CCFP priority topic 76 of 105
Personality Disorder on the CCFP exam
6 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 6 key features for Personality Disorder. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 6
Trait or new change
Tell a lifelong pattern from a recent change, and find any drug or medical cause first.
CFPC skill Clinical reasoning, patient-centred approach, selectivityPhase History, hypothesis generation, diagnosisSources Health Canada
On the exam
A teen started a seizure drug, and angry outbursts began seven weeks ago. Expect a short menu (pick several from a list).
Pick what to ask about tonight.
Common mistakes
Asking about his birth, early milestones or tonight's fight about his phone. None explains a change that began seven weeks ago.
Approach
- Ask when it began. A personality is set by the teens or early adulthood and shows everywhere. A change over weeks is something else.
- Ask about every new drug and dose. Levetiracetam, a seizure drug, can cause anger, aggression, irritability, low mood and personality change.
- Ask about alcohol, cannabis and other drugs.
- Screen for depression: mood, interest, sleep, energy. In a teen, low mood often shows as irritability.
- Look for a medical cause: a head injury, a new neurological sign, thyroid disease, a mass in the brain.
- Ask about thoughts of suicide. Seizure drugs call for watching for them.
- A trait is not an illness. Name a disorder only for a rigid, lasting pattern that harms life in many settings.
| Lasting pattern | New change | |
|---|---|---|
| When it began | By the teens or early adulthood | Weeks or months ago, in someone who was different |
| Where it shows | Home, school, work, with many people | Out of keeping with the person family knew |
| Look for | How it harms work, love and care | New drugs, substance use, low mood, a medical illness |
| Next step | Steady care and clear limits | Find and treat the cause |
Key feature 2 of 6
How you talk
Change how you speak so the patient can trust you, and find what blocks their care.
CFPC skill Communication, patient-centred approachPhase Treatment
On the exam
A woman with borderline personality disorder misses booked visits, then turns up in crisis. Expect a short menu (pick several from a list).
Pick what helps her get care.
Common mistakes
Seeing her only when she arrives in crisis, which teaches that a crisis is the way in. Long, open visits you cannot keep up are wrong too.
Approach
- Book short visits at set times, not only when she is in crisis.
- Be warm, calm and the same each time. Mixed messages feed conflict.
- Name the feeling you see, even when you will not grant the request.
- Use plain words. Ask her to say the plan back. Give it to her in writing.
- Ask what gets in the way: missed visits, fights with staff, phone or form trouble, clinics that turned her away.
- Give her one main contact in the clinic.
- Agree on what she does in a crisis, and who she calls.
Key feature 3 of 6
Your own reaction
Notice what a patient stirs up in you, and keep it from steering your care.
CFPC skill Professionalism, patient-centred approachPhase Treatment
On the exam
A teen with borderline personality disorder insults you as you explain a new diagnosis. You feel angry. Expect one best answer.
Pick your next move.
Common mistakes
Handing her to a colleague, stepping out to give her space, or warning her to stop. Each acts on your anger, and she hears rejection.
Approach
- Name the feeling to yourself: anger, dread, the urge to leave or to rescue.
- One insult is not a danger to you. Stay in the room.
- Answer her distress, not the insult: "This is a lot of news at once."
- Keep your voice even, and finish the explanation she needs.
- Check that the feeling is not changing your tests, your drugs or your follow-up.
- If a patient often gets to you, talk it over with a trusted colleague.
Key feature 4 of 6
Behaviour and limits
Name a hard behaviour calmly, agree on aims, hold firm limits, and keep caring for the patient.
CFPC skill Communication, professionalism, patient-centred approachPhase Treatment, follow-up
On the exam
A teen shouts at his father and kicks a chair, then steps back. He holds nothing. Expect one best answer.
Pick what you say and do now.
Common mistakes
Calling security, offering a sedative, or saying the visit ends unless he calms down. Sending him out with his father ends your assessment too.
Approach
- Check safety first: your seat, the door, help close by.
- Name the behaviour plainly and calmly: "Kicking the chair is not OK. I want to hear what is going on."
- Offer a choice, such as a short break with you, and keep the assessment going.
- Keep sedation for agitation that talking cannot settle.
- Agree on a few aims the patient can reach.
- Set firm limits on visit length, refills and how to reach you. Tell your staff, so everyone says the same thing.
- Keep caring for the patient. End care only if your safety, or someone else's, is truly at stake.
| What you see | What it means | What to do |
|---|---|---|
| Raised voice, swearing | Upset, no threat yet | Listen, name the feeling, name the behaviour |
| Kicks an object, then backs off | Settling, holds nothing | Keep space, talk calmly, offer a choice |
| Moves toward you, or holds a weapon | Real danger | Leave, call for help, then think of sedation |
Key feature 5 of 6
New symptoms
In a patient known to have a personality disorder, look for a new illness when the story changes.
CFPC skill Clinical reasoningPhase Hypothesis generation
On the exam
A teen with borderline personality disorder has four weeks of agitation, a pulse of 122 and a tremor. Expect a short menu (pick several from a list).
Pick what to ask, examine and test.
Common mistakes
Blaming a fight with friends, or a crisis. A head scan or a drug screen misses the point: a swollen neck points to the thyroid.
Approach
- Ask what is new, and how it differs from her usual pattern.
- Take vital signs and examine her every time. A fast pulse, a tremor and weight loss are physical signs, not a crisis.
- Feel the neck. A swelling with these signs points to an overactive thyroid. Send thyroid blood tests.
- Screen for depression, substance use and suicide risk as well. These illnesses are common in her group too.
- Treat her symptoms, but prescribe small amounts at a time after past overdoses. See her often.
Key feature 6 of 6
Check the old label
When someone else has named a personality disorder, check it yourself, because a wrong name does harm.
CFPC skill Clinical reasoning, patient-centred approachPhase DiagnosisSources Health Canada
On the exam
A counsellor's letter says a teen has a personality disorder, like his father. Expect one best answer.
Pick the best next step.
Common mistakes
Ordering personality tests now, or accepting the name because his father has it. Brushing it off as normal teen behaviour is wrong too.
Approach
- Take your own history: when it began, how it changed, where it shows, what it costs.
- A family history does not make the diagnosis.
- A change over weeks after a new drug, with low mood, is not a personality disorder. Levetiracetam can cause irritability and depression.
- Treat the drug effect and the depression first. Assess personality only once they have settled.
- A wrong name follows the patient. Staff may stop listening and miss a new illness.
- Write what you found and why, so the next clinician sees your reasons.
- Book follow-up. Low mood and a drug effect both need a plan.
Flashcards
Answer it first, then check.
KF 1A calm teen has had angry outbursts for seven weeks. Personality disorder?
No. A personality is lasting. Check new drugs, mood and substance use first.
KF 1Which seizure drug can bring new anger and irritability?
Levetiracetam. Its Canadian monograph lists aggression, anger, irritability, depression and personality change. Source: Health Canada
KF 3A patient insults you, and you want to leave the room. What now?
Notice the urge, and stay. Answer the distress, and finish the plan.
KF 4A teen kicks a chair, then steps back, empty-handed. Security or talk?
Talk. Name the behaviour calmly and keep assessing. A show of force can make it worse.
KF 5Borderline personality disorder, a pulse of 122, tremor and weight loss. Just a crisis?
Not until you have looked. Examine the neck and test the thyroid.
KF 5She has overdosed twice and needs a new medicine. How do you prescribe?
Small amounts at a time, with close follow-up. Do not withhold what she needs.
KF 6A letter says your new patient has a personality disorder. Do you accept it?
No. Take your own history. The name may be wrong, and it shapes all later care.
FAQ
Can a teenager have a personality disorder?
Rarely, and only with care. The traits must be lasting and seen in many settings, not tied to one stage or illness. Antisocial personality disorder is for adults only.
Is a difficult patient the same as a personality disorder?
No. Hard visits have many causes: fear, pain, a new illness, a long wait, your own bad day. A personality disorder is a lasting pattern, not one hard visit.
Which guideline does the exam follow?
No Canadian guideline covers this topic. Marks go to sound reasoning. Look for other causes, make your own assessment, and keep a steady relationship with clear limits.
When can I stop seeing a patient?
Rarely, and never in the middle of a crisis. A real threat to you or your staff can justify it. Even then, cover urgent needs and check your provincial college's policy.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Drug Product DatabaseHealth Canada