Psychological and emotional abuse OSCE — recognition, safeguarding plan and safety

Station A — Six-year-old belittled and confined by her mother (8 minutes)

A six-year-old girl is brought to your clinic for bedwetting and "behaviour problems." Her mother describes her, in front of her, as "evil, stupid, a waste of space," and tells you she locks her in her room for hours "to teach her a lesson." The child sits frozen, eyes on her mother, silent. There are no marks on her body. You are alone with the candidate in the room. [2]

Candidate tasks:

1. Classify what you are observing using Glaser's framework, naming the behavioural categories, and explain why this is abuse despite the absence of a physical mark. [2] [4]
2. Outline the focused assessment, including what you must ask and look for, and the concurrent risks to exclude. [12] [5]
3. Agree the immediate and stepped safeguarding response, including your reporting obligation. [4] [12]

Examiner marking points:

• Recognises psychological and emotional abuse, not "behaviour problems"; names the three definitional features — sustained pattern, caregiver relationship, harm or likely harm to development. [2]
• Names the categories present (spurning, terrorizing/confinement, denying responsiveness) and the abuse-versus-neglect distinction; states that witnessing intimate-partner violence is a recognised form and asks about it. [4]
• Explains the toxic-stress cascade and cites that emotional maltreatment is as harmful as physical or sexual abuse (Vachon) — "no bruise does not mean no abuse." [8] [5]
• Sees the child alone; takes collateral from school, GP and welfare; documents the interaction factually; examines for concurrent physical abuse, neglect and sexual abuse; asks directly about self-harm and IPV. [12]
• Reports on reasonable suspicion within the jurisdiction; builds the stepped, trauma-informed plan (recognise/report → protect → support/repair); states the paediatrician coordinates and that the repair is relational. [5] [12]

Station B — Four-year-old with symptoms no one can find (8 minutes)

A four-year-old boy's mother insists he has severe, frequent symptoms that no examination, investigation or clinician across three hospitals has been able to find. She brings thick files of recorded readings and is angry that "no one is taking him seriously." A junior colleague asks you what to do. [12]

Candidate tasks:

1. Identify the overlap pattern and explain the risk to the child. [12] [4]
2. Outline your assessment and immediate response, and what you must not do. [4] [12]

Examiner marking points:

• Names fabricated or induced illness as an overlap of emotional and physical abuse — a caregiver fabricates, exaggerates or induces illness to meet adult needs, exposing the child to harmful investigation and treatment. [12]
• Identifies the clues: poor fit between reported and observed findings, resistance to recovery, and fragmented care across multiple services; recognises the psychological distortion of the child's body-sense. [12] [4]
• Outlines the response: review the records and the child carefully, involve the safeguarding/child-protection team and a senior colleague, share information across the services involved, and protect the child from further harmful investigation — do not confront the caregiver alone or order a cascade of tests to appease. [4] [12]
• States that this meets the threshold for a child-protection referral and that the paediatrician coordinates with the multi-agency team; applies trauma-informed, documented, need-to-know information sharing throughout. [5] [12]