Do they have a rigid or negative cognitive style?.Do they have problems with affect modulation?.did the patient model their parent's behaviours, or did they rebel against their parent's behaviours – you either “act like your parents” or “act the opposite of your parents because you don't want to be like them”)? How did their family act and what is the family structure (i.e.Is there a history of concussions or traumatic brain injuries?.Are there toxic exposures in utero, birth complications, or developmental disorders?.What do we know about their consistent personality characteristics?.Predisposing (What is their “set up?” What were they working with initially?) However, like with anything, the more you practice, the better you will become at formulating. In psychiatry, formulation appears more complicated because human behaviour and the brain itself is extraordinarily complex.
Understanding how each factor contributes to a disease can better guide treatment decisions. These factors all combine to cause the person to develop diabetes.
The patient may have a strong family history of the disease, a sedentary job, environmental exposures, and/or a nutritionally-poor diet. For example, type II diabetes does not develop because of a single pathophysiological cause. Like most things in medicine, there are multifactorial causes of diseases, illnesses, and disorders. You are probably already formulating, but just don't know it. However, formulation tells us how the person became depressed as a result of their genetics, personality, psychological factors, biological factors, social circumstances ( childhood adverse events and social determinants of health), and their environment. For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. Diagnosis is not the same as formulation! In mental health, when there is a group of consistent symptoms seen in a population, these symptoms can be categorized into a distinct entity, called a diagnosis (this is what the DSM-5 does).