This is a presentation describing various defense mechanisms with examples. In between there is a quiz, in which viewers are supposed to identify the defense depicted in the pictures. This presentation would be useful to teach defense mechanisms to students of psychiatry and psychology. References are used from the Comprehensive textbook of psychiatry. The pictures are downloaded from google images.

1. Defense Mechanisms
Dr Nilima Shah
Assistant Professor, Psychiatry
B.J. Medical College
Ahmedabad

2. Defense mechanisms
• Intrapsychic conflict
Anxiety
Reliance on defense mechanisms

3. Structural theory of mind

4. Defense Mechanisms
Sigmund Freud- Introduced the concept, Repression
Anna Freud- Comprehensive study
George Vaillant’s classification
• Narcissistic
• Immature
• Neurotic
• Mature

5. Normality and Mental health
• Mental health as above normal
• Mental health as positive psychology
• Mental health as maturity
• Mental health as socioemotional intelligence
• Mental health as subjective well-being
• Mental health as resilience

6. Mental Health as Resilience
• “ It is not stress that kills individuals but the healthy
mastery of stress that permits individuals to survive”
• 3 broad classes of coping:
• Consciously seeking social support
• Conscious cognitive strategies
• Adaptive involuntary coping mechanisms (defense)

7. Lodestars of Human Conflict
Ego
Affect Reality
RelationshipsConscience
Instinct , id, drive, passion,
emotion, impulse
Sudden changes in
existing reality
People who you
cannot live with or
without
Cultural taboos,
imperatives, social
learning, superego
Involuntary Homeostatic
mental mechanisms (Defense)

8. ‘Defense’
• The term was discarded by 1970 due to lack of
consistent definition and rater reliability
• Since 1970 idea of ‘involuntary coping’ re-entered.
• Later experimental strategies like videotape and q-
sort have improved reliability
• DSM IV- TR offered a tentative hierarchy and glossary
of consensually validated definitions

9. Levels of defensive adaptation: DSM IV TR
• High Adaptive Level
• Mental Inhibition Level
• Minor Image-distorting Level
• Disavowal Level
• Major Image-distorting Level
• Action Level
• Defensive dysregulation level

10. High Adaptive level
• Affiliation
• Altruism
• Anticipation
• Humor
• Suppression
• Sublimation
• Self-assertion
• Self-observation

11. Affiliation
• Turning to others for help and support
E.g. going to support group, therapy or a spiritual
counsel

12. Altruism
• Dealing with stressors by dedicating oneself to
meeting the needs of others.
• Constructive service to others which brings pleasure
and satisfaction.
• E.g. A person whose parents died in a road-traffic
accident forms an organization for creating public
awareness in traffic rules

13. Anticipation
• Dealing with stressors by anticipating the
consequences and the feelings associated with
possible future events and considering realistic
solutions
• E.g. A person who is getting old thinks ahead and
plans his retirement wisely

14. Humor
• The individual deals with emotional conflicts, or
internal or external stressors, by emphasizing the
amusing or ironic aspects of the conflict or stressor
E.g. Gallows humor ( humor in the face of or about very
unpleasant, serious, or painful circumstances)
As a man is about to be executed, the firing squad
leader offers the man about to be executed a
cigarette. He replies, "No thanks, I'm trying to quit."

15. Suppression
• The individual deals with emotional conflicts, or
internal or external stressors, by voluntarily avoiding
thinking about disturbing problems, wishes, feelings
or experiences temporarily.
E.g. Focusing on studying for the exam and not
worrying about job opportunities after passing at the
moment.

16. Sublimation
• Channeling of unacceptable and potentially
disruptive impulses/ thoughts/ emotions into socially
acceptable behavior
• E.g Punching bag to channel angry impulses. Sports

17. Self-assertion
• The individual deals with emotional conflicts, or
internal or external stressors, by expressing one's
feelings and thoughts directly in order to achieve
goals. Firmly and respectfully
• Not aggressively/coercively/manipulatively
• E.g. Wife regarding husband consuming alcohol:
“I said I was leaving and that he had to make a choice
between me and drinking, and I left and went to
Florida with my parents. I met my parents there, and
I found a job there”

18. Self-observation
• The individual deals with emotional conflicts, or
internal or external stressors, by reflecting on his or
her own thoughts, feelings, motivation and behavior
• E.g. Diary writing, self-exploration, bibliotherapy

19. Mental Inhibitions level
• Displacement
• Dissociation
• Intellectualization
• Isolation of Affect
• Reaction formation
• Repression
• Undoing

20. Displacement
• Generalizing or redirecting a feeling about or a
response to an object onto another, usually less
threatening, object. The person may or may not be
aware that the affect/impulse expressed toward the
displaced object was really meant for someone else.
• E.g. The boss gets angry on his employee who goes
home and shouts at his wife, who in turn shouts at
their son. The son goes and kicks the dog.
• A man wins a lottery, turns to the person next to
him, and gives him a big hug!

21. Dissociation
• Breaking off part of memory, consciousness or
perception of the self or environment to avoid a
problem situation
• E.g. An otherwise honest person cheating in income
tax and keeping both the sets of values separated
and unintegrated
• E.g. Dissociative amnesia

22. Intellectualization
• The excessive use of abstract thinking or complex
explanations to avoid disturbing feelings.
• E.g. A person who is in heavy debt builds a complex
spreadsheet of how long it would take to repay using
different payment options and interest rates.

23. Isolation of Affect
• Not experiencing simultaneously the cognitive
and affective components of an experience
because the affect is kept from consciousness.
• E.g. Medical student dissects a cadaver without
being disturbed by thoughts of death.

24. Reaction formation
Substituting behavior, thoughts, or feelings that are
diametrically opposed to a person’s unacceptable
thoughts or feelings.
E.g. A married woman who is disturbed by feeling
attracted to one of her husband's friends treats him
rudely.
E.g. Treating someone you strongly dislike in an
excessively friendly manner in order to hide your
true feelings.

25. Repression
• The involuntary exclusion of a painful or conflictual
thought, impulse, or memory from awareness
• E.g. A child who is abused by a parent later has no
recollection of the events, but has trouble forming
relationships.

26. Undoing
• Behavior designed to symbolically make amends for
negate previous thoughts, feelings, or actions.
• E.g. When asked to recommend a friend for a job, a
man makes comments which prevent the friend's
getting the position; a few days later, the man drops
in to see his friend and brings him a small gift.

27. Minor image distortion level
• Devaluation
• Idealization
• Omnipotence

28. Devaluation
• Attributing exaggeratedly negative qualities to
oneself or others
• E.g. A writer about herself: “Oh I am not a real
writer.. I just write non-fiction. I have no
imagination”
• E.g. Wife about husband: “Oh he did care for me in
his own twisted way”

29. Idealization
• Attributing exaggerated positive qualities to self or
others.
• E.g. A lover speaks in glowing terms of the beauty
and intelligence of an average-looking woman who is
not very bright.

30. Omnipotence
• Acting superior to others, as if one possessed special
powers or abilities, to artificially prop up self-esteem
• E.g. Someone acts self-assured and asserts an 'I can
handle anything' attitude, in the face of obviously
doing a doubtful or poor job of dealing with his own
problem

31. Quiz time

37. “ As a diabetic I can’t have it now, but if my
HbA1c comes normal the next month, I shall
treat myself with a small piece.

38. Disavowal level
• Denial
• Projection
• Rationalization

39. Denial
• Refusing to acknowledge some aspect of external
reality or of his or her experience that would be
apparent to others
• E.g. A person refusing to accept his physician’s
opinion that he has cancer and seeking a second
opinion

40. Projection
• Falsely attributing his or her own unacknowledged
feelings; impulses; or thought to others. The subject
disavows his or her own feelings, intentions or
experience by means of attributing them to others
• E.g. A man does not like another person. But he has
a value that says he should like everyone. So he
projects onto him that he does not like him. This
allows him to avoid him and also handle his own
feeling of dislike.
• E.g. An unfaithful man suspects his wife of infidelity

41. Rationalization
• Devising reassuring or self-serving but incorrect
explanations for his or her own or others' behavior
• E.g. A parent punishes his child badly and says that it
is for his own good!
• E.g A person evades paying tax and then explains
how the government is anyway wasting money and it
is better for people to keep with themselves only as
much money as they can

42. Major image distortion level
• Autistic fantasy
• Projective identification
• Splitting

43. Autistic fantasy
• Excessive daydreaming as a substitute for human
relationships, more direct and effective action, or
problem solving
• E.g. Someone tells a story of future plans which are
apparently unrealistic. However, it becomes clear
that he obtains gratification from elaborating the
details while ignoring the constraints or effort
potentially involved. He enjoys the fantasy, prefering
not to discuss the reality aspects.

44. Projective Identification
• In projective identification the subject has an affect
or impulse which he finds unacceptable and projects
onto someone else, as if it was really that other
person who originated the affect or impulse.
• However, the subject does not disavow what is projected --unlike in simple
projection-- but remains fully aware of the affects or impulses, and simply
misattributes them as justifiable reactions to the other person!
• E.g. The person accuses the interviewer of having negative feelings like
anger towards the subject; due to the subject's own angry or accusatory
state. No matter what the interviewer says, the latter cannot set the
subject straight. The more muddled things become, the angrier the
subject gets (e.g. 'I know you think I'm stupid, your question was childish
... so of course I'm angry')

45. Splitting
• Viewing himself or herself or others as all good or all
bad, failing to integrate the positive and negative
qualities of the self and others into cohesive images;
often the same individual will be alternately idealized
and devalued
• E.g. A patient in the ward tells a nurse that she is the
only person who cares for him, and yet, the very next
day, refuses to talk to her.

46. Action level
• Acting out
• Apathetic withdrawal
• Help-rejecting complaining
• Passive Aggression

47. Acting out
• Acting out involves the expression of feelings, wishes
or impulses in uncontrolled behavior with apparent
disregard for personal or social consequences
• E.g. A child’s temper tantrum when he does not get
his way with the parent
• E.g . Self- injury may be a form of acting out,
expressing in physical pain what one cannot stand to
face emotionally

48. Apathetic withdrawal
• Decreases emotions, activity and social interactions
• E.g. On especially difficult days Mr. X (suffers from
cancer) is sad and appears to lack energy. He then
withdraws into a state of apathy, a protective
distancing marked by emotional indifference and a
reduction in social interactions and outside activities.
He shows unusually passive submission to events
and to caregivers.It allows him to make his life more
bearable

49. Help-rejecting complaining
• Help-rejecting complaining involves the repetitious
use of a series of complaint in which the person
ostensibly asks for help. However, covert feelings of,
hostility or resentment towards others are expressed
simultaneously by the person’s rejection of the
suggestions, advice, or whatever others offer.
“Depicting oneself with self-pity as the unsavable
victim”
• E.g. The subject presents a seemingly insoluble dilemma
about an important problem in life (e.g.threatened job loss,
health, marriage) and systematically rejects all suggestions
that others offer to a degree that prevents any progress
toward a solution

50. Passive Aggression
• Indirectly and unassertively expressing aggression
toward others. There is a facade of overt compliance
masking covert resistance toward others
• E.g. Not talking to a friend because she forgot your
birthday
• E.g. A patient refusing to take antihypertensive
medication after a family quarrel

51. Defensive dysregulation level
• Delusional projection
• Psychotic denial
• Psychotic distortion

52. Delusional projection
• Persecutory delusions
• E,g. A 43 year old, single, farmer claims that spacemen at
night cause his headaches.
• Interviewer: I will protect you against these spacemen and
give you medication that will relieve your headache
• Patient : So do you believe that spacemen cause my
headache?
• Interviewer: I cant tell you that, but I know you feel this and I
know that the medication may help

53. Psychotic Denial
• Negation of obvious reality
• E.g. A person having complex hallucinations of
deceased mother and believing that she is still alive.

54. Psychotic distortion
• Profound misperception and misinterpretation of
external reality and feelings
• E.g. megalomaniacal beliefs/ delusions; collecting
coins in a bag and believing that one is a millionaire

55. Quiz time

64. Thankyou