一位因表淺自殘入院的22歲女性被診斷出患有邊緣性人格障礙症 (BPD)。在下午班期間，她抓住護理師 A 的手熱情地說：「妳是我這輩子見過最完美如天使般的護士。大夜班的 B 護士是個無情邪惡的怪物，她討厭我還故意拒絕給我安眠藥。我只信任妳。拜託妳能不能去跟醫生說幫我多加一顆藥？」就在隔天，當護理師 A 拒絕讓她提早使用電話的請求後，該個案尖叫著說：「妳跟 B 護士一樣都是沒有價值的垃圾！」該個案正經典地展現了哪一種具體行為操縱策略？
A 22-year-old female admitted for superficial self-mutilation has a diagnosis of Borderline Personality Disorder (BPD). During the afternoon shift, she grasps Nurse A's hand and says passionately, "You are the most perfect and angelic nurse I have ever met in my life. Nurse B from the night shift is a heartless, evil monster who hates me and deliberately refused my sleeping pills. I only trust you. Can you please talk to the doctor to get me an extra pill?" The very next day, after Nurse A denies a request for early phone privileges, the client screams, "You are worthless garbage just like Nurse B!" Which specific behavioral manipulation tactic is this client classically exhibiting?
- AReaction Formation反向作用
- BEcholalia模仿言語
- CTransference移情作用
- DSplitting分裂正確答案
- D分裂
本題測驗精神科最具代表性的人格障礙：邊緣性人格障礙症（Borderline Personality Disorder, BPD）的經典特徵。此疾患者極度缺乏穩定的自我認同且極度害怕被拋棄。他們在人際關係中會使用一種防衛機轉叫做「分裂作用（Splitting，非黑即白）」。因為他們的大腦無法將同一事物身上好的特質與壞的特質進行『整合』。所以當醫療人員滿足他們時，他們會將其『極端理想化（Idealization，完美的天使）』；但只要一次需求被拒絕，他們就會瞬間將同一人『極端貶低（Devaluation，無價值的垃圾）』。他們也經常利用這種將某人捧高、把另一人踩低的手法（如本例捧護士A踩護士B）來操縱團隊、挑撥離間。選項D（Splitting）是正解。選項C移情作用（Transference）是將對過去如父母的情感轉移到護士身上。選項A反向作用在前面考過。選項B回音語（Echolalia）是自閉症或思覺失調重複別人說話的症狀。
- A反向作用
反向作用的行為與潛意識中不可接受的感覺完全相反；它無法解釋用極端的貶低與奉承來操縱工作人員的行為。
- B模仿言語
回音是指無意義、像鸚鵡般重複別人說的話，通常見於自閉症或僵直症中，在此處完全無關。
- C移情作用
移情作用是不知不覺地將對某個重要人物的童年情感轉移到醫療提供者身上，而非在極端的讚美與憎恨之間突兀切換。
- D · 正確答案分裂
分裂（非黑即白）是 BPD 標誌性的僵化防衛機轉；病患將人物分類為「全好（天使）」或「全壞（怪物）」，因為他們缺乏整合複雜特質的能力。
「非黑即白(Splitting)」是 BPD 的靈魂，也是精神科國考出題頻率最高的專有名詞。台美的精神科在應付這類病患時，都強調一項原則：團隊間不准有秘密，必須設立一致的界線 (Set consistent limits)，否則護理站會因為病患的挑撥離間立刻引發內鬨大戰。
English explanation
This question tests the hallmark behavior of Borderline Personality Disorder (BPD): Splitting. Clients with BPD have an unstable self-image and intense fear of abandonment. They use the defense mechanism of 'splitting' (black-and-white thinking) because they cannot integrate good and bad qualities in the same person. When a caregiver meets their needs, they idealize them as 'perfect angels'; the moment a need is denied, they abruptly devalue the same person as 'worthless garbage.' They also pit staff against each other (praising one nurse while degrading another) to manipulate the team. Option D (Splitting) is correct. Transference (C) involves transferring childhood feelings onto a provider. Reaction formation (A) is acting opposite to an unconscious feeling. Echolalia (B) is the meaningless repetition of others' speech, typical of autism or schizophrenia.
最近修訂：2026-05-16