415 Clinical Neuropsychiatry (2017) 14, 6, 415-423 415 ASSESSING SITUATIONAL DYSPHORIA IN BORDERLINE PATIENTS: DEVELOPMENT AND PRELIMINARY VALIDATION OF THE SITUATIONAL DYSPHORIA SCALE (SITDS) Alessandra D’Agostino, Antonella Aportone, Mario Rossi Monti, Vladan Starcevic Abstract 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 diffcult 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 fnal version of SITDS, consisting of 24 items, was derived after conducting two factor analyses, a hierarchical cluster analysis and further refnement 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. Key words: dysphoria, situational dysphoria, psychometric properties, borderline personality disorder Declaration of interest: none Alessandra D’Agostino 1 , Antonella Aportone 1 , Mario Rossi Monti 1 , Vladan Starcevic 2 1 Borderline & Body Lab, Department of Humanistic Studies, University of Urbino, Italy. 2 Discipline of Psychiatry, Sydney Medical School – Nepean, University of Sydney, Australia. Corresponding author Alessandra D’Agostino, Borderline & Body Lab, Department of Humanistic Studies, University of Urbino, Italy, via Saff, 15, 61029, Urbino (PU), Italy. E-mail: ales.dagostino@gmail.com. Introduction Dysphoria is as an emotional state that is the psychopathological core of borderline personality disorder (BPD) (Rossi Monti 2012, Stanghellini and Rosfort 2013, Rossi Monti and D’Agostino 2014). It consists of a combination of tension, irritability, discontent and unhappiness that persists and is associated with a growing impulsivity (Starcevic 2007). This emotional constellation is a centrifugal force that can fragment the borderline person’s representations of oneself and of others, inducing a painful experience of incoherence and inner emptiness, a feeling of uncertainty and inauthenticity in relationships, along with a sense of futility and inanity of the whole life (Stanghellini and Rosfort 2013). Considering that this emotional experience is so fundamental for BPD, it is referred to as “background dysphoria”. The characteristics of dysphoria change in certain circumstances, with the predominant sense of pressure, an urge to act and experience of a quasi-explosion. This is usually related to the environmental and interpersonal context, represents the here-and-now experience of individuals with BPD (Rossi Monti and D’Agostino in press) and is referred to as “situational dysphoria”. It is often experienced as impatience and intolerance that can lead to outbursts of anger and violent behaviour. In addition, situational dysphoria is characterised by a feeling of being “on edge” and heightened anxiety and vigilance. Considering that situational dysphoria occurs in response to situational triggers, it represents a temporary, but repetitive experience of borderline patients. Taking into account these perspectives, background dysphoria and situational dysphoria are very important for understanding both the basic and transient experience of borderline patients. However, assessing adequately these two forms of dysphoria has been diffcult. In fact, while a self-report instrument for background dysphoria already exists (Nepean Dysphoria Scale; Berle and Starcevic 2012) and has been translated and validated into Italian language (D’Agostino et al. 2016), a scale for situational dysphoria did not exist until recently. This article aims to explain the development of a questionnaire for assessment of situational dysphoria in BPD (the Situational Dysphoria Scale) and test its psychometric properties. Submitted June 2017, Accepted OctOber 2017 © 2017 Giovanni Fioriti Editore s.r.l.