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BPD Engagement — MRCPsych Paper B MCQ

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ModeratePersonality DisordersBPD EngagementMRCPsych Paper B

A 29-year-old woman with borderline personality disorder and comorbid depression has missed several initial outpatient appointments. She says that she still wants treatment, and assessment identifies no acute crisis or immediate risk. According to NICE CG78, which is the most appropriate treatment plan?

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Correct answer: A — Review her preferences and willingness to engage, then agree structured, supervised treatment integrating both conditions

The correct answer is A. NICE recommends considering the person's preferences, willingness to engage, motivation, capacity to maintain therapeutic boundaries and available support when planning psychological treatment for borderline personality disorder. Treatment should be structured, use an explicit integrated theoretical approach and include therapist supervision. Comorbid depression should be managed within this well-structured borderline personality disorder programme rather than in an isolated pathway. Automatic discharge is not supported by CG78, but neither does CG78 specifically recommend assertive outreach solely because appointments are missed. Crisis-team referral requires evidence of a crisis or escalating risk, which is absent here. Brief unstructured treatment is inappropriate as a specific intervention for borderline personality disorder, and appointment frequency should be adapted collaboratively to clinical needs rather than reduced automatically.

Reference: National Institute for Health and Care Excellence. Borderline personality disorder: recognition and management (CG78), recommendations 1.3.4.1, 1.3.4.3 and 1.3.6.2. 2009; last reviewed 30 July 2024. https://www.nice.org.uk/guidance/cg78/chapter/Recommendations