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PTSD with Dissociation — MRCPsych Paper B MCQ

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HardAnxiety & Stress-Related DisordersPTSD with DissociationMRCPsych Paper B

A 35-year-old woman with emotionally unstable personality disorder and PTSD following repeated childhood trauma is referred for trauma-focused cognitive behavioural therapy. During emotionally activating discussions, she has episodes of blank staring, altered awareness and subsequent amnesia. These have been clinically assessed as dissociative rather than epileptic. Her accommodation is stable, and she has no current substance misuse or imminent risk to herself or others. Which modification to her treatment plan is most consistent with NICE NG116?

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Correct answer: D — Allow additional sessions to build trust and manage dissociation and emotional dysregulation that may impede trauma-focused work

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · B = shown as D

B is correct. NICE recommends adapting treatment for people with PTSD and additional needs by allowing extra time to develop trust and helping them manage barriers to trauma-focused therapy, specifically including dissociation and emotional dysregulation. This may involve grounding, affect-regulation work and additional sessions integrated with the trauma-focused intervention. NICE does not mandate an entirely separate stabilisation phase or require dissociation to disappear before trauma processing. Standard treatment without adaptation may impair engagement, making A inappropriate. C unnecessarily withholds an effective first-line treatment. Admission is not indicated without risks or needs requiring inpatient care, excluding D. Comorbid personality disorder is not a reason to defer or exclude PTSD treatment, excluding E.

Reference: National Institute for Health and Care Excellence. Post-traumatic stress disorder (NG116), recommendation 1.7.3: Care for people with PTSD and complex needs. 2018; reviewed 8 April 2025. https://www.nice.org.uk/guidance/ng116/chapter/recommendations