Psychiatric Nursing: DEFENSE MECHANISM

Coping Mechanism
• Coping mechanisms involve efforts to decrease the stress response
• Theses are task –oriented reactions, which are classified because of conscious
efforts utilized by the concerned individual to allay his anxiety
• Done consciously
• Example 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
• Protective coping mechanism of the ego, largely unconscious
• Attempts to protect the individual from feelings of inadequacy and worthlessness and
to prevent awareness of anxiety
• Protect against anxiety caused by undesirable, unacceptable and usually
unconscious feelings
• Similar to coping mechanisms but they are traditionally defined as being
unconscious, intrapsychic processes
• Both defense mechanisms and coping mechanisms serve the same protective
purpose for clients.
• Defense mechanism will provide the nurse with clues about a client’s feelings,
motives and behaviors

When any of the defenses are used exclusively or

excessively by a client, this coping behavior becomes
maladaptive and pathological

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Psychiatric Nursing:
Purpose:
1. To decrease anxiety
2. To protect ego
3. to increase self-esteem
Types of Defense Mechanisms
Mechanism Definition
• Process by which a person
makes up for a perceived
weakness by strongly
Compensation
emphasizing a feature that he
or she considers more
desirable
• Unconscious expression of
mental conflict as a physical
Conversion
symptoms to relieve tension or
anxiety
• Avoidance of disagreeable
realities by ignoring or refusing
to recognize them, the simplest
Denial and most primitive of all
defense mechanism
• Commonly used by client who
are substance abuse
Displacement • Shift of emotions from a person • A boy is angry because he has
or object to another, usually
neutral or less dangerous,
person or object
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DEFENSE MECHANISM
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
• Ms. Halili has just been told that
her breast biopsy indicates a
malignancy. When her husband
ask her about the laboratory
result, she told him that she
haven’t received or seen the
result
just been punished by his mother
for drawing on their wall. He
begins to play war with his
Psychiatric Nursing:
• Commonly used by with Phobic
disorder
• The separation of a group of
mental or behavioral processes
from the rest of the person’s
Dissociation
consciousness or identity
• Commonly used by client with
Amnesia
• A conscious creation of
distortion of unacceptable
Fantasy fears, wishes and behaviors
• Use imagination or
daydreaming
• Process by which a person
tries to become like someone
Identification he or she admires by taking on
thoughts, mannerisms or tastes
of that person
• Excessive reasoning or logic is
used to avoid experiencing
Intellectualization disturbing feeling
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 the
earliest mechanisms of the
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DEFENSE MECHANISM
soldier toys and has them fight
with each other
• 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
• A nursing student dreams that
she has identified the cause of
mental illness and that all the
clients will be cured
• Lolit, 15 years old, has her hair
styled like that of her young
English teacher, whom she
admires
• 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, “Don’t scribble in
your nursery rhyme books, just
look at the pretty pictures”, thus
expressing his parents’ values.
Psychiatric Nursing: DEFENSE MECHANISM

child, important in formation of

conscience
• Commonly used by client with
Depression
• Splitting off of emotional • A medical student dissects a
components of a thought, cadaver for her anatomy course
Isolation
which may be temporary or without being disturbed by
long term thoughts of death
• Attributing one’s thoughts or • A young woman who denies she
impulses to another person. has sexual feelings about a co-
Through this process one can worker accuses him without
attribute intolerable wishes, basis of trying to seduce her
Projection
emotional feelings, or
motivation to another person
• Commonly used by client with
paranoid
• Offering asocial acceptable or • Bistek fails an examination and
apparently logical explanation complains that the lectures were
to justify or make acceptable not well organized or clearly
Rationalization
otherwise unacceptable presented
impulses, feelings, behaviors
and motive
• Development of conscious • A married woman who feels
attitudes and behavior patterns attracted to one of her husband’s
Reaction that are opposite to what one friends treats him rudely
Formation really feels or would like to do
• Commonly used by client with
Bipolar disorder
Regression • Retreat to behavior • Four-year-old Nicole, who has

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Psychiatric Nursing: DEFENSE MECHANISM

characteristic of an earlier level been toilet trained for over a

of development year, begins to wet her pants
again
• Involuntary exclusion of a • Mr. Kho does not recall hitting
painful or conflictual thought, his wife when she is pregnant
impulse, or memory from
awareness. It is the primary
Repression ego defense, and other
mechanisms tends to reinforce
it
• Commonly used by client
Catatonic
• Viewing people and situations • A friend tells you that you are the
as either all good or all bad. most wonderful person in the
Failure to integrate the positive world one day, and how much
Splitting and negative qualities of she hates you the next day
oneself
• Commonly used by client with
borderline
• Acceptance of a socially • Ed has an impulsive and
approved substitute goal for a physically aggressive nature. He
Sublimation drive whose normal channel of tries out for the football team and
expression is blocked becomes a star tackle

• Unconscious replacement of • A student nurse decides to be a

unacceptable impulses, teacher because she is unable to
Substitution attitudes, needs or emotions master clinical competencies
with those that are more
acceptable

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Psychiatric Nursing: DEFENSE MECHANISM

• A process often listed as a • A young man at work finds he is

defense mechanism, but really
is a conscious counterpart of
repression. It is intentional
Suppression 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
Symbolization
representation of an internal
idea, attitude or feeling
• Act or communication that
partially negates a previous
Undoing / one; a primitive defense
Restitution mechanism
• Commonly used by client with
Obsessive compulsive disorder
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
• 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

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
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Psychiatric Nursing: DEFENSE MECHANISM
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 behavior
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
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Psychiatric Nursing: DEFENSE MECHANISM
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

8 Gerald T Evangelista, RN, MAN