Defense Mechanisms

Definition and Classification

Definition

Defense mechanisms (ego defenses) are subconscious processes that act to protect the ego. Defense mechanisms may be seen in times of stress or as part of personality disorders Personality Disorders A major deviation from normal patterns of behavior. Cluster A Personality Disorders. While these mechanisms may provide rapid, short-term relief from unpleasant feelings ( anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder, shame, guilt), they may also result in long-term complications (hinder insight Insight Psychiatric Assessment, prevent treatment compliance Compliance Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. Veins: Histology).

Classification

Grouped by the relative degree of maturity according to psychologist George Vaillant’s classifications:

• Pathologic or narcissistic-psychotic
• Immature
• Neurotic
• Mature

Pathologic or Narcissistic-Psychotic Defense Mechanisms

Pathologic defense mechanisms are based on avoiding, negating, or distorting reality, and are commonly found in young children, adult dreams/fantasies, or as part of psychotic processes.

Denial

• Avoiding a painful reality by pretending that it does not exist
• Example: A soldier’s wife continues to believe that her husband will return home, despite receiving a letter about his death.

Distortion

• Grossly reshaping reality to fit inner desires
• May include grandiose delusions or hallucinations Hallucinations Subjectively experienced sensations in the absence of an appropriate stimulus, but which are regarded by the individual as real. They may be of organic origin or associated with mental disorders. Schizophrenia
• Example: A student believes she failed an exam because the questions were unfair and not because she didn’t prepare properly.

Delusional projection

• Holding a fixed belief that is not rectified when faced with evidence of the contrary
• Often persecutory in nature
• Example: A man commits a crime and is convinced that he is being followed wherever he goes.

Immature Defense Mechanisms

Immature defense mechanisms arise from anxieties with intimacy or its loss. They are encountered in preadolescent years and in adults, especially those affected by personality disorders Personality Disorders A major deviation from normal patterns of behavior. Cluster A Personality Disorders.

Acting out

• An individual tends to hide unacceptable feelings by socially inappropriate actions (e.g., exaggerated outburst).
• Often seen in individuals with borderline or antisocial personality disorder Antisocial Personality Disorder A personality disorder whose essential feature is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. The individual must be at least age 18 and must have a history of some symptoms of conduct disorder before age 15. Cluster B Personality Disorders
• Examples:
  • Instead of just saying, “I’m very angry with you,” the person who acts out may throw an object at the person or at the wall, which acts as a type of pressure release. 
  • A child’s temper tantrum is also a form of acting out when they don’t get their way with a parent. 
  • Self-injury is a third type of acting out, in which physical pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways acts as a substitute for that which a person cannot stand to feel emotionally.

Idealization

• Perceiving and focusing only on the best qualities of a person
• Example: A worker describes his boss as being the best in the world, ignoring any flaws.

Introjection (identification)

• Unconsciously simulating behaviors of someone who is perceived to be more powerful
• Conscious patterning is referred to as imitation.
• Example: children taking on behaviors and attitudes of their parents

Passive aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder

• Indirect way of expressing aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder
• Seen in individuals with borderline personality disorder Borderline Personality Disorder A personality disorder marked by a pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. Cluster B Personality Disorders
• Example: An office worker purposefully shows up late to work everyday after having a conflict with his manager.

Projection

• Attributing unacceptable feelings, desires, or thoughts to someone else
• Associated with paranoid personality disorder Paranoid Personality Disorder A personality disorder characterized by the avoidance of accepting deserved blame and an unwarranted view of others as malevolent. The latter is expressed as suspiciousness, hypersensitivity, and mistrust. Cluster A Personality Disorders
• Example: A man who had an extramarital affair accuses his wife of being unfaithful.

Regression Regression Corneal Abrasions, Erosion, and Ulcers

• Reverting to a behavior that is more childlike (turning back to a previous developmental level) during stressful situations
• Example: When the 2nd child is born, the older 4-year-old sibling starts having temper tantrums or demands breast milk as well.

Splitting

• Inability to conceptualize both negative and positive qualities of oneself or others
• Common form of defense mechanism Defense mechanism Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. Psychotherapy in individuals with borderline personality disorder Borderline Personality Disorder A personality disorder marked by a pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. Cluster B Personality Disorders
• Example: An individual views all physicians Physicians Individuals licensed to practice medicine. Clinician–Patient Relationship as competent while viewing all nurses as incompetent.

Denial

• Refusal to accept reality or facts
• Prevents an individual from dealing with disagreeable feelings
• Example: A woman diagnosed with breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer decides to defer her interventions, claiming she feels good.

Neurotic Defense Mechanisms

Neurotic defense mechanisms are common among individuals with neurotic disorders as well as normal/healthy-appearing individuals. Neurotic defense mechanisms alleviate distressing effects and may be more socially acceptable.

Displacement

• Redirection of unpleasant emotions or impulses toward another person or object (from higher to lower in perceived hierarchy)
• Example: A husband who is angry at his boss shouts at his children when he gets home.

Dissociation

• A feeling of disconnection from a stressful or traumatic event Traumatic event An emotionally painful, shocking, stressful, and sometimes life-threatening experience. It can result from witnessing distressing events such as natural disasters, physical or sexual abuse, and terrorism or other acts of violence. Posttraumatic Stress Disorder (PTSD)
• Allows individuals to block out mental trauma and stress by “removing” themselves from an uncomfortable situation
• May develop into a dissociative disorder
• Example: A boy who experienced sexual abuse Sexual Abuse Sexual abuse and assault are major public health problems that affect many people from all walks of life, including people of all ages and genders, but it is more prevalent in women and girls, with reports of up to 1 in 3 experiencing sexual assault at some time in their life. Sexual Abuse stares at the wall and daydreams whenever confronted with traumatic memories.

Intellectualization

• Using information and facts to avoid dealing with unpleasant situations
• Example: While a patient is dying on the operating table due to an error Error Refers to any act of commission (doing something wrong) or omission (failing to do something right) that exposes patients to potentially hazardous situations. Disclosure of Information, a surgeon calmly explains the technical details/complications of the procedure to the students.

Isolation affect

• Separating an event from the emotions that accompany it
• Example: A woman who experienced a bomb attack recounts the incident in a matter-of-fact manner.

Rationalization

• Coming up with rational explanations for events in a way other than the real reason
• Seen in individuals with obsessive-compulsive disorders
• Example: A student blames his teacher for failing an exam to avoid admitting he did not prepare adequately.

Reaction formation

• Transforming unacceptable emotions or impulses to the exact opposite direction
• Example: A person intrigued by certain ideas becomes a strong, outspoken voice against those ideas/actions.

Repression

• Involuntarily pushing an unpleasant or unacceptable feeling or thought out from consciousness
• Example: Victims of sexual abuse Sexual Abuse Sexual abuse and assault are major public health problems that affect many people from all walks of life, including people of all ages and genders, but it is more prevalent in women and girls, with reports of up to 1 in 3 experiencing sexual assault at some time in their life. Sexual Abuse often repress associated memories, which then become difficult to access.

Undoing

• Behaving or acting in a way to reverse unacceptable behavior
• Example: religious penance, including praying and confessing one’s sins

Mature Defense Mechanism

Mature defense mechanisms are more sophisticated and require more experience and self-awareness. Mature defense mechanisms help approach reality in a more meaningful and socially adaptive way.

Altruism

• Performing acts that benefit others in order to vicariously experience pleasure
• May help individuals in avoiding negative feelings
• Example: A selfish chief executive officer regularly donates to charity organizations.

Humor

• Expressing uncomfortable feelings (often in the form of jokes) without causing oneself discomfort
• Example: A man with sleep apnea Sleep apnea Repeated cessation of breathing for > 10 seconds during sleep and results in sleep interruption, fatigue, and daytime sleepiness. Obstructive Sleep Apnea makes jokes about his continuous positive airway Airway ABCDE Assessment pressure ( CPAP CPAP A technique of respiratory therapy, in either spontaneously breathing or mechanically ventilated patients, in which airway pressure is maintained above atmospheric pressure throughout the respiratory cycle by pressurization of the ventilatory circuit. Noninvasive Ventilation) mask.

Sublimation

• Satisfying one’s wishes or impulses in a socially acceptable manner → channeling rather than preventing them
• Example: A childless elderly man who always wanted to have children spends a lot of time teaching his nephew soccer.

Suppression

• Deliberately ignoring an uncomfortable or unacceptable impulse or emotion to diminish discomfort and accomplish a task
• Example: A student breaks up with his girlfriend the night before an important exam. He does not show any emotion until he has taken his exam.

Clinical Relevance

• Personality disorders Personality Disorders A major deviation from normal patterns of behavior. Cluster A Personality Disorders: a cluster of mental diseases that involve semipermanent patterns of thoughts and behavior that can be harmful and obstinate. Individuals with personality disorders Personality Disorders A major deviation from normal patterns of behavior. Cluster A Personality Disorders have difficulties in handling everyday stresses and issues and their behavior can lead to serious issues with relationships and work. Psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy may involve identifying immature defense mechanisms and transforming them into more mature types.
• Somatoform disorders: Somatic symptom disorder Somatic symptom disorder Somatic symptom disorder (SSD) is a condition characterized by the presence of 1 or more physical symptoms associated with excessive thoughts and feelings about symptom severity. Symptoms are usually not dangerous, but the patient devotes excessive time and energy to figuring out their underlying cause and how to treat them. Somatic Symptom Disorder, conversion disorder Conversion disorder Conversion disorder (CD), also called functional neurological symptom disorder, is a psychiatric disorder with prominent motor or sensory impairment which is not compatible with any known neurologic medical condition. The deficits are not consciously produced. Functional Neurological Symptom Disorder (Conversion Disorder), and illness anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder disorder have psychodynamic models of etiology that are thought to arise from a maladaptive defense mechanism Defense mechanism Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. Psychotherapy. Individuals with somatoform disorders shield themselves from emotional stress, which is subconsciously manifested as a physical symptom or a threat of illness.