Patient reports suicidal ideation.

How often does the patient think of suicide?

1. If every day, go to question 2.

2. Does the patient have a suicide plan? If no, go to question 3. Test for personality disorder.

3. Does the patient exhibit impulsive behaviour, such as spending large sums of money? If patient says no, continue with other questions. Patient must have at least # _ of symptoms in order to be diagnosed as having a personality disorder.

4. Ask patient about sexual orientation? Is the patient sometimes confused about this?

Doctor writes: Patient says no, but is upset about this question. Complains about being compulsively drawn to bad situations “like a broken compass.” Unclear.

5. Does the patient fear abandonment?

Doctor writes: Patient starts to cry. I repeat the question. Patient is very angry. Says family abandoned her. Glares and stops talking, says doesn’t like being tested for a personality disorder,  doesn’t believe in personality disorders, finds them “demeaning and disrespectful.” Patient very uncooperative and angry. Borderline personality disorder.

From Noble Orphan (Demeter Press, 2012).