Anxiety, OCD, Somatic, Dissociative and Personality Presentations
Recognition, formulation, differential diagnosis, treatment and outcomes across anxiety, obsessive-compulsive, somatic, dissociative and personality-related presentations.
How to prepare for MRCPsych Paper B
Integrate clinical formulation, safety and current UK practice with disciplined appraisal of design, bias, estimates and applicability.
Core concepts
Concept 1
Anxiety, obsessive-compulsive, somatic, dissociative and personality-related presentations require precise phenomenology and a formulation that includes avoidance, safety behaviours, trauma, relationships and physical causes.
Exam cue: Describe whether a thought is worry, obsession, rumination, delusion or trauma re-experiencing before naming a disorder.
Concept 2
Evidence-based care matches intervention intensity and model to the maintaining process, severity, comorbidity, preference and risk rather than to a label alone.
Exam cue: Identify the short-term relief and long-term cost of avoidance, reassurance, checking or another maintaining behaviour.
Risk pitfalls and guardrails
Assuming medically unexplained means imagined or excluding further proportionate medical review.
Guardrail: Do not choose an option because it is merely familiar or associated; show why it best answers this lead-in.
Using a personality diagnosis as a fixed moral judgement rather than a longitudinal clinical formulation.
Guardrail: Do not diagnose from one feature; establish context, course, impairment, exclusions and the classification system in use.
Memory anchors
What characterises an obsession?
A recurrent intrusive thought, image or urge experienced as unwanted, usually provoking distress and attempts to resist or neutralise it.
How can a safety behaviour maintain anxiety?
It prevents disconfirmation of the feared prediction and attributes safety to the behaviour rather than the situation.
What is dissociation?
A disruption in the usual integration of consciousness, memory, identity, emotion, perception, body representation or behaviour.
What is the first principle in somatic symptom assessment?
Take symptoms and distress seriously while integrating proportionate medical assessment with psychological and social formulation.
Why is collaborative formulation important in personality-related difficulty?
It links patterns, triggers, vulnerabilities, strengths and goals without reducing the person to a diagnostic label.
Checkpoint rule
Do the check-up only after you can summarize each concept in one sentence and identify one dangerous pitfall from memory.
Knowledge Check (after reading)
Short check-up to confirm understanding of this module.
Check-up Questions
A patient has recurrent abrupt surges of intense fear with palpitations, breathlessness and fear of dying, peaking within minutes. What is the most likely phenomenon?
A patient avoids buses and shopping centres because escape or help might be difficult if panic occurs. What is the most likely diagnosis?
Answer all questions to submit.
Next step personalized recommendations
Continue learning
Move forward only after this module is stable.
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