Assessment

Watch video below of a young person speak about their experience with borderline personality disorder, diagnosis, and ongoing care.

  1. Developing an enduring therapeutic relationship with the patient is particularly important in the case of borderline personality disorder. Show interest and concern in the patient while maintaining clear boundaries.
  2. Treating clinicians should be aware of transference and countertransference issues that may arise as these may have an impact on engagement. See video below of Dr. May Emeleus speaking about transference and countertransference in primary care.
  3. Although diagnosis of borderline personality disorder is appropriate in young people under 18 years old if the symptoms cause significant interference with their daily functioning for at least 1 year, a diagnosis of Borderline Personality Disorder should only be made by specialist mental health professionals. Be aware of symptoms indicating possible borderline personality disorder - refer to video below.
  4. Assessment in primary care should focus on assessing risk to self and others, comorbid symptoms and the young person's social, occupational, interpersonal and psychological functioning. What do I do if I identify a high acute risk of suicide?
  5. Always assess for substance use as this can influence risk
  6. Never assume a young person has borderline personality disorder based on self-harm alone
  7. Refer on – Assessment is highly specialised and should be conducted by experienced mental health clinicians. 
  8. Be mindful of history-taking where trauma is present as it can be re-traumatising -be sensitive to whether obtaining details about adverse past experiences is necessary or appropriate at this point. View video below of Dr Sandra Radovini speaking about taking a clinical history where trauma is suspected.
  9. The SCID-V can be used to guide a conversation about Borderline Personality Disorder symptoms to identify whether referral for a comprehensive assessment by an experienced mental health clinician is needed.
  10. Where there isn’t access to an experienced mental health clinician, seek psychiatric advice (use telepsychiatry if needed)

Experiencing Borderline Personality Disorder

 

Transference and Countertransference

 

When to Suspect Borderline Personality Disorder

 

Taking a Clinical History When Trauma is Suspected