Updated: 8/27/2020

Ego Defenses

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Questions
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Evidence
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Topic
Overview
  • Unconscious processes that prevent undesirable feelings (such as anxiety or depression)
Immature Defenses (More Primitive)
  • Acting out
    • use actions to express unacceptable feelings and thoughts
      • tantrums
  • Dissociation
    • temporary drastic change in behavior
    • extreme forms can result in dissociative identity disorder (multiple personality disorder)
  • Denial
    • avoidance of awareness of some painful reality
      • initially refusing to believe a diagnosis of AIDS or cancer
  • Displacement  
    • taking feelings out on a neutral 3rd party
      • fight with wife → yell at dog
  • Fixation
    • "stuck" in an earlier developmental stage
      • Freud's "oral fixation"
  • Fantasy
    • substituting an imaginary, less disturbing view of the world when the actual reality is difficult or painful
  • Identification
    • imitating behavior (good or bad) of a more powerful person
      • abused child becomes abusive parent later in life
  • Isolation of affect
    • separation of emotion from events or ideas
      • describing murder in graphic detail without emotional response
  • Passive aggression
    • expression of angry feelings in a non-confrontational way
  • Projection
    • attributing unacceptable internal feelings to an external source 
      • Philandering husband claims his wife is cheating
  • Rationalization
    • making excuses to avoid the real reason for actions or to avoid self-blame
      • claiming that grades are not important anyway after failing a test
  • Reaction formation
    • replacing an unwanted idea or feeling with its opposite ("an equal and opposite reaction")
      • a patient with hypersexual thoughts becomes a nun
  • Regression
    • reversion to more childlike behavior
      • particularly seen in children under stress (illness, punishment, birth of new sibling, or fatigue)
      • e.g. toilet trained child wets the bed while he is hospitalized
  • Repression
    • involuntary withholding of bad thoughts from consciousness
  • Splitting
    • belief that people are either all good or all bad
      • resident is mean but the medical student is warm and caring
    • seen in borderline personality disorder
Mature Defenses (Less Primitive)
  • Altruism
    • alleviating guilt through charity and generosity
      • e.g. criminal donates to church
  • Humor
    • appreciating the humor in a situation to relieve stress
      • joke about your licensing exams
  • Sublimation 
    • replacing an unacceptable action with a more acceptable action
      • aggressive personality is redirected toward a successful military career
  • Suppression 
    • voluntary withholding of an idea or feeling from consciousness

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Questions (16)
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(M1.PY.15.112503) At a counseling session, a 15-year-old boy recounts his childhood. He explained that his father was an angry, violent man who physically abused him and his younger brother every time he was drunk - which was almost every night. The boy said that the only way he could escape the situation was to believe that he himself was a superhero that would fight crime. Which of the following best describes the ego defense of this male?

QID: 107066
1

Dissociation

30%

(7/23)

2

Denial

0%

(0/23)

3

Isolation of affect

4%

(1/23)

4

Fantasy

61%

(14/23)

5

Splitting

0%

(0/23)

M 2 E

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(M1.PY.15.0) A 47-year-old man presents to his PCP for a wellness checkup. His PCP attends the patient's church where he is a pastor and notes the patient vehemently speaks out against alcohol use. However, upon obtaining a history, the patient endorses drinking roughly 5 alcoholic beverages every night. Which of the following ego defenses best explains his behavior?

QID: 107041
1

Acting out

4%

(1/24)

2

Displacement

17%

(4/24)

3

Projection

4%

(1/24)

4

Reaction formation

62%

(15/24)

5

Rationalization

8%

(2/24)

M 2 D

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(M1.PY.15.112501) An 8-year-old girl presents to the psychiatrist to discuss the recent divorce of her parents. The girl explains that her mother is the most caring and loving mother anyone could ever have and that she will be spending the majority of her time with her mother. On the other hand, she exclaims that her father is an evil person and hates him. Which of the following ego defenses is best demonstrated by this girl?

QID: 107064
1

Acting out

2%

(2/88)

2

Denial

2%

(2/88)

3

Projection

1%

(1/88)

4

Regression

0%

(0/88)

5

Splitting

92%

(81/88)

M 2 D

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(M1.PY.15.27) A father calls the pediatrician because his 7-year-old son began wetting the bed days after the birth of his new born sister. He punished his son for bedwetting but it only made the situation worse. The pediatrician advised him to talk with his son about how he feels, refrain from drinking water near bedtime, and praise his son when he keeps the bed dry. Which of the following best describes the reappearance of bedwetting?

QID: 107043
1

Regression

90%

(26/29)

2

Repression

3%

(1/29)

3

Isolation of affect

0%

(0/29)

4

Identification

0%

(0/29)

5

Rationalization

0%

(0/29)

M 2 D

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(M1.PY.15.27) A 38-year-old male presents for counseling by a psychologist mandated by the court. The patient explains that he does not mean to hit his wife when they are arguing, but something just comes over him that he cannot control. Upon further discussion, the patient reveals that his father was incarcerated several times for physically abusing his mother. Which of the following best describes the behavior seen in this patient?

QID: 107045
1

Acting out

11%

(3/27)

2

Dissociation

0%

(0/27)

3

Identification

70%

(19/27)

4

Reaction formation

11%

(3/27)

5

Splitting

4%

(1/27)

M 2 D

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(M1.PY.14.4) A prominent male politician has secret homosexual desires. However, rather than engaging in homosexual behavior, he holds rallies against gay rights and regularly criticizes gay people. The politician is displaying which of the following defense mechanisms?

QID: 100004
1

Repression

9%

(11/121)

2

Reaction formation

74%

(90/121)

3

Denial

3%

(4/121)

4

Displacement

5%

(6/121)

5

Sublimation

7%

(8/121)

M 2 D

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(M1.PY.13.33) A 58-year-old male has had long-term involvement in the world of organized crime. He very recently retired from his post within this organization. This former mafia boss has now suddenly started making large contributions to several local charities. Which of the following ego defenses best characterizes this gentleman's behavior?

QID: 100033
1

Altruism

63%

(12/19)

2

Denial

0%

(0/19)

3

Displacement

5%

(1/19)

4

Sublimation

5%

(1/19)

5

Atonement

21%

(4/19)

M 2 E

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(M1.PY.13.7) A 42-year-old male presents to your office with cellulitis on his leg secondary to a dog bite. You suspect that the causative agent is a small, facultatively anaerobic, Gram-negative rod sensitive to penicillin with clavulanate. When you ask the patient how the bite occurred, the patient explains that he had a fight with his wife earlier in the day. Frustrated with his wife, he yelled at the family pet, who bit him on the leg. Which of the following defense mechanisms was this patient employing at the time of his injury?

QID: 100007
1

Projection

4%

(3/69)

2

Reaction formation

1%

(1/69)

3

Regression

3%

(2/69)

4

Repression

1%

(1/69)

5

Displacement

87%

(60/69)

M 2 E

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(M1.PY.13.13) A 47-year-old woman is upset with her neighbor for playing music too loudly late at night. Rather than confront her neighbor directly, the woman makes a habit of parking her car in a manner that makes it difficult for her neighbor to park in his spot. Which of the following defense mechanisms is this woman demonstrating?

QID: 100013
1

Sublimation

0%

(0/28)

2

Regression

4%

(1/28)

3

Acting out

11%

(3/28)

4

Displacement

0%

(0/28)

5

Passive aggression

82%

(23/28)

M 2 E

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(M1.PY.13.15) A 55-year-old male with a history of stage I colon cancer status-post left hemicolectomy presents to your office for follow-up. You intend to discuss the results from his recent surveillance colonoscopy, which showed no remaining cancer, no polyps, and a well-healed anastmosis. During your meeting, you note that the patient is exhibiting the defense mechanism of suppression. Which of the following statements from the patient is consistent with your impression?

QID: 100015
1

"Last week I volunteered for the local Cancer Society. Helping other cancer patients just makes me feel better."

3%

(3/118)

2

"Oh, doctor, I'm just so grateful to be seeing you. I just know you've cured my cancer. I probably don't even need to check anymore."

11%

(13/118)

3

"I'm sorry I was late today. I also didn't get any of the labs you asked for."

7%

(8/118)

4

"Ever since I had the colonoscopy, I've been having headaches and backaches and just pain all over! I'm sure it's from the cancer."

8%

(10/118)

5

"I really haven't thought about the colonoscopy until today. Worrying before getting the results wasn't going to help anything."

69%

(82/118)

M 1 C

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Evidence (17)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (24)
Private Note