PsychSense: Sensible Psychological Solutions

Question and Answer

I am a new nurse on a psychiatric inpatient unit. I was told that I was allowing a patient to “split.”  The person who said this to me seemed annoyed. Can you tell me what it means? What did I do wrong? I didn’t want to ask her.

 You may have heard the expression “splitting” as a description of the way that persons with personality disorders  relate to others.  Splitting is a coping mechanism (also called a defense mechanism) that is used by both persons with and without Borderline Personality Disorder.  It is a mechanism that is considered immature and is an unhealthy way to deal with disappointment in relationships.

• How does Splitting Work?  

  Splitting is defined as the inability to reconcile the presence of both positive and negative aspects in another. Splitting allows the person who uses it  to see others as either all good or all bad. Of course no human being is either “all good or all bad” but a combination of strengths and weakness. Splitting and Relationships  Although being the “all good” person may initially feel flattering, be aware that it will not last! When the person who is seen as all good disappoints (which of course is inevitable when expectations are unrealistic) they quickly become “all bad”. It is often this change in perception that will make someone struggling with BPD enraged. Persons who use splitting have unrealistic and unobtainable expectations of others, chaotic relationships, and are inevitably disappointed.

• Splitting and Relationships.
  
  Although being the “all good” person may initially feel flattering, be aware that it will not last! When the person who is seen as all good disappoints (which of course is inevitable when expectations are unrealistic) they quickly become “all bad”. It is often this change in perception that will make someone struggling with BPD enraged. Persons who use splitting have unrealistic and unobtainable expectations of others, chaotic relationships, and are inevitably disappointed. In order to grow and heal, a person who uses splitting as a way of  coping must somehow come to terms with the limitations of other human beings (and of themselves).
  
• Dealing with Splitting.

  In order to grow and heal, a person who uses splitting as a way of  coping must somehow come to terms with the limitations of other human beings (and of themselves). On an inpatient unit the best way to deal with splitting is not to engage in conversations about other staff with patients. Refer them to the person themselves or if necessay the nurse leader.  It is critical that all  staff are clear and in agreement  about the treatment and approaches to be used with the patient . This is also the same way to deal with difficult people in work or social groups who try to get people to take sides on an issue. an open discussion with everyone involved is the best strategy to avoid splitting.