Psych CASC / OSCE · General adult psychiatry — personality disorders
Explain avoidant personality disorder and therapy plan — CASC communication station
MRCPsych/FRANZCP-style communication station: explain AVPD without stigma, outline CBT exposure plan, clarify limited medication role, address isolation and alcohol safety behaviour, check understanding.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the outpatient clinic. [1]
Candidate instructions. Explain avoidant personality disorder in plain language without stigma, clarify its relationship to social anxiety, outline why structured CBT (exposure and dropping safety behaviours) is first-line, clarify that medication treats anxiety or depression rather than “curing personality,” discuss alcohol as a short-term social crutch, and check understanding. The examiner plays the patient. [1][2]
Candidate scenario
Your patient meets DSM criteria for AVPD with longstanding social inhibition, self-view as inferior, avoidance of intimacy despite wanting a partner, and occupational avoidance of meetings. He also meets criteria for social anxiety disorder. He sometimes drinks before social events. He is not currently suicidal. You plan CBT referral and will discuss SSRI options if anxiety remains severe. [1][3]
Marking domains
- Empathy, structure and agenda-setting
- Non-stigmatising explanation of AVPD as a treatable pattern of fear of rejection
- Clear link to social anxiety without collapsing or oversimplifying
- Named psychotherapy plan (exposure, safety behaviours, beliefs)
- Accurate medication expectations
- Alcohol advice without blame
- Safety-netting for low mood after rejection
- Checks understanding [2][3]
Reveal assessor key
Open and agenda-set. Name time available; ask his main fears about the label first (broken, untreatable, pejorative). [1]
Explain diagnosis. "Avoidant personality disorder describes a long-term pattern of holding back in work and relationships because of a deep fear of being criticised or rejected, and a view of yourself as not good enough socially. Many people with this pattern also have social anxiety. It is a recognised condition and people can improve with the right help — it is not a moral failure and it is not code for 'we will not help you.'" [1][2]
Explain treatment. The main treatment is structured talking therapy, usually CBT. Together we build a step-by-step plan to face feared situations, reduce habits that keep anxiety going (like staying silent or using alcohol for courage), and test the belief that others will reject you. Tablets do not rewire personality on their own; antidepressants can help if social anxiety or depression is severe, alongside therapy. [2][3]
Alcohol and safety-net. Drinking before social events can become a trap; offer practical alternatives and support to cut down. If mood drops after rejection or criticism, contact the service/crisis line early. [1]
Close. Summarise, teach-back, written information, follow-up appointment, hope grounded in treatability. [1][2]
References
- [1]Lampe L, Malhi GS Avoidant personality disorder: current insights Psychol Res Behav Manag, 2018.PMID 29563846
- [2]Weinbrecht A, Schulze L, Boettcher J, Renneberg B Avoidant Personality Disorder: a Current Review Curr Psychiatry Rep, 2016.PMID 26830887
- [3]Mayo-Wilson E, Dias S, Mavranezouli I, Kew K, Clark DM, et al. Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis Lancet Psychiatry, 2014.PMID 26361000