Clients often do not improve, not because of a lack of therapeutic skill, but because of something else going on that they never thought to ask about. Screening clients for all common disorders is a protection against missing an important therapeutic target. The First Step Questionnaire published in Towards a Mental Health System that Works Scott (2017) London: Routledge, is such a screen, covering all the common disorders and importantly asking clients whether or not they want help with a particular difficulty, but also with a ‘don’t know’ option, so that ambivalence can be recognised from the outset. There is also an interview version the 7 Minute Interview. [ The validity studies on the Questionnaire/Interview are considered in the Simply Effective trilogy Scott (2009), (2011) and (2013).] I have now revised the Questionnaire/ Interview to take into account the changed diagnostic criteria for PTSD in DSM-5 and added a screen for borderline personality disorder (BPD)
The symptom questions of the PTSD screen are from the Primary Care PTSD Checklist for DSM-5, from the US National Centre for PTSD, a positive response to 3 or more symptom questions is a positive screen for PTSD. The BPD screen is based on a paper by Zimmerman et al (2017) Clinically useful screen for borderline personality disorder in psychiatric outpatients, British Journal of Psychiatry, 210, 165-166. Of those with BPD over 90% endosed the affective instability question in item 11 below, but only 38% of those with affective instability had BPD i.e most of those with affective instability don’t have BPD. This illustrates that screening questions are only ever a starting point, if you don’t ask further clarifying questions in terms of the full DSM-5 criteria they can be very misleading. [Adding the anger item, see item 11 to the BPD screen meant that 97% of those with BPD answered ‘yes’ two both symptom questions according to Zimmerman et al (2017)]. It remains to be seen how much the question about wanting help adds to diagnostic accuracy, it is known that it does so for the depression screen.
Name: Date:
D.o.b:
The First Step Questionnaire – Revised
This questionnaire is a first step in identifying what you might be suffering from and pointing you in the right direction. In answering each question just make your best guess; don’t think about your response too much, there are no right or wrong answers.
1. | Yes | No | Don’t know |
During the past month have you often been bothered by feeling, depressed or hopeless? | |||
During the past month have you often been bothered by little interest or pleasure in doing things? | |||
Is this something with which you would like help? |
2. | Yes | No | Don’t know |
Do you have unexpected panic attacks, a sudden rush of intense fear or anxiety? | |||
Do you avoid situations in which the panic attacks might occur? | |||
Is this something with which you would like help? |
3.
In your life, have you ever had any experience that was so frightening, horrible or upsetting that, in the past month, you |
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Yes | No | Don’t know | |
i. Have had nightmares about it or thought about it when you did not want to? | |||
ii. Tried hard not to think about it or went out of your way to avoid situations that reminded you of it? | |||
iii. Were constantly on guard, watchful, or easily startled? | |||
iv. Felt numb or detached from others, activities, or your surroundings? | |||
v. Felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused? | |||
Is this something with which you would like help? |
4. | Yes | No | Don’t know |
Are you a worrier? | |||
Do you worry about everything? | |||
Has the worrying been excessive (more days than not) or uncontrollable in the last 6 months? | |||
Is this something with which you would like help? |
5. | Yes | No | Don’t know |
When you are or might be in the spotlight say in a group of people or eating/writing in front of others do you immediately get anxious or nervous | |||
Do you avoid social situations out of a fear of embarrassing or humiliating yourself? | |||
Is this something with which you would like help? |
6. Obsessive Compulsive Disorder | Yes | No | Don’t know |
Do you wash or clean a lot? | |||
Do you check things a lot | |||
Is there any thought that keeps bothering you that you would like to get rid of but can’t? | |||
Do your daily activities take a long time to finish? | |||
Are you concerned about orderliness or symmetry? | |||
Is this something with which you would like help? |
7. | Yes | No | Don’t know |
Do you go on binges were you eat very large amounts of food in a short period? | |||
Do you do anything special, such as vomitting, go on a strict diet to prevent gaining weight from the binge? | |||
Is this something with which you would like help? |
8. | Yes | No | Don’t know |
Have you felt you should cut down on your alcohol/drug? | |||
Have people got annoyed with you about your drinking/drug taking? | |||
Have you felt guilty about your drinking/drug use? | |||
Do you drink/use drugs before midday? | |||
Is this something with which you would like help? |
9. | Yes | No | Don’t know |
Do you ever hear things other people don’t hear, or see things they don’t see? | |||
Do you ever feel like someone is spying on you or plotting to hurt you? | |||
Do you have any ideas that you don’t like to talk about because you are afraid other people will think you are crazy? | |||
Is this something with which you would like help? |
10. | Yes | No | Don’t know |
Have there been times, lasting at least a few days when you were unusually high, talking a lot, sleeping little? | |||
Did others notice that there was something different about you?
If you answered ‘yes’, what did they say?
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Is this something with which you would like help? |
11. | Yes | No | Don’t know |
Do you have a lot of sudden changes of mood, usually lasting for no more than a few hours? | |||
Do you often have temper outbursts or get so angry you lose control? | |||
Is this something with which you would like help? |