Defens mechanism

DEFENSE MECHANISM IN PSYCHIATRY AS DEFINED IN ctp AND PSYCHOANALYTICAL THEORY

1. DEFENSE MECHANISMS DR.SETHU.P.S JUNIOR RESIDENT DEPT. OF PSYCHIATRY GOVT.T.D.M.C ALAPPEY KERALA INDIA SETHU

2. Introduction Defense mechanisms are a major component of the psychoanalytic theory These have been used to understand psychopathology using psychodynamic concepts SETHU

3. historical aspects Concept of defense mechanisms began with Sigmund Freud In his theories of the mind, postulated certain unconscious ego processes that he called defense mechanisms Considered “ repression ” as the cornerstone and also considered some other defense mechanisms SETHU

4.  Concept was further extended by Anna Freud in her book “ The ego and the mechanisms of defense ” where she described sublimation, displacement, denial, identification, and altruism SETHU

5. Later Kernberg and Klein described splitting, projective identification and psychotic denial The rise of the object-relations theory further spurred new understanding into the concept SETHU

6. Definition The concept of defense mechanisms has not been static and a uniformly acceptable definition has not been arrived at. Habitual, unconscious and sometimes pathological mental process that is employed to resolve conflict between instinctual needs, internalized prohibitions and external reality. These mechanisms imply integrated, dynamic psychological processes. ( Vaillant , 1971 ) The ways and means by which the ego wards off displeasure and anxiety, and exercises control over impulsive behavior, affects and instinctual behavior. ( A Freud , 1946) SETHU

7. By 1970, the term, defense mechanisms , like many psychoanalytic metaphors, had beenlargely discarded by empirical social scientists. Consistency of definition and rater reliabilitywere lacking. Over the last 30 years, however, the idea of involuntary coping has entered the literature of empirical cognitive psychology under such rubrics as “hardiness, “ selfdeception ,” and “emotional coping” and “illusion.” SETHU

8. From DSM-IV Defense mechanisms (or coping styles) 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. Defense mechanisms mediate the individual's reaction to emotional conflicts and to internal and external stressors. The individual defense mechanisms are divided conceptually and empirically into related groups that are referred to as Defense Levels . SETHU

9. High adaptive level This level of defensive functioning results in optimal adaptation in the handling of stressors. These defenses usually maximize gratification and allow the conscious awareness of feelings, ideas, and their consequences. They also promote an optimum balance among conflicting motives. Examples of defenses at this level are •anticipation •affiliation •altruism •humor •self-assertion •self-observation •sublimation •suppression SETHU

10. Mental inhibitions (compromise formation) level Defensive functioning at this level keeps potentially threatening ideas, feelings, memories, wishes, or fears out of awareness. Examples are displacement •dissociation •intellectualization •isolation of affect reaction formation •repression •undoing SETHU

11. 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 SETHU

12. 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 SETHU

13. 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 SETHU

14. Action level This level is characterized by defensive functioning that deals with internal or external stressors by action or withdrawal. Examples are •acting out •apathetic withdrawal •help-rejecting complaining •passive aggression SETHU

15. Level of defensive dysregulation. This level is characterized by failure of defensive regulation to contain the individual's reaction to stressors, leading to a pronounced break with objective reality. Examples are •delusional projection •psychotic denial •psychotic distortion SETHU

16. VAilLaNT’S FOUR stages Mature Narcissistic Immature Neurotic SETHU

17. Mature Defenses Altruism Anticipation Asceticism Humor Sublimation Suppression SETHU

18. Mature Defenses Altruism Using constructive and instinctually gratifying service to others to undergo a vicarious experience. It includes benign and constructive reaction formation. Anticipation Realistically anticipating or planning for future inner discomfort. The mechanism is goal-directed SETHU

19. Mature Defenses Asceticism Eliminating the pleasurable effects of experiences. There is a moral element in assigning values to specific pleasures. Humor Using comedy to overtly express feelings and thoughts without personal discomfort or immobilization and without producing an unpleasant effect on others. SETHU

20. Mature Defenses Sublimation Achieving impulse gratification and the retention of goals but altering a socially objectionable aim or object to a socially acceptable one. Suppression Consciously or semiconsciously postponing attention to a conscious impulse or conflict. Issues may be deliberately cut off, but they are not avoided. SETHU

21. NARCISSISTIC DEFENSES Denial Distortion Projection SETHU

22. NARCISSISTIC DEFENSES Denial Avoiding the awareness of some painful aspect of reality by negating sensory data. Denial abolishes external reality. Denial may be used in both normal and pathological states. Distortion Grossly reshaping external reality to suit inner needs (including unrealistic megalomanic beliefs, hallucinations, wish-fulfilling delusions) SETHU

23. NARCISSISTIC DEFENSES Projection Perceiving and reacting to unacceptable inner impulses and their derivatives as though they were outside the self. On a psychotic level, this defense mechanism takes the form of frank delusions about external reality (usually persecutory) and includes both perception of one's own feelings in another and subsequent acting on the perception (psychotic paranoid delusions). SETHU

24. IMMATURE DEFENSES Acting out Blocking Hypochondriasis Introjection Passive-aggressive Regression Schizoid fantasy Somatisation SETHU

25. IMMATURE DEFENSES Acting out Expressing an unconscious wish or impulse through action to avoid being conscious of an accompanying affect. Blocking Temporarily or transiently inhibiting thinking. Affects and impulses may also be involved. Hypochondriasis Exaggerating or overemphasizing an illness for the purpose of evasion and regression. SETHU

26. IMMATURE DEFENSES Introjection Internalizing the qualities of an object. Passive-aggressive Expressing aggression toward others indirectly through passivity, masochism, behavior and turning against the self. Regression Attempting to return to an earlier libidinal phase of functioning to avoid the tension and conflict evoked at the present level of development. SETHU

27. IMMATURE DEFENSES Schizoid fantasy Indulging in autistic retreat in order to resolve conflict and to obtain gratification. Somatization Converting psychic derivatives into bodily symptoms and tending to react with somatic manifestations, rather than psychic manifestations. SETHU

28. NEUROTIC DEFENSES Controlling Displacement Externalization Inhibition Intellectualization Isolation Rationalization Dissociation Reaction formation Repression sexualisation SETHU

29. NEUROTIC DEFENSES Controlling Attempting to manage or regulate events or objects in the environment to minimize anxiety and to resolve inner conflicts. Displacement Shifting an emotion or drive cathexis from one idea or object to another that resembles the original in some aspect or quality. SETHU

30. NEUROTIC DEFENSES Externalization Tending to perceive in the external world and in external objects elements of one's own personality, including instinctual impulses, conflicts, moods, attitudes, and styles of thinking. Inhibition Consciously limiting or renouncing some ego functions, alone or in combination, to evade anxiety arising out of conflict with instinctual impulses, the superego, or environmental forces or figures. SETHU

31. NEUROTIC DEFENSES Intellectualization Excessively using intellectual processes to avoid affective expression or experience. Isolation Splitting or separating an idea from the affect that accompanies it but is repressed. Social isolation refers to the absence of object relationships. SETHU

32. NEUROTIC DEFENSES Rationalization Offering rational explanations in an attempt to justify attitudes, beliefs, or behavior that may otherwise be unacceptable. SETHU

33. NEUROTIC DEFENSES Dissociation Temporarily but drastically modifying a person's character or one's sense of personal identity to avoid emotional distress. Fugue states and hysterical conversion reactions are common manifestations of dissociation. Reaction formation Transforming an unacceptable impulse into its opposite. Reaction formation is characteristic of obsessional neurosis, but it may occur in other forms of neuroses as well SETHU

34. NEUROTIC DEFENSES Repression Expelling or withholding from consciousness an idea or feeling. Primary repression refers to the curbing of ideas and feelings before they have attained consciousness secondary repression excludes from awareness what was once experienced at a conscious level. Sexualization Endowing an object or function with sexual significance that it did not previously have or possessed to a smaller degree in order to ward off anxieties associated with prohibited impulses or their derivatives. SETHU

35. Controversies Pertaining to Defense Mechanisms Defense mechanisms have certain difficulties inherent in them. They are- Subjective Intra-psychic phenomena that needs to be inferred rather than observed. Accused of lacking psychometric properties of reliability and validity. Suspect to idiosyncratic interpretation. Lack of consensually based definitions, common list of defense mechanisms SETHU

36. Clinical implications Pollock and Andrews (1989)- found that there were correlations between anxiety disorders and specific defense mechanisms when compared to general population. Panic disorder- displacement Agoraphobia- somatization, displacement, reaction formation, idealization Social phobia- displacement, less likely to use humor OCD- undoing, projection, acting out, less likely to use humor SETHU

37. It has been postulated by Vaillant that Cluster A PD- fantasy and projection Cluster B PD- acting out, splitting, dissociation and devaluation. Cluster C PD- passive aggression, hypochondriasis. SETHU

38. Uses Of Defense Mechanisms Defense mechanisms have important bearings in- Diagnosis Eliciting and understanding of psychopathology Treatment planning and execution via various modalities Assessment of response to treatment Management of chronic, debilitating illnesses and cancer Management of non-compliance SETHU

39. references Ego Mechanisms of Defense: A Guide for Clinicians and Researchers, G.E.Vaillant Comprehensive Textbook of Psychiatry, 9 th edition Introduction to psychology, Clifford.T.Morgan , Richard.A.King SETHU

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