Psych CASC / OSCE · General adult psychiatry — trauma and stressor-related disorders
Explain complex PTSD and a trauma-informed treatment plan — CASC communication station
MRCPsych/FRANZCP-style communication station: explain ICD-11 CPTSD in plain language, DSO triad, collaborative trauma-focused and skills-based plan, optional sertraline with monitoring, safety-netting, and trauma-informed stance.
On this page & tools
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 complex PTSD in accessible language (PTSD plus difficulties with emotions, self-worth and relationships after prolonged trauma), contrast carefully with BPD without pejorative language, outline a skills-then-trauma-processing plan with patient control, discuss optional sertraline with early monitoring, and safety-net for worsening ideation or unsafe home situations. Check understanding. The examiner plays the patient. [1][4]
Candidate scenario
Your patient has prolonged childhood trauma with intrusion, avoidance, hypervigilance, emotional storms, shame and relationship distrust. You recommend a trauma-informed pathway including skills work and later trauma-focused therapy (e.g. STAIR then processing, or another TF protocol). She fears being labelled "borderline" and fears "reliving everything." She asks about sertraline 50 mg daily as an option. [2][3]
Marking domains
- Empathy, structure, agenda-setting, trauma-informed stance (choice, collaboration)
- Accurate plain-language CPTSD explanation (PTSD + emotions/self/relationships)
- Careful non-stigmatising BPD differential / comorbidity language
- Clear therapy plan with control and pacing (not forced flooding; not endless delay)
- Medication explanation with dose, early review, non-addiction clarification
- Safety-netting and teach-back [1][4]
Reveal assessor key
Open. Name time; ask main fears first (label of BPD, reliving, medication). [4]
Explain CPTSD. After prolonged trauma, some people have classic PTSD (unwanted memories, avoidance, feeling on edge) plus longer-term difficulties regulating emotions, harsh self-judgement/shame, and trouble with trust and closeness — that is what ICD-11 calls complex PTSD. It is treatable and not a character flaw. [1]
BPD language. Borderline personality pattern focuses more on long-standing abandonment fears, identity instability and impulsive self-harm patterns; trauma is common but not required. Some people have features of both — we treat the problems, not a pejorative label. [1]
Therapy. We start with safety and skills for emotions and relationships, then work on trauma memories in a paced, collaborative way (e.g. STAIR then trauma processing, or PE/CPT/EMDR with support). She stays in control of detail and pace; this is not random flooding. Evidence supports these approaches for many people. [2]
Medication option. Sertraline is an SSRI starting at about 50 mg daily; benefits build over weeks; early nausea/sleep change can occur; we review early because mood or suicidal thoughts can worsen in a minority after starting — contact us/emergency same day if that happens. Not an intoxicating addiction like alcohol, but do not stop abruptly later without a plan. [3]
Close. Summarise, teach-back, crisis contacts, book review and therapy referral. [4]
References
- [1]Brewin CR, Cloitre M, Hyland P, et al. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD Clin Psychol Rev, 2017.PMID 29029837
- [2]Cloitre M, Stovall-McClough KC, Nooner K, et al. Treatment for PTSD related to childhood abuse: a randomized controlled trial Am J Psychiatry, 2010.PMID 20595411
- [3]Brady K, Pearlstein T, Asnis GM, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder JAMA, 2000.PMID 10770145
- [4]Harris M, Fallot RD Designing trauma-informed addictions services New Dir Ment Health Serv, 2001.PMID 11291263