peer reaponse- psych assesment

post 1
Discuss unique features associated with interviewing a patient who has a narcissistic personality disorder. Describe your approach to the comprehensive assessment of someone with this personality disorder.
Narcissistic personality disorder is characterized by a patient presenting with a heightened sense of self importance, lack of empathy, and grandiose feelings of uniqueness (Sadock, et al., 2017). It is important when performing an assessment on this type of patient, that although they present as strong and uncaring, their self esteem is fragile, and they are extremely vulnerable to even minimial criticism (Sadock, et al., 2017). Keeping this in mind, while performing a comprehensive assessment, it is important for the provider to realize the narcissiscist will more than likely see no issue with their negative behaviors, and show no sympathy for the people they may have hurt (Sadock, et al., 2017). It may be a more difficult process to get the narcissist to open up about their flaws, although it may be difficult, a person with narcissistic personality disorder often suffers from different disorders as well. In a study I reviewed they highlight, in a 12 month period 40.8% also suffered with substance abuse, 28.6% suffered from a mood disorder, and 40% suffering from anxiety as well (Kacel, et al., 2017). It is important to keep in mind that these disorders also play a crucial role, and helping the narcissist recognize the problems within themselves, they may also begin building a better relationship with those around them. It may also be appropriate, with the patients permission, to allow relatives or close friends to describe their association with the narcissist and how they view them. In another study I reviewed they interviewed relatives and asked the following questions regarding their narcissist family members, they inquired of issues with grandiosity, arrogance, entitlement, jealousy, explotion, vulnerability, and self-esteem (Day, et al., 2020). In this article the relatives shed light that the narcissist presents as a grandiose behavior, that did not respond to critism, and believed everyone owed them thanks just for being there (Day, et al., 2020). When utilizing this measure, it may help the narcissit see that everyone does not view them as “special,” and their flaws are more noticeable than they may think. It is also an important concept we do not offend the narcissist to the point they would not return for treatment, this is a chronic and difficult to treat disease that involves numerous different concepts within a treatment plan (Sadock, et al., 2017). It is important to realize narcissist also do not tolerate medication rejection well. Within the interview, it is important to gather information regarding past medication usage including SSRIS or antidepressants (Sadock, et al., 2017). With this type of information, the provider may be able to better utilize pharmacologic treatments for concurrent disorders such as depression or anxiety that often go hand in hand with the narcissistic disorder.
post 2
Discuss unique features associated with interviewing a patient who has borderline personality disorder. Describe your approach to the comprehensive assessment of someone with this personality disorder.
The DSM- 5 (2013) describes borderline personality disorder as, a pervasive pattern of instability of interpersonal relationships, self- image, and affects, marked by impulsivity, beginning in early adulthood and present in a variety of contexts (pp. 663). Symptoms may include extreme behaviors to avoid abandonment, labile and intense interpersonal relationships, lack of identity, impulsivity that may be harmful, recurrent suicidal/ self-mutilating behaviors, unstable affect marked by reactive mood, chronic empty feeling, unstable anger regulation, and disassociation (National Institute of Mental Health, 2017).
When providing a comprehensive assessment, it is critical to complete a strong differential diagnosis list due to the potential for a mood disorder to be present. For example, an individual with borderline personality disorder may engage in unsafe impulsive acts that can mimic hypo/mania, therefor it is important to assess for elevated mood at the time of the behaviors. In conjunction, a comprehensive family psychiatric history should be obtained assessing for increased risk of borderline personality disorder, as well as a thorough psychosocial background including traumas, abandonment, adversity, precipitating events, and current/past self harm/suicidal behaviors (National Institute of Mental Health, 2017). It is critical to keep in mind the importance of the therapeutic relationship while conducting assessments and treatments, due to the likelihood the patient with struggle with idealizing the practitioner and devaluing the practitioner, potentially in a short amount of time and in a continuous cycle.
A practitioner may find screening tools such as the SI-Bord or the Temporal Bayesian Network Model helpful in identifying borderline personality disorder and discriminating against other cluster B personality disorders. The SI- Bord is a self-administered, 5 question likert scale to aid in the diagnostic process (Lohanan et. al., 2020). The Temporal Bayesian Network has shown to be 96% accurate when utilizing this interviewing approach with individuals with borderline personality disorder, as well as major depressive disorder and PTSD (Selby et. al., 2020).

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