一位邊緣型人格障礙（BPD）病人即將出院，對護理師說：「你是這裡唯一關心我的護理師，其他人都對我很壞。」這屬於哪種心理防衛機制？
A client with borderline personality disorder is being discharged. The client says to the nurse, 'You are the only nurse who ever cared about me. Everyone else here is mean.' This is an example of which defense mechanism?
- ASplitting✓ 正解分裂
- BProjection投射
- CReaction Formation反向作用
- DRationalization合理化
「分裂（Splitting）」是邊緣型人格障礙最典型的防衛機制。病人在心理上無法整合他人的優點與缺點，將人看作是「全好」或「全壞」。題目中病人將一名護理師理想化（全好），而將其他工作人員貶低（全壞），這是典型的分裂表現。選項 B 投射是將自己的情緒歸咎於他人；選項 C 反向作用是表現出與內心相反的行為；選項 D 合理化是為不當行為找藉口。臨床思路上，識別分裂機制對護理團隊至關重要，因為這常導致醫療團隊內部的不和諧（Staff Splitting），護理師需保持專業界線並維持團隊溝通的一致性。
Splitting is the hallmark defense mechanism of borderline personality disorder. The patient cannot integrate positive and negative qualities and views others as either 'all good' or 'all bad.' Idealizing one nurse while devaluing the rest of the staff exemplifies splitting. This pattern frequently causes 'staff splitting'—team conflict that must be addressed by maintaining consistent communication and clear boundaries. Projection, reaction formation, and rationalization are different defense mechanisms.
在美國的精神科實務中，預防「Staff Splitting」是團隊會議的重點；台灣則較多強調藥物管理與個別心理治療，對護理團隊如何集體應對病人分裂行為的臨床指引較少見。