Defense mechanism

DEFENSE MECHANISM
DR V K SAHU
RESIDENT PSYCHIATRY

Scheme of Presentation
• Objective of presentation
• History
• Basic concepts
• Important properties
• Definition
• Purpose of defense mechanisms
• Classification
• Some important defense mechanisms
• Measurement
• Defense mechanisms and major clinical syndromes

Objective of Presentation
• Identification and notation of defense mechanisms can be an
important part of the psychological assessment and influence
on the treatment process
• Familiarisation with benefits and harms of defense mechanism.

History
• The concept of defense first appeared in Sigmund Freud’s article
"The Neuro-Psychoses of defense" (1894) and was next discussed in
"Further Remarks on the Neuro-Psychoses of defense" (1896) and
"The Aetiology of Hysteria" (1896).
• For Freud, the concept of defense refers to the ego's attempts at
psychic transformation in response to representations and affects that
are painful, intolerable, or unacceptable.
• He abandoned the concept of defense for a period in favor of the
concept of repression. He then reintroduced it in "Neurotic
Mechanisms in Jealousy, Paranoia and Homosexuality" (1922).

History
• In an appendix to Inhibitions, Symptoms, and Anxiety (1926), Freud
reverted to the old concept of defense. He also retained the word
“repression” for special method of defense.
• Freud's list of basic Defense Mechanisms includes: Denial, Displacement,
Intellectualization, Projection, Rationalization, Reaction formation,
Regression, Repression and Sublimition.
• The first comprehensive study of defense mechanisms was reported by
Anna Freud in her landmark work, The Ego and the Mechanisms of
defense (1937).

The tripartite model of the mind
• Freud
• Ego
• ID
• Superego
• The id is need gratifying and impulsive,
instinctual
• Hedonic drives for instance
• Superego is roughly eq. to conscience
• Determines that some needs are not
consistent with an underlying view of one’s
self (Ego ideal)

Ego
• Ego is the mediator between the unconscious world of the Id
and Superego and the conscious world of reality
• The ego’s job is to mediate the struggle between the superego
and id
• When superego and id are in conflict the person experiences
‘signal anxiety’
• Ego must convert the signal anxiety to defuse it and make it
less threatening.

Ego Defenses
• If the signal anxiety cannot be defused it may overwhelm the
ego and allow the primitive primary process thinking of the
unconscious to become manifested in the conscious life of the
person

Basic concept –Types of Anxiety
• Reality Anxiety: most basic form of anxiety ,typically based on fears of
real and possible events, such as being bitten by a dog or falling from a
ladder.
• Neurotic Anxiety: comes from an unconscious fear that the basic
impulses of the ID will take control of the person, leading to eventual
punishment.
• Moral Anxiety: form of anxiety comes from a fear of violating values and
moral codes, and appears as feelings of guilt or shame.

Basic Concept
• According to Freud, anxiety is an unpleasant inner state that people seek
to avoid.
• When anxiety occurs, the mind first responds by an increase in problem-
solving thinking, seeking rational ways of escaping the situation.
• If this is not fruitful (and maybe anyway), ego has some tools it can use in
its job as the mediator, tools that help defend the ego, these are called
Ego Defense Mechanisms or Defenses.
• They helped shield the ego from the conflicts created by the id, superego,
and reality.

Important properties
• Freud discovered most of the defense mechanisms and
identiﬁed ﬁve of their important properties:
1 Defenses are a major means of managing instinct and affect.
2 They are unconscious.
3 They are discrete (from one another).
4 Although often the hallmarks of major psychiatric syndromes,
defenses are dynamic and reversible.
5 They can be adaptive as well as pathological.

Definition
• In Freudian psychoanalytic theory, defense mechanisms are
unconscious psychological strategies brought into play by various
entities to cope with reality and to maintain self-image.
• White and Gilliland (1975) stated that the term mechanisms of
defense refers to the various automatic, involuntary, and
unconsciously instituted psychological activities by which the
human being attempts to exclude unacceptable urges or impulses
from awareness.
• According to American Psychiatric Association (1994), “defense
mechanisms are patterns of feelings, thoughts, or behaviors that are
relatively involuntary. They arise in response to perceptions of
psychic danger or conflict, to unexpected change in the internal or
external environment, or in response to cognitive dissonance.”

Purpose of Defense Mechanisms
• Allow individuals a period of respite to master changes in self-image that
cannot be immediately integrated, as might result from puberty, an
amputation, or a promotion (i.e., changes in reality).
• Deflect or deny sudden increases in biological drives. Awareness of
instinctual wishes is usually diminished; alternatively, antithetical wishes
may be passionately adhered to.
• Enable individuals to mitigate unresolved conflicts with important people,
living or dead.
• Keep anxiety, shame, and guilt within bearable limits during sudden
conflicts with conscience and culture.

Classification of defense mechanisms
• The list of defense mechanisms is huge and there is no theoretical
consensus on the number of defense mechanisms.
• Classifying defense mechanisms according to some of their properties
(i.e. underlying mechanisms, similarities or connections with personality)
has been attempted.
Defenses employed by ego can be listed according to variety of
classification:-
Developmental by Anna Freud
Valliant (1971)
Bond et al. (1983)
Perry and Copper (1985)
American Psychiatric Association (1994)

Development by Anna Freud
• Normally there is an orderly sequence
as the child matures.
• Oral (0-18 months) - narcissistic
defenses (Projection, denial, distortion)
• Anal (18months-3 years) - Identification,
undoing, reaction formation, isolation,
regression
• Phallic / oedipal (3- 6 years) -
Intellectualization
• Latency (6 years to puberty) -
Symbolization, sublimation

Orderly Sequence of Development
• If significant trauma occurs the child may
have difficulty learning the mechanisms
that are normally learned at these times.
• Fixated – uneven development of ego
function which results in a part of the
ego retaining more primitive or
immature function
• Repetition compulsion – replay of
events related to significant traumas

Developmental Aspects
• The Id is the earliest component of the psychodynamic apparatus
• The infant is basically in a pleasure seeking mode of operating
(sometimes this is confused with ‘sexuality’)
• The infant also conceives of the world in a narcissistic fashion. Things
exist only as they relate to him or her
• At times the pleasure seeking runs into barriers in the outside world
• This result in infants being confronted with reality
• New skills and coping mechanisms develop

Vaillant’s Classification
Level I - Pathological Defenses
• The mechanisms on this level, when predominating, almost
always are severely pathological. These defenses, in
conjunction, permit one to effectively rearrange external
experiences to eliminate the need to cope with reality.
• The pathological users of these mechanisms frequently appear
irrational or insane to others. These are the "psychotic"
defenses, common in overt psychosis. However, they are found
in dreams and throughout childhood as well.
• e.g. psychotic denial, distortion.

Level II - immature defenses
• These mechanisms are often present in adults and more commonly
present in adolescents.
• Lessen distress and anxiety provoked by threatening people or by
uncomfortable reality.
• People who excessively use such defenses are seen as socially
undesirable in that they are immature, difficult to deal with and seriously
out of touch with reality.
• Overuse almost always leads to serious problems in a person's ability to
cope effectively.
• These defenses are often seen in severe depression and personality
disorders.(e.g. fantasy, projection, passive aggression, acting out,
dissociation)

Level III - Neurotic defenses
• These mechanisms are considered neurotic, but fairly common in adults.
• have short-term advantages in coping, but can often cause long-term
problems in relationships, work and in enjoying life when used as one's
primary style of coping with the world.
• (e.g. intellectualization, reaction formation, somatization, displacement,
repression)

Level IV - Mature defenses:
• Commonly found among emotionally healthy adults & are considered
mature, even though many have their origins in an immature stage of
development.
• They have been adapted through the years in order to optimize success in
life and relationships. The use of these defenses enhances pleasure and
feelings of control.
• These defenses help us integrate conflicting emotions and thoughts, while
still remaining effective. Those who use these mechanisms are usually
considered virtuous.
• e.g. humor, sublimation, suppression, altruism, anticipation.

Narcissistic Immature Neurotic Mature
Denial Acting out Displacement Altruism
Projection Regression Dissociation Humor
Distortion Passive-aggressive
behavior
Reaction formation Sublimation
Splitting Schizoid fantasy Repression Anticipation
Somatization Isolation Suppression
Introjection Rationalization Asceticism
Hypochondriasis Sexualization
Blocking Intellectualization

Bond et al. (1983)
• Maladaptive action defense style: Inability to deal with impulses by
taking constructive action (withdrawal, acting out, regression, inhibition,
passive aggression, and projection).
• Image-distorting defense style: Split the image of self and others into
good & bad, strong & weak (splitting, primitive idealization, and
omnipotence with devaluation).
• Self-sacrificing defense style: perceive one self as kind and helpful to
others (reaction formation and pseudo-altruism).
• Adaptive defense style: Constructive type of mastery over conflicts
(humor, suppression, and sublimation).

Perry and Copper (1985)
• Disavowal : disavow experiences, affects or impulses; projection, denial,
rationalization.
• Action: releases feelings and impulses through actions ; acting out ,
passive aggression.
• Borderline : distort self & others images; splitting and projective
identification.
• Narcissistic : serves to regulate self-esteem and mood; omnipotence,
primitive idealization, devaluation.
• Obsessional :neutralize affect without distorting external reality; isolation,
intellectualization.
• Mature: mastery over conflicts; humor, suppression, sublimation.

American Psychiatric Association (1994)
• Defensive deregulation : failure of defensive regulation-leading to
pronounced break with objective reality
• delusional projection
• psychotic denial
• psychotic distortion
• Action : deals with stressors by action or withdrawal
• acting out
• passive aggression
• help-rejecting complaining
• Major image-distorting : gross distortion of image of self or others
• autistic fantasy
• splitting

• Disavowal : keeping stressors out of awareness with or without a
misattribution of these to external cause
• denial
• projection
• rationalization
• Minor image-distorting : distortions in the image of the self or others
• devaluation
• idealization
• omnipotence

Mental inhibitions: keeps potentially threatening ideas or feelings out of
awareness
• displacement
• reaction formation
• repression
• undoing
High-adaptive: optimal adaptation in handling stressors
• anticipation
• altruism
• humor
• sublimation
• suppression

Results of Mature Defenses
1) Excellent adjustment as an adult,
2) Happiness,
3) Job satisfaction,
4) Rich friendships,
5) Fewer medical hospitalizations over life,
6) Better overall health,
7) A lower incidence of mental illness.

Results of Immature Defenses:
1) Poor adjustment as an adult,
2) Higher divorce rates and marital discord
3) Poor friendship patterns,
4) Higher incidence of mental illness,
5) Greater number of sick leave days taken,
6) Poorer health generally

Denial
• Denial is simply refusing to acknowledge that
an event has occurred.
• Denial is one of Freud's original defense
mechanisms. It is considered one of the most
primitive of the defense mechanisms because
it is characteristic of early childhood
development. It is a form of repression, where
stressful thoughts are banned from memory.
• Many people use denial in their everyday lives
to avoid dealing with painful feelings or areas
of their life they don’t wish to admit.
Example: 1) Patient denies that his
physician's diagnosis of cancer is correct and
seeks a second opinion.
2) Alcoholics vigorously deny that they have a
problem.

Denial
• Ego feels anxiety from perception of
strong external or internal danger it
can’t escape or deal with directly
What you do:
• Tell yourself it is not happening
• Tell yourself it is not your fault
• Conscious denial

Displacement
• Displacement is the shifting of actions from a desired target to a substitute
target when there is some reason why the first target is not permitted or
not available.
• Where possible the second target will resemble the original target in some
way.
• It occurs when the Id wants to do something of which the Super ego does
not permit. The Ego thus finds some other way of releasing the psychic
energy of the Id.
• Thus there is a transfer of energy from a repressed object to a more
acceptable object.

Displacement
• Displacements are often quite satisfactory and workable
mechanisms for releasing energy more safely.
• Examples
A man wins the lottery. He turns to the person next to him and
gives the person a big hug.

Intellectualization
• Intellectualization is a 'flight into reason', where the
person avoids uncomfortable emotions by focusing
on facts and logic. The situation is treated as an
interesting problem that engages the person on a
rational basis, whilst the emotional aspects are
completely ignored as being irrelevant.
• Example : A person who is in heavily debt builds a
complex spreadsheet of how long it would take to
repay using different payment options and interest
rates.
• Intellectualization protects against anxiety by
repressing the emotions connected with an event.
It is also known as 'Isolation of affect' as the
affective elements are removed from the situation.

Projection
• When a person has uncomfortable thoughts or feelings, they may project
these onto other people, assigning the thoughts or feelings that they need
to repress to a convenient alternative target.
• Neurotic projection is perceiving others as operating in ways one
unconsciously finds objectionable in yourself.
• Complementary projection is assuming that others do, think and feel in the
same way as you.
• It turns neurotic or moral anxiety into reality anxiety, which is easier to
deal with.

Projection
What you do:
• Attribute your own undesirable
impulses, feeling, or desires to another
person
Examples:
• “I hate her” really means “I think she
hates me”
Problems:
• Misperceive the other person’s
motivations
• Don’t deal with your own feelings
• Overreaction

Rationalization
• When something happens that we find
difficult to accept, then we will make up a
logical reason why it has happened.
• When a person does something of which the
moral super ego disapproves, then the ego
seeks to defend itself by adding reasons that
make the action acceptable to the super ego.
Thus we are able to do something that is
outside our values and get away with it
without feeling too guilty.

Rationalization
What you do:
• Make up excuses for inadequacies, failure,
or loss
Examples:
• A parent punishes a child and says that it is
for the child's 'own good'.
• A person evades paying taxes and then
rationalizes it by talking about how the
government wastes money (and how it is
better for people to keep what they can).
• If I had better teachers, I would have gotten
higher grades.
Problems:
• Energy would be better spent on improving.
• The truth catches up with you.

Reaction Formation
• Reaction Formation occurs when a person feels an urge to do or say
something and then actually does or says something that is
effectively the opposite of what they really want. It also appears as a
defense against a feared social punishment.
• A common pattern in Reaction Formation is for the person to show
‘excessive behavior’.
What you do:
• In defense against the threatening impulse, express the opposite
impulse.
• Psychoanalysts believe that extreme patterns of Reaction Formation
are found in paranoia and obsessive-compulsive disorder (OCD),
where the person becomes trapped in a cycle of repeating a behavior
that they know (at least at a deep level) is somehow wrong.

Reaction-Formation
• Examples:
• A person who is angry with a colleague
actually ends up being particularly
courteous and friendly towards them.
• Someone frightens you so you act super
nice
• Someone frightens you so you snub
them
• The sex offender becomes the great
protector of society.
Problems:
• False persona

Regression
• Regression involves taking the position of a child in some
problematic situation, rather than acting in a more adult way.
• (Return to earlier and more comfortable developmental level)
• This is usually in response to stressful situations, with greater
levels of stress potentially leading to more overt regressive acts.
• Can be simple and harmless, such as a person who is sucking a
pen (as a Freudian regression to oral fixation)
• may be more dysfunctional, such as crying or using petulant
arguments.

Problems:
Does not solve the problem
People think you are immature
You are not learning to cope well

Repression
• Repression involves placing uncomfortable thoughts in
relatively inaccessible areas of the subconscious mind.
Thus when things occur that we are unable to cope with
now, we push them away, either planning to deal with
them at another time or hoping that they will fade away on
their own accord.
• The level of 'forgetting' in repression can vary from a
temporary abolition of uncomfortable thoughts to a high
level of amnesia, where events that caused the anxiety
are buried very deep.
• A high level of repression can cause a high level of
anxiety or dysfunction, although this may also be caused
by the repression of one particularly traumatic incident.

Repression
• Repression is not all bad. If all uncomfortable memories
were easily brought to mind we would be faced with a
non-stop pain of reliving them.
• e.g. A child who is abused by a parent later has no
recollection of the events, but has trouble forming
relationships.
• A man has a phobia of snakes but cannot remember
the first time he was afraid of them.
Problems:
• Diverts needed energy
• Blocks out stressful situations that could be worked out

Acting out
• Performing an extreme behavior in order to
express thoughts or feelings the person feels
incapable of otherwise expressing. e.g. Instead of
saying, “I’m angry with you,” a person who acts
out may instead throw a book at the person, or
punch a hole through a wall.
• When a person acts out, it can act as a pressure
release, and often helps the individual feel calmer
and peaceful once again.
• For instance, a child’s temper tantrum is a form of
acting out when he or she doesn’t get his or her
way with a parent.
• Self-injury may also be a form of acting-out,
expressing in physical pain what one cannot stand
to feel emotionally.

Dissociation
• Dissociation is when a person loses track of
time and/or person, and instead finds another
representation of their self in order to continue
in the moment.
• People who have a history of any kind of
childhood abuse often suffer from some form
of dissociation.
• In extreme cases, dissociation can lead to a
person believing they have multiple selves
(“multiple personality disorder”).
• People who use dissociation often have a
disconnected view of themselves in their world.
Time and their own self-image may not flow
continuously, as it does for most people.

Undoing
• Undoing is the attempt to take back an
unconscious behavior or thought that is
unacceptable or hurtful.
• A person tries to 'undo' an unhealthy,
destructive or otherwise threatening
thought by engaging in contrary
behavior.
• By “undoing” the previous action, the
person is attempting to counteract the
damage done by the original comment,
hoping the two will balance one another
out.
• Ex. A man gives her wife a bunch of
roses after their argument last night

Hypochondriasis
• Exaggerating and overemphasizing an illness for the purpose of evasion
and regression. In hypochondriasis, responsibility can be avoided, guilt
can be circumvented , and instinctual impulses are warded off. Because
hypochondriacial impulse are ego-alien, the afflicated person experiences
dysphoria and a sense of affliction.

Idealization
 Valuing something more than it is worth/
attributing exaggerated positive qualities to
self or others
• Yourself (conceited) “I am so wonderful.
Everyone has to like me.”
• Others or possession (money, house, car)
• “I need that new Coach purse! It will
complete me!!!”

Fantasy
What is done:
• Dreaming, imagining instead of living in the present
world, because you don’t feel competent to achieve.
• Pretending
Examples:
• Wanting to look good and pretending to yourself that
you are one of the movie stars you read about.
• Making up stories about how successful you are,
rather than working on your success.
Problems:
• You get stuck in the fantasy rather than
using your talents to become successful.

Passive aggression
• Aggression towards others expressed indirectly or passively such as
using procrastination.

Somatization
• The transformation of negative feelings towards others into
negative feelings toward self, pain, illness, and anxiety.

Splitting
• A primitive defense. Negative and positive
impulses are split off and not integrated.
• Fundamental example: An individual
views other people as either innately good
or innately evil, rather than a whole
continuous being.
• it can even be splitting of the ego when the
patient is existentially insecure.

Compensation
What you do:
• Develop or strengthen positive traits to make up
for limitations
• Distract attention from the weaknesses
Examples:
• Weak in school, excellent in sports.
• Class clown
Problems:
• Unbalanced
• Incompetent in some areas

Sublimation
• Transformation of unwanted impulses
into something less harmful.
• This can simply be a distracting
release or may be a constructive and
valuable piece of work.
• Sublimation is probably the most
useful and constructive of the defense
mechanisms as it takes the energy of
something that is potentially harmful
and turns it to doing something good
and useful.

Sublimation
• Freud believed that the 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.
• Example - A angry man does pushups
to work off his temper.

Anticipation
• Dealing with stressors by anticipating the
consequences and feelings associated
with possible future events and
considering realistic solutions.
• Ex: getting old –think ahead and
plan your retirement wisely!

Altruism
• Constructive service to
others that brings
pleasure and personal
satisfaction.

Humor
It’s okay if I lost a leg at
least I can dress up like a
pirate now
hahahahahhahahahahah
a
• Overt expression of ideas and
feelings (especially those that
are unpleasant to focus on or
too terrible to talk about) that
gives pleasure to others.
• The thoughts retain a portion of
their innate distress, but they
are "skirted round" by witticism.

Suppression
• Conscious decision to postpone
attention to an impulse or
conflict. Conscious set-up and
unconscious follow through. The
suppressed content temporarily
resides in the unconscious.

• Distortion: A gross reshaping of external reality to meet internal
needs(including unrealistic megalomania beliefs, hallucinations, wish-
fulfilling delusions)and using sustained feelings of delusional superiority
and entitlement.
• Isolation: Separation of feelings from ideas and event.
e.g. describing a murder with graphic details with no emotional response.

• Identification: The unconscious modeling of one's self upon
another person's character and behavior.
e.g. An insecure young man joins a fraternity to boost his self-
esteem.
• Introjection: Identifying with some idea or object so deeply that
it becomes a part of that person.

Measurement of Defense Mechanisms
• Defense Mechanism Test (Kragh, 1955)
• Defense Style Questionnaire (Bond et al, 1983)
• Defense Mechanisms Rating Scale (Perry, 1989)
• Clinical Vignette Method (Valliant, 1976)
• Defense Mechanism Inventory (Gleser & Ihilevitch, 1969)

Defense Mechanisms & Major Clinical Syndrome
Sr. no. Personality disorder Defense mechanisms
1 Cluster A Fantasy
Projection
2 Cluster B Acting out
Splitting
Dissociation
Devaluation
3 Cluster C Passive aggression
Help rejecting complaining

SR.NO. Disorder Defense mechanisms
1 Anxiety Repression
2 Phobia Displacement
Regression
3 OCD Isolation of affect
Undoing
Reaction formation
4 Depression Regression
Turning of aggression against self
5 Mania Denial
Projection
Regression
6 Paranoid Projection
Regression
Rationalization
7 Schizophrenia Regression
Projection
Isolation of affect

• Anxiety: When repression proves to be inadequate, previously contained
primitive instinctual urges threaten to come to expression and this threat
creates the sense of apprehension characteristics of anxiety.
• Phobia: Through the mechanism of displacement a phobia replaces
anxiety. Regression is inherent as phobia involves return to primitive
mode of thought through which child copes with his own threatening
impulses.
• Mania : Denial is the defense mechanism characteristic of mania. When
denial is threatened patient may then resort to Projection - attributing his
own anger to others. Regression- return to the magical thinking
characteristic of a small child.

• OCD :
Isolation of affect is responsible for the symptom of obsessional
thoughts, Undoing creates compulsive acts (a ritual which magically
undoes a forbidden unconscious impulse) and Reaction formation
(development of attitudes opposite to the impulses being defended
against) accounts for scrupulosity and other exaggerated
characteristics of cleanliness.
• Depression :
In less severe form of depression, that is depression out of
proportion to the reality of the loss, the loss produces regression
and revives the intense sense of hopelessness and despair that a
small child experiences.
In extreme depression the effect of identification with the lost object
and the use of the mechanism of turning aggression against the
self.

• Paranoid:
Reliance on the defense mechanism of projection characterizes
paranoid disorders. Regression is inherent in the production of paranoid
delusions. Rationalization is constant companion to projection – ability to
give plausible and logical reasons for his irrational beliefs is monumental.
• Schizophrenia :
Regression- primitive characteristics of patients thought and behavior;
return to infantile modes of mental functioning
Projection- involved in the formation of delusions of persecution or
influence
Isolation of affect – is involved in the calm detached way patient thinks
or speaks of frightening things

TAKE HOME POINTS
• Defense mechanisms do not usually get rid of the problem.
• Even more extreme forms can be adaptive when briefly
activated under severe stress.
• Defenses change over time.
• Helping in adopting mature forms of psychological improves
mental health & it can reduce reliance on mind-altering
substances.

References
• CTP , 9th Edition
• Introduction to Psychology, Morgan and King
• Ego Defence Mechanism , George E Vaillant

“Flowers are restful to look at. They have neither emotions nor conflicts.”
Sigmund Freud

Defense mechanism

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