Emerging PD in Adolescents — MRCPsych Paper B MCQ
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Correct answer: D — Describe the emerging features now; borderline personality disorder may be diagnosed under 18 if full criteria are met after CAMHS assessment
Explanation lettering: E = shown as B · D = shown as C · B = shown as D · C = shown as E
NICE does not impose an absolute age threshold of 18 for diagnosing borderline personality disorder. CG78 explicitly covers young people under 18 who meet diagnostic criteria and recommends CAMHS assessment when repeated self-harm, risk-taking or marked emotional instability raises suspicion. This girl does not meet full criteria, so a formal diagnosis should not be assigned merely as a mandatory “provisional” diagnosis; her emerging features, developmental formulation and clinical needs should instead be documented and addressed. C is incorrect because assessment and treatment are not prohibited before 18. A invents a NICE requirement, while D and E have no basis in guidance. Her self-harm still requires an age-appropriate psychosocial assessment.
Reference: NICE. Borderline personality disorder: recognition and management (CG78), Context and recommendations 1.1.1.2 and 1.2.1.1, 2009. https://www.nice.org.uk/guidance/cg78/chapter/Recommendations