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Mental Health Nursing · Chapter 10

Trait, State or Disorder — and the Words You Chart

A personality disorder is not an unusual style and it is not a bad week. It has to be pervasive, inflexible, traceable to early adulthood, impairing, and not better explained by a substance, another disorder or the situation the person is standing in. Open each gate for yourself, commit to a verdict, then take the second bench: strike every verdict word out of a chart note and see the behavioural version that replaces it.

The five gates

1 of 5
Your verdict

Strike the verdicts

“Difficult” is not a finding — it is a report of how you feel. These three notes are shown exactly as they were written, as the labelled before. Click every phrase that is a verdict about the person rather than an observation of behaviour, then check the note. The described-behaviour rewrite appears on the right.
Before · as charted

What this case is

0
Gates correct
0
Verdicts correct
0
Notes cleaned
Answer the five gatesSet each gate to yes or no, choose a verdict, and the reasoning for every gate appears here. There is no penalty for being wrong — the gates are where the learning is.
The three questions that sort almost everything. Does it show up nearly everywhere, or only in one relationship? Can the person choose another response when the first one fails? Has it been there since adolescence, or did it start six weeks ago? A pattern that is situational, flexible or new is not a personality disorder — it is a person under stress, and stress is treatable today.

The note, rewritten

After · described behaviour
Check a note on the left and its rewrite appears here, alongside a line on what each struck phrase was doing.
Why this is a safety intervention, not an etiquette rule. Once a verdict word enters a record, later clinicians assess less, believe less, and investigate physical complaints less. People carrying these labels have been sent home from emergency departments with untreated fractures and untreated sepsis. That is diagnostic overshadowing, and describing behaviour instead of character is the countermeasure you personally control.