Updated: 12/27/2016

Ego Defenses

Topic
Review Topic
0
0
Questions
15
0
0
Evidence
15
0
0
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 similar acceptable action
      • aggressive personality is redirected toward a successful military career
  • Suppression 
    • voluntary withholding of an idea or feeling from consciousness
 

Please rate topic.

Average 4.4 of 7 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (15)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
Calculator

(M1.PY.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? Review Topic

QID: 100033
1

Altruism

67%

(6/9)

2

Denial

0%

(0/9)

3

Displacement

0%

(0/9)

4

Sublimation

0%

(0/9)

5

Atonement

33%

(3/9)

M1

Select Answer to see Preferred Response

PREFERRED RESPONSE 1
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M1.PY.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? Review Topic

QID: 107064
1

Acting out

3%

(2/61)

2

Denial

2%

(1/61)

3

Projection

2%

(1/61)

4

Regression

0%

(0/61)

5

Splitting

92%

(56/61)

M1

Select Answer to see Preferred Response

PREFERRED RESPONSE 5
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M1.PY.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? Review Topic

QID: 107043
1

Regression

86%

(12/14)

2

Repression

7%

(1/14)

3

Isolation of affect

0%

(0/14)

4

Identification

0%

(0/14)

5

Rationalization

0%

(0/14)

M1

Select Answer to see Preferred Response

PREFERRED RESPONSE 1

(M1.PY.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? Review Topic

QID: 107045
1

Acting out

8%

(1/12)

2

Dissociation

0%

(0/12)

3

Identification

83%

(10/12)

4

Reaction formation

8%

(1/12)

5

Splitting

0%

(0/12)

M1

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(M1.PY.0) A 47-year-old male presents to a psychiatrist for the first time, explaining that he is tired of living his 'double life.' At church, he preaches vehemently against the sin of drinking alcohol, but at home he gets drunk every night. Which of the following ego defenses best explains his behavior? Review Topic

QID: 107041
1

Acting out

7%

(1/15)

2

Displacement

27%

(4/15)

3

Projection

0%

(0/15)

4

Reaction formation

53%

(8/15)

5

Rationalization

13%

(2/15)

M1

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(M1.PY.112503) At a counseling session, a 15-year-old male 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 was a superhero that would fight crime. Which of the following best describes the ego defense of this male? Review Topic

QID: 107066
1

Dissociation

20%

(2/10)

2

Denial

0%

(0/10)

3

Isolation of affect

0%

(0/10)

4

Fantasy

80%

(8/10)

5

Splitting

0%

(0/10)

M1

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(M1.PY.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? Review Topic

QID: 100004
1

Repression

8%

(7/87)

2

Reaction formation

75%

(65/87)

3

Denial

5%

(4/87)

4

Displacement

5%

(4/87)

5

Sublimation

7%

(6/87)

M1

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(M1.PY.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? Review Topic

QID: 100007
1

Projection

5%

(3/61)

2

Reaction formation

2%

(1/61)

3

Regression

3%

(2/61)

4

Repression

2%

(1/61)

5

Displacement

87%

(53/61)

M1

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(M1.PY.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? Review Topic

QID: 100013
1

Sublimation

0%

(0/10)

2

Regression

0%

(0/10)

3

Acting out

0%

(0/10)

4

Displacement

0%

(0/10)

5

Passive aggression

100%

(10/10)

M1

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(M1.PY.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? Review Topic

QID: 100015
1

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

3%

(3/108)

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."

12%

(13/108)

3

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

6%

(7/108)

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."

9%

(10/108)

5

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

69%

(74/108)

M1

Select Answer to see Preferred Response

PREFERRED RESPONSE 5
ARTICLES (15)
Topic COMMENTS (24)
Private Note