DEFENSE MECHANISM IS THE UNCONSCIOUS PSYCHOLOGICAL MECHANISM EMPLOYED BY US WHICH PREVENTS US FROM FALLING PREY TO INTOLERABLE ANXIETY, HOWEVER AT TIMES WE OFTEN PAY A HEAVY COST FOR USING IT IN PATHOLOGICAL WAYS.

1. By Dr Abid rizvi
M.D
REGISTRAR
DEPARTMENT OF PSYCHIATRY.
Jnmch
ALIGARH MUSLIM UNIVERSITY

2. INTRODUCTION

3. Freud
Unconscious mental processes
employed by the ego to reduce
anxiety

4.  Orign in the study of hysterical patients.
 Freud topographical theory
unconscious(repressed)
conscious(repressing)

6. STRUCTURAL THEORY OF THE MIND
Id ego and the superego.

7.  Freud :: repression  defense.
 Repression directed primarily direct expression of
the sexual instinct.

8.  after Freud had formulated his final theory of
anxiety, it was possible to study the operation of the
various defense mechanisms in light of their
mobilization in response to danger signals.

9. Anxiety and tension
 major drive  is the reduction in tension, and that
a major cause of tension was anxiety. He identified
three different types of anxiety.

10. Reality Anxiety.
 most basic anxiety, based on fears of real & plausible
events, ( being bitten by a dog)
 most common is taking oneself away from the
situation, (running away from the dog).

11. Neurotic Anxiety.
 unconscious fear that the basic impulses of the ID
will take control of the person, leading to eventual
punishment.
 (this is thus a form of Moral Anxiety).

12. Moral Anxiety.
 This form of anxiety comes from a fear of violating
values and moral codes, and appears as feelings of
guilt or shame.

13. Freud's Defense Mechanisms include:
 Denial: claiming/believing that what is true to be actually
false.
 Displacement: redirecting emotions to a substitute target.
 Intellectualization: taking an objective viewpoint.
 Projection: attributing uncomfortable feelings to others.
 Rationalization: creating false but credible justifications.
 Reaction Formation: overacting in the opposite way to the
fear.
 Regression: going back to acting as a child.
 Repression: pushing uncomfortable thoughts into the
subconscious.
 Sublimation: redirecting 'wrong' urges into socially
acceptable actions.

14.  Systematic & comprehensive study of ego defenses
 Anna Freud.
 “ everyone, whether normal or neurotic, uses a
characteristic repertoire of defense mechanisms but
to varying degrees.”

15.  anxiety occurs  the mind responds by increase in
problem-solving seeking rational ways of
escaping the situation.
 If this is not fruitful, a range of defense mechanisms
may be triggered.

16.  “tactics which the Ego develops to help deal with the
Id and the Supego.”
sigmond freud.

17. All Defense Mechanisms share two common
properties :
 They often appear unconsciously.
 They tend to distort, transform, or otherwise falsify
reality.

18.  “ are automatic psychological processes that protect
the individual against anxiety and from the
awareness of internal or external dangers or
stressors. “
 Individuals are often unaware of these processes as
they operate.
 mediate the individual's reaction to emotional
conflicts and to internal and external stressors “

19.  Level I - pathological defences (i.e. psychotic denial,
delusional projection,distortion)
 Level II - immature defences (i.e. fantasy, projection,
passive aggression, acting out)
 Level III - neurotic defences (i.e. intellectualization,
reaction formation, dissociation, displacement,
repression)
 Level IV - mature defences (i.e. humour, sublimation,
suppression, altruism, anticipation)

20. The defense mechanism

21. An attractive 28 years highly seducing female was
unaware of her flirtarious behavior.She was confused
about the sexual advances shown by so many men
and explained it by their animalistic tendencies, being
interested in sex rather than the whole person.

23.  conscious aspect of her sexual feeling has been
REPRESSED and were expressed unconsciously
through her behavoir.

24.  Main mechanism of defense.
 “exclusion from awareness(consciousness) of urges,
thought, fantasies feeling, and memories that would
be threatening if allowed into consciousness”
 Assessment of dangerousness is unconscious and at
times irrrational (eg a impulse dangerous in
childhood, naive now ,still been perceived as
dangerous and mobilization of defense just as real
threat)

25.  Its automatic, spontaneous, unconscious ego action
that prevents awareness of an intolerable internal
state, ideas or feeling.
 Buried into deep recesses of unconscious .
 Not destroyed but blocked ,strive for awareness .
 Depletes energy- ego energy.

26.  Basic DM,WORKS in conjuction of others.
 Others come in scene  repression fails.
 In normal individual during childhood .whole of the
oedipal complex is repressed.
 Frequent brief lapses of memory.
 Freudian slips episodic failure of repression.

28.  An elderly widowed male always carried a gun with
him and had riot control bombs at home and warned
others about the possibility of approaching danger.
He has been such suspicious when her wife died
accidently by his pulling the trigger.

30.  He was handling his feeling of anger towards
himself by PROJECTING it to several outside agency,
and reacted to them as real treats of the outside
world.

31.  “refers to disowning one’s attitude ,feeling and
urgess, and attributing them to some other person
to or object.”
 Anxiety diminished (person no longer responsible
for the possession of the unacceptable urges).

32.  High price is paid  perceptual distortion.
 Like denial – one of the primitive mechanism.
 Used excessively  dellusion & hallucination.
 Major role in personality development(child cast
out their anger onto their parents )

33.  Projection can be used in different grades.
 Normally used at time of stress and fleetingly.
 More a person relies on it more distorted will be his
perception of the external world.
 Beyond a certain point – paranoid delusion.

34.  “in case of paranoia, the projection of the accusation
onto other, without any alteration
of content and thus with no reference to reality,
become manifest as delusional process”
sigmond freud(fragment of an analysis of
hysteria CASE OF DORA)

36. A 35 YEARS old female lost her only child in acute
illness. She was in a shock like state for few days. After
this she started behaving as though nothing has
happened .She washed his clothes, prepared meals
cleaned the dead child’s room and talked to others as
though nothing has happened. She did’nt respond to
any attempt to correct her thinking.

38.  Death of the child could not be tolerated –extreme
DENIAL.
 PROTECTED HER FEELING but grossly distorted her
perception of reality.

40.  “excluding from awareness some aspect of
disturbing reality”
 A young and immature ego delays awareness of a
threatening world until greater level of maturity is
reached.
 Childhood fantasies.
 Normal in time of stress(eg war )or excessively used
in psychosis.

41.  Repression defends against affects and drive while,
denial abolishes external reality.

43. A 30 years old male was convinced that he was the best
musician(in reality very mediocre). HE sent his tapes
to music industry and when they were rejected he
said that they don’t want him to hijack the entire
music market.
He did’nt do to his regular work as that was the
would be a waste of time.

45.  His mediocre musical abilities were casting serious
doubt about his value as a person.
 He used distortion and distorted the rejection of his
recording in order to satisfy his internal need.
 This protected his ego against feeling of
worthlessness.

46.  “reshaping external reality to satisfy inner need”
 Seen in childhood fantasies and wish full filling
dreams.
 Denial denies the existence of reality while
distortion distorts external reality
 Unrealistic megalomania, hallucination, delusion.

48.  A 14 years old boy was a good student. His
performance deteriorated. His father spent most of
the time on business trip and mother only emphasized
on his studies with no emotional support. The more
she worked hard on his studies the more he would fail.
More she was aggressive more he would under achive
.This was very shameful for the mother and she would
feel humiliated among her friends.

49. 

50.  Had multiple issues ,not taken care by her mother.
 Her aggression towards her mother was expressed
in a was that was not threatening to his ego.
 Feeling of aggression was expressed through his
PASSIVELY turning against the self

51.  Unconscious expression of aggression towards
others expressed indirectly, through passivity,
masochism, and turning against the self.
 PAB CONVERTS anger at others into silly,
provocative behavior or failure that bothers other
more than the individual.

53. A married woman could not tolerate it if things were
disorderly or un kept. Her insistence on order,
promptness, and attention to detail made her a
successful at work. But at home life of family and
friends was hell. Entire household was tormented by
her behavior.

55.  A 35 old male vehemently opposes homosexual
relationships. He thrashed his boss and
consequently had to loose his job on learning that
boss was gay. Beside this he had a number of
hetrosexual relationships with a large number of
females. One day his girlfriend came to know that
his only permanent affair was with a man.??

56.  Patient had difficulty in toilet training and
conforming in general.
 Her instinctual drive to dirty up his surrounding had
been defended against by reaction formation and
been retained as part of his personality.

57.  Refers to converting disturbing attitude, behavior
and feeling into the opposite.
 OCD
 “the existence of extreme of behaiour always leads
one to suspect the opposite. Those who make too
great an issue of their virtue may reveal how
formidable temptation has become.”

58.  Realted to rigorous self decipline.
 Useful in many profession but emotionally draining.

60.  A child suddenly starts to wet the bed after years of
not doing so, this happened after the arrival of new
sibling.

61. 

63.  one of Freud's original defense mechanisms, is a
form of retreat, going back to a time when the
person felt safer and where the stresses in question
were not known, or where an all-powerful parent
would take them away.

64.  The stress of fixations used to explain a range of
regressive behaviors
 Oral fixation can lead to increase smoking .
• anal fixation can lead to anal retentive behaviors
Tidying and fastidiousness.
• Phallic fixation can lead to conversion hysteria.

66.  a 35 year old army jawan was out of his home most of
the time. Once on returning home after a long posting
he started having recurrent thought of killing his
wife.
 He had continuous thought, without any feeling ,and
was very anxious because those came against his
wish . He was anxious as to what would happen if he
actually kill his wife.

68.  Wife, having AFFAIR, husband discovered.
 Recent discovery was anxiety provoking and
threatening to the integrity of ego.
 ISOLATED feeling(anger) from the idea(killing his
wife) repressed feeling in his unconscious, while
the idea saperated from feeling was less threatening
and allowed into consiousness.

69.  “Separation of idea from its appropriate affect”
 The idea deprived of its affective tone enters
conscious awareness , but the affect is repressed.
 Protective due to the repression of the affect.
 The idea itself may be tormenting, guilt producing,
but the discomfort is not as that if the affect is
suddenly made conscious.

70.  Seen in obsessional thinking.
 Initial numb like feeling following trauma, person
is consciously aware of the incident but it feel to him
as unreal and foreign.
 If feelings allowed into consciousness person is
better able to deal with the situation.

72.  A medical student was caught smoking in his room by
his father. On being caught he gave explanation for
his smoking as being protecting against ulcerative
colitis . His gave father advise to smoke as it is also
protective against Alzheimer's..

74.  Act of giving logical believable explanations for
behaviors that is in fact irrational.
 Unconscious urges that are unacceptable& provides
a acceptable tolerant reason for the behavior.
 Not conscious lying or excuse giving(unconsciously
motivated).

76.  A newly married female has been recently diagnosed
with breast cancer. After a phase of denial she start
discussing the odds of her survival with her oncologist
in an unemotional way . Further more she started
calculating the odds that her husband would divorce
her onces she undergoes mastectomy. she talked
about these emotionally laden topics plainly and in
great detail.

77. 

78.  Excessively using intellectual processes to avoid
affective expression or experience.
 Attention is paid to external reality to avoid the
expression of inner feelings, and stress is excessively
placed on irrelevant details to avoid perceiving the
whole.
 Intellectualization is closely allied rationalization.

79.  Heavy use of jargon when ordinary language would
suffice is often used as a device of intellectualization.
 By using complex terminology, the focus becomes on
the words and finer definitions rather than the
human effects.

80.  Freud believed that memories have both conscious
and unconscious aspects, and that
intellectualization allows for the conscious analysis
of an event in a way that does not provoke anxiety.

81.  A 40 year old male kicked his dog when ever he had
an argument with his wife. He was upset by his
unacceptable rage toward her. On one occasion he
tried to strangulate it. Dog happened to the favorate
of his wife. He was unaware of his anger towards his
wife.

82. 

83.  He displaced the anger (wife) onto the family dog
and kicked it.
 Anger at dog was less threatening & most
importantly , could be tolerated within his conscious
awareness.

85.  “Shifting an emotion or drive cathexis from an idea
or object to another that resembles in some aspect”
.
 Allows symbolic expression of idea or drive that is
less distressing.
 Angry feeling for one person may be displaced onto
other that have some degree of similarity.

86.  Seen in phobic reaction in which particular situation
provokes anxiety, displaced from unconscious
sources
 Assures the coherent functioning of ego by
circumscribing the anxiety producing situation
which the ego tends to avoid.

87.  Displacement may involve retaining the action and
simply shifting the target of that action.
 Where this is not feasible, the action itself may also
change.

88.  Thus there is a transfer of energy from a repressed
object-cathexis to a more acceptable object.

90.  Before going to school each day, a 13 year old male
went through elaborate series of rituals . He checked
his closet & checked under his bed exactly 3 times; he
straightened a picture on the leaving room wall. On
his way to & from school, he walked in definite path
ways in relation to several telephone polls he passed.
If he deviated from this routine, he became quite
anxious.

92.  He was sexually inhibited, & experiencing guilt
about masturbatory fantasies. His ritualistic
behavior served the purpose of decreasing(UNDO)
guilt & anxiety by magically undoing his
unacceptable sexual fantasies & urges.

93.  “ACT which magically cancel out or reverse a
previous act or thought.”
 Previous act or thought was motivated by
unconscious unacceptable urges, and undoing
serves the puspose of temporalily abolishing the
urges.

94.  A strong fixation to magical thinking.
 Religious ritual.

96.  16/f returning late night from movie was robbed of
all her belonging at gun point. She called her father
and narrated whole story who came on the scene and
took her to the cops. There she denied anything that
had happened. She had no signs of anxiety and said
she might have dropped all her belongings.

97. 

98.  This is example of dissociative amnesia

99.  temporarily but drasticallly modifying a person’s
character or one’s sense of personal identity to
avoid emotional distress.
 Seen as dissociative amnesia , DID,

101.  In german concentration camps, certain prisoners
began to behave arrogantly, just like their german
captors. They would behave in a way that would
seem unappealing & undesirable to them.

103.  On august 1973 two thieves Jan-Erik Olsson and
Clark Olofsson held four Stockholm bank employees
hostage at gunpoint in a vault. When the victims
were released, their reaction shocked the world.
They displayed behavior patters as their captors,
refused to cooperate and make charges against the
captors. One female victim went on to have
relationship with the captor.

104. “internalizing attitude or behavior pattern of
significant people’s in one’s life”
 Important early in life and in the maturation of ego.
 A developing child identifies with the values,
attitude and behavior of the paarent, and these
memories become part of his personality.

105.  Hence the environment of the child must be healthy
and of desirable people.
 During oedipal conflict boy identifies with the father.
“I’ll be like u than be afraid of u.”
important in ending the oedipal complex and child
taking the value and beliefs of father.

106.  IDENTIFICATION WITH THE AGRESSOR
Gives inner feeling of being as strong as the
aggressor and so decreases anxiety.

108.  A 44 year old successful bussinessman achieved
considerable success in bussiness then he began to
devote time to philanthropic & organizations,
specialy those that assisted underprevelaged children.
He enjoyed seeing the children lives improved
through his efforts.

109. 

110.  He himself was poor in his childhood. Clearly he
channeled many aggressive feelings into this work.
His altruism, offered intrapsychic assistance in
dealing with his aggressive drives.

111.  high adaptive defense mechanism against feelings of
inferiority or a lack of fulfillment.
 “using constructive and instinctually gratifying
service to other to undergo a vicarious experience”.
 The service rendered to others offers real benefit.
and the id impulse is atleast partially gratified by the
behavior.
 Altuistic surrender.-(self sacrifice).

112.  if an individual becomes dependent upon these acts
in order to maintain a feeling of worth, altruism is
no longer a high adaptive defense mechanism.

114.  A 25 year old female student was having exam. she
had been invovled in romantic relationship, but had
developed serious questions about her feelings for
him. She wanted time to think before making a
decision . She postponed dealing with the relationship
question
 This was accomplished in reasonable period of time &
allowed her to deal more affectively with the
important personal issues with young man. The
problem was not avoided but had been postponed to
a more advantagious time.

115. 

117.  “Consciously or semiconsciously postponing
attention to a conscious conflict to a more suitable
time”
 Conflict is postponed but not avoided.
 Not a true defense mechanism.

119.  A 53/m had anticipated the possibility of serious
illness at some point in life, & the problems that
would be created on an emotional as well as
practical level. He had made good, common
practical arrangements in terms of medical
insurance.
 When he had develop a serious medical problem
requiring surgery, he was naturally upset, but not
nearly so much as if he had not anticipated.
 His physical recovery was assisted by his
emotionally mature way of dealing with the illness.

120. 

121.  “realistically anticipting and planning for future
inner disscomfort”

122.  A brilliant student with strong urge to control
people finds himself attracted to careers in
medicine in which he can have great power and
control over patients and staff in the context of
doing good for people. The underlying aggressive
urge might sometimes be seen in mistreatment of
nurses.

123. 

125.  “ channeling of unwanted impulses into something
less harmful and socially acceptable. This can simply
be a distracting release or may be a constructive and
valuable piece of work”.
 faced with the dissonance of uncomfortable
thoughts, we create psychic energy. This has to go
somewhere.
 Sublimation channels this energy away from
destructive acts and into something that is socially
acceptable and/or creatively effective.

126.  Many sports and games are sublimations of
aggressive urges,
 most useful and constructive of the defense
mechanisms.

127.  “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”.

128. ACTING OUT
The direct expression of an unconscious wish or
impulse in action to avoid being conscious of the
accompanying affect.
 chronic level, acting out involves giving in to
impulses to avoid the tension that results from
postponement of expression

129. Hypochondriasis
 Transformation of reproach toward others arising
from bereavement, loneliness, or unacceptable
aggressive impulses into self-reproach and somatic
complaints of pain, illness, and so forth.

133.  Affiliation

136.  Influence diagnostic condition and impede progress
 It is very important for the practitioner to be aware
and recognize how they influence treatment (APA,
2000).
 DSM-III was the first to included a multiaxial
system

137.  3 optional axes(APPENDEX B) in DSM 4 TR .
DFS,SOFAS,GARF.
 DFS on axis 2 along with pd and mental retardation.
Benefit increases information conveyed
Loss crushes under its own weight.

138.  Defense mechanisms can be classified into groups or
levels that indicate how they affect an individual's
functioning
◦ High Adaptive Level
◦ Mental Inhibition Level
◦ Minor Image-distorting Level
◦ Disavowal Level
◦ Major Image-distorting Level
◦ Action Level

139. High Adaptive Level:
 result in optimal adaptation to stress.
 maximize feelings of well being and
 Allow the conscious awareness of feelings, ideas,
and their consequences.
 promote an optimum balance among conflicting
motives

140. ◦ anticipation
◦ affiliation
◦ altruism
◦ humor
◦ self-assertion
◦ self-observation
◦ sublimation
◦ suppression

141.  Mental Inhibition Level keep potentially
threatening ideas, feelings, memories, wishes, or
fears out of awareness. Diminished awareness can
affect the person's ability to relate to others.
 displacement
 dissociation
 intellectualization
 isolation of affect
 reaction formation
 repression
 undoing

142.  Minor image-distorting level. This level is
characterized by distortions in the image of the self,
body, or others that may be employed to regulate
self-esteem. Examples are
 devaluation
 idealization
 omnipotence

143.  Disavowal level. This level is characterized by
keeping unpleasant or unacceptable stressors,
impulses, ideas, affects, or responsibility out of
awareness with or without a misattribution of these
to external causes. Examples are
 denial
 projection
 rationalization

144.  Major image-distorting level. This level is
characterized by gross distortion or misattribution
of the image of self or others. Examples are
 autistic fantasy
 projective identification
 splitting of self-image or image of others

145.  Action Level: This level is characterized by defenses
that deal with internal or external stressors by
action or withdrawal.
 acting out
 apathetic withdrawal
 help-rejecting complaining
 passive aggression

146.  Level of defensive dysregulation. This level is
characterized by failure of defensive regulation to
contain the individual's reaction to stressors,
 lead ins to a pronounced break with objective
reality. Examples are
 delusional projection
 psychotic denial
 psychotic distortion

147.  Fully functioning mature adults are flexible 
capable of range of defensive maneuvers
 They are able to meet their needs through this
flexibility - the need to protect themselves, and the
need to connect with others to satisfy intimate and
economic needs

148.  S.freud --anna freud ---george valliant.
 ???unconscious mind.
 Orign of behaviorism and death knell of
psychoanalysis.
 D. S. Holmes et all (1972, 1974, 1990) published
various studies negating unconscious mental
operations.

149.  In the past decade, new ideas about defense
mechanisms have begun to develop.
 classical psychoanalytic theory had explained
defenses as
 counterforces to the expression of instinctual drives,
contemporary psychoanalytic self-psychology and
object relations theory broadened the role of
defense to include the maintenance of self-esteem
and the protection of selforganization.

150.  Baumeister et al. (1998) discussed research from
modern social psychology that provides evidence
for the use of defense mechanisms in situations
where there is a threat to self-esteem.

151.  increasing body of evidence for psychological
functioning outside of awareness and for defenses
 important implications for anyone involved in the
treatment of patients, either medical/psychiatric.

152. Therapeutic Noncompliance
 Pts serious medical conditions with bad compliance
,strong use of DM
 Premature termination /avoidance of therapy may
be significantly influenced by dm.

153.  "By thoughtlessly challenging irritating, but partly
adaptive, immature defenses, a clinician can evoke
enormous anxiety and depression in a patient and
rupture the [therapeutic] alliance" (Vaillant, 1994)

154. Assessment of Coping Strategies
and Outcomes.
 Defense mechanisms have been found to make
independent contributions to the prediction of
adjustment.
 Relying solely on self-report measures for this purpose
is questionable, for it ignores the possibility that
either intentionally or unintentionally, the self-report
is biased.

155. Facilitating Differential Diagnosis.
 use of immature defenses  BPD
 patients with psychoses use defenses that are
less mature than those used by patients with
personality

156. Demonstrating the Benefits of Psychotherapy
or Other Interventions.
 The relation between therapeutic benefits and
defense use has been demonstrated in several
clinical studies.
 After 15 months of intensive therapy, hospitalized
patients showed a significant decrease in immature
defenses.

157. PSYCHOSES:
*In the acute stage  complete loss of the ego’s DM
Disturbing thoughts, feelings, and impulses intrude into
the consciousness
*As the individual gradually improves defenses appear
 Projection
 Delusional denial
 Distortion
 Regression

158. NEUROTIC CONDITIONS:
(Anxiety Disorders; Somatoform Disorders;
Dissociative Disorders in DSM IV R)
*defenses are used non-adaptively in social
interaction
*they are stereotyped and repeated

159.  Phobia: Displacement
Avoidance
Symbolization
Restriction of the Ego

160. Somatoform Disorders:
Somatization
Conversion
Passivity

161. Dissociative Disorders:
Dissociation
Denial

162. DEPRESSION
--Turning against the self
--Passivity
--Isolation
--Identification

163. Obsessive-Compulsive Disorder
--Isolation
--Intellectualization
--Reaction formation
--undoing

164. MATURE BEHAVIOR
--Suppression
--Humor and wit
--Sublimation
--Intellectualization
--Asceticism

165.  "Today, no mental status or clinical formulation
should be considered complete without an effort to
identify the patient's dominant defense mechanism"
(Vaillant, 1992, p. 3).

166. “SOMETIMES A CIGAR IS JUST A CIGAR”
---SIGMOND FREUD.

167.  Comprehensive textbook of psychiatry.
 Ego and the mechanism of defense(anna freud).
 Ego and the id (sigmond freud).
 Biography of sigmund freud (ernest jones).
 Psychoneurosis and the mechanism of
defense(freud).

168.  Defense Mechanisms in Psychology Today
(Phebe Cramer Williams College).
 Seven Pillars of Defense Mechanism Theory*
(Phebe Cramer).
 Defense
Mechanisms(http://changingminds.org/explanation
s/behaviors/coping/defense_mechanisms.htm)

169.  DSM 4 tr classification of defense.