A 38-year-old woman with suspected cluster B personality disorder has identity disturbance, chronic emptiness, frantic abandonment avoidance, intense and unstable relationships alternating between idealisation and devaluation, and impulsive self-harm. The operative defence mechanism most associated with this disorder is:
- A Intellectualisation
- B Splitting (black-and-white thinking) ✓
- C Reaction formation
- D Sublimation
Explanation
Borderline personality disorder (BPD) is characterised by splitting as the primary ego defence mechanism — the inability to tolerate ambivalence leads to viewing people as all-good or all-bad (idealisation/devaluation cycles). This reflects a failure of object constancy development (Kernberg's object relations theory). The alternating idealisation and devaluation of the treating team is a classic manifestation of splitting in clinical settings and can cause significant ward management problems. Understanding splitting helps clinicians avoid counter-therapeutic responses (rescuing or punishing).
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.