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Clinical Atlas Prestige · Evidence-first

Psych CASC / OSCESpecialty psychiatry — gender and sexuality

Psych CASC / OSCE · Specialty psychiatry — gender and sexuality

Explain gender dysphoria, affirming care and mental health support — CASC communication station

MRCPsych/FRANZCP-style communication station: explain gender dysphoria, affirmative care, parallel MH treatment, hormone liaison, anti-conversion stance, and safety-netting.

communication
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
A 22-year-old non-binary person (they/them) newly assessed in clinic wants a plain-language explanation of gender dysphoria versus identity, what affirmative mental health care involves, why depression and suicide risk are addressed in parallel, what hormone pathways roughly entail (specialist-led, fertility counselling), why conversion therapy will not be offered, and how their partner can support without pressure.

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the gender and mental health clinic. [2]

Candidate instructions. Explain gender dysphoria in plain language, outline affirmative psychosocial care, discuss parallel treatment of depression/suicide risk, describe specialist hormone pathways with fertility counselling (without unsupervised prescribing), state that conversion efforts are not offered, advise partner support, and check understanding. The examiner plays the patient. [2][3]

Candidate scenario

Your patient meets criteria for gender dysphoria with non-binary goals (possible low-dose masculinising hormones later; no genital surgery planned). They have moderate depression and occasional self-harm urges when misgendered at work. A relative has urged "conversion therapy." They fear psychiatry will try to stop them being non-binary. [1][4][5]

Marking domains

  • Empathy, structure, use of they/them pronouns consistently
  • Clear distinction: identity vs dysphoria (distress/impairment)
  • Affirmative stance without abandoning thoroughness
  • Parallel mental health care and safety-net for self-harm/suicidality
  • Hormone pathway: specialist-led, monitoring, fertility discussion
  • Explicit refusal of conversion practices with brief rationale
  • Partner support coaching without pressure
  • Teach-back / checks understanding [2][4][6]
Reveal assessor key

Open and agenda-set. Affirm name/pronouns; name time; ask priorities (fear of conversion; work stress; hormones; partner role). [2]

Explain dysphoria. "Gender dysphoria is the clinically significant distress that can come with a mismatch between your gender and the sex you were assigned at birth. Being non-binary is your identity — we are not trying to change that. We assess distress, safety, and what care might help." [1]

Affirmative care. Respect identity; explore goals; support social affirmation where helpful; treat depression and workplace stress; collaborate with gender services. Thorough assessment is supportive, not hostile. [2][3]

Risk and MH. Elevated self-harm/suicidality is recognised in the literature; we make a safety plan and treat mood — this is not a punishment or a barrier invented to block care. [5]

Hormones. If wanted, endocrine/gender specialists discuss options, partial medicalisation for non-binary goals, monitoring, and fertility — I will not start hormones today unsupervised; we will liaison. [6][3]

Conversion. We do not offer therapies aimed at changing your gender identity; evidence associates conversion efforts with harm. [4]

Partner. Support means using correct pronouns, reducing pressure, helping with practical safety — not forcing decisions. [2]

Close. Summarise, teach-back, crisis contacts, follow-up. [2][5]

References

  1. [1]Zucker KJ, Lawrence AA, Kreukels BP Gender Dysphoria in Adults Annu Rev Clin Psychol, 2016.PMID 26788901
  2. [2]Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 Int J Transgend Health, 2022.PMID 36238954
  3. [3]Safer JD, Tangpricha V Care of Transgender Persons N Engl J Med, 2019.PMID 31851801
  4. [4]Turban JL, Beckwith N, Reisner SL, Keuroghlian AS Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults JAMA Psychiatry, 2020.PMID 31509158
  5. [5]Marshall E, Claes L, Bouman WP, et al. Non-suicidal self-injury and suicidality in trans people: A systematic review of the literature Int Rev Psychiatry, 2016.PMID 26329283
  6. [6]Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline Endocr Pract, 2017.PMID 29320642