offering valuable insights into BPD treatment needs. The study highlights the potential of these models to support early detection and intervention by improving prognosis and guiding more personalized treatment. (PsycInfo Database Record (c) 2026 APA, all rights reserved).