View source for WBR0589

 {{WBRQuestion
|QuestionAuthor= {{SSK}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|Prompt=A 42 year-old-woman has had 7 relationships in the past year all of which she claims were the most intense loves of her life. She has written many songs about her relationships and has sworn she would kill herself if any of her previous lovers tried to leave her. She has also had 2 episodes of major depression in the past year and was arrested for assaulting one of her friends after they had a minor argument. Which of the following types of defense mechanisms is most likely to be present in this patient?
|Explanation=Borderline personality disorder is characterized by a pattern of excessive instability of interpersonal relationships and self-image. Patients are usually impulsive, have a pattern of intense unstable relationships, and recurrent suicidal behavior or threats. Patients can also exhibit mood instability, self-mutilation, and chronic feelings of emptiness. A classical defense mechanism associated with borderline personality disorder is splitting. Splitting is described as intolerance to ambiguity with a belief that people are either completely good or bad at a given time. Patients have alternating extremes of idealization and devaluation towards certain individuals. 
Ex: All waiters are nice and kind, while waitresses are mean and insensitive.
|AnswerA=Rationalization
|AnswerAExp=A defense mechanism characterized by attempts to logically reason out certain behaviors to avoid self-blame. This defense mechanism is not characteristic of borderline personality disorder.
|AnswerB=Altruism
|AnswerBExp=A defense mechanism characterized by kindness and generosity towards other to relieve a guilty conscience. This defense mechanism is not usually a feature of borderline personality disorder.
|AnswerC=Humor
|AnswerCExp=A defense mechanism characterized by creating an amusing situation out of an awkward or difficult one. This defense mechanism is not common of borderline personalities.
|AnswerD=Denial
|AnswerDExp=A defense mechanism by which one avoids a certain difficult reality by denying it ever happened. This defense mechanism is not characteristic of borderline personality disorder.
|AnswerE=Splitting
|AnswerEExp=Splitting is a defense mechanism seen in borderline personality disorder by which a patient sees people and situations as completely black or white due to intolerance towards incertitude.
|EducationalObjectives=Splitting is a defense mechanism seen in borderline personality disorder by which a patient sees people as either completely bad or good with no room for ambiguity.
|References=American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA:American Psychiatric Publishing.
|RightAnswer=E
|WBRKeyword=Borderline personality disorder, Cluster B, Defense mechanisms, Splitting, Psychiatry,
|Approved=Yes
}}