Borderline Interview Model.docx
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ScribdTranslationsBorderline Interview Model.docx
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ScribdTranslationsInterview model for Borderline Personality Disorder (BPD)
Personal Data:
Name:
Age:
Date of Birth:
Gender:
Marital Status:
Profession:
Contact:
Clinical History:
Reason for attendance:
Describe the main reasons that brought you to the consultation.
What symptoms or concerns would you like to discuss?
History of Development:
Describe your childhood and adolescence. What were your family relationships like?
Have there been traumatic events, abuse, or difficult situations in your history?
Current Symptoms:
What emotional and behavioral symptoms are you currently facing?
How do these symptoms affect your daily life, relationships, and overall well-being?
Interpersonal Relationships:
Talk about your relationships with family, friends, romantic partners, and colleagues.
work.
Do you find it difficult to maintain stable relationships? Is there a pattern of relationships?
intense and unstable?
Impulsivity and Risky Behaviors:
Have you engaged in impulsive behaviors, such as excessive spending, substance use,
unprotected sex, self-harm or dangerous behaviors?
How do you feel before and after acting impulsively?
Self-image and Identity:
How do you see yourself? Do you feel a stable identity or does it vary depending on the situations?
Is there a feeling of emptiness or lack of purpose in your life?
History of Previous Treatments:
Have you ever sought help for emotional or mental health problems before?
What treatments were performed? Did they have any impact?
History of Trauma or Abuse:
Have you ever experienced any type of trauma, abuse, or disturbing event? This can include events in
childhood or in adulthood.
History of Self-Harm or Suicide Attempts:
Have you had suicidal thoughts, suicide attempts, or self-harming behaviors?
Family History:
Is there a history of mental health issues in the family, including BPD?
Current Well-Being:
How do you feel about your mental and emotional health at the moment?
What do you consider as strengths and resources in your life?
Final Observations:
This script is part of the evaluation process. An appropriate diagnosis and treatment.
require a complete clinical assessment.
The diagnosis and treatment should be carried out by a mental health professional.
qualified.
