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Psychiatry 1st LE > Stress, Coping, and Defense Mechanisms (trans 4) > Flashcards

Stress, Coping, and Defense Mechanisms (trans 4) Flashcards

1
Q

Defense Mechanisms

A
  1. Narcissistic-Psychotic Defense (NPD) or (Immature/Pathological)
  2. Immature Defenses (ID)
  3. Neurotic Defenses (ID)
  4. Mature Defenses (MD)
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2
Q

STRESS
 A normal physical response to events that make you feel threatened or upset your balance in some way
 A circumstance that disturbs the normal physiological functioning of a person
 When you sense danger (real or imagined). The body’s defense kicks into high gear in a rapid, automatic process.

A 
Stress Response
 Fight or flight or freeze
 Foot on the gas, foot on the brake, foot on both
 Involvement of the Autonomic Nervous System particularly the Sympathetic System
 Involvement also of the
o Neurotransmitter
o Endocrine
o Immune systems
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3
Q

Freud’s Theory

 Our psychic apparatus (mind) has 3 components:

A

id, ego and superego

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4
Q

Freud’s Theory: Id

A

 Instinct drives instinct
 Operated under primary processing
 Not synonymous with unconscious

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5
Q 
Freud’s Theory: Ego
Spans all three dimensions:
o Unconscious
o Preconscious
o Conscious
A

 Conscious and Preconscious- logical and abstract thinking, verbal expressions
 Unconscious- defense mechanism
 Controls motility, perception, contact with reality
 Controls the delay and modulation of the drive expression (id) through the defense mechanism

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6
Q

Freud’s Theory: Functions of the Ego

A
  1. Control and regulation of the industrialized drives
  2. Judgment- secondary process thinking
  3. Relation to reality
  4. Object relationships
  5. Synthetic function
  6. Primary autonomic ego function
  7. Secondary autonomic ego function
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7
Q

Freud’s Theory: Superego

A

 Establishes and maintains an individual’s moral conscience
 Ideals and values internalized from parents
 Provides ongoing scrutiny of the person’s behavior, thoughts and feelings
 Makes comparisons with expected standards of behavior and offers approval or disapproval => occurs largely in the unconscious

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8
Q

Freud’s Theory: DEFENSE MECHANISMS
 a coping technique that REDUCES ANXIETY arising from unacceptable or potentially HARMFUL impulses
 are UNCONSCIOUS, NOT used consciously
 means designated to PROTECT us from things we don’t want to deal with
 help the EGO cope with ANXIETY

A

Why study defense mechanisms?
 Identification and notation of defense mechanisms can be an important part of the psychological assessment and influence on the treatment process.

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9
Q

Narcissistic-Psychotic Defense (Immature/Pathological)
 Very immature
 Idealised aspects of the self are preserved and its limitations denied
 Occur in psychotic individuals, young children and adult dreams or fantasies
 part of a psychotic process
 Avoiding, negating, disturbing reality

A
  1. Projection
  2. Denial
  3. Distortion
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10
Q

Narcissistic-Psychotic Defense (Immature/Pathological) - Projection

A
  • Attributing one’s own thoughts, feelings, or motives to another
  • Perceiving and reacting to unacceptable inner impulses as though they were outside of oneself
  • On a psychotic level, it comes in the form of delusion – about external reality usually persecutory like psychotic delusions
  • Hallucinated recrimination
    Ex. Man who wants another woman thinking that his wife is cheating on him
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11
Q

Narcissistic-Psychotic Defense (Immature/Pathological) - Denial

A
  • Refusing to accept that something exists or happened
  • psychotic denial of external reality which affects the perception of external reality more than the perception of internal reality.
    Ex. Seeing but refusing to acknowledge what one sees or hearing or negating what one actually hears (denial to a sensory experience)
  • Not all denial is psychotic
  • Avoids becoming aware of some painful aspects of reality
  • May lead to fantasy or delusion
  • Common response in patients with newly diagnosed cancer or AIDS
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12
Q

Narcissistic-Psychotic Defense (Immature/Pathological) - Distortion

A
  • Grossly shaping the experience of external reality to suit inner needs
  • Unrealistic megalomaniac beliefs, hallucination, wish-fulfilling delusions, delusional, grandiosity, superiority or entitlement
    Ex. A kid who believes he has gained the powers of Spiderman, tried climbing the wall of his house
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13
Q 
Immature Defenses (ID)
- Difficult to deal with and seriously out of touch with reality
A
  1. Acting Out
  2. Hypochondriasis
  3. Introjection
  4. Passive Aggressive
  5. Regression
  6. Schizoid Fantasy
  7. Somatization
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14
Q

Immature Defenses (ID): Acting Out

A
  • Direct expression of an unconscious wish or impulse in action to avoid being conscious of the accompanying affect
  • The unconscious fantasy is lived out and impulsively enacted in behaviour
  • Giving in to an impulse to avoid the tension from the postponement of their expression
    Ex. Temper tantrums
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15
Q

Immature Defenses (ID): Hypochondriasis

A
  • Transformation of reproach towards others arising from bereavement, loneliness or unacceptable aggressive impulses into self reproach in the form of somatic complaints of pain, illness etc.
  • Real illness may be over emphasized or exaggerated for evasive and regressive possibilities
  • Responsibilities may be avoided, guilt circumvented, and impulses warded off
    Ex. You keep on believing that you are sick, when you are itchy, you immediately think you have cancer or other illnesses
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16
Q

Immature Defenses (ID): Introjection

A
  • Involves the internalization of characteristics of the object with the goal of ensuring closeness to and constant presence of the object
  • If the object dies/leaves, introjection nullifies or negates the loss by taking on characteristics of the object, thus internally preserving the object
  • Introjection of a feared object serves to avoid anxiety through internalizing the aggressive characteristics of the object thereby putting the aggressive under one’s own control => identification with the aggression
  • Identification of the victim (self punitive traits, takes in both the destruction and preservation of the object)
    Ex. Main defense mechanism in depression-I identify myself with my mom, I introjected her good and not so good qualities, I want to become a doctor like her, but when she dies, I become angry, depressed and I want to die to
17
Q

Immature Defenses (ID): Passive Aggressive

A
  • Aggression toward an object expressed indirectly and ineffectively through passivity, masochism, and turning against oneself
    Ex. PROCRASTINATION
18
Q

Immature Defenses (ID): Regression

A
  • A reverse to immature patterns of behavior
  • Return to a previous developmental stage or functioning to avoid the anxieties or hostilities involved in the latter stage
  • Disruption of equilibrium at a later phase of development
    Ex. Thumb sucking, fetal position when depressed
19
Q

Immature Defenses (ID): Schizoid Fantasy

A
  • Tendency to use fantasy to indulge in autistic retreat to the purpose of conflict resolution and gratification
    Ex.if you want to be a surfer and you go to school in a surfer’s outfit with a surf board, in a mental exam, they are inappropriately dressed
20
Q

Immature Defenses (ID): Somatization

A
  • Conversion of psychic deviations into bodily symptoms/somatic manifestations
    Ex. Paralysis, headaches, chest pains, weakness, sickness obtained from stress
21
Q

Neurotic Defenses (ND)
 Common in apparently normal and healthy, as well as in neurotic disorders
 Function in alleviation of distressing affects
 Having an adaptive or socially acceptable aspect

A
  1. Controlling
  2. Displacement
  3. Dissociation
  4. Intellectualization
  5. Rationalization
  6. Reaction Formation
  7. Repression
  8. Sexualization
  9. Undoing
  10. Withdrawal
22
Q

Neurotic Defenses (ND): Controlling

A
  • Excessive attempt to manage or regulate events or objects in the environment in the interest of minimizing anxiety and solving internal conflicts
  • Unconsciously control circumstances
23
Q

Neurotic Defenses (ND): Displacement

A
  • Diverting emotional feelings (usually anger) from the original source of target to a suitable replacement
  • Involves a purposeful, unconscious shifting of impulses or affective investment from one object to another object to solve a conflict
  • “Displace your feelings to another object”
    Ex. Bang the door, kick the wall, throw your laptop
24
Q

Neurotic Defenses (ND): Dissociation

A
  • Temporary but drastic modification of character or sense of personal identity to avoid emotional distres
  • “I’m not a medical student, I’m an engineer; iba na yung pagkatao mo. It’s a dissociative state. It usually happens in conversion reactions.”
25
Q

Neurotic Defenses (ND): Intellectualization

A
  • Thinking about something logically or coldly and without emotion
  • Control of affects and impulses by way of thinking about them instead of experiencing them
  • Systemic excess of thinking, deprived of affect, to defend against anxiety caused by unacceptable impulses
  • “When you’re asked something, you keep on explaining, you beat around the bush”
  • “Uso ‘to sa mga matatalino.”
26
Q

Neurotic Defenses (ND): Rationalization

A
  • Creating false but plausible excuses to justify unacceptable behavior
  • A justification of attitude, beliefs, or behavior that might otherwise be unacceptable by an incorrect application of justifying reasons or the invention of a convincing fallacy
  • “Siguro kaya ako nanalo, dahil ‘ganito, ganyan, ganyan,’ pero parang tama naman. Pero alam mo medyo hindi.”
27
Q

Neurotic Defenses (ND): Reaction Formation

A
  • Behaving in a way that is exactly the opposite of one’s true feelings
  • Management of unacceptable impulses in the antithecal form
  • Equivalently an expression of the impulse in the negative
    Ex. When you don’t want to lend your things to someone but you still do
28
Q

Neurotic Defenses (ND): Repression

A
  • Keeping distressing thoughts and feelings buried in the unconcious
  • Expelling and witholding from conscious awareness of an idea or feeling
  • “Happens in anxiety”
  • Something is bothering you but you keep it in the unconscious so you will not somatize it; if repression fails as a defense mechanism, it will result in an anxiety attack
29
Q

Neurotic Defenses (ND): Sexualization

A
  • The endowing of an object or function with sexual significance that it did not previously have or possess to a lesser degree to ward off anxiety associated with prohibited impulses
30
Q

Neurotic Defenses (ND): Undoing

A
  • Person who tries to “undo” an unhealthy, destructive, or threatening thought by acting out the reverse of that unacceptable thought.
  • Seen in OCDs
    Ex. Hand washing problem
31
Q

Neurotic Defenses (ND): Withdrawal

A
  • Removing oneself from events, stimuli, and interactions under the threat of being reminded of painful thoughts and feelings
32
Q

Mature Defenses
• Healthy and adaptive thought of the life cycle
• Socially adaptive
• Useful in the integration of personal needs and motives, social demands, and interpersonal relations
• Seen as seemingly admiral and virtuous patterns of behavior

A
  1. Altruism
  2. Anticipation
  3. Asceticism
  4. Humor
  5. Sublimation
  6. Suppression
  7. Identification
33
Q

Mature Defenses: Altruism

A
  • Vicarious but constructive and instinctually gratifying service to others even to the detriment of self
  • Different from altruistic surrender (masochistic surrender)
  • “Mother Teresa; charity work
34
Q

Mature Defenses: Anticipation

A
  • Realistic anticipation of or planning for future inner discomfort which implies overly concerned planning, worrying and anticipation of dire and dreadful possible outcomes
  • “Alam mo na sesemplang ka na so aral ka na nang mabuti” ; “you worry, but you prepare so that you do not worry so much, so this is very mature”
35
Q

Mature Defenses: Asceticism

A
  • Elimination of directly pleasurable affects
  • Attributable to an experience
  • Moral element: implicit in setting values on specific pleasures
  • Directed against all “base” pleasures perceived consciously and gratification is derived from renunciation
  • “Into charity, heroism, giving, so coping is very positive. It is very close to altruism”
36
Q

Mature Defenses: Humor

A
  • Overt expressions of feelings without discomfort and unpleasant effects on others
  • Allows one to bear what is too terrible to be borne
  • “The best form of coping”, “laugh at yourself without being mean to others, without being sarcastic”
37
Q

Mature Defenses: Sublimation

A
  • Most acceptable of all defensive mechanisms, an expression of anxiety in socially acceptable ways
  • Gratification of an impulse whose goal is retained but whose aim or object is changed from a socially objectionable one to a socially valued one
  • Desexualization of drive impulses
  • Aggression sublimation through sports and all games
  • “Sublimate your conflict into something, externalize it into another form like sports, arts or music”
38
Q

Mature Defenses: Suppression

A
  • Conscious or semiconscious decision to postpone attention to a conscious impulse or conflict
  • “I’m thinking about this a lot. I’ll think about it later, let me just finish this. Suppress it for the moment. Alam mo na di pwedeng sabay-sabay”
39
Q

Mature Defenses: Identification

A
  • Identify with someone. “I wanna be like this person”

- Very common form of defense mechanism

Psychiatry 1st LE (4 decks)

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