NCLEX-RNPsychosocial IntegrityHard
A client with a diagnosis of borderline personality disorder tells the nurse, "You are the only staff member who really understands me. The other nurses are terrible and don't care about me at all." Which is the nurse's best response?
- A"Thank you, I do try hard to understand you."
- B"I appreciate that, but the other nurses are skilled and caring too."
- C"It sounds like you're having a hard time trusting the staff consistently."
- D"You shouldn't say things like that about your other nurses."
Show answer & explanationAnswer & explanation
Correct answer: C. "It sounds like you're having a hard time trusting the staff consistently."
This statement is a classic example of splitting, a defense mechanism common in borderline personality disorder in which people or things are viewed as all good or all bad. The therapeutic response addresses the underlying pattern of splitting without validating the idealization or devaluation, helping the client recognize the behavior.
Why the other options are wrong
- A. Accepting the idealization reinforces splitting behavior and sets up staff for future devaluation.
- B. While factually defending colleagues, this misses the opportunity to address the underlying dynamic.
- D. This is judgmental and does not address the underlying defense mechanism.
Splitting (Borderline Personality Disorder)
A defense mechanism in which a person views others or situations as either all good or all bad, with no middle ground, common in borderline personality disorder.
- Leads to staff conflict if not addressed consistently
- Consistent, unified team approach is essential
- Therapeutic response names the pattern nonjudgmentally
- Avoid reinforcing idealization or devaluation
Memory trick: All good, all bad — never in between, that's splitting's scene.