DEFENSE MECHANISMS

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ppt on defense mechanisms in psychiatry by dr rajan jain md 1st year at gmch chandigarh

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DEFENSE MECHANISMS: 

Presenter: Rajan Jain Moderator: Prof. Priti Arun DEFENSE MECHANISMS

Scheme of Presentation: 

Scheme of Presentation History Basic concept Important properties Definition Purpose of defense mechanisms Some important defense mechanisms Classification Measurement Defense mechanisms and major clinical syndromes Critiques

History : 

History The concept of defense first appeared in Sigmund Freud’s article "The Neuro-Psychoses of Defence " (1894) and was next discussed in "Further Remarks on the Neuro-Psychoses of Defence " (1896) and "The Aetiology of Hysteria" (1896). Finally, in the text entitled "Instincts and their Vicissitudes" (1915), turning against the self and reversal into the opposite were identified as defense mechanisms, in addition to repression and sublimation. For Freud, the concept of defense refers to the ego's attempts at psychic transformation in response to representations and affects that are painful, intolerable, or unacceptable. He abandoned the concept of defense for a period in favor of the concept of repression. He then reintroduced it in "Neurotic Mechanisms in Jealousy, Paranoia and Homosexuality" (1922).

History : 

History In an appendix to Inhibitions, Symptoms, and Anxiety (1926), Freud reverted to the old concept of defense. He also retained the word “repression” for special method of defense. Freud's list of basic Defense Mechanisms includes: Denial, Displacement, Intellectualization, Projection, Rationalization, Reaction formation, Regression, Repression and Sublimition . The first comprehensive study of defense mechanisms was reported by Anna Freud in her landmark work, The Ego and the Mechanisms of Defence (1937). Anna Freud expanded her father’s work by providing detailed descriptions of a number of individual defense mechanisms.

Basic Concept: 

Basic Concept In Sigmund Freud's topographical model of personality, the ego is the aspect of personality that deals with reality. While doing this, the ego also has to cope with the conflicting demands of the id and the superego . The id seeks to fulfill all wants, needs, and impulses while the superego tries to get the ego to act in an idealistic and moral manner. What happens when the ego cannot deal with the demands of ones desires, the constraints of reality, and ones own moral standards? Anxiety acts as a signal to the ego that things are not going right.

Basic concept : 

Basic concept He identified three different types of anxiety. Reality Anxiety: This is the most basic form of anxiety and is typically based on fears of real and possible events, such as being bitten by a dog or falling from a ladder. The most common way of reducing tension from Reality Anxiety is taking oneself away from the situation, running away from the dog or simply refusing to go up the ladder. Neurotic Anxiety: This is a form of anxiety which comes from an unconscious fear that the basic impulses of the ID (the primitive part of our personality) will take control of the person, leading to eventual punishment(this is thus a form of Moral Anxiety). Moral Anxiety: This form of anxiety comes from a fear of violating values and moral codes, and appears as feelings of guilt or shame.

Basic concept: 

Basic concept According to Freud, anxiety is an unpleasant inner state that people seek to avoid. When anxiety occurs, the mind first responds by an increase in problem-solving thinking, seeking rational ways of escaping the situation. If this is not fruitful (and maybe anyway), ego has some tools it can use in its job as the mediator, tools that help defend the ego, these are called Ego Defense Mechanisms or Defenses . They helped shield the ego from the conflicts created by the id, superego, and reality.

Basic concept: 

Basic concept

Important properties: 

Important properties Defenses are a major means of managing impulse and affect Defenses are unconscious Defenses are discrete from one another Although often the hallmarks of major psychiatric syndromes, defenses are dynamic and reversible; Defenses can be adaptive as well as pathological.

Definition: 

Definition In Freudian psychoanalytic theory , defense mechanisms are unconscious psychological strategies brought into play by various entities to cope with reality and to maintain self-image. White and Gilliland (1975) stated that the term mechanisms of defense refers to the various automatic, involuntary , and unconsciously instituted psychological activities by which the human being attempts to exclude unacceptable urges or impulses from awareness. According to American Psychiatric Association (1994), “defense mechanisms are patterns of feelings, thoughts, or behaviors that are relatively involuntary . They arise in response to perceptions of psychic danger or conflict, to unexpected change in the internal or external environment, or in response to cognitive dissonance.”

Purpose of defense mechanisms: 

Purpose of defense mechanisms First, defenses allow individuals a period of respite to master changes in self-image that cannot be immediately integrated, as might result from puberty, an amputation, or a promotion (i.e., changes in reality). Second, defenses can deflect or deny sudden increases in biological drives. Awareness of instinctual wishes is usually diminished; alternatively, antithetical wishes may be passionately adhered to. Third, defenses enable individuals to mitigate unresolved conflicts with important people, living or dead. Finally, ego mechanisms of defense can keep anxiety, shame, and guilt within bearable limits during sudden conflicts with conscience and culture.

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Use of mature defenses 1) Excellent adjustment as an adult, 2) Happiness, 3) Job satisfaction, 4) Rich friendships, 5) Fewer medical hospitalizations over life, 6) Better overall health, 7) A lower incidence of mental illness.

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Use of immature defenses: 1) Poor adjustment as an adult, 2) Higher divorce rates and marital discord, 3) Poor friendship patterns, 4) Higher incidence of mental illness, 5) Greater number of sick leave days taken, 6) Poorer health generally

Denial : 

Denial Denial is simply refusing to acknowledge that an event has occurred. Denial is one of Freud's original defense mechanisms. It is considered one of the most primitive of the defense mechanisms because it is characteristic of early childhood development. It is a form of repression, where stressful thoughts are banned from memory. Many people use denial in their everyday lives to avoid dealing with painful feelings or areas of their life they don’t wish to admit. Example: 1) Patient denies that his physician's diagnosis of cancer is correct and seeks a second opinion. 2) Alcoholics vigorously deny that they have a problem.

Displacement : 

Displacement Displacement is the shifting of actions from a desired target to a substitute target when there is some reason why the first target is not permitted or not available. Where possible the second target will resemble the original target in some way. It occurs when the Id wants to do something of which the Super ego does not permit. The Ego thus finds some other way of releasing the psychic energy of the Id. Thus there is a transfer of energy from a repressed object to a more acceptable object.

Displacement: 

Displacement Displacements are often quite satisfactory and workable mechanisms for releasing energy more safely. Examples 1) The boss gets angry and shouts at a person. He goes home and shouts at his wife. She then shouts at their son. With nobody left to displace anger onto, he goes and kicks the dog. 2) A man wins the lottery. He turns to the person next to him and gives the person a big hug.

Intellectualization : 

Intellectualization Intellectualization is a 'flight into reason', where the person avoids uncomfortable emotions by focusing on facts and logic. The situation is treated as an interesting problem that engages the person on a rational basis, whilst the emotional aspects are completely ignored as being irrelevant . Example : A person who is in heavily debt builds a complex spreadsheet of how long it would take to repay using different payment options and interest rates. Intellectualization protects against anxiety by repressing the emotions connected with an event. It is also known as 'Isolation of affect' as the affective elements are removed from the situation.

Projection : 

Projection When a person has uncomfortable thoughts or feelings, they may project these onto other people, assigning the thoughts or feelings that they need to repress to a convenient alternative target . Neurotic projection is perceiving others as operating in ways one unconsciously finds objectionable in yourself. Complementary projection is assuming that others do, think and feel in the same way as you. It turns neurotic or moral anxiety into reality anxiety, which is easier to deal with.

Projection : 

Projection Projection is a common attribute of paranoia, where people project dislike of themselves onto others such that they believe that most other people dislike them . Projection helps justify unacceptable behavior, for example where a person claims that they are sticking up for themselves amongst a group of aggressive other people. Examples 1) an unfaithful husband suspects his wife of infidelity. 2) A man does not like another person. But he has a value that says he should like everyone. So he projects onto them that they do not like him. This allows him to avoid them and also to handle his own feelings of dislike.

Rationalization : 

Rationalization When something happens that we find difficult to accept, then we will make up a logical reason why it has happened. When a person does something of which the moral super ego disapproves, then the ego seeks to defend itself by adding reasons that make the action acceptable to the super ego. Thus we are able to do something that is outside our values and get away with it without feeling too guilty. Examples 1) A parent punishes a child and says that it is for the child's 'own good'. 2) A person evades paying taxes and then rationalizes it by talking about how the government wastes money (and how it is better for people to keep what they can).

Reaction Formation : 

Reaction Formation Reaction Formation occurs when a person feels an urge to do or say something and then actually does or says something that is effectively the opposite of what they really want. It also appears as a defense against a feared social punishment . A common pattern in Reaction Formation is for the person to show ‘excessive behavior ’. Example: A person who is angry with a colleague actually ends up being particularly courteous and friendly towards them. Psychoanalysts believe that extreme patterns of Reaction Formation are found in paranoia and obsessive-compulsive disorder (OCD), where the person becomes trapped in a cycle of repeating a behavior that they know (at least at a deep level) is somehow wrong.

Regression : 

Regression Regression involves taking the position of a child in some problematic situation, rather than acting in a more adult way . This is usually in response to stressful situations, with greater levels of stress potentially leading to more overt regressive acts. Regressive behavior can be simple and harmless, such as a person who is sucking a pen (as a Freudian regression to oral fixation), or may be more dysfunctional , such as crying or using petulant arguments . Examples 1) A person who suffers a mental breakdown assumes a fetal position, rocking and crying. 2) A child suddenly starts to wet the bed after years of not doing so (this is a typical response to the arrival of a new sibling). 3) A patient makes childish demands and becomes dependent on the nurse for care that they could do for themselves.

Repression : 

Repression Repression involves placing uncomfortable thoughts in relatively inaccessible areas of the subconscious mind . Thus when things occur that we are unable to cope with now, we push them away, either planning to deal with them at another time or hoping that they will fade away on their own accord. The level of 'forgetting' in repression can vary from a temporary abolition of uncomfortable thoughts to a high level of amnesia, where events that caused the anxiety are buried very deep . A high level of repression can cause a high level of anxiety or dysfunction, although this may also be caused by the repression of one particularly traumatic incident.

Repression : 

Repression In Freudian terminology, repression is the restraining of a cathexis by an anti- cathexis . Repression is not all bad. If all uncomfortable memories were easily brought to mind we would be faced with a non-stop pain of reliving them. e.g. A child who is abused by a parent later has no recollection of the events, but has trouble forming relationships. A man has a phobia of snakes but cannot remember the first time he was afraid of them.

Sublimation : 

Sublimation Sublimation is the transformation of unwanted impulses into something less harmful. This can simply be a distracting release or may be a constructive and valuable piece of work. Sublimation is probably the most useful and constructive of the defense mechanisms as it takes the energy of something that is potentially harmful and turns it to doing something good and useful. Freud believed that the greatest achievements in civilization were due to the effective sublimation of our sexual and aggressive urges that are sourced in the Id and then channeled by the Ego as directed by the Super ego. Example - A angry man does pushups to work off his temper. A person who has an obsessive need for control and order becomes a successful business entrepreneur.

Acting out: 

Acting out Acting Out is performing an extreme behavior in order to express thoughts or feelings the person feels incapable of otherwise expressing. e.g. Instead of saying, “I’m angry with you,” a person who acts out may instead throw a book at the person, or punch a hole through a wall. When a person acts out, it can act as a pressure release, and often helps the individual feel calmer and peaceful once again. For instance, a child’s temper tantrum is a form of acting out when he or she doesn’t get his or her way with a parent. Self-injury may also be a form of acting-out, expressing in physical pain what one cannot stand to feel emotionally.

Dissociation: 

Dissociation Dissociation is when a person loses track of time and/or person, and instead finds another representation of their self in order to continue in the moment. People who have a history of any kind of childhood abuse often suffer from some form of dissociation. In extreme cases, dissociation can lead to a person believing they have multiple selves (“multiple personality disorder”). People who use dissociation often have a disconnected view of themselves in their world. Time and their own self-image may not flow continuously, as it does for most people.

Undoing: 

Undoing Undoing is the attempt to take back an unconscious behavior or thought that is unacceptable or hurtful. A person tries to 'undo' an unhealthy, destructive or otherwise threatening thought by engaging in contrary behavior. For instance, after realizing you just insulted your significant other unintentionally, you might spend then next hour praising their beauty, charm and intellect. By “undoing” the previous action, the person is attempting to counteract the damage done by the original comment, hoping the two will balance one another out. A teenager who feels guilty about masturbation ritually touches door knobs a prescribed number of times following each occurrence of the act.

PowerPoint Presentation: 

Blocking: Temporarily and transiently inhibiting thinking. Affect and impulses may also be involved. Tension arises when impulse, affect or thought is inhibited. Hypochondriasis: Exaggerating and overemphasizing an illness for the purpose of evasion and regression. In hypochondriasis, responsibility can be avoided, guilt can be circumvented , and instinctual impulses are warded off. Because hypochondriacial impulse are ego-alien, the afflicated person experiences dysphoria and a sense of affliction.

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Fantasy : Tendency to retreat into fantasy in order to resolve inner and outer conflicts. Idealization : Unconsciously choosing to perceive another individual as having more positive qualities than he or she may actually have. Passive aggression : Aggression towards others expressed indirectly or passively such as using procrastination. Somatization : The transformation of negative feelings towards others into negative feelings toward self, pain, illness, and anxiety.

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Distortion: A gross reshaping of external reality to meet internal needs(including unrealistic megalomania beliefs, hallucinations, wish-fulfilling delusions)and using sustained feelings of delusional superiority and entitlement. Splitting: A primitive defense. Negative and positive impulses are split off and not integrated. Fundamental example: An individual views other people as either innately good or innately evil, rather than a whole continuous being. Isolation : Separation of feelings from ideas and events, for example, describing a murder with graphic details with no emotional response.

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Altruism : Constructive service to others that brings pleasure and personal satisfaction. Anticipation : Realistic planning for future discomfort. Humor : Overt expression of ideas and feelings (especially those that are unpleasant to focus on or too terrible to talk about) that gives pleasure to others. The thoughts retain a portion of their innate distress, but they are "skirted round" by witticism. Identification : The unconscious modeling of one's self upon another person's character and behavior. e.g. An insecure young man joins a fraternity to boost his self-esteem. Introjection : Identifying with some idea or object so deeply that it becomes a part of that person.

Classification of defense mechanisms : 

Classification of defense mechanisms The list of defense mechanisms is huge and there is no theoretical consensus on the number of defense mechanisms. Classifying defense mechanisms according to some of their properties (i.e. underlying mechanisms, similarities or connections with personality) has been attempted. Defenses employed by ego can be listed according to variety of classification:- Developmental by Anna Freud Valliant (1971) Haan (1977) Bond et al. (1983) Perry and Copper (1985) American Psychiatric Association (1994)

Developmental by Anna Freud: 

Developmental by Anna Freud Normally there is an orderly sequence as the child matures. Oral (0-18 months) - narcissistic defenses (Projection, denial, distortion) Anal (18months-3 years) - Identification, undoing, reaction formation, isolation, regression Phallic / oedipal (3- 6 years) - Intellectualization Latency (6 years to puberty) - Symbolization, sublimation If significant trauma occurs the child may have difficulty learning the mechanisms that are normally learned at these times.

Vaillant’s Classification : 

Vaillant’s Classification In George Eman Vaillant's (1971) categorization, defences form a continuum related to their psychoanalytical developmental level. Vaillant's levels are: Level I - Pathological Defenses The mechanisms on this level, when predominating, almost always are severely pathological. These defenses, in conjunction, permit one to effectively rearrange external experiences to eliminate the need to cope with reality. The pathological users of these mechanisms frequently appear irrational or insane to others. These are the "psychotic" defences, common in overt psychosis. However, they are found in dreams and throughout childhood as well. e.g. psychotic denial, distortion.

Vaillant’s Classification : 

Vaillant’s Classification Level II - immature defenses These mechanisms are often present in adults and more commonly present in adolescents. These mechanisms lessen distress and anxiety provoked by threatening people or by uncomfortable reality. People who excessively use such defences are seen as socially undesirable in that they are immature, difficult to deal with and seriously out of touch with reality. These are the so-called "immature" defences and overuse almost always leads to serious problems in a person's ability to cope effectively. These defences are often seen in severe depression and personality disorders.(e.g. fantasy, projection, passive aggression, acting out, dissociation)

Vaillant’s Classification : 

Vaillant’s Classification Level III - Neurotic defenses These mechanisms are considered neurotic, but fairly common in adults. Such defences have short-term advantages in coping, but can often cause long-term problems in relationships, work and in enjoying life when used as one's primary style of coping with the world. (e.g. intellectualization, reaction formation, somatization , displacement, repression)

Vaillant’s Classification : 

Vaillant’s Classification Level IV - Mature defenses: These are commonly found among emotionally healthy adults and are considered mature, even though many have their origins in an immature stage of development. They have been adapted through the years in order to optimize success in life and relationships. The use of these defences enhances pleasure and feelings of control. These defences help us integrate conflicting emotions and thoughts, while still remaining effective. Those who use these mechanisms are usually considered virtuous. e.g. humor, sublimation, suppression, altruism, anticipation.

Haan (1977) : 

Haan (1977) Described 20 ego processes with explicit definitions. She divided these styles into two groups of 10 each, described as coping (healthy) and defending (pathological) She validated her scheme by correlating her results with important individually derived measures of mental health.

Bond et al. (1983) : 

Bond et al. (1983) Maladaptive action defense style : Inability to deal with impulses by taking constructive action (withdrawal, acting out, regression, inhibition, passive aggression, and projection). Image-distorting defense style : Split the image of self and others into good & bad, strong & weak (splitting, primitive idealization, and omnipotence with devaluation). Self-sacrificing defense style : perceive one self as kind and helpful to others (reaction formation and pseudo-altruism). Adaptive defense style : Constructive type of mastery over conflicts (humor, suppression, and sublimation).

Perry and Copper (1985): 

Perry and Copper (1985) Disavowal : disavow experiences, affects or impulses; projection, denial, rationalization. Action: releases feelings and impulses through actions ; acting out , passive aggression. Borderline : distort self & others images; splitting and projective identification. Narcissistic : serves to regulate self-esteem and mood; omnipotence, primitive idealization, devaluation. Obsessional : neutralize affect without distorting external reality; isolation, intellectualization. Mature: mastery over conflicts; humor, suppression, sublimation.

American Psychiatric Association (1994): 

American Psychiatric Association (1994) Defensive deregulation : failure of defensive regulation-leading to pronounced break with objective reality delusional projection psychotic denial psychotic distortion Action : deals with stressors by action or withdrawal acting out passive aggression help-rejecting complaining Major image-distorting : gross distortion of image of self or others autistic fantasy splitting

American Psychiatric Association (1994): 

American Psychiatric Association (1994) Disavowal : keeping stressors out of awareness with or without a misattribution of these to external cause denial projection rationalization Minor image-distorting : distortions in the image of the self or others devaluation idealization omnipotence

American Psychiatric Association (1994): 

American Psychiatric Association (1994) Mental inhibitions: keeps potentially threatening ideas or feelings out of awareness displacement reaction formation repression undoing High-adaptive: optimal adaptation in handling stressors anticipation altruism humor sublimation suppression

Measurement of Defense Mechanisms: 

Measurement of Defense Mechanisms Defense Mechanism Test ( Kragh , 1955) Defense Style Questionnaire (Bond et al, 1983) Defense Mechanisms Rating Scale (Perry, 1989) Clinical Vignette Method (Valliant, 1976) Defense Mechanism Inventory ( Gleser & Ihilevitch , 1969)

Defense Mechanisms and Major Clinical Syndrome: 

Defense Mechanisms and Major Clinical Syndrome Sr. no. Personality disorder Defense mechanisms 1 Cluster A Fantasy Projection 2 Cluster B Acting out Splitting Dissociation Devaluation 3 Cluster C Passive aggression Help rejecting complaining

PowerPoint Presentation: 

SR.NO. Disorder Defense mechanisms 1 Anxiety Repression 2 Phobia Displacement Regression 3 OCD Isolation of affect Undoing Reaction formation 4 Depression Regression Turning of aggression against self 5 Mania Denial Projection Regression 6 Paranoid Projection Regression Rationalization 7 Schizophrenia Regression Projection Isolation of affect

PowerPoint Presentation: 

Anxiety : When repression proves to be inadequate, previously contained primitive instinctual urges threaten to come to expression and this threat creates the sense of apprehension characteristics of anxiety. Phobia : Through the mechanism of displacement a phobia replaces anxiety. Regression is inherent as phobia involves return to primitive mode of thought through which child copes with his own threatening impulses. Mania : Denial is the defense mechanism characteristic of mania. When denial is threatened patient may then resort to Projection - attributing his own anger to others. Regression- return to the magical thinking characteristic of a small child.

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OCD : Isolation of affect is responsible for the symptom of obsessional thoughts, Undoing creates compulsive acts (a ritual which magically undoes a forbidden unconscious impulse) and Reaction formation (development of attitudes opposite to the impulses being defended against) accounts for scrupulosity and other exaggerated characteristics of cleanliness. Depression : In less severe form of depression, that is depression out of proportion to the reality of the loss, the loss produces regression and revives the intense sense of hopelessness and despair that a small child experiences. In extreme depression the effect of identification with the lost object and the use of the mechanism of turning aggression against the self.

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Paranoid: Reliance on the defense mechanism of projection characterizes paranoid disorders. Regression is inherent in the production of paranoid delusions. Rationalization is constant companion to projection – ability to give plausible and logical reasons for his irrational beliefs is monumental. Schizophrenia : Regression - primitive characteristics of patients thought and behavior; return to infantile modes of mental functioning Projection- involved in the formation of delusions of persecution or influence Isolation of affect – is involved in the calm detached way patient thinks or speaks of frightening things

Critiques: 

Critiques Although the studies on defense mechanisms flourished from the 1930s to the 1960s, they eventually had their critics. Chief among these was D. S. Holmes (1972, 1974, 1990) who concluded that the majority of memory results previously attributed to repression were better explained by differences in attentional processes. Holmes (1968, 1978, 1981) also concluded that defensive projection should be regarded as a myth. As , it was never clear how seeing another person as dishonest (for example) would enable the individual to avoid recognizing his or her own dishonesty. The perceptual defense studies were also criticized on methodological grounds. The difficulty individuals had in perceiving taboo words might well have been due to factors such as word length, differential stimulus familiarity, and social unacceptability (whereby the perceiver suppresses verbalization; Howes & Solomon, 1950; McGinnies , Comer, & Lacy, 1952).

PowerPoint Presentation: 

Bushman and Baumeister (1998) studied aggressive responses to an ego threat as a function of narcissism. Narcissists became more aggressive toward someone who had insulted them, but neither narcissists nor non-narcissists showed any increased aggression toward a third person. This study was specifically designed to examine displaced aggression and failed to find any sign of it. Displacement would only qualify as a defense mechanism if the original, unacceptable impulse were prevented from causing some damage to self-esteem (or having some similar effect, such as stimulating anxiety). There is no evidence of any such effect. Clinicians, however, continued to use the concept of defense, arguing that the laboratory research lacked ecological validity. Interest in defense mechanisms also continued in the field of personality assessment.

PowerPoint Presentation: 

Psychoanalytic self-psychology and object relations theory broadened the role of defense to include the maintenance of self-esteem and the protection of self-organization (Cooper, 1998; Fenichel , 1945). Recently, the negative conclusions of Holmes have been called into question. Paulhus et al. (1997) pointed out that "equally careful reviewers (Cooper, 1992; Erdelyi , 1985) have drawn much more favorable conclusions from the same literature”. In fact, defense mechanisms and defensive processes are being discussed today across the broad field of psychology.

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