Defense mechanisms

Question 1

Topographic theory (Freud)

Answer 1

1. Unconscious: Includes repressed thoughts that are out of one’s awareness; involves primary process thinking (primitive, pleasure-seeking urges with no regard to logic or time, prominent in children and psychotics). Thoughts and ideas may be repressed into the unconscious because they are embarrassing, shameful, or otherwise too painful.
2. Preconscious: Contains memories that are easy to bring into awareness, but not unless consciously retrieved.
3. Conscious: Involves current thoughts and secondary process thinking (logical, organized, mature, and can delay gratification).

Question 2

Structural theory (Freud)

Answer 2

1. Id: Unconscious; involves instinctual sexual/aggressive urges and primary process thinking.
2. Ego: Serves as a mediator between the id and external environment and seeks to develop satisfying interpersonal relationships; uses defense mechanisms to control instinctual urges and distinguishes fantasy from reality using reality testing. Problems with reality testing
   occur in psychotic individuals.
3. Superego: Moral conscience. Represents “morality, society, and parental teaching.”

Question 3

Types of defense mechanisms

Answer 3

Defense mechanisms are used by the ego to protect oneself and relieve anxiety by keeping conflicts out of awareness. They are unconscious processes that may be normal and healthy when used in moderation (ie, adaptive), or they may be unhealthy and seen in some psychiatric disorders when used excessively (ie, maladaptive).

Mature defense mechanisms are healthy and adaptive, and they are seen in normal adults. Neurotic defenses are encountered in obsessive-compulsive patients, hysterical patients, and adults under stress. Immature defenses are seen in children, adolescents, psychotic patients, and some nonpsychotic patients. They are the
most primitive defense mechanisms.

Question 4

Mature defenses

Answer 4

Mature ego defenses are commonly found in healthy, high-functioning adults. These defenses often help people integrate conflicting emotions and thoughts.

1. Altruism: Performing acts that benefit others in order to vicariously experience pleasure.
2. Humor: Expressing (usually) unpleasant or uncomfortable feelings without causing discomfort to self or others.
3. Sublimation: Satisfying socially objectionable impulses in an acceptable manner (thus channeling them rather than preventing them). (Eg: Person with unconscious urges to physically control others becomes a prison guard.)
4. Suppression: Purposely ignoring an unacceptable impulse or emotion in order to diminish discomfort and accomplish a task. (Eg: Nurse who feels nauseated by an infected wound puts aside feelings of disgust to clean wound and provide necessary patient care.)

[Thought suppression, as a defense mechanism, is a conscious process that involves avoiding paying attention to a particular emotion. Therefore, it is not
an unconscious reaction.]

Question 5

Neurotic defenses

Answer 5

1. Controlling: Regulating situations and events of external environment to relieve anxiety.
2. Displacement: Shifting emotions from an undesirable situation to one that is personally tolerable. (Eg: Student who is angry at his mother talks back to his teacher the next day.)
3. lntellectualization: Avoiding negative feelings by excessive use of intellectual functions and by focusing on irrelevant details or inanimate objects. (Eg: Physician dying from colon cancer describes the pathophysiology of his disease in detail to his 12-year-old son.)
4. Isolation of affect: Unconsciously limiting the experience of feelings or emotions associated with a stressful life event in order to avoid anxiety. (Eg: Woman describes the recent death of her beloved husband without emotion.)
5. Rationalization: Creating explanations of an event in order to justify outcomes or behaviors and to make them acceptable. (Eg: “My boss fired me today because she’s short tempered and impulsive, not because I haven’t done a good job.”)
6. Reaction formation: Doing the opposite of an unacceptable impulse. (Eg: Man who is in love with his married coworker insults her.)
7. Repression: Preventing a thought or feeling from entering consciousness. (Repression is unconscious, whereas suppression is a conscious act.)

Question 6

Immature defenses

Answer 6

1. Acting out: Giving in to an impulse, even if socially inappropriate, in order to avoid the anxiety of suppressing that impulse. (Eg: Man who has been told his therapist is going on vacation “forgets” his last appointment and skips it.)
2. Denial: Not accepting reality that is too painful (Eg: Woman who has been scheduled for a breast mass biopsy cancels her appointment because she believes she is healthy.)
3. Regression: Performing behaviors from an earlier stage of development in order to avoid tension associated with current phase of development. (Eg: Woman brings her childhood teddy bear to the hospital when she has to spend the night.)
4. Projection: Attributing objectionable thoughts or emotions to others. (Eg: Husband who is attracted to other women believes his wife is having an affair.)

Question 7

Other defense mechanisms

Answer 7

1. Splitting: Labeling people as all good or all bad (often seen in BPD). (Eg: Woman who tells her doctor, “You and the nurses are the only people who understand me; all the other doctors are mean and impatient.”)
2. Undoing: Attempting to reverse a situation by adopting a new behavior. (Eg: Man who has had a brief fantasy of killing his wife by sabotaging her car takes the car in for a complete checkup.)