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Splitting Defence — MRCPsych Paper B MCQ

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ModeratePsychotherapySplitting DefenceMRCPsych Paper B

A 25-year-old woman with borderline personality disorder is receiving structured psychotherapy. During one session, she describes her therapist as exceptionally caring and as the only person who understands her. At the next session, after the therapist maintains an agreed therapeutic boundary, she describes the therapist as entirely uncaring and cruel. She is unable to acknowledge caring and frustrating qualities in the therapist at the same time. Which defence mechanism best accounts for this pattern?

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Correct answer: C — Splitting

The correct answer is **B, splitting**. Splitting is an immature defence in which positive and negative qualities of the self or another person cannot be integrated into a coherent whole. The therapist is therefore experienced first as wholly caring and later as wholly cruel after a boundary is enforced, producing the characteristic oscillation between idealisation and devaluation. This pattern is particularly associated with borderline personality organisation. Projection would involve attributing the patient's own unacceptable feelings or impulses to someone else. Repression keeps distressing mental content outside conscious awareness. Sublimation redirects an unacceptable impulse into a socially constructive activity. Intellectualisation involves focusing on abstract or technical explanations to avoid the associated emotion.

Reference: Story GW et al. A social inference model of idealization and devaluation. Psychological Review. 2024;131(3):749–780. https://pubmed.ncbi.nlm.nih.gov/37602986/