A 72-year-old woman is admitted to the hospital due to abnormal vaginal bleeding. Uterine cancer is diagnosed and the patient is scheduled for a hysterectomy. Following successful surgery, the patient compliments her surgeon, exclaiming that she is "a brilliant doctor who saved my life." After an uneventful recovery, the patient is ready to return home. On the day of discharge, a nurse informs her that the surgeon is running late due to an emergency. The patient responds angrily that the surgeon is "terrible and doesn't care about patients." Which of the following is the most likely explanation for this patient's behavior?

Question

A 72-year-old woman is admitted to the hospital due to abnormal vaginal bleeding.  Uterine cancer is diagnosed and the patient is scheduled for a hysterectomy.  Following successful surgery, the patient compliments her surgeon, exclaiming that she is "a brilliant doctor who saved my life."  After an uneventful recovery, the patient is ready to return home.  On the day of discharge, a nurse informs her that the surgeon is running late due to an emergency.  The patient responds angrily that the surgeon is "terrible and doesn't care about patients."  Which of the following is the most likely explanation for this patient's behavior?

Quizplus · Accepted Answer

11ec160b_3611_0877_9249_095659a998fd_MD0001_00 Defense mechanisms are unconscious means of responding and adapting to situations to minimize anxiety and promote self-preservation. Splitting is a defense mechanism that involves experiencing the self or others in extremes, either all positive or all negative, which allows "bad" qualities to be completely separated from the "good." Although splitting provides a less complicated way of looking at people and situations, it prevents the integration of positive and negative qualities into a cohesive whole, resulting in unpredictable fluctuations between the two extremes. In this situation, the patient initially idealizes the surgeon but later characterizes her as the opposite extreme when frustrated and disappointed that she is running late. Splitting is commonly seen in borderline personality disorder and can contribute to the unstable relationships and mood instability that exemplify this disorder. (Choice A) Acting out refers to the expression of unacceptable thoughts or impulses through actions (eg, if this patient reacted by tearing up her discharge paperwork or throwing her food tray at the nurse). (Choice B) In displacement, negative feelings associated with a person or situation are transferred to a less threatening object or person (eg, if this patient said the nurse was "terrible" and unresponsive to her needs when in fact it is how she feels about the surgeon). (Choice C) Passive aggression involves expressing hostility indirectly in an unassertive way (eg, if this patient expressed her anger by remaining noncommunicative during the discharge process or deliberately neglected to sign her discharge papers). (Choice D) In projection, one's own unacceptable thoughts or feelings are perceived as coming from someone else (eg, if this patient on the day of discharge felt that the surgeon was angry with her). (Choice E) Reaction formation is the redirection of an unacceptable impulse into its opposite (eg, if this patient sent the physician a thank-you note and lavish gift instead of expressing her anger). Educational objective: Splitting is a defense mechanism that involves organizing experiences of the self or others into extremes to keep positive and negative aspects separated. It is commonly seen in patients with borderline personality disorder. __________ References: Defense mechanisms reported by patients with borderline personality disorder and axis II comparison subjects over 16 years of prospective follow-up: description and prediction of recovery. (http://www.ncbi.nlm.nih.gov/pubmed/23223866) Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. (http://www.ncbi.nlm.nih.gov/pubmed/23458114)

A 72-Year-Old Woman Is Admitted to the Hospital Due to Abnormal