24th October 2023

Defence Mechanisms

It is very likely that you’ll be tested on your understanding and application of the defence mechanisms in your EMQs (also possibly in the SBAs). It is common for you to be given an example of a patient and their use of a specific defence mechanism in a particular situation, with you expected to choose the mechanism being used by the person. Similar types of questions will be included for you to practise at the end of the chapter.

Defence mechanisms are unconscious strategies used by the person (or mind) to protect itself in situations of overwhelming emotion, such as anxiety or stress. They can be thought of as a way to explain a variety of human behaviours or experiences that can occur both in the presence or absence of psychopathology.

Anna Freud was responsible for naming what was originally thought of as the Freudian defences before more were added by Klein (see brackets) and others. Vaillant was responsible for classifying and organising them into the subcategories of mature, immature and neurotic defences. Below, you can find descriptions and examples of the most commonly found defence mechanisms:

Mature defences

(Use this mnemonic to remember – SASHA)

Sublimation – The transfer of perceived unhelpful impulses or sexual urges onto more socially acceptable or productive alternatives, for example, guilt being transferred into charity work. It is suggested that Freud sublimated his sexual desires by devoting his life to science.

Altruism – Describes the mechanism of fulfilling one’s own needs through a dedication to the lives of others and their needs. By using this defence mechanism, the person receives partial gratification, either directly or indirectly.

Suppression – A temporary voluntary avoidance of engagement with a conscious feeling or stressor in order to postpone dealing with it at present. There is an acknowledgement of emotional discomfort, but the person can continue focusing on a more pressing task or thought until the suppressed material is ready to be returned.

Humour – The use of comedy by emphasising certain amusing or ironic aspects of a particular stressor or event in order to relieve tension. It serves to outwardly express thoughts and feelings in a situation with everyone rather than at the expense of a single person.

Anticipation – The process of planning for future distress or stressors by using mental preparation to mitigate the effects and consider realistic, alternative solutions. The future distress is experienced, allowing rehearsal to prepare an adaptive response to the stressor.

Immature defences

Acting out – The process of acting with disregard or thought about the negative personal or social consequences. It is used to expel troublesome feelings rather than deal with them. The person will often feel guilty after, on reflection, after the event.

Passive aggression – The act of indirectly and non-assertively expressing anger towards others through passive activities. It is characterised by venting hostile or resentful feelings indirectly towards others.

Projection (sometimes called a narcissistic defence) – Defined as falsely attributing anxieties, impulses or stressors to an external origin, for instance, onto another person’s actions. Thus, internal threats become externalised and then are easier to cope with.

Somatisation – Psychological distress is converted into physical distress and expressed as bodily symptoms.

Somatosensory amplification – The experience of magnifying bodily sensations as particularly intense or upsetting, thought to form the basis for somatisation and somatoform disorders.

Melanie Klein was a psychoanalyst who developed an approach to defence mechanisms that focused on the ways in which individuals cope with internal conflicts and anxieties. Klein believed that defence mechanisms were an important part of the human psyche and that they could be seen as unconscious processes that helped individuals manage their emotions and deal with difficult or threatening situations. Klein believed that defence mechanisms were primarily developed in childhood as a way for individuals to deal with the anxieties and conflicts that arise from their relationships with others, particularly their parents. She also emphasised the importance of the internalisation of object relations in the formation of defence mechanisms. Below are examples of the main ‘Kleinian’ defences; you can use the mnemonic ‘SIIPDDOG’ to remember them more easily:

Splitting – The act of viewing oneself or others as all good or bad, with the failure to integrate the positive and negative attributes into a coherent whole picture of the person. This is usually learned from inconsistency from caregivers in early life. This is commonly seen in those with emotionally unstable personality disorder.

Idealisation – Exaggerating the positive attributes of one’s self or others in order to protect against feelings of powerlessness and unimportance. These feelings can also be attributed to organisations or belief systems, not just individual people.

Introjection – This defence involves internalising external objects or experiences, often in an attempt to gain control over them. For example, a child who is abused by a caregiver may internalise the abuser’s behaviour as a way to gain a sense of control over the situation.

Projective identification – The process of projecting an aspect about oneself onto someone else, with the attempt to convince the person that this originated in them. This may lead to the other person mistakenly believing that this is the truth and, therefore, may behave in a similar manner to the projector.

Devaluation/denigration – Exaggerating the negative attributes of one’s self or others in order to boost self esteem or avoid disappointment.

Denial (sometimes called a narcissistic defence) – Defined as the refusal to acknowledge some aspect of external reality that would be apparent to others. It may persist despite repeated reiteration of the facts. The term denial is often used inappropriately for the knowing or conscious avoidance of painful topics or thoughts.

Omnipotence – The act of behaving in a superior way to others, usually as a result of lowered self esteem or feelings of helplessness.

Grandiosity – Overcompensating for feelings of inferiority or insecurity by developing an exaggerated sense of self-importance or superiority. This can manifest as arrogance, fantasies of power and success, and/or entitlement. It can be seen as a way for individuals to protect themselves from feelings of inadequacy or vulnerability by creating a false sense of superiority. However, it can also lead to interpersonal conflicts and a lack of empathy for others.

Neurotic defences

Displacement – The process of redirecting an unpleasant feeling or response from an object onto another, usually less threatening, one. The feeling is fully expressed but is misdirected to a target that is perceived as less threatening.

Dissociation – Temporary altering of a person’s own identity or consciousness to avoid significant emotional distress. Dissociated material is often perceived as too threatening or anxiety provoking to be allowed into awareness.

Identification with the aggressor – Whereby a person adopts the behaviour and values of an aggressor to feel safe or powerful. It can be seen in abusive relationships, workplace environments, or marginalised groups. While it may provide temporary relief, it can cause harm in the long term.

Intellectualisation – The excessive use of abstract thinking to avoid disturbing feelings. The person distances themselves from the emotional aspects of an idea by using generalisation to minimise the importance of their inner feelings on the problem.

Isolation of affect – The separation of the cognitive and affective aspects of an experience. The person is able to remember details of a likely traumatic event but does not experience the associated painful feelings. This is the converse of repression.

Rationalisation – Seeking to logically explain or find justification for a behaviour or attitude that is felt to be unacceptable.

Reaction formation – Refers to the denial of an unacceptable impulse or thought by replacing it with the opposing behaviour. This substitution occurs unconsciously.

Regression – Falling back to childish behaviours/feelings in order to avoid dealing with a conflict or overwhelming stress.

Repression – Defined by the unconscious forgetting of disturbing feelings or memories in order to protect the self from past experiences. There is some overlap with denial.

Undoing – The use of specific behaviours or rituals to symbolically alleviate unpleasant or uncomfortable thoughts and/or feelings. This is commonly seen in OCD.

References

• Di Giuseppe, M., & Perry, J. C. (2021). The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning With the Defense Mechanisms Rating Scales Q-Sort. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2021.718440
• Casey, P. & Kelly, B. (Ed) Fish’s Clinical Psychopathology. (3rd ed.). RCPsych publications. Appendix II, 129-130.
• Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (11th ed.). Wolters Kluwer. 161-162.