Personality Disorders

  • Based on understanding of developmental history (further described in section on developmental history).

 

  • Understanding of early development - early relationships and forming of attachments - relationships with primary care giver consider exploring instability and abuse. When period of increased freedom in adolescence - problems experienced with conflicts with society, self harm, relationships.

 

  • Develop an understanding of personal relationships has developed their subsequent attachments in adulthood.

 

  • Elicit history of personal relationships, both friendships and romantic in nature, number, length, difficulties, patient reflections and understanding of difficulties.

 

  • Emphasis on difficulties experienced which result in subjective distress; in terms of self-harm, interactions with the law, romantic relationships etc.

 

  • Risk assessment related to presentation.

 

  • Patient understanding of problem and the way they view their difficulties, if they believe they need treatment and if they view this in a biological, psychological or social way.

 

Emotionally Unstable Personality Disorders

 

  • History of difficulties in attachment

    • "How were things when you were younger?"

 

  • Chronic feelings of emptiness marked by disturbance in self-image, aims and internal preferences

    • "How do you view yourself?"

 

  • Intense and unstable relationships with providers of care with the perception that are breaking down followed by crisis

    • "When you came to see us/went to hospital/were distressed what was happening/"

    • "Is that similar in any way to what may have been going on in the past?"

 

  • Crisis associated with suicidal gestures and attempts

    • "Have you been admitted to hospital before/harmed yourself before? What was happening then?"

    • "When did this first happen, how many times have you been admitted/self harmed in the past?"

 

If thoughts of self-harm, for thorough risk assessment; these can be complex due to the nature of the patient's problem.