Defense mechanisms

Ahmed Elshafei, MBBCh, MPHc

HEA - 125
Learning Objectives
• Define the components of psychic structures

• Describe how the different defenses are used to manage internal

conflict
Psychic Structures
Based on Freudian theory
• Id
• Controls primitive instincts and drives (what we want to do)
• Present at birth
• Influences sex and aggression
Psychic Structures
Ego

• Tries to “accommodate” reality

• Rational
• Resolves conflicts between id and superego
Psychic Structures
Superego
• Determines our conscience or moral compass (what we ought
to do)
• Begins development by age 5
• Learned from caretakers
• Insists on socially acceptable behavior, sometimes to the point
of individual deprivation
• Can be punitive
Learning Objectives
• Define the components of psychic structures

• Describe how the different defenses are used to manage internal

conflict
General Issues
Defense mechanisms are a concept born out of Freudian psychology:
• Id: animalistic, instinctive urges, sex, aggression, and other primary processes

• Super-ego: the conscience, the moral compass insisting on socially acceptable behavior,
sometimes to the point of individual deprivation begins to develop at age 5-9 (punitive part)

• Ego: rational and language-based executors linking to reality(realistic part)

 Defense Mechanisms
• Defenses are the primary tools of the ego used to manage internal
conflicts between the id and superego
• They are the means by which the ego wards off anxiety, and controls
instinctive urges and unpleasant effects (emotions)
Defense Mechanisms
• All defenses are unconscious, with one exception: suppression
• Defenses change over time; we are only aware of our defenses in
retrospect
• Defenses are adaptive as well as maladaptive
 Four clusters of defense mechanisms
1) Narcissistic: the boundary between self and others is highly
2) Immature: sense of self is stronger with the narcissistic defenses
but the ego has areas of vulnerability.
3) Anxiety: fairly strong and robust sense of self and ego. These
defenses serve to address the unpleasant discomforts of anxiety.
4) Mature: these defenses distort reality
Narcissistic Defenses: Projection
• When a person attributes his own wishes, desires,
thoughts, or emotions to someone else
• Internal states are perceived as a part of someone else
or of the world in general
• A cheating spouse accuses partner of cheating
• A girl talks about her doll as having certain feelings, which are
really what the girl feels
Narcissistic Defenses: Projection
• Main defense mechanism seen in paranoid personality disorder

• Paranoia results from the use of projection

Narcissistic Defenses: Denial
Not allowing reality to penetrate to avoid acknowledgment
of a painful aspect of reality
• After surviving a heart attack, a patient insists on continuing his
lifestyle as if nothing had happened
• A woman prepares dinner for her husband expecting him to
come home, even though he died a month earlier
Narcissistic Defenses: Denial
• Substance users are often “in denial”
• They claim they are not addicted and do not have a problem in the face of
clearly dysfunctional or dangerous behavior
• Denial often first response to bad news, such as the impending
death of a loved one or oneself
Narcissistic Defenses: Splitting
When people and things in the world are idealized (all
good) or devalued (all bad)
• World pictured in extreme terms rather than a realistic blend
of good and bad qualities
• “This doctor is a miracle worker, but that doctor is totally
incompetent.”
• “He’s just so perfect and wonderful,” says a teenage girl in love
Narcissistic Defenses: Splitting
• Main defense mechanism seen in borderline personality disorder

• Prejudice and behavioral stereotypes are also a result of splitting

Immature Defenses: Blocking
Temporary or transient block in thinking or an inability to
remember
• A student is unable to recall the fact needed to answer the
exam question, although he recalls it as he walks out of the
exam
• In the middle of a conversation, a woman pauses, looks
confused, and asks what she was just talking about
• Often happens in embarrassing moments
Immature Defenses: Regression
Returning to an earlier stage of development already
completed (unconscious childish behavior in an adult)
• A husband speaks to his wife in “baby talk” when he is sick
• A man assumes a fetal position after a traumatic event
• A previously toilet trained child wets the bed following the
birth of a new sibling
Immature Defenses: Somatization
When psychological conflict is converted into bodily
symptoms
• A student gets a headache while taking an exam
• A woman feels queasy and nauseated before asking someone
out on a date
• A man who witnesses a traumatic event becomes blind
• Main defense mechanism of somatic symptom disorders
Immature Defenses: Introjection
Introjection (= Identification) is when we acquire
characteristics of others as our own
• Unconscious form of imitation
• Opposite of projection
• Resident dresses and acts like the attending physician
• A child scolds her friend out loud in the same manner that she was
scolded by her mother
• Defense mechanism used in psychotherapy
Anxiety Defenses: Displacement
State When the target of an emotion or drive changes to a substitute
target
• A recently disciplined employee yells at his wife instead of his boss
• A woman watching a movie featuring love scenes with a handsome actor
goes out and seduces an unattractive man
• Defense mechanism seen in phobias
Anxiety Defenses: Repression
When an idea or feeling is withheld from consciousness
• Also called unconscious forgetting
• A child who was abused by her mother and treated for the abuse now has
no memory of any mistreatment by her mother
• A man who survived 6 months as a hostage cannot recall anything about his
life during that time period
• One of the most basic defense mechanisms
Anxiety Defenses: Isolation of Affect
Separation of an idea or event from the emotions (affect) that
accompany it
• A child who has been beaten discusses the beatings without any display of
emotion
• A combat pilot is calm while ejecting out of his plummeting aircraft
• Important adaptive defense mechanism for self-preservation
Anxiety Defenses: Intellectualization
When facts and logic are used to avoid confronting emotions
• A patient with a bone protruding from his leg focuses on the physics that
allow such an event to occur
• A medical student speaks excessively about medical details in order to avoid
the emotional content of a bad diagnosis
Anxiety Defenses: Intellectualization
“Physicians who are too concerned with the technical aspects of the
profession and not enough with the patient may well be using
intellectualization”
Anxiety Defenses: Acting Out
Emotional or behavioral outburst masks underlying feelings
or ideas
• A child throws temper tantrum when abandoned
• New-onset drug use in an adolescent boy after parents’ divorce
• “Whistling in the dark” to hide underlying fear
• Defense mechanism that can be seen in borderline and
antisocial personality disorders
Anxiety Defenses: Rationalization
When rational explanations are used to justify attitudes, beliefs, or
behaviors that are unacceptable

• Not a reasoned action, but a search for reasons to allow an

unacceptable action
Anxiety Defenses: Rationalization
A murderer saying, “Yes, I believe killing is wrong but I killed him
because he really deserved it.”
• A teenage girl who makes a vow of chastity until marriage tells
herself that oral sex is not really sex, and can give a string of
reasons
• Defense mechanism seen in substance use disorders
Anxiety Defenses: Reaction Formation
When an unacceptable impulse is transformed into its opposite

• Excessive overreaction can be a sign of reaction formation

• A student who always wanted to be a physician expresses relief and says,
“This is the best news I’ve ever heard,” after not being accepted into medical
school
Anxiety Defenses: Reaction Formation
A teenage boy intrigued by “dirty pictures” organizes an anti-pornography
campaign
• Two co-workers fight all the time because they are actually very attracted to
each other

• Defense mechanism commonly seen in obsessive-compulsive

disorder and anxiety disorders
Anxiety Defenses: Undoing
Performing an act to undo a previous unacceptable act or thought

• A man who is sexually aroused by a woman he meets immediately leaves

and buys his wife flowers

• Can include superstitions such as throwing salt over your shoulder to avoid
bad luck
Anxiety Defenses: Undoing
A man repeatedly checks to make sure the burners on the stove are turned off
before leaving the house because he is fearful the house will burn down

• Defense mechanism seen in obsessive- compulsive disorder

Anxiety Defenses: Passive-aggression
When hostility is expressed covertly
• A patient angry with her physician shows up late for
appointments
• A student agrees to share class notes with classmates but goes
home without sharing them after they upset her in class
• A communications director does not take questions from people
who challenge his views
Anxiety Defenses: Passive-aggression
• The feelings of hostility are unconscious, and the person using the
defense is generally unaware of them

• Defense mechanism seen in borderline personality disorders and

young children
Anxiety Defenses: Dissociation
Separates the self from one’s experience
• A woman who was raped reports that she felt “as if she was
floating on the ceiling” watching it happen
• The survivor of an automobile accident tells of the feeling that
everything happened in slow motion
• A child who was sexually abused recalls only the “bad man who
came to her in her dreams.”
• Primary defense mechanism in dissociative disorders
Mature Defenses: Humor
Permits the overt expression of feelings and thoughts
without personal discomfort
• A student smiles when he realizes that a particularly
intimidating professor looks like a penguin
• An overweight comedian makes jokes about being fat
• Laughter covers the pain and anxiety
Mature Defenses: Sublimation
When impulse gratification is achieved by channeling the
unacceptable or unattainable impulse into a socially
acceptable direction
• Jack the Ripper becomes a surgeon
• A patient with exhibitionist fantasies becomes a stripper
• Considered by some to be the most mature defense
mechanism
Mature Defenses: Suppression
Conscious decision to forget or ignore
• A student with a pending exam decides to forget about it and
go out for the evening
• A woman who is afraid of heights ignores the drop of a steep
cliff to appreciate the beautiful view
• A terminally-ill cancer patient puts aside his anxiety and enjoys
a family gathering
• Only conscious defense mechanism