DEFENSE MECHANISM Coping Mechanism

y y y y

Coping mechanisms involve efforts to decrease the stress response These are task oriented reactions, which are classified because of conscious efforts utilized by the concerned individual to allay his anxiety Done consciously Examples are as follows: T Turning to a comforting person (significant others) R Relying on self -disciple (self-control) I Intense expression of feelings (crying to release tension) U Using symbolic substitutes M Making use of friends to talk it out P Privately thinking it through

Defense Mechanism y Protective coping mechanism of the ego, largely unconscious y Attempts to protect the individual from feelings of i nadequacy and worthlessness and to prevent awareness of anxiety y Protect against anxiety caused by undesirable, unacceptable and usually unconscious feelings y Similar to coping mechanisms but they are traditionally defined as being unconscious, intrapsychic processes y Both defense mechanisms and coping mechanisms serve the same protective purpose for clients. y Defense mechanism will provide the nurse with clues about a clients feelings motives and behaviours When any of the defenses are used exclusively or excessively by a client, this coping behavior becomes maladaptive and pat hological DEFENSE MECHANISM Purpose: 1. To decrease anxiety 2. To protect ego 3. To increase self-esteem Types of Defense Mechanisms Mechanism Compensation Definition Process by which a person makes up for a perceived weakness by strongly emphasizing a feature that he or she considers more desirable Unconscious expression of mental conflict as a physical symptoms to relieve tension or anxiety Avoidance of disagreeable Example A business man perceived his small physical stature negatively. He tries to overcome this buy being aggressive, forceful and controlling in business dealings Woman experiencing blindness after witnessing a murder

Conversion

Denial

Ms. Halili has just been told that her

realities by ignoring or refusing to recognize them, the simplest and most primitive of all defense mechanism Commonly used by client who are substance abuse

breast biopsy indicates a malignancy. When her husband ask her about the laboratory result, she told him that she havent received or seen the result

Displacement

Shift of emotions from a person or object to another, usually neutral or less dangerous, person or object Commonly used by with Phobic disorder

A boy is angry because he has just been punished by his mother for drawing on their wall. He begins to play war with his soldier toys and has them fight with each other

Dissociation

The separation of a group of mental or behavioural processes from the rest of the persons consciousness or identity Commonly used by client with Amnesia

A man is brought to the emergency room by the police and is unable to explain who he is and where he lives or work

Fantasy

A conscious creation of distortion of unacceptable fears, wishes and behaviors Use imagination or daydreaming

A nursing student dreams that she has identified the cause of mental illness and that all the clients will be cured

Identification

Process by which a person tries to become like someone he or she admires by taking on thoughts, mannerisms or tastes of that person Excessive reasoning or logic is used to avoid experiencing disturbing feeling

Lolit, 15 years old, has her hair styled like that of her young English teacher, whom she admires

Intellectualization

Introjection

Intense identification in which person incorporates qualities or values of another person or group into his or her own ego structure. It is one of t he earliest mechanisms of the child, important in formation of conscience Commonly used by client with Depression

A woman avoids dealing with her anxiety in shopping malls by explaining that shopping is a frivolous waste of time and money Eight-year-old Hayden tells his sister Vicky, Dont scribble in your nursery rhyme books, just look at the pretty pictures, thus expressing his parents values.

Isolation

Projection

Splitting off of emotional components of a thought, which may be temporary or long term Attributing ones thoughts or impulses to another person. Through this process one can attribute intolerable wishes, emotional feelings, or motivation to another person Commonly used by client with paranoid Offering asocial acceptable or apparently logical explanation to justify or make acceptable otherwise unacceptable impulses, feelings, behaviors and motive Development of conscious attitudes and behavior patterns that are opposite to what one really feels or would like to do Commonly used by client with Bipolar disorder

A medical student dissects a cadaver for her anatomy course without being disturbed by thoughts of death A young woman who denies she has sexual feelings about a co worker accuses him without basis of trying to seduce her

Rationalization

Bistek fails an examination and complains that the lectures were not well organized or clearly presented

Reaction Formation

A married woman who feels attracted to one of her husbands friends treats him rudely

Regression

Retreat to behavior

Repression

Involuntary exclusion of a painful or conflictual thought, impulse, or memory from awareness. It is the primary ego defense, and other mechanisms tends to reinforce it Commonly used by client Catatonic Viewing people and situations as either all good or all bad. Failure to integrate the positive and negative qualities of oneself Commonly used by client with borderline Acceptance of a socially approved substitute goal for a drive whose normal channel of expression is blocked

Four-year-old Nicole, who has characteristic of an earlier level of development been toilet trained for over a year, begins to wet her pants again Mr. Kho does not recall hitting his wife when she is pregnant

Splitting

A friend tells you that you are the most wonderful person in the world one day, and how much she hates you the next day

Sublimation

Ed has an impulsive and physically aggressive nature. He tries out for the football team and becomes a star tackle

Substitution

Suppression

Unconscious replacement of unacceptable impulses, attitudes, needs or emotions with those that are more acceptable A process often listed as a defense mechanism, but really is a conscious counterpart of repression. It is intentional exclusion of material from consciousness. At times, it may to repression Commonly used by client with Anorexia nervosa Use of external objects to become an outward representation of an internal idea, attitude or feeling Act or communication that partially negates a previous one; a primitive defense mechanism Commonly used by client with Obsessive compulsive disorder

A student nurse decides to be a teacher because she is unable to master clinical competencies

A young man at work finds he is thinking so much about his date that is interfering with his work. He decides to put it out of his mind until he leaves the office for the day

Symbolization

An engagement ring symbolizes love and a commitment to another person Eric makes a passionate declaration of love to Patricia on a date. At their next meeting he treats her formally and distantly

Undoing / Restitution

Levels/Classification of Defense Mechanism 1. Psychotic Mechanism i. Delusional projection ii. Denial iii. Distortion grossly reshaping external reality to suit inner impulses; use to sustained feelings of delusional superiority or entitlement Ex. An ugly person believes he is Mr. Suave iv. Splitting 2. Narcissistic Defenses i. Denial ii. Distortion iii. Projection 3. Immature Mechanism i. Acting-out expressing an unconscious wi8sh or impulse through action ii. Dependency constantly seeking approval iii. Hypochondriasis exaggerating or overemphasizing an illness for the purpose of evasion or regression iv. Identification v. Passive-aggressive behavior expressing aggression towards other behaviour indirectly through passivity, masochism and turning against self vi. Projection vii. Rationalization viii. Regression ix. Schizoid fantasy autistic retreat 4. Neurotic Defenses

i. Displacement ii. Dissociation iii. Emotional Isolation protective withdrawal iv. Intellectualization v. Reaction Formation vi. Repression 5. Mature Mechanism i. Altruism - others first before self; using constructive and instinctually gratifying service to others ii. Anticipation realistically anticipating or planning for future inner discomfort iii. Asceticism eliminating the pleasurable effects of experience iv. Humor to make light of the situation; using comedy to overtly express feelings and thoughts without personal discomfort v. Sublimation vi. Suppression vii. Undoing 6. Others i. Introjections ii. Compensation iii. Conversion