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✓ 正解分裂
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。
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.
「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。