Psych CASC / OSCE · General adult psychiatry — personality disorders
Explain BPD diagnosis and therapy plan — CASC communication station
MRCPsych/FRANZCP-style communication station: explain BPD without stigma, outline structured psychotherapy (DBT or equivalent), clarify limited medication role, address self-harm and crisis plan, 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. [3]
Candidate instructions. Explain the diagnosis of borderline personality disorder in plain language without stigma, outline why structured psychotherapy is first-line, clarify that medication is not a cure for BPD itself, discuss safety planning for self-harm urges, and check understanding. The examiner plays the patient. [3]
Candidate scenario
Your patient meets DSM criteria for BPD with recurrent self-harm used mainly to reduce emotional pain, intense fear of abandonment, and unstable relationships. You plan referral to a DBT-informed programme (or structured clinical management if DBT is waitlisted). She is not currently suicidal with a plan. She drinks when distressed. [1][3]
Marking domains
- Empathy, structure and agenda-setting
- Non-stigmatising explanation of BPD as a treatable pattern of emotion and relationship difficulty
- Clear psychotherapy plan (name, structure, what she will learn)
- Accurate medication expectations (not disease-modifying for BPD; treat other conditions if present)
- Safety-netting and crisis plan
- Alcohol advice without blame
- Checks understanding [2][3]
Reveal assessor key
Open and agenda-set. Name time available; ask her main fears about the label first (untreatable, attention-seeking, personality attack). [3]
Explain diagnosis. "Borderline personality disorder describes a pattern of very intense emotions that shift quickly, fear of being left, unstable relationships, a shaky sense of self, and sometimes self-harm to cope with unbearable feelings. It is a recognised medical diagnosis and many people improve with the right help. It is not a moral failure and it is not code for 'we will not help you.'" [3]
Explain treatment. The main treatment is structured talking therapy. In DBT you learn skills for mindfulness, surviving crises without self-harm, regulating emotions, and handling relationships; you also have individual sessions and a team supporting the therapists. If DBT is not immediately available, structured clinical management still helps. Medication does not treat the whole condition; we use medicines mainly if there is depression, another illness, or a short carefully reviewed trial for a specific severe symptom — not as a lifelong cocktail by default.[1][2]
Safety and alcohol. Co-create a plan for urges: skills, people to call, crisis contacts, reducing access to means. Heavy drinking worsens impulsivity; offer practical support to cut down. [3]
Close. Summarise, teach-back, written information, follow-up appointment, hope grounded in evidence that people recover. [1][3]
References
- [1]Linehan MM, Comtois KA, Murray AM, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder Arch Gen Psychiatry, 2006.PMID 16818865
- [2]Kendall T, Burbeck R, Bateman A Pharmacotherapy for borderline personality disorder: NICE guideline Br J Psychiatry, 2010.PMID 20118465
- [3]Bohus M, Stoffers-Winterling J, Sharp C, et al. Borderline personality disorder Lancet, 2021.PMID 34688371