Assessment > Psychiatric Interview > History of Presenting Complaint > Personality Disorders
Personality Disorders
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Based on understanding of developmental history (further described in section on developmental history).
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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.
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Develop an understanding of personal relationships has developed their subsequent attachments in adulthood.
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Elicit history of personal relationships, both friendships and romantic in nature, number, length, difficulties, patient reflections and understanding of difficulties.
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Emphasis on difficulties experienced which result in subjective distress; in terms of self-harm, interactions with the law, romantic relationships etc.
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Risk assessment related to presentation.
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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
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History of difficulties in attachment
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"How were things when you were younger?"
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Chronic feelings of emptiness marked by disturbance in self-image, aims and internal preferences
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"How do you view yourself?"
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Intense and unstable relationships with providers of care with the perception that are breaking down followed by crisis
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"When you came to see us/went to hospital/were distressed what was happening/"
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"Is that similar in any way to what may have been going on in the past?"
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Crisis associated with suicidal gestures and attempts
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"Have you been admitted to hospital before/harmed yourself before? What was happening then?"
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"When did this first happen, how many times have you been admitted/self harmed in the past?"
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If thoughts of self-harm, for thorough risk assessment; these can be complex due to the nature of the patient's problem.