Psychiatric Mental Health, part 8: Defense Mechanisms
July 26, 2021 Updated: September 07, 2021 8 min read 1 Comment
Maybe you've heard, "you're compensating" or "that's projection," in response to something you've said or done before. If that happened, you were being accused of using some of the more commonly-known defense mechanisms! In this article, we'll cover the key defense mechanisms you need to know about, with examples.
This series follows along with our Psychiatric Mental Health Nursing Flashcards which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
What are defense mechanisms?
Defense mechanisms are conscious or unconscious coping mechanisms used to decrease anxiety.
Defense mechanisms by themselves are certainly not indicative of a mental health disorder. As you read this list, you may identify many of these within yourself and your own behavior from time to time!
Some defense mechanisms can be very useful and effective, as they may prevent violence, lashing out, or protect the patient from unmanageable stress.
The defense mechanisms we'll cover here are avoidance, compensation, conversion, denial, displacement, dissociation, identification (introjection), intellectualization, projection, rationalization, reaction formation, regression, repression, splitting, sublimation, suppression, and undoing.
Avoidance is avoiding people or situations that cause distressing thoughts or feelings. A patient demonstrating avoidance stays away from those things.
Compensation is when one focuses on their strengths as opposed to their perceived weaknesses.
For example, someone who struggles academically might focus on excelling in sports instead. Or, someone who is self-conscious about their height may enhance other physical characteristics, like the size of their muscles.
Conversion is the development of physical symptoms in response to stress without an underlying medical cause. You can think of this as someone "converting" their stress to a physical ailment.
Denial is refusing to accept the reality of a situation. Denial is also one of the five stages of grief. For example, a patient who does not accept their cancer diagnosis is in denial.
Displacement is transferring feelings or emotions from one target to another.
For example, if a patient is given a poor diagnosis and takes it out on their nurse by yelling at them, that would be an example of displaced anger, fear, or overwhelm.
Disassociation is when someone compartmentalizes or disconnects from reality.
A classic example of disassociation is a soldier in combat who feels like they are observing themselves from the outside.
The defense mechanism identification, which is also called introjection, is when someone adopts the beliefs, behaviors, or feelings of another person.
Intellectualization is avoiding the emotions associated with a particular situation, and instead focusing on the facts and logic.
Projection is when one attributes their own thoughts and feelings onto someone else who may not have those thoughts and feelings.
Cathy explains this as being like a movie projector— you are projecting your own thoughts and feelings onto someone else like a movie projector projects images onto a screen.
Projection as a defense mechanism is fairly well-known in popular culture. If you accuse someone of something and they retort, "That's projection," you know they think it's actually you who is doing the thing.
Rationalization is an attempt to justify unacceptable behavior using a logic-based explanation.
For example, if a student cheated on a test, and says, "I didn't have to know that stuff anyway," they are attempting to rationalize their unacceptable behavior.
The defense mechanism reaction formation is when someone expresses the opposite feelings or behavior from what they actually feel, because their true feelings may seem unacceptable or anxiety-producing to them.
For example, young people may tease someone they have a crush on. "Killing someone with kindness" who you don't like is another example of reaction formation.
Regression is a defense mechanism where a person reverts to an earlier developmental level in response to a stressor.
For example, if a family has a new baby, and that baby's older sibling, who is already potty-trained, suddenly starts wetting their bed/wetting their pants, that is regressing in response to a stressor (the baby).
Repression is the subconscious, involuntary blocking of unpleasant feelings or painful memories.
With repression, you don’t realize you’re doing it (vs. suppression).
Splitting is another defense mechanism. With splitting, an individual fails to recognize both the positive and negative attributes of another person. Splitting can be described as an all-or-nothing mentality.
For example, a patient may say, "This nurse is terrible, and I hate her, and she's the worst nurse ever," about a nurse they don't like, and say, "this nurse is amazing and wonderful and perfect," about a nurse they do like.
Patients with borderline personality disorder may employ splitting as a defense mechanism.
Sublimation is taking unacceptable impulses and transforming them into socially acceptable behaviors.
For example, someone gets in a big argument and wants to punch the other person, but instead they go home and punch their pillow, or they go to the gym and punch a punching bag.
As a reminder, not all defense mechanisms are maladaptive or bad. Arguably, punching a pillow is much better than punching a person!
Suppression is the conscious or voluntary blocking of unpleasant feelings or painful memories.
Again, it's important to not get repression and suppression confused. When someone is suppressing, they are aware they are doing it. With repression, they are not aware.
The defense mechanism undoing is when a person attempts to cancel out an unacceptable behavior or thought by doing something to reverse it.
For example, if a manager is excessively harsh on an employee during their performance review, then feels bad about it, so then they are excessively nice/do special things for the employee—that's undoing. They are attempting to undo their behavior.
Level Up RN's teaching on defense mechanisms is intended to help prepare you for psychiatric/mental health nursing exams. The Psychiatric Mental Health Nursing video series is intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI and NCLEX.
Hi. I'm Cathy with Level Up RN, and in this video, we are going to go over defense mechanisms. Defense mechanisms are unconscious or conscious coping mechanisms used to decrease anxiety. And there's a lot to go over here. I'm going to be going over 17 defense mechanisms in alphabetical order. If you have our cards, I highly recommend going through these multiple times, maybe take them for a walk so that you have that repetition, and that will, hopefully, help you remember all the different defense mechanisms. At the end of this video, I will be giving you guys a little quiz, a little name-that-defense mechanism, to see how well you learn them. Okay. So let's go through, starting with A.
So our first defense mechanism is avoidance.
Avoidance is pretty straightforward. So you're avoiding people or situations that cause distressing thoughts or feelings. So you're just staying away from those things.
Then we have compensation.
Compensation is where we focus on our strengths as opposed to our perceived weaknesses. So an individual who struggles academically maybe will focus on their sports instead.
Then we have conversion.
Conversion is the development of physical symptoms in response to stress without an underlying medical cause.
Then we have denial, which is also pretty straightforward. So this is really where you refuse to accept the reality of a situation.
Then we have displacement.
Displacement is where we transfer our feelings or emotions from one target to another.
So, for example, if a patient is given a poor diagnosis and they take it out on their nurse by yelling at them, that would be an example of displacement. Then we have disassociation. This is where someone compartmentalizes or disconnects from reality. So a classic example of disassociation would be a soldier in combat who feels like he's observing himself from the outside.
Next, we have identification. This is where someone adopts the beliefs or behaviors of another person.
And then, after that, we have intellectualization.
Intellectualization is avoiding the emotions associated with a particular situation and instead focusing on the facts and logic.
And then, projection is another defense mechanism. This is where we attribute our own thoughts and feelings onto someone else who may not have those. So it's like a movie projector. You're projecting your own thoughts and feelings on someone else.
Then we have rationalization.
So rationalization is an attempt to justify unacceptable behavior using a logic-based explanation. So let's say there's a student who cheated on a test, and he says, "Well, I didn't have to know that stuff anyway, and that's why I cheated." So he's attempting to justify or rationalize his unacceptable behavior.
Then we have reaction formation.
So with reaction formation, an individual expresses the opposite feelings or behavior from what is actually felt.
So my example of reaction formation is, when I was younger, I used to swim on the swim team, and we would go to practice like every day. And I used to carpool with this boy. His name was Matt. And Matt would tease me all the time. He was so mean to me and tease me, and so I couldn't stand Matt. But I came to find out later on that he really liked me, and that was his way of expressing it when he was young. So, "I like her, but I don't know what to do, so I'm going to just tease her." So that's my example for reaction formation.
Next, we have regression.
Regression is a defense mechanism where an individual reverts to an earlier developmental level in response to a stressor. So let's say a family has a new baby, and that baby's older sibling, who had been potty-trained for a like a year or more, suddenly starts wetting their bed and wetting their pants. They are regressing in response to a stressor, which is that baby.
So that's a classic example of regression.
Then we have repression.
Repression is the subconscious, so involuntary blocking of unpleasant feelings.
It's important to not get repression and suppression confused.
So with repression, you don't realize you're doing it, and that's a little cool chicken hint on our card here, which will, hopefully, help you remember the difference between those two.
Splitting is another defense mechanism.
With splitting, an individual fails to recognize both the positive and negative attributes of an individual. It's kind of like an all-or-nothing mentality. And I've seen that with some patients at the hospital where they're like, "This nurse is terrible, and I hate her, and she's the worst nurse ever. And this nurse is amazing and wonderful and perfect," right? And it's just black and white. No gray. This defense mechanism is very commonly used with a borderline personality disorder.
Next, we have sublimation.
With sublimation, someone takes their unacceptable impulses and transforms them into socially acceptable behaviors. So let's say someone gets in a big fight with someone and wants to punch them, but instead, they go home, and they punch their pillow, or they go to the gym and punch a punching bag.
That would be an example of sublimation.
And the way I remember that one is with sublimation, you substitute an acceptable target.
And then we have suppression, which I kind of mentioned before. But that is the conscious or voluntary blocking of unpleasant feelings. And then, finally, we have undoing. Undoing is where someone attempts to cancel out unacceptable behavior or thought by doing something to kind of reverse it. So let's say a manager is really excessively harsh on an employee during their performance review. And then they kind of feel bad about being so harsh, so then, afterwards, they go out of their way to be excessively nice and do special things for the employee. So they're trying to really undo their acceptable behavior.
All right. That's it. We got through all 17 of those defense mechanisms. All right. Quiz time. So get ready to name that defense mechanism. I have three for you.
Number one: what is the subconscious or involuntary blocking of unpleasant feelings? If you said repression, you are correct.
Number two: what do you call it when unacceptable impulses are transformed into socially acceptable behaviors? The answer is sublimation.
Then number three: what do you call it when someone expresses the opposite behavior or feelings from what is actually felt? That is reaction formation. So I hope you did good on that. If you didn't, don't worry. There's a lot of defense mechanisms. It really takes repetition. Hopefully, this video has been helpful. Take care, and good luck studying.
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