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Borderline personality disorder crisis — MCCQE Part 1 MCQ

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HardPersonality/BehaviourBorderline personality disorder crisisMCCQE Part 1

24-year-old woman presents with self-inflicted superficial cuts after relationship conflict. She denies current intent to die but has chronic emptiness and impulsivity. Which of the following is the most appropriate next step?

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Correct answer: D — Assess acute risk, validate distress and arrange structured follow-up/DBT-informed care

Assess acute risk, validate distress and arrange structured follow-up/DBT-informed care is best because crisis care should balance safety with non-escalating, consistent management. Provide reassurance only and arrange no follow-up is suboptimal because mental health risk often requires structured follow-up or urgent escalation; Use long-term benzodiazepine monotherapy as default treatment is suboptimal because benzodiazepine monotherapy is rarely an appropriate long-term strategy; Avoid direct risk assessment to preserve rapport is suboptimal because direct assessment of suicide, violence, capacity and substance use is clinically appropriate; Attribute symptoms to personality or culture without assessing illness is suboptimal because diagnostic overshadowing risks missing treatable mental illness. Dismissive responses increase risk; unnecessary admission can also be harmful.

Reference: Canadian psychiatric guidance