"Level of defensive operations" refers to whether the person’s defenses are based primarily on repression or on splitting. Defenses based on repression, such as isolation of affect, reaction formation, intellectualization, rationalization, and some forms of denial, function by making or keeping ideas or affects unconscious. Defenses based on splitting, such as projection, projective identification, and pathological idealization and devaluation, function by allowing the person to experience thought or affect as if it originated from outside of the self. Patients whose level of defensive operations revolve around splitting and related defenses lack object constancy in that they have difficulty conceptualizing others as having both good and bad qualities. This cripples the person’s capacity for meaningful relationships with others, a hallmark of personality dysfunction. Defensive operations can be well assessed within the patient’s relationship with the clinician, even during the evaluation, and the clinician should be attuned to clues about level of defensive operation in order to predict the presence or absence of serious character pathology. In the example here, the clinician notes that although there is denial of axis II traits, the patient is immediately "tremendously grateful." Although this feature is not pathognomonic for a personality disorder, very strong feelings—positive or negative—on the part of the patient early on should alert the clinician to the possibility of pathological idealization or devaluation. In this patient, early idealization quickly gave way to devaluation after an "average expectable" error on the clinician’s part. Similarly, the fact that the patient indicates that she does not have friends signals major difficulties in object relationships, another indication of poor ego functioning.