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 example: claiming 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 example: drug 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 scenario: particularly 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