# A nurse is assessing a 28-year-old client with suspected borderline personality disorder. Which assessment finding would be most indicative of this diagnosis? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543384 > language: ko > subject: Mental Health ## 문제 A nurse is assessing a 28-year-old client with suspected borderline personality disorder. Which assessment finding would be most indicative of this diagnosis? ## 보기 1. Consistent pattern of grandiosity and need for admiration from others 2. Intense fear of abandonment alternating with idealization and devaluation of relationships **✔ 정답** 3. Persistent disregard for social norms and rights of others with lack of remorse 4. Excessive need to be taken care of with submissive and clinging behaviors **정답: 2** ## 해설 Borderline personality disorder is most indicated by an intense fear of abandonment with unstable relationships alternating between idealization and devaluation. Other options describe features of narcissistic, antisocial, or dependent personality disorders. ## 심화 해설 Correct Answer: 2 The most indicative assessment finding for borderline personality disorder (BPD) is an intense fear of abandonment alternating with idealization and devaluation of relationships. This pattern, often called "splitting," is a core feature of the disorder and directly reflects the underlying personality pathology described in the research literature. The psychometric analysis of the Borderline Personality Inventory (BPI) confirms that the structure of BPD is grounded in Kernberg's theory of borderline personality organization [1]. A central component of this model is the use of primitive defenses, with splitting being paramount. Splitting is the unconscious inability to integrate positive and negative qualities of the self and others into a cohesive whole. Clinically, this manifests as the rapid shift between idealizing a person (seeing them as all-good) and devaluing them (seeing them as all-bad), which is typically triggered by a perceived threat of rejection or abandonment. The intense, frantic efforts to avoid this real or imagined abandonment drive the tumultuous interpersonal relationships characteristic of BPD. This relational instability is further explained by deficits in mentalization, which is the capacity to understand one's own and others' mental states. Research using ecological momentary assessment demonstrates that difficulties with mentalizing are linked to BPD traits and fluctuate in daily life [4]. When a patient with BPD experiences stress in a relationship, their ability to mentalize can fail, making it difficult to perceive a partner’s intentions accurately. This failure reinforces the splitting dynamic, as the partner's momentary inattention can be misinterpreted as malicious abandonment, leading to devaluation, whereas a small gesture of care can lead to intense idealization. The emotional intensity behind this fear of abandonment is fueled by profound emotion dysregulation, which is strongly connected to adverse childhood experiences (ACEs) like emotional and sexual abuse [3]. A history of trauma disrupts the development of stable emotional regulation capacities. Consequently, the fear of abandonment is not a mild anxiety but a visceral, overwhelming emotional crisis that can trigger dissociative symptoms. The alternating idealization and devaluation can be understood as a maladaptive, desperate strategy to manage this unbearable emotional pain and secure the attachment figure. From a dimensional personality trait perspective, the distinction between BPD and healthy controls is captured by specific maladaptive traits . The correct answer reflects the high levels of Negative Affectivity (specifically Separation Insecurity and Emotional Lability) and Disinhibition (specifically Impulsivity) that define the disorder. In contrast, the other options describe different personality pathology domains: Option 1 aligns with narcissistic personality disorder (grandiosity, need for admiration), Option 3 with antisocial personality disorder (disregard for norms, lack of remorse), and Option 4 with dependent personality disorder (excessive need to be taken care of, submissive behavior).References (research sources) - [1]Internal Structure, Reliability, and Gender-Related Item Functioning of the Borderline Personality InventoryResearch articleSoroko E, Kleka P, Cierpiałkowska LW, Leichsenring F. (2026) · DOI: 10.31234/osf.io/fdb2u_v1 - [3]Beyond the Scars: An Analysis of Adverse Childhood Experiences and the Interconnections Between Emotion Dysregulation, Dissociation, and Trauma in Patients with Borderline Personality Disorder.Research articleCiringione L, Perinelli E, Mancini F, Prunetti E. (2025) · DOI: 10.3390/brainsci15080889 - [4]Mentalizing on the edge: borderline traits and their association with real-time self-reflection - an ecological momentary assessment study.Research articleHöller I, Schwitzky S, Forkmann T, Forster S, Santangelo PS. (2026) · DOI: 10.1186/s40479-026-00347-1 ## 임상 시나리오 Assessing Borderline Personality DisorderIdentifying the Core Feature of Relational Instability The most indicative finding is a pattern of unstable interpersonal relationships characterized by alternating extremes of idealization and devaluation, often called splitting. This is driven by an intense fear of real or imagined abandonment. Splitting is a primitive defense mechanism where the patient cannot integrate positive and negative attributes of self and others. A person is viewed as all good or all bad, shifting rapidly based on perceived rejection or conflict. This relational pattern is distinct from other personality disorders. It is not the grandiosity of narcissistic PD, the disregard for others seen in antisocial PD, or the submissive clinging of dependent PD. CautionBe aware that frantic efforts to avoid abandonment can lead to impulsive behaviors (e.g., self-harm, substance use). Assess for suicidal ideation and self-mutilation risk, as these are common safety concerns in BPD. ## 핵심 개념 - **Splitting** — A primitive defense mechanism where a person fails to integrate positive and negative qualities of self and others, leading to alternating idealization and devaluation. - **Borderline Personality Disorder (BPD)** — A personality disorder characterized by instability in interpersonal relationships, self-image, and affects, and marked impulsivity, often driven by a fear of abandonment. - **Mentalization** — The capacity to understand one's own and others' mental states, often impaired in BPD, contributing to relational difficulties. ## 같은 주제 문제 - [A nurse is caring for a client with borderline personality disorder who frequently engages…](https://mymerci.kr/pages/nclex_q.php?qn_id=543385) - [A nurse is caring for a client with borderline personality disorder who has intense fear o…](https://mymerci.kr/pages/nclex_q.php?qn_id=543386) - [A nurse is caring for a 25-year-old client with borderline personality disorder in an inpa…](https://mymerci.kr/pages/nclex_q.php?qn_id=543387) - [A nurse is caring for a client with borderline personality disorder who has been admitted …](https://mymerci.kr/pages/nclex_q.php?qn_id=543388) - [A nurse is caring for a 25-year-old client with major depressive disorder who has a histor…](https://mymerci.kr/pages/nclex_q.php?qn_id=543389) - [A nurse is caring for a 40-year-old client with bipolar disorder who has been admitted fol…](https://mymerci.kr/pages/nclex_q.php?qn_id=543390) - [A nurse is caring for a client with borderline personality disorder who has been admitted …](https://mymerci.kr/pages/nclex_q.php?qn_id=543391) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._