A 26-year-old woman with Borderline Personality Disorder repeatedly views her therapist as either 'the best doctor in the world' or 'completely useless and uncaring' across different sessions. This alternation is an example of which defence mechanism?

• A Reaction formation
• B Splitting ✓
• C Projective identification
• D Intellectualization

Explanation

Splitting is the central defence mechanism of Borderline Personality Disorder (and also Narcissistic PD). It involves viewing people (and the self) as all-good or all-bad, without integrating ambivalent qualities. It is a primitive defence arising from failure of object constancy during development. Projective identification involves projecting one's own unacceptable feelings onto another and then identifying with those projected feelings while influencing the other person to act accordingly. Reaction formation substitutes an opposite impulse for an unacceptable one. Intellectualization uses abstract thinking to distance from emotional experience.

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

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Written and medically reviewed by the StethoPrep medical team.