Review Question - QID 105745

Passive-aggressive behavior occurs when an individual indirectly expresses hostility via stubbornness, resentment, or other means; in this case, the wife burns the toast to express her displeasure with her husband's change in work schedule.

Ego defenses are unconscious mental processes used to resolve conflict and prevent undesirable feelings such as anxiety or depression. Defense mechanisms may be pathological or neurotic, mature or immature. Passive-aggression is an example of an immature defense mechanism, as is denial. Examples of mature defense mechanisms include humor, suppresion or sublimation.

Perry et al. review defenses in schizotypal, borderline, antisocial, and narcissistic personality disorders. In borderline personality disorder, the most commonly used defense is splitting. In paranoid personality disorder, projection is the major defense mechanism.

Vaillant reviews ego mechanisms of defense and personality psychopathology. By including a patient's defensive style as part of the diagnostic formulation, the clinician is better able to comprehend what seems initially most unreasonable about the patient and to appreciate what is adaptive as well as maladaptive about the patient's defensive distortions of inner and outer reality. Clinical appreciation of the immature defenses (such as hypochondriasis, fantasy, dissociation, acting out, projection, and passive aggression) is particularly useful in classifying and caring for individuals with personality disorders.

Incorrect Answers:
Answer 1: Fixation occurs when an individual remains at a more childish level of development i.e. men fixating on sports games.
Answer 2: Splitting occurs when an individual starts to believe that people are either all good or all bad at different times due to intolerance of ambiguity i.e. a patient says that all the nurses are cold and insensitive but the doctors are warm and friendly. It is typically seen in borderline personality disorder.
Answer 3: Denial is characterized by avoidance of awareness of painful realities. This is common in patients who have received a new fatal diagnosis.
Answer 4: Regression occurs when one turns back the maturational clock and goes back to earlier modes of dealing with the world. i.e. bedwetting in children under stress.