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Complex PTSD Phase-Based Treatment — MRCPsych Paper B MCQ

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HardAnxiety & Stress-Related DisordersComplex PTSD Phase-Based TreatmentMRCPsych Paper B

A 32-year-old woman has PTSD following repeated childhood abuse, with marked emotional dysregulation, interpersonal instability and frequent dissociative episodes. She has stable accommodation, no current substance misuse and wishes to begin evidence-based PTSD treatment. According to NICE NG116, which is the most appropriate adaptation to treatment planning?

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Correct answer: D — Address dissociation as a barrier to trauma-focused therapy and provide additional time or sessions according to need

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

B is correct. NICE NG116 recommends adapting treatment for people with complex PTSD or other additional needs by helping them manage barriers to trauma-focused therapy, including dissociation and emotional dysregulation. Extra time should be allowed to develop trust, with the duration or number of sessions increased according to individual need. NICE does not require a fixed stabilisation-only phase or complete resolution of dissociation before trauma processing, so A overstates the guidance; stabilisation and reintegration remain areas identified for further research. Supported computerised trauma-focused CBT is unsuitable where severe dissociative symptoms are present, excluding C. Comorbid personality disorder does not require remission before PTSD treatment and is not a reason to withhold trauma-focused therapy, excluding D and 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 2025. https://www.nice.org.uk/guidance/ng116/chapter/recommendations