Synopsis
Assess enduring personality difficulty through severity, functioning, traits and context, while separating it from episodic illness, trauma responses, neurodevelopmental difference, substance effects and culturally understandable behaviour.
- Dimensional assessment asks how severe and pervasive the difficulty is, which domains of self and interpersonal functioning are affected, and which trait tendencies help describe the pattern.
- Base formulation on repeated patterns across time and settings, not on behaviour during one crisis, one difficult consultation or one disputed account.
- Explore identity, self-direction, emotional regulation, impulse control, empathy, intimacy, relationships, work, daily living and the consequences for the person and others.
- Separate enduring traits from depression, bipolar disorder, psychosis, PTSD, dissociation, autism, ADHD, learning disability, substance exposure, pain and acquired brain disease.
- Interpret directness, eye contact, family roles, emotional expression and help seeking within cultural, social, developmental and communication context.
- Ask whether diagnostic language feels useful, explain uncertainty and record the person's own account, strengths, goals and preferences alongside difficulties.
- Assess current suicide, self-harm, violence, neglect, exploitation and safeguarding needs directly; personality assessment never replaces a present-focused safety formulation.
- Review formulation longitudinally because functioning and risk can change, and because a diagnosis should open access to suitable care rather than become an exclusion label.