skip to main content

Abandonment Schema — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePsychotherapyAbandonment SchemaMRCPsych Paper B

A 29-year-old woman with borderline personality disorder has attended weekly psychotherapy for 6 months. When her therapist explains that she will be away for a planned 2-week break, the patient becomes intensely anxious and angry, repeatedly seeks reassurance and says that the therapist is rejecting her. She understands the therapist's explanation, has no hallucinations or delusions, and has no apparent external incentive for reporting distress. Which formulation best explains her reaction?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Insecure attachment with activation of abandonment fears

The correct answer is E. The planned absence activates attachment-related fears of rejection and abandonment, producing intense anxiety, anger and reassurance seeking. This is consistent with the interpersonal instability and abandonment sensitivity associated with borderline personality disorder. NICE specifically warns that changes, transitions and endings in treatment can provoke strong emotional reactions and crises. Antisocial traits involve disregard for others rather than attachment-driven distress. Psychosis would require impaired reality testing, such as delusions or hallucinations, which is absent here. She understands the proposed break, arguing against intellectual disability as the explanation. Malingering requires intentional fabrication for an identifiable external gain; neither is present.

Reference: National Institute for Health and Care Excellence. Borderline personality disorder: recognition and management, CG78, sections 1.1.6 and Context. Published 2009; last reviewed 2024. https://www.nice.org.uk/guidance/cg78