Psychological and emotional abuse OSCE — recognition, safeguarding plan and safety

Station A — Six-year-old belittled and confined by her mother (8 minutes)

A six-year-old girl is brought to your clinic for bedwetting and "behaviour problems." Her mother describes her, in front of her, as "evil, stupid, a waste of space," and tells you she locks her in her room for hours "to teach her a lesson." The child sits frozen, eyes on her mother, silent. There are no marks on her body. You are alone with the candidate in the room. ^[2]

Candidate tasks:

1. Classify what you are observing using Glaser's framework, naming the behavioural categories, and explain why this is abuse despite the absence of a physical mark. ^{[2] [4]}
2. Outline the focused assessment, including what you must ask and look for, and the concurrent risks to exclude. ^{[12] [5]}
3. Agree the immediate and stepped safeguarding response, including your reporting obligation. ^{[4] [12]}

Examiner marking points:

• Recognises psychological and emotional abuse, not "behaviour problems"; names the three definitional features — sustained pattern, caregiver relationship, harm or likely harm to development. ^[2]
• Names the categories present (spurning, terrorizing/confinement, denying responsiveness) and the abuse-versus-neglect distinction; states that witnessing intimate-partner violence is a recognised form and asks about it. ^[4]
• Explains the toxic-stress cascade and cites that emotional maltreatment is as harmful as physical or sexual abuse (Vachon) — "no bruise does not mean no abuse." ^{[8] [5]}
• Sees the child alone; takes collateral from school, GP and welfare; documents the interaction factually; examines for concurrent physical abuse, neglect and sexual abuse; asks directly about self-harm and IPV. ^[12]
• Reports on reasonable suspicion within the jurisdiction; builds the stepped, trauma-informed plan (recognise/report → protect → support/repair); states the paediatrician coordinates and that the repair is relational. ^{[5] [12]}