Psych CASC / OSCE · General adult psychiatry — personality disorders
Explain avoidant PD and therapy plan — CASC communication station
MRCPsych/FRANZCP-style communication station: explain AVPD without stigma, outline CBT/exposure and schema options, clarify medication role for comorbidity, address ASD differential gently, 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 outpatient clinic. [1]
Candidate instructions. Explain avoidant personality disorder in plain language without stigma, outline structured psychological therapy, clarify that tablets do not “cure personality” but may help depression or social anxiety if present, gently address how autism differs and when further assessment is considered, and check understanding. The examiner plays the patient. [1][3]
Candidate scenario
Your patient meets criteria for avoidant PD: wants closeness, avoids work meetings and dating for fear of humiliation, feels inadequate, and is hypersensitive to criticism. No clear lifelong autism developmental history has been established yet; he is not currently suicidal. You plan CBT with graded exposure; schema therapy if broader lifelong patterns dominate. [1][2]
Marking domains
- Empathy, structure and agenda-setting
- Non-stigmatising explanation of AVPD as a treatable pattern
- Clear psychotherapy plan (exposure hierarchy, cognitive work)
- Accurate medication expectations
- Balanced comment on autism differential without false certainty
- Hope and safety-netting
- Checks understanding [1][3]
Reveal assessor key
Open and agenda-set. Name time; ask his main fears (“broken forever,” tablets, autism). [1]
Explain diagnosis. “Avoidant personality disorder describes a long-standing pattern of wanting connection but holding back because criticism or rejection feels unbearable, with a strong sense of being not good enough. It is a recognised clinical pattern and people improve with the right help. It is not a moral failure and it is not the same as simply being a bit shy when the pattern is this pervasive and impairing.” [1]
Explain treatment. Main treatment is structured talking therapy. In CBT we build a step-by-step exposure ladder, test fearful predictions, and practice skills in real situations. If deeper lifelong beliefs dominate, schema therapy is another evidence-supported option. Tablets do not rewire personality; we use medicines mainly if depression or social anxiety is also present, with clear review. [1][2]
Autism question. Autism involves early developmental differences in social communication and restricted/repetitive patterns. If that history is unclear we can assess carefully rather than guessing today; some people have both kinds of difficulty, but labels should be accurate. [3]
Close. Summarise, teach-back, written information, follow-up, crisis contacts if mood worsens, realistic hope. [1]
References
- [1]Lampe L, Malhi GS Avoidant personality disorder: current insights Psychol Res Behav Manag, 2018.PMID 29563846
- [2]Bamelis LL, Evers SM, Spinhoven P, Arntz A Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders Am J Psychiatry, 2014.PMID 24322378
- [3]Lugnegård T, Hallerbäck MU, Gillberg C Personality disorders and autism spectrum disorders: what are the connections? Compr Psychiatry, 2012.PMID 21821235