Splitting in BPD Clinical — MRCPsych Paper B MCQ

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ModeratePersonality DisordersSplitting in BPD ClinicalMRCPsych Paper B

A woman with borderline personality disorder initially describes her therapist as flawless and as the only person who has ever understood her. After the therapist has to reschedule one appointment, she describes the same therapist as entirely uncaring and incompetent. In object relations theory, which defence mechanism best explains this abrupt change?

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Correct answer: C — Splitting

The correct answer is **B, splitting**. In object relations theory, splitting involves difficulty integrating positive and negative qualities of the same person into a stable, nuanced representation. The therapist is therefore experienced first as wholly good and, following a minor disappointment, as wholly bad. Projection would involve attributing the patient’s own unacceptable feelings or impulses to the therapist. Sublimation redirects an impulse into a socially acceptable activity. Rationalisation supplies a plausible but inaccurate justification for behaviour or feelings. Reaction formation replaces an unacceptable impulse with its opposite; it does not specifically account for alternating idealisation and devaluation of the same person.

Reference: Story GW et al. A social inference model of idealization and devaluation. Psychological Review. 2024;131(4):1060–1080. https://pubmed.ncbi.nlm.nih.gov/37602986/