一位邊緣性人格障礙（BPD）病人對護理師說：「大夜班護理師比妳好多了，她才是真的關心我。」這種行為是哪種防衛機制的例子？
A client with Borderline Personality Disorder (BPD) tells a nurse, 'The night nurse is so much better than you. She actually cares about me.' This behavior is an example of which defense mechanism?
- ASplitting✓ 正解分裂
- BReaction Formation反向作用
- CProjection投射
- DRationalization合理化
核心概念是邊緣性人格障礙的特徵性防衛機制：分裂（Splitting）。這是一種將人、事、物極端化為「全好」或「全壞」的心理運作，缺乏整合矛盾特質的能力。為什麼正確答案對？因為病人將大夜班護理師理想化（全好），同時將白班護理師貶低（全壞），這是典型的分裂表現，目的是應對內心的焦慮與對被遺棄的恐懼。臨床思路上，護理師需識別此行為，避免團隊成員因被挑撥而產生衝突。安全優先原則要求醫療團隊必須保持高度一致性（Team Consistency），不因病人的評價而改變護理標準。
The core concept is the defense mechanism characteristic of borderline personality disorder: splitting. This is a psychological process of polarizing people, events, and things as 'all good' or 'all bad,' reflecting an inability to integrate contradictory qualities. Why is the correct answer right? The client idealizes the night-shift nurse (all good) while devaluing the day-shift nurse (all bad), a classic manifestation of splitting that serves to cope with internal anxiety and fear of abandonment. Clinically, the nurse must recognize this behavior and avoid being pitted against other team members. The principle of safety first requires the entire healthcare team to maintain a high degree of staff consistency, refusing to alter the standard of care based on the client's evaluations.
在美國的精神科護理中，對 BPD 病人的「分裂」行為有非常標準化的團隊共識會議（Staff meetings），強調界限一致。台灣臨床上，護理師有時會因為病人的讚美而感到高興，或因被批評而受傷，較容易落入病人的分裂陷阱，需要加強團隊溝通。