Review Question - QID 203736

This likely borderline personality patient is displaying an immature ego defense known as primitive idealization, a sub-type of splitting. In this case, the patient is viewing the doctor who is caring for her as quite literally an ideal figure because he is showing her a reasonable amount of care.

Splitting is a common phenomenon in borderline patients and manifests itself as viewing others as either all good or all bad, both of which are unsubstantiated given the amount of positive or negative influence that the person has on the patient's life.

Angstman et al. report that the treatment of borderline personality disorder involves many modalities of psychotherapy. The key to effective psychotherapy is the setting of appropriate limits and boundaries between the patient and the provider. The use of antidepressants has not been supported by the literature except in cases where the patient has comorbid psychiatric conditions.

A recent Cochrane review found that second-generation antipsychotics, mood stabilizers, and dietary supplementation with omega-3 fatty acids have some beneficial effects in patients with borderline personality disorder.

Incorrect answers:
1. Identification is the modeling of behavior after someone who is more powerful. The patient is not modeling her behavior after anyone, she is merely admiring it.
2. Denial is the avoidance of awareness of an unpleasant reality.
3. Displacement is the process whereby avoided ideas or feelings are transferred to some neutral person or object such as a man kicking his dog because his wife left him. The feelings she is displaying at the intern are not meant for someone else and so are not being avoided.
5. Projection is the unconscious expulsion of an unacceptable emotion or thought onto an external source. However intense her feelings her, the patient is expressing them herself and not attributing them to the intern.