A 30-year-old woman with borderline personality disorder, when angry with her therapist, describes him as 'the worst therapist in the world who has never helped anyone,' yet one week prior praised him as 'the only one who truly understands her.' This pattern BEST exemplifies which defence mechanism?

• A Projection
• B Projective identification
• C Splitting ✓
• D Idealization without splitting

Explanation

Splitting is the inability to integrate the positive and negative qualities of oneself or others into a cohesive whole. Objects are experienced as either all-good or all-bad, with abrupt shifts between the two poles. It is a hallmark defence of Borderline Personality Disorder and is considered an immature defence in Vaillant's hierarchy. The patient alternates between idealizing and devaluing the therapist. Projective identification (also prominent in BPD) involves projecting unwanted feelings onto another person and then behaving in ways that induce that feeling in them. Projection attributes one's own feelings to another without the inducing element.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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