MBBS OSCE · Psychiatry
OSCE — Personality Disorders
Eight-minute OSCE station on Personality Disorders: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Personality Disorders.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Personality disorders (PD) are enduring, inflexible, and pervasive patterns of inner experience and behaviour that deviate markedly from the expectations of the individual's culture, are stable over time, begin by adolescence or early adulthood, lead to distress or impairment, and are not better explained by another mental disorder, substance use, or a medical condition. DSM-5 groups them into three clusters: Cluster A (odd, eccentric) — paranoid, schizoid, schizotypal; Cluster B (dramatic, emotional, erratic) — antisocial, borderline, histrionic, narcissistic; Cluster C (anxious, fearful) — avoidant, dependent, obsessive-compulsive (OCPD). Borderline personality disorder (BPD) is the most c
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Recurrent self-harm, suicide attempts, and intense fear of abandonment - borderl |
| Safety | Acute self-harm or suicide attempt in known BPD - assess risk; treat medical con |
| Safety | Persistent deceitfulness, law-breaking, aggression, lack of remorse since age 15 |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.