The nurse has recently set limits for a patient with borderline personality disorder. The patient tells the nurse, "You used to care about me. I thought you were wonderful. Now I can see I was mistaken. You're hateful."
Which phenomenon is represented by this response? a. Splitting
b. Denial
c. Reaction formation
d. Projection
A
Splitting involves an inability to recognize that an individual can have both positive and negative qualities. Instead, when a person exhibits positive qualities, the patient idealizes that person, and when the person displeases the patient, the patient denigrates that same person. In this case, the patient is switching from idealization to denigration in response to a perceived negative aspect of the nurse. Denial is a defense mechanism wherein anxiety is reduced by blocking awareness or acceptance of whatever is causing the anxiety. Reaction formation involves unconsciously doing the opposite of an anxiety-provoking impulse. Projection is a defense mechanism wherein the person denies that the anxiety-provoking urge or thought exists and instead projects it onto others, so that the patient perceives others as having the thought or urge that is really their own (but unacceptable for them to face).
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