Detailed psychiatric history and mental state examination including

Important developmental and interpersonal factors such as:

• Family and parental relationships including attachment patterns
• Reactions to key developmental events and transitions
• Losses, separations, relocations and responses to such events
• Preliminary assessment of history trauma and neglect. Full exploration at assessment stage can be dysregulating and counterproductive if the patient does not have adequate self-regulatory skills. However, the patient should be made aware that traumatic events can be returned to in due course. An instrument such as the Trauma History Screen (Carlson, 2005) may be useful in gaining a trauma history.
• Peer and romantic relationships
• Important memories

Co-occurring disorders:

• Axis 1
  • Post-traumatic conditions
    • Reliving experiences
    • Constriction/avoidance
    • Hyperarousal
• Substance use
• Other mental illness
• Physical health conditions
• Risk assessment: consider using a structured tool such as STORM
• Personal strengths and attributes
• Motivation to change
• Symptoms: current difficulties or disturbance in the following domains:
  • Cognitive/perceptual
  • Affective
  • Interpersonal
  • Relationship with self/sense of self
    • Interpersonal relationships
    • Relationship with society
• Behavioural/impulse control

Traits: traits underlie the symptoms and can be grouped into 4 domains:

• Dysregulated (internalizing)
• Dissocial (externalizing)
• Detached (schizoid)
• Compulsive (anankastic)

Collateral information:

• Healthcare records
  • Informant information from (as appropriate):
    Family
    Friends and acquaintances
    Professionals
• Clinician observations:
  • Of interactions with others
  • Within clinical encounters

Formal structured assessment tools to be used where appropriate include

CORE-Outcome Measure (CORE-OM): self-reported general measure of well-being,
problems, risk and functioning. This comes in CORE-34 (34 item) and CORE-10 (10
item) forms. (CORE, 1998)

Global Assessment of Functioning (GAF): clinician-completed global assessment of
functioning on 0-100 scale. Global Assessment of Functioning (GAF) represents axis 5 of DSM-IV (DSM-IV, 1994).

Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD): clinician
completed semi-structured interview for borderline personality disorder based on the 9
DSM-IV criteria (Zanarini, 2003).

Borderline Estimate of Severity over Time (BEST): self-reported measure of borderline
personality disorder used in STEPPS. This measure is reasonably sensitive to change as it includes items relating to adoption of more adaptive behaviours. (Pfohl and Blum, 1997).

WHOQOL-BREF: self-report quality of life measure (WHO, 2004).

Filter Questionnaire: self-report tool for presence of unhelpful core beliefs typically
associated with borderline personality disorder (from STEPPS, Blum et al., 2008).

Personality Belief Questionnaire (PBQ): self-report tool for presence of unhelpful core
beliefs associated with a broad range of personality disturbance (Beck, 2001).

Process of Recovery Questionnaire (PRQ): The Process of Recovery Questionnaire (PRQ) is a self-report measure of recovery (Neil et al., 2007).

Standardised Assessment of Personality Abbreviated Scale (SAPAS): SAPAS is a short self report screening tool for presence of personality disorder (Moran, 2003).

Trauma History Screen (THS): Trauma History Screen (THS) is a self-report instrument assessing nature and severity of historical traumatic events. (Carlson, 2005).

Personality Assessment Schedule (PAS): clinician-completed semi-structured interview of personality pathology from a trait perspective. (Tyrer, 1988).

Clinical Global Impression (CGI): CGI is a locally adapted clinician-completed tool with self-report counterpart measuring clinical baseline and global change.

Some of these tools can be found in the Appendix. No tool used alone is adequate to diagnose personality disorder and the information gathered should be placed in the context of an overall assessment. Many of these tools can be repeated during and after treatment to measure progress and outcomes.