Updated: 8/7/2019

Ego Defenses

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Questions
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Overview
  • Unconscious processes that prevent undesirable feelings
  • Can be immature or mature
    • immature are more primitive
    • mature are more evolved
Immature Defenses
  • A man is fired from his job as an accountant that he has had for the past 27 years.  When he hears the news he yells, knocks things off his bosses desk and locks himself in a bathroom stall.
    • acting out
      • use actions to express unacceptable feelings and thoughts (tantrum)
  • A woman is in a terrible car accident where her newborn is ejected from the car and dies due to the impact.  While in the ED being treated for her wounds, the patient appears calm and is in no distress.  Though she does recall some sort of car accident she can't remember what happened to her newborn and seems to be doing well.
    • dissociation
      • temporary drastic change in behavior
      • extreme forms can result in dissociative identity disorder (multiple personality disorder)
  • A 69-year-old male is diagnosed with biopsy confirmed prostate cancer.  Upon receiving this information the patient tells his wife confidently that he does not have prostate cancer and that he is completely fine.
    • denial
      • avoidance of awareness of some painful reality (denying reality)
  • An 18-year-old female is dumped by her boyfriend.  She takes the news at the time well and seems alright.  When she arrives home that night she yells at her mother telling her that she has never listened to her and never cared about her with no instigating event.
    • displacement
      • taking feelings out on a neutral 3rd party  
  • A mother wishes her eldest soon goodbye as he leaves on his final tour of duty on the frontline.  She was worried at first but no longer is as the amulet she gave him will act as shield and bring him back home safely.
    • fantasy
      • retreat into fantasy to solve problems 
  • A young man spends a large amount of his time outside the female dormitories.  He pretends to be reading a math textbook but enjoys looking in through the windows of his female classmates, particularly as they undress. (voyeurism)
    • fixation
      • "stuck" in an earlier developmental stage (in particular, something sexually oriented)
  • The chief surgical resident is often demeaning to his residents and shows very little respect for the nursing team.  The following year, another residents becomes the new chief resident on the same service and exhibits the exact same behavior.
    • identification
      • imitating behavior (good or bad) of a more powerful person
        • another example: abused child becomes abusive parent later in life
  • A female witnesses the murder of her husband at a farmer's market.  When the police come she describes the event succinctly and without emotion.
    • isolation of affect
      • separation of emotion from events or ideas
  • A young male tells his best friend that he does not like her outfit.  She takes the comment well at the time, but over the next several weeks decides to ignore all his messages and not hang out with him.
    • passive aggression
      • expression of angry feelings in a non-confrontational way 
      • typically intentional, not meeting the emotional needs of others is the method of passive aggression
  • A young woman has routinely been flirting with one of her coworkers.  When she goes on a date with her boyfriend she acuses him of cheating on her and trying to spend time with other women.
    • projection
      • attributing unacceptable internal feelings to an external source  
  • A young male is fired from his job as a laboratory technician for routinely contaminating samples.  He states that it is actually a good thing that this happened as he has been spending 60 hours per week at his job and it was causing him too much stress.  He states that now he is now happier and it was something he never wanted to do anyway.
    • rationalization
      • making excuses to avoid the real reason for actions or to avoid self-blame
        • another classic exampleclaiming that grades aren't important anyway after failing a test
  • A man is diagnosed with pancreatic cancer.  When he explains the diagnosis to his family he seems focused on discussing the scientific literature related to treatment, and the recent advances associated with the outcomes and mortality.  He does not seem to display concern or sadness for his diagnosis.
    • intellectualization 
      • excessive use of intellectual processes to avoid affective expression or experience
  • A young female in college finds her college professor extremely physically attractive and the way he lectures to be very sensual.  When she talks to her friends about him she says he is "repulsive" and his lectures are "dull and boring."
    • Reaction formation 
      • Replacing an unwanted idea or feeling with its opposite ("an equal and opposite Reaction")
        • another common exampledrug addict speaking out against drugs
  • A 45-year-old male always watches his favorite football team play on Sundays.  During this time he cheers, dances, yells, and throws tantrums if they lose.
    • regression
      • reversion to more childlike behavior
      • note that acting out is also present in this case
        • high-yield scenarioparticularly seen in children under stress (illness, punishment, birth of new sibling, fatigue)
          • e.g., toilet-trained child wets the bed while he is hospitalized
  • A female college student has been attending the student mental health clinic for stress management.  Upon reviewing the female's chart the psychiatrist sees that she was raped 1 month ago;however, upon questioning she is completely unable to recall the event.
    • repression
      • involuntary witholding of bad thoughts from consciousness
      • in contrast, suppression, which is voluntary, is choosing not to think about something that causes stress or unwanted emotions
  • A male raves that his doctor is the best in the United States.  She is gorgeous, punctual, intelligent, and always helps him.  When he finds out that she is 5 minutes late due to one of her other appointments, he tells everyone that she is actually a terrible doctor and is incompetent.
    • splitting
      • belief that people are either all good or all bad
      • seen in borderline personality disorder
Mature Defenses 
  • A man has been stealing from his school he teaches at for the past 2 years.  He has began to feel terrible for his behavior and has began volunteering at soup kitchens every weekend as a means to deal with his actions.
    • altruism 
      • alleviating guilt through charity 
  • An obese male is counseled by his physician to begin exercising more.  The patient returns for a follow-up visit and explains to the doctor that while he hasn't exercised much, but he has been eating quicker which he jokes is getting his jaw muscles in shape.
    • humor
      • appreciating the humor in a situation to relieve stress
  • An artist has recurrent suicidal ideation and anxiety.  Whenever she experiences these feelings, she expresses her inner angst on the canvas creating beautiful works of art that depict the sorrow that resides within the depths of her soul.
    • sublimation 
      • replacing an unacceptable action with a similar acceptable action
  • A young male is particularly emotionally tender when it comes to discussing his ex-girlfriend.  Whenever she is brought up, he chooses to not discuss her and talks about something else.
    • suppression
      • voluntary withholding of an idea or feeling from consciousness
      • in contrast to repression which is an involuntary ability to recall an event
 

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Questions (7)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
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(M2.PY.77) A 38-year-old woman is voted off the board of her garden club for tardiness and incomplete work on the spring fair. When she arrives home, her husband attempts to console her and she yells at him for constantly criticizing her. Which defense mechanism is the woman using? Review Topic

QID: 106885
1

Intellectualization

0%

(0/33)

2

Projection

0%

(0/33)

3

Displacement

94%

(31/33)

4

Reaction formation

0%

(0/33)

5

Isolation of affect

0%

(0/33)

M2

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SUBMIT RESPONSE 3

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(M2.PY.73) A professional golfer tees off on the first day of a tournament. On the first hole, his drive slices to the right and drops in the water. He yells at his caddy, then takes his driver and throws it at his feet, blaming it for his poor swing. Notably, the golfer had had a long fight with his wife last night over problems with family finances. The golfer's actions on the course represent which type of defense mechanism? Review Topic

QID: 105743
1

Sublimation

0%

(0/75)

2

Displacement

95%

(71/75)

3

Isolation of affect

1%

(1/75)

4

Rationalization

3%

(2/75)

5

Repression

0%

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