Defense Mechanisms PDF

Defense Mechanisms ➔ Mental Health- state of well being; making healthy choices ➔ Defense Mechanism- process of thinking & acting developed by ‘ego’ to protect from physical/emotionally painful/dangerous situations ◆ Unconscious or partially, automatic, subtle...

Defense Mechanisms ➔ Mental Health- state of well being; making healthy choices ➔ Defense Mechanism- process of thinking & acting developed by ‘ego’ to protect from physical/emotionally painful/dangerous situations ◆ Unconscious or partially, automatic, subtle form of dishonesty/reality distortion, when one isn’t able to cope/didn’t learn how ◆ Purpose: protect against anxiety & suffering by helping tolerate a reality that’s too aggressive, painful or discordant w/ ones self image (ego) ◆ Triggers- tensions w/ personality, external pressures, fear of losing respect, other peoples judgment, fear of violence ◆ Pathological/Immature/Neurotic (anxiety) vs mature ◆ Sporadic vs Extensive use ◆ Under duress people use less mature defense mechanisms Types: ➔ Affiliation- turning to others/organizations for support/being right or superior ◆ Barry PA, Religion, Military, Front line workers ◆ Can be a healthy defense mechanism ➔ Acting Out- Doing inappropriate things w/o considering consequence as rxn to situation of control or unspoken protest; used for attention/freedom ◆ Unprotected sex, rap persona, unapproved relationships, clowning, dress & adornment ➔ Autistic Fantasy- excess day dreaming, unable/unwilling to isolate resources to create desired reality ◆ Actor/musician/sports/fame fantasy ◆ Keeps people from risk ➔ Compensation- building up other aspects of themselves to adjust for shortcomings ◆ I believe I’m not good at sports but I’m a scholar ➔ Compliance- reluctantly accepting the desires of someone else to ‘keep the peace’ ➔ Controlling- trying to make a person act/think/feel a way ◆ Arguing, micromanaging, domestic violence, rejected lover homicide ➔ Denial- refusing to acknowledge painful/inconvenient/overwhelming aspects of reality ◆ HIV/STD, Alcoholism/Drug Abuse, Climate change ➔ Displacement- transferring negative feelings about one object to another ◆ Kicking the dog/spouse after being ridiculed @ work ➔ Dissociation- lacking connection in ones thoughts, memory & sense of identity ◆ Movies, PTSD, Derealization/Dissociative identity disorder, Severe abuse, Hypnosis ➔ Externalization (Neurotic Defense Mechanism)- Blame problems on another ◆ Applicants & their low grades ➔ Intellectualization- relying excessively on details/facts to maintain distance from painful emotions ➔ Inhibition- Involuntary decrease/loss of motivation to engage in goal directed activity to prevent arising anxiety from conflicts w/ unacceptable impulses ◆ Restraining one's impulses/behavior, consciously or unconsciously, due to lack of confidence, fear of consequences, or morals ◆ Religious prohibitions against sex ◆ Become a lawyer instead of an actor ➔ Isolation- Being alone to avoid uncomfortable feelings & interactions ◆ ‘I need some down time’ ➔ Passive Aggressive- Indirectly expressing aggressive feelings/anger toward others ◆ ‘Why didn't you pick up the groceries’ → ‘Forgot’ ➔ Introjection- internalizing qualities of object/person ◆ Advertising strategy; can be healthy if quality is integrated ◆ Adopting qualities that other people see as ‘desirable’ ➔ Projection- falsely assigning unacceptable/difficult to accept feelings or character traits to another; can be +/- ◆ Falling in love, scapegoat, racism ➔ Projective Identification- person accepts & takes on projection of another; can be +/- ◆ Doc/PA has ‘god complex’ ◆ ‘Dumb blonde’ ◆ Basically seeing yourself how other people see you ➔ Rationalization- making an acceptable excuse for an unacceptable behavior ◆ Didn't get a job because the ‘job didn't pay enough’ ◆ Didn’t get a date because ‘they probs have herpes’  ◆ Being abused as a child because ‘children need to be disciplined’ ➔ Regression- acting like a younger, less mature person ◆ Baby talk, thumb sucking, whining ➔ Repression- unconsciously denying impulses to keep them from becoming conscious; Unwanted thoughts being pushed out of consciousness ◆ Repressed memories of sexual abuse ◆ Can lead to somatization- physical expression of repression ➔ Reaction formation- unconscious converting unwanted/dangerous thoughts, feeling or impulses into their opposite ◆ I like you so I’m gonna be mean to you ➔ Ritual Undoing- superstitious behavior & thoughts ◆ Pregame ritual, full moon, jinxing, bible dropping ➔ Sexualization - inappropriate imposition of sexuality upon person through objectification, overvaluing or emphasizing person’s appearance/sexual behavior ◆ Defense against uncomfortable emotions, advertising, form of projecting certain characteristics in need of relating ➔ Splitting- compartmentalizing opposite affective state; good or bad, no gray area ◆ Politics, hallmark of borderline personality Healthy defense mechanisms/Coping Skills- Oh I have a healthy SAASH ➔ Objectivity ➔ Integration ➔ Sublimation (Mature)- channeling unacceptable impulses, thoughts or emotions into socially acceptable ◆ Punching bag to channel anger, sports, having a muse ➔ Altruism- Dedication to meeting others needs ◆ Advisor, Sponsor, Improves depression ➔ Anticipation- thinking about & preparing for possible adversity ◆ Boy Scout Motto- be prepared ◆ Hurricanes ➔ Suppression- avoiding thinking about a stressor; trying to forget/avoiding thinking about painful or unwanted thoughts ◆ Trauma patient ➔ Humor- dealing w/ stress using irony, dark humor w/o denying reality ◆ Medical talk; could be mature or immature When Defense Mechanisms Considered Pathological ➔ It’s inappropriate for age ➔ There’s Quantity > Quality ➔ It lacks honesty & intimacy in relationships ➔ Overreliance- Chronic suppression of feelings (somatization/physical sx) ➔ It impairs functioning & attainment of goals Managing Patients w/ Defense Mechanisms ➔ Self check & processing ➔ Go w/ the resistance ➔ Gently exploring ➔ Coping skills are conscious ➔ Problem solving ➔ Understand the pt & respect their denial; it gives time to build up energy to face adversity (reality is painful) ➔ Reframing  ➔ Courage & mirroring Coping Mechanisms ➔ Conscious & Intentional (M&Ms) ➔ Flexible ➔ Health Promoting: Positive Well being, Quality of Life, Net Reduction of suffering, Better able to handle future conflicts, Honest ➔ Deals w/ source of anxiety Defense Mechanism vs Coping ➔ Defense Mechanism: What parts of the distressing events, feeling & story need to be distorted ➔ Coping: How the events/feelings can be managed effectively Defense Mechanisms Defense Mechanisms o Defense Mechanisms: process of thinking and acting developed by the “ego” to protect from physical and/or emotionally painful/dangerous situations ▪ Can be unconscious or partially conscious (mostly unconscious) ▪ Automatic ▪ Used when one is not able to cope/did not learn how o What Triggers Defense Mechanisms ▪ external pressures, tensions with one’s personality, fear of losing respect, other people’s judgment, fear of violence o Everyone uses defense mechanisms; they are identified as mature or neurotic/primitive o Under duress people tend to use less mature defense mechanisms Coping Mechanisms o Conscious and intentional (M&Ms), flexible, health promoting: well-being, quality of life, net reduction of suffering, better able to handle future conflicts, honest, deals with source of anxiety Defense Mechanisms o Primitive/Neurotic: ▪ Affiliation: turn to others for support (healthy), being “right” or superior (unhealthy) ▪ Acting out: engage in inappropriate behavior without consideration of consequences, usually as a reaction to a situation (unprotected sex, rock and roll persona, unapproved relationships, self-demeaning) ▪ Autistic fantasy: excessive daydreaming, unwilling /unable to sequester resources to create reality (actor or fantasy). Thinking about doing something but never doing anything to make it happen.  ▪Compensation: build up other aspects of themselves to adjust for any perceived/real shortcomings (a person who believes that they are not good at sports may throw themselves into studying) ▪ Compliance: acquiescing to the desires of someone else to “keep the peace” ▪ Controlling: trying to make a person act/think/feel a certain way (rejected lover homicide, arguing, micromanaging) ▪ Denial: refuse to acknowledge aspect of reality (HIV/STDS, Alcoholism) ▪ Displacement: transfer negative feelings about one object to another (Kicking the dog or spouse) ▪ Dissociation: lack of connection in a person’s thoughts, memory and sense of identity (Movies, PTSD, severe abuse, driving somewhere and you don’t know how you got there) ▪ Externalization: blame problems on another (applicants + low grades) ▪ Intellectualization: rely excessively on details/facts to maintain distance from painful emotion (“a great case”) ▪ Inhibition: Involuntary decrease or loss of motivation to engage in goal directed activity to prevent arising anxiety from conflicts with “unacceptable” impulses (religious prohibitions against sex, become a lawyer instead of an actor) ▪ Introjection (or Identification): internalizing the qualities of an object or person. Advertising strategy. (Identify w/ the quality of something else) Can be healthy if quality is integrated. ▪ Isolation: being alone to avoid uncomfortable feelings and interactions (“I need some down time”) ▪ Passive-aggressive: indirectly express aggressive feelings/anger towards other (walking in late on purpose) ▪ Projection: falsely attribute unacceptable feelings to another (falling in love, scapegoat) ▪ Projection identification: the person accepts and “takes on” the projection of another- positive or negative (“dumb blonde”) ▪ Rationalization: not getting the job à it didn’t pay enough ▪ Regression: acting like a younger, less mature person (baby talk) ▪ Repression: expel disturbing thoughts from consciousness, act like something else is going on bc they don’t even know it (repressed memories of sexual abuse) ▪ Reaction formation: do opposite of what you feel (older sibling becomes loving to younger baby, but wants to kill them/ Helga bullying Arnold even though she likes him) ▪ Ritual and undoing: superstitious behavior and thoughts (pregame rituals, full moon, “you’re gonna jinx it”, OCD) ▪ Sexualization: inappropriate imposition of sexuality on a person, through objectification or emphasizing the person’s appearance ▪ Splitting: “good” or “bad”, no middle ground (politics, Hallmark of Borderline Personality Disorder) o Mature (Defense Mechanisms/Coping Skills: ▪ Oh, I have a healthy SA2SH (usually conscious or somewhat conscious) Objectivity, Integration, Sublimation, Altruism/Anticipation, Suppression, Humor  ▪ Sublimation: channeling of an unacceptable and potentially disruptive impulse, thoughts or emotions, into a socially acceptable behavior. Dealing with emotional stressors by using energy (punching bag to channel anger impulses) ▪ Altruism: deal with stress or conflict through dedication to meeting others (sponsor in AA, enneagram- need to be needed, volunteer) ▪ Affiliation: turn to other for support (sports teams) ▪ Anticipation: think about and prepare for possible adversity (boy scout motto à be prepared) ▪ Suppression: avoid thinking about a stressor (trauma patient) ▪ Humor: deal with stress by seeing ironing, dark humor (medical talk) Defense Mechanisms VS Coping o Defense Mechanism: what parts of the distressing events, feelings, and “Self” story must be distorted o Coping: how the events/feelings can be managed Medical causes of psychiatric illnesses (this is from the previous class) What factors make it more likely for a psychiatric illness to be caused by a physical condition? o Cancer; Cancer treatments, including interferon; Cushing syndrome; Dementing illnesses; Huntington disease; Hypothyroidism; Multiple sclerosis; Parkinson disease; SLE; Sleep apnea; Stroke; traumatic brain injury; hypo/hyperglycemia, DM, Electrolyte abnormality, Meningitis, vitamin B12 insufficiency, UTI How would one work up a patient for a medical cause of a psychiatric illness? o Thorough H and P: Family history, including (controversial) race/ethnicity, Social history, Environmental exposures; work/hobbies/home; History of abuse/trauma/military experience; Sleep apnea screen: Epworth sleepiness scale