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3.4 Defense Mechanisms
When providing clients with stress management techniques and effective coping strategies, nurses must be aware of common defense mechanisms. are reaction patterns used by individuals to protect themselves from anxiety that arises from stress and
conflict.[1] Excessive use of defense mechanisms is associated with specific mental health disorders. With the exception of suppression, all other defense mechanisms are unconscious and out
of the awareness of the individual. See Table 3.4 for a description of common defense mechanisms.
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- 3.4 Defense Mechanisms
- Which defense mechanism is most commonly used by clients who are alcoholics?
- Which defense mechanism is most commonly used by clients who are diagnosed with schizophrenia?
- Which Behaviour is the client displaying when pretending to be ill?
- What factor would precipitate a client’s use of confabulation?
Table 3.4 Common Defense Mechanisms
Defense MechanismsDefinitionsExamplesConversion
Anxiety caused by repressed impulses and feelings are converted into a physical symptoms.[2]
An individual scheduled to see their therapist to discuss a past sexual assault experiences a severe headache and cancels the appointment.
DenialUnpleasant thoughts, feelings, wishes, or events are ignored or excluded from conscious awareness to protect themselves from overwhelming worry or
anxiety.[3],[4]
A client recently diagnosed with cancer states there was an error in diagnosis and they don’t have cancer.
Other examples include denial of a financial problem, an addiction, or a partner’s infidelity.
DissociationA feeling of being disconnected from a stressful or traumatic sự kiện – or feeling that the sự kiện is not really happening – to block out mental trauma and protect the mind from too much
stress.[5]
A person experiencing physical abuse may feel as if they are floating above their bodies observing the situation.
DisplacementUnconscious transfer of one’s emotions or reaction from an original object to a less-threatening target to discharge
tension.[6]
An individual who is angry with their partner kicks the family dog. An angry child breaks a toy or yells a sibling instead of attacking their father. A frustrated employee criticizes their spouse instead of their
boss.[7]
IntrojectionUnconsciously incorporating the attitudes, values, and qualities of another person’s personality.[8]
A client talks and acts like one of the nurses they admire.
ProjectionA process when one attributes their individual positive or negative characteristics, affects, and impulses to another person or
group.[9]
A person conflicted over expressing anger changes “I hate him” to “He hates me.”[10]
RationalizationLogical reasons are given to justify unacceptable behavior to defend against feelings of guilt, maintain self-respect, and protect oneself from
criticism.[11]
A client who is overextended on several credit cards rationalizes it is okay to buy more clothes to be in style when spending money that was set aside to pay for the monthly rent and utilities. A student caught cheating on a test rationalizes, “Everybody cheats.”
Reaction FormationUnacceptable or threatening impulses are denied and consciously replaced with an opposite, acceptable
impulse.[12]
A client who hates their mother writes in their journal that their mom is a wonderful mother.
RegressionA return to a prior, lower state of cognitive, emotional, or behavioral functioning when threatened with overwhelming external problems or internal
conflicts.[13]
A child who was toilet trained reverts to wetting their pants after their parents’ divorce.
RepressionPainful experiences and unacceptable impulses are unconsciously excluded from consciousness as a protection against
anxiety.[14]
A victim of incest indicates they have always hated their brother (the molester) but cannot remember why.
SplittingObjects provoking anxiety and ambivalence are viewed as either all good or all bad.[15]
A client tells the nurse they are the most wonderful person in the world, but after the nurse enforces the unit rules with them, the client tells the nurse they are the worst person they have ever met.
SuppressionA conscious effort to keep disturbing thoughts and experiences out of mind or to control and inhibit the expression of unacceptable impulses and feelings. Suppression is similar to repression, but it is a conscious
process.[16],[17]
An individual has an impulse to tell their boss what they think about them and their unacceptable behavior, but the impulse is suppressed because of the need to keep the job.
SublimationUnacceptable sexual or aggressive drives are unconsciously channeled into socially acceptable modes of expression that indirectly provide some satisfaction for the original drives and protect individuals from anxiety induced by the original
drive.[18]
An individual with an exhibitionistic impulse channels this impulse into creating dance choreography. A person with a voyeuristic urge completes scientific research and observes research subjects. An individual with an aggressive drive joins the football
team.[19]
SymbolizationThe substitution of a symbol for a repressed impulse, affect, or idea.[20]
A client unconsciously wears red clothing due a repressed impulse to physically harm someone.
Which defense mechanism is most commonly used by clients who are alcoholics?
Rationalization. In those with substance use disorder, rationalization is providing good reasons for the use of drugs or alcohol, instead of the real and true reasons. It is used to defend oneself against feelings of guilt, as well as to protect oneself against criticism and maintain self-respect.
Which defense mechanism is most commonly used by clients who are diagnosed with schizophrenia?
Option A: Regression, a return to earlier behavior to reduce anxiety, is the basic defense mechanism in schizophrenia.
Which Behaviour is the client displaying when pretending to be ill?
Factitious disorder is a serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury.
What factor would precipitate a client’s use of confabulation?
Confabulation can be precipitated by internal factors (e.g., cognitive deficits) or external factors (e.g., repeated questioning or negative feedback in stressful situations).
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