Defense Mechanisms

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Defense Mechanisms Nursing Care Management

In this study guide, we will be discussing defensive mechanisms including the different types and how they manifest in a person.

Defense mechanisms were first described by Sigmund Freud, an Austrian psychiatrist, who is regarded as the father of psychoanalysis. He believed that individual uses defense mechanism consciously or unconsciously as a way to deflect anxiety and to cover up feelings that affects self-esteem. His work was later developed by his daughter Anna Freud and other psychoanalysts.

What are Defense Mechanisms? 

The term defense mechanism refers to a predominantly unconscious self-protective process that seeks to shield the ego from intense feelings or affect and impulses.

  • Additionally, these intrapsychic processes modify, nullify, or convey painful affects or tendencies so they can be tolerated consciously.
  • Defense mechanisms mostly operate at the subconscious level of awareness, so people are not aware of what they are doing.

Major Defense Mechanisms

Learning defense mechanism has become an integral component of psychotherapy. Some of the major defense mechanism that are widely used are the following:

Defense MechanismDefinitionExample
DisplacementRedirection of negative urges or feelings from an original object to a safer or neutral substitute.The man who is angry with his boss and returns home and becomes angry instead with his wife or children.
DenialRefusal to admit to a painful reality, which is treated as if it does not exist.The woman who miscarries denies that she has lost the baby and continues to wear maternity clothes.
IntellectualizationUse of excessive reasoning rather than reacting or changing.A woman attending Alcoholics Anonymous meeting reports that she is a nurse and has conducted many 12-step sessions.
IntrojectionEngulfment or incorporation of specific traits, behaviors or qualities into self or ego structure.A depressed man who incorporates the negative feelings and hatred of his estranged wife, who recently filed for divorce.
ProjectionBlame of other’s or things for one’s own feelings or thoughts.The client experiencing paranoia blames others for disliking him.
RationalizationAn effort to replace or justify acceptable reasons for feelings, beliefs, thoughts, or behaviors for real ones.A woman who overextended credit cards rationalizes that she can use er savings to pay for a new dress she recently purchased.
Reaction formationRepression of painful or offensive attitudes or traits with unconscious opposite ones.The college student who feels angry and hostile toward her professor is overtly friendly and agreeable in class.
RegressionRetreat to an earlier developmental stage.The 3-year old child who begins wetting his pants after the birth of a new sibling.
RepressionUnconscious, purposeful forgetting of painful or dangerous thoughts (the most basic defense mechanism).The married woman who expresses hostility toward a male co-worker to avoid dealing with her sexual attraction to him.
SublimationNormal form of dealing with undesirable feelings or thoughts by keeping them in an acceptable context.The woman who is unable to bear children begins working in a preschool.
SuppressionConscious and deliberate forgetfulness of painful or undesirable thoughts and ideas.A rape victim attempts to forget the incident and fails to report it to the proper authorities.

Practice Quiz: Defense Mechanism

Nursing practice questions for Defense Mechanism. For more practice questions, visit our NCLEX practice questions page.

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Practice Quiz: Defense Mechanism

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1. Mr. Warren, an attorney who throws books and furniture around the office after losing a case is referred to the psychiatric nurse in the law firm’s employee assistance program. Nurse Lorraine knows that the client’s behavior most likely represents the use of which defense mechanism?

A. Projection
B. Regression
C. Intellectualization
D. Reaction-formation

1. Answer: B. Regression

  • Option B: An adult who throws temper tantrums, such as this one, is displaying regressive behavior, or behavior that is appropriate at a younger age.
  • Option A: In projection, the client blames someone or something other than the source.
  • Option C: In intellectualization, the client overuses rational explanations or abstract thinking to decrease the significance of a feeling or event.
  • Option D: In reaction formation, the client acts in opposition to his feelings.

2. Brent is admitted to a psychiatric unit with a diagnosis of undifferentiated schizophrenia. Which of the following defense mechanisms is probably used by Brent?

A. Regression
B. Repression
C. Projection
D. Rationalization

2. Answer: A. Regression

  • Option A: Regression, a return to earlier behavior to reduce anxiety, is the basic defense mechanism in schizophrenia.
  • Option B: Repression is the basic defense mechanism in the neuroses; it’s an involuntary exclusion of painful thoughts, feelings, or experiences from awareness.
  • Option C: Projection is a defense mechanism in which one blames others and attempts to justify actions; it’s used primarily by people with paranoid schizophrenia and delusional disorder.
  • Option D: Rationalization is a defense mechanism used to justify one’s action.

3. Nurse Raffy recognizes that paranoid delusions usually are related to the defense mechanism of:

A. Regression
B. Repression
C. Identification
D. Projection

3. Answer: D. Projection

  • Option D: Projection is a mechanism in which inner thoughts and feelings are projected onto the environment, seeming to come from outside the self rather than from within.

4. Nurse Lucas is aware that the defense mechanism commonly used by clients who are alcoholics is:

A. Displacement
B. Compensation
C. Denial
D. Projection

4. Answer: C. Denial

  • Option C: Denial is a method of resolving conflict or escaping unpleasant realities by ignoring their existence.

5. A client who abuses alcohol and cocaine tells a nurse that he only uses substances because of his stressful marriage and difficult job. Which defense mechanisms is this client using?

A. Sublimation
B. Displacement
C. Projection
D. Rationalization

5. Answer: D. Rationalization

  • Option D: Rationalization is the defense mechanism that involves offering excuses for maladaptive behavior. The client is defending his substance abuse by providing reasons related to life stressors. This is a common defense mechanism used by clients with substance abuse problems.
  • Options A, B, and C: None of the remaining defense mechanisms involves making excuses for behaviors.

References

Sources and references for this study guide for defense mechanisms:

  • Black, J. M., & Hawks, J. H. (2005). Medical-surgical nursing. Elsevier Saunders,.
  • Vaillant, G. E. (1992). Ego mechanisms of defense: a guide for clinicans and researchers. American Psychiatric Pub.
  • Videbeck, S. L. (2017). Psychiatric Mental Health Nursing.
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