Mental health articles

OF mental health care and mentally ill

Assessment of personality disorder

Patients with personality disorder may present with a range of behavioural, emotional or associated problems.

Enduring personality changes

Previous personality may change permanently after catastrophic experiences in adult life (such as hostage-taking, torture or other disaster) or severe mental illness

Common presentations of personality disorder

Aggression Anxiety and depression

Bingeing, vomiting, purging and other eating problems

Alcohol and substance misuse

Deliberate self-harm

Those with Cluster A problems may be less likely to present, but the distinction to be made will be between personality disorder and psychotic illness. For Cluster B, aggression (toward themselves or others), fluctuating mood, anxiety, depression, problems with eating, alcohol and substance misuse, may be the initial presenting features.

In Cluster C disorders, depression and anxiety may predominate. Assessment involves taking a detailed history with particular attention to early experience, behaviour and events, in addition to the individual’s reaction to them and the context in which they occurred. The individual’s personal history is continued into adulthood, covering work, relationships, alcohol and substance misuse, forensic history and current social circumstances.

The aims are to establish whether there are recurring patterns of behaviour or emotional response and the impact of any emerging patterns on relationships, work and overall level of function. The individual’s psychiatric and medical histories are important in identifying any exclusion to the diagnosis, past interventions and their effects positive or negative. Mental state examination is needed to identify comorbid conditions or exclusions.

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