Psych CASC / OSCE · General adult psychiatry — personality disorders
Explain dependent personality disorder and autonomy-focused plan — CASC communication station
MRCPsych/FRANZCP-style communication station: explain DPD without stigma, outline CBT autonomy plan, clarify limited medication role, address abandonment fears in the alliance, safety-net after losses.
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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 dependent personality disorder in plain language without stigma, clarify how it differs from healthy interdependence, outline why structured psychotherapy building graded autonomy is first-line, clarify that medication treats depression or anxiety rather than "curing personality," address fear that independence means the team will abandon her, and check understanding. The examiner plays the patient. [1][2]
Candidate scenario
Your patient meets DSM criteria for DPD with longstanding difficulty making decisions without others, fear of being alone without care, difficulty disagreeing, and urgent re-partnering after breakups. She has mild-moderate depressive symptoms without current active suicidal plan. You plan CBT-oriented referral with autonomy goals and will discuss SSRI options if depression worsens. [1][3]
Marking domains
- Empathy, structure and agenda-setting
- Non-stigmatising explanation of DPD as a treatable pattern of excessive need for caretaking
- Clear distinction from healthy interdependence and from avoidant/borderline caricatures without oversimplifying
- Named psychotherapy plan (graded autonomy, assertiveness, reassurance reduction)
- Accurate medication expectations
- Alliance: independence goals without abandonment
- Safety-netting for low mood after relationship loss
- Checks understanding [2][3]
Reveal assessor key
Open and agenda-set. Name time available; ask her main fears about the label first (weak, untreatable, abandoned if she improves). [1]
Explain diagnosis. "Dependent personality disorder describes a long-term pattern of feeling unable to manage life without a lot of guidance and care from others, going along with things to keep support, and feeling panicked about being left alone to cope. Wanting closeness and support is human — the diagnosis is about when that need is so strong and fixed that it costs freedom, safety, or mood. It is recognised 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. Together we build step-by-step practice of making decisions, expressing disagreement safely, and coping for short periods alone, while reducing habits that keep helplessness going (like always needing someone else to decide). Tablets do not rewire personality on their own; antidepressants can help if depression is significant, alongside therapy. Getting more independent does not mean we walk away — we plan support while skills grow. [2][3]
Safety-net. If mood drops after a breakup or threat of loss, contact the service/crisis line early rather than waiting until panic forces an unsafe relationship. [1]
Close. Summarise, teach-back, written information, follow-up appointment, hope grounded in treatability. [1][2]
References
- [1]Disney KL Dependent personality disorder: a critical review Clin Psychol Rev, 2013.PMID 24185092
- [2]Bornstein RF From dysfunction to adaptation: an interactionist model of dependency J Pers, 2012.PMID 22458867
- [3]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