WBR0288

Author	[[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1] (Reviewed by Yazan Daaboul, M.D. and Alison Leibowitz [2])]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::A married couple seek marital counseling before applying for a divorce. The woman explains that her husband suddenly snapped and requested divorce for no obvious reason or trigger. She states that he woke up one night and said "I noticed you don’t love me”. Following multiple counseling sessions, the counselor then notices that the man is probably unaware to the fact that he hates his wife and believes she hates him too. The man is demonstrating which of the following defense mechanisms?]]
Answer A	AnswerA::Acting out
Answer A Explanation	[[AnswerAExp::Acting out is an immature defense mechanism characterized by expressing unacceptable feelings and thoughts through actions. For example, instead of saying, “I’m angry with you,” a person who acts out may instead throw a book at the person. Tantrums among children are an example of acting out.]]
Answer B	AnswerB::Displacement
Answer B Explanation	[[AnswerBExp::Displacement is an immature defense mechanism characterized by the redirection of thoughts, feelings, and impulses onto a neutral person or an object. For example, a husband having a bad day at work may arrive home and act aggressively at home with his wife and children.]]
Answer C	AnswerC::Reaction formation
Answer C Explanation	AnswerCExp::Reaction formation is an immature defense mechanism when a person compulsively behaves opposite to his unconscious desires. For example, a man discontented with his job may request to work extra-hours.
Answer D	AnswerD::Projection
Answer D Explanation	AnswerDExp::Projection is an immature defense mechanism that involves taking one's own unacceptable qualities or feelings and ascribing them to other people. For example, a man who unconsciously hates his wife thinks that his wife doesn't like him.
Answer E	AnswerE::Denial
Answer E Explanation	[[AnswerEExp::Denial is an immature defense mechanism characterized by blocking an aspect of reality from conscious awareness. For example, a man who has been recently diagnosed with terminal cancer denies that he has cancer or he might die from his condition.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::Defense mechanisms are psychological processes that are utilized to manipulate reality and avoid undesirable emotions. Defense mechanisms may be mature (high adaptive level) or immature (mental inhibitors). While mature defense mechanisms are considered optimal means to deal with stresses, immature defense mechanisms may be mental inhibitors, image-distorting, or disavowal. Mature defense mechanisms include the following: Anticipation: Plan for future stressors by goal-directed worrying processes. Altruism: Perform constructive service to others for self-satisfaction. Humor: Use comedy to express feelings Sublimation: Channel a socially unacceptable behavior to an acceptable one to achieve satisfaction and gratification. Suppression: Consciously block attention to an unresolved issue In contrast, other non-mature defense mechanisms may be mental inhibitors that prevent the surfacing of threatening or undesirable feelings; they may also be image-distorting processes that regulate self-esteem. Narcissistic defenses: Denial: Avoid painful experiences by totally abolishing sense of reality. Distortion: Reshape reality to better fit with one's desires, including sense of delusional superiority, entitlement, or megalomanic beliefs. Projection: React to unacceptable inner feelings as though they are external to self. Immature defenses: Acting out: Express unconscious desire through action or aggression Blocking: Transiently inhibit a thinking process. Unlike repression, blocking involves feeling of tension upon blocking of thoughts. Fixation: Remain at a more childish level of development. Hypochondriasis: Exaggerate an illness for evasion and regression. Introjection: Internalize object qualities and obliterate the distinction between a subject and an object, including identification with an aggressor. Passive-aggression: Express aggression through passivity and masochism. Regression: Return to earlier developmental stage to avoid stressors; it is common in children. Schizoid fantasy: Daydream and retreat to obtain gratification yet avoid interpersonal intimacy. Somatization: Convert of psychological aspects into bodily symptoms. Neurotic defenses: Controlling: Manage and regulate objects to resolve inner stressors. Displacement: Shift a feeling from one object to another. Externalization: Perceive one's own personality in external objects. Inhibition: Consciously limit ego functions to avoid anxiety that arise from the environment and the superego. Intellectualization: Use intellectual strategies to avoid expression. Isolation: Separate an idea from the affect that accompanies it. Rationalization: Suggest rational thoughts to explain behavior. Dissociation: Transiently alter one's character or identity to evade undesired feelings. Reaction formation: Convert an unacceptable impulse to its complete opposite, common in obsessional neurosis and may be a permanent feature. Repression: Unconscious withdraw idea from the conscious process. Ideas may either never reach one's conscious (primary repression) or may be expelled form the conscious process once experienced (secondary repression). Sexualization: Endow an object with sexual importance. Educational Objective: Projection is a defense mechanism that involves taking one's own unacceptable qualities or feelings and ascribing them to other people. For example, a woman who subconsciously abhors her job, might believe that her boss loathes her. References: Vaillant GE. Ego mechanisms of defense and personality psychopathology. J Abnorm Psychol. 1994;103(1):44-50. First Aid 2014 page 500]]
Approved	Approved::Yes
Keyword	WBRKeyword::Defense mechanisms, WBRKeyword::Projection, WBRKeyword::Ego defenses, WBRKeyword::Immature defenses, WBRKeyword::Mature defenses
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