Cluster B personality disorders Quiz: Ace Your Exams

A 20-year-old man is brought to the emergency department by his parent after injuring his arm. The patient broke up with his partner earlier today; several hours later, his parent found him in his room attempting to use a knife to cut his wrist. He has been hospitalized four times for similar suicide attempts in the past three years following breakups with romantic partners. The patient reports that he was not trying to kill himself and that “I just feel like I don’t know how to deal with anger and stress.” His parent mentions that, since middle school, the patient has had periods of sadness lasting 1-2 days in which he goes into a “bottomless black hole,” where it is “near impossible” to make him feel better. Vitals are within normal limits. Physical examination shows multiple rows of well-healed scars bilaterally on the wrists. Which of the following defense mechanisms does this patient most likely demonstrate considering his most likely diagnosis?