Defense Mechanisms

Defense mechanisms are normal subconscious means of resolving inner conflicts between an individual’s subjective moral sense and their thoughts, feelings, or actions. Defense mechanisms serve to protect the self from unpleasant feelings (anxiety, shame, and/or guilt) and are divided into pathologic, immature, mature, neurotic, and other types.

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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. While these mechanisms may provide rapid, short-term relief from unpleasant feelings (anxiety, shame, guilt), they may also result in long-term complications (hinder insight, prevent treatment compliance).

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
  • 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.

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
  • Example: 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 acts as a substitute for that which a person cannot stand to feel emotional.

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

  • Indirect way of expressing aggression
  • Seen in individuals with borderline personality disorder
  • Example: An office worker 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
  • Example: A man who had an extramarital affair accuses his wife of being unfaithful.

Regression

  • 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 in individuals with borderline personality disorder
  • Example: an individual who sees all physicians as competent while viewing the nurses as terrible

Denial

  • Refusal to accept reality or facts
  • Prevents an individual from dealing with disagreeable feelings
  • Example: A woman diagnosed with 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
  • 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 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, 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 explanations for rationale 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 telling the truth that it was he who didn’t study well.

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 often repress associated memories, which then become hard to access.

Undoing

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

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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 cruel 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 makes jokes about his continuous positive airway pressure (CPAP) 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.

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Clinical Relevance

  • 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 have difficulties in handling everyday stresses and issues and their behavior can lead to serious issues with relationships and work. Psychotherapy may involve identifying immature defense mechanisms and transforming them into more mature types.
  • Somatoform disorders: Somatic symptom disorder, conversion disorder, and illness anxiety disorder have psychodynamic models of etiology that are thought to arise from a maladaptive defense mechanism. Individuals with somatoform disorders shield themselves from emotional stress, which is subconsciously manifested as a physical symptom or a threat of illness.

References

  1. Le, T., et al. (Ed.) (2019). Psychiatry. In Le, T. et al. (Ed.), First Aid Step 1 2019 (21st ed., pp. 542–543).
  2. Bailey R., Pico J. (2020). Defense Mechanisms. https://www.ncbi.nlm.nih.gov/books/NBK559106/ 
  3. Sadock, B.J., Sadock, V.A., Ruiz, P. (Eds.) (2014). Theories of personality and psychopathology. In Sadock, B.J., et al. (Ed.), Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (11th ed., pp. 160–162). Lippincott Williams and Wilkins.

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