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Explore the role of defense mechanisms in psychological well-being, potential maladaptive behaviors, and methods of coping with threats. Learn about different types of defense mechanisms and their impact on individuals of all ages.
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Defense mechanisms • Defense mechanisms are helpful and, if used in a proper manner, are healthy. Some disorders, such as personality disorders and psychosis, may in fact be caused in part by inadequate use of appropriate defensce mechanisms. However, if misused, the defense mechanisms may also be unhealthy. • The maladaptive use of defense mechanisms can occur in a variety of cases, such as when they become automatic and prevent individuals from realizing their true feelings and thoughts or when they put the person in actual danger. For example, someone who is in denial about the possibility that a new sexual partner could carry an STD may not take appropriate precautions to protect their own sexual health.
Defense mechanisms • Defense mechanisms can also be maladaptive when they are continually used in a way that disrupts reality-testing. Repeated denial and paranoid projection use can cause people to lose touch with the real world and their surroundings and consequently isolate themselves from it and dwell in a ‘created’ world of their own design. For example, people with addictive behaviour are known to misuse such defense mechanisms as denial. Defense mechanisms can also be harmful if: • There are too few defenses which can be employed in coping with threats; • There is too much superego activity, which causes the use of too many defenses.
List of defense mechanisms • Sigmund Freud was the first person to develop the concept of defense mechanisms, however it was his daughter Anna Freud who clarified and conceptualized it. • She has described various different defense mechanisms. • The list of particular defense mechanisms is huge and there is no theoretical consensus on the amount of defense mechanisms. It has been attempted to classify defense mechanisms according some of their properties (ie. underlying mechanisms, similarities or connexions with personality).
Compensation • Compensation occurs when someone takes up one behavior because one cannot accomplish another behavior.
Denial • An ego defense mechanism that operates unconsciously to resolve emotional conflict, and to reduce anxiety by refusing to perceive the more unpleasant aspects of external reality.
Displacement • An unconscious defense mechanism, whereby the mind redirects emotion from a ‘dangerous’ object to a ‘safe’ object. • In psychoanalytic theory, displacement is a defense mechanism that shifts sexual or aggressive impulses to a more acceptable or less threatening target; redirecting emotion to a safer outlet.
Intellectualization • Concentrating on the intellectual components of the situations as to distance oneself from the anxiety provoking emotions associated with these situations
Projection • Attributing to others, one’s own unacceptable or unwanted thoughts and/or emotions. • Projection reduces anxiety in the way that it allows the expression of the impulse or desire without letting the ego recognize it.
Rationalization • The process of constructing a logical justification for a decision that was originally arrived at through a different mental process
Reaction formation • The converting of unconscious wishes or impulses that are perceived to be dangerous into their opposites
Regression • The reversion to an earlier stage of development in the face of unacceptable impulses
Repression • The process of pulling thoughts into the unconscious and preventing painful or dangerous thoughts from entering consciousness.
Sublimation • The refocusing of psychic energy (which Sigmund Freud believed was limited) away from negative outlets to more positive outlets. These drives which cannot find an outlet are rechanneled. In Freud’s classic theory, erotic energy is only allowed limited expression due to repression, and much of the remainder of a given group’s erotic energy is used to develop its culture and civilization. • Freud considered this defense mechanism the most productive compared to the others that he identified. Sublimation is the process of transforming libido into ‘social useful’ achievements, mainly art. Psychoanalysts often refer to sublimation as the only truly successful defense mechanism.
Undoing • A person tries to 'undo' a negative or threatening thought by their actions.
Suppression • The conscious process of pushing thoughts into the preconscious.
Dissociation • Separation or postponement of a feeling that normally would accompany a situation or thought.
Humor. • Refocuses attention on the somewhat comical side of the situation as to relieve negative tension; similar to comic relief.
Idealization • Form of denial in which the object of attention is presented as "all good" masking true negative feelings towards the other.
Identification • The unconscious modeling of one's self upon another person's behavior.
Introjection • Identifying with some idea or object so deeply that it becomes a part of that person.
Inversion • Refocusing of aggression or emotions evoked from an external force onto one's self.
Somatization • Manifestation of emotional anxiety into physical symptoms.
Splitting • Primitive defense mechanism-when a person sees external objects or people as either "all good" or "all bad."
Substitution • When a person replaces one feeling or emotion for another.
Introduction and History of Mental Illness • Our earliest explanation of what we now refer to as psychopathology involved the possession by evil spirits and demons. Many believed, even as late as the sixteenth and seventeenth centuries that the bizarre behavior associated with mental illness could only be an act of the devil himself. To remedy this, many individuals suffering from mental illness were tortured in an attempt to drive out the demon. • Most people know of the witch trials where many women were brutally murdered due to a false belief of possession. When the torturous methods failed to return the person to sanity, they were typically deemed eternally possessed and were executed
The medical model • By the eighteenth century we began to look at mental illness differently. It was during this time period that "madness" began to be seen as an illness beyond the control of the person rather than the act of a demon. Because of this, thousands of people confined to dungeons of daily torture were released to asylums where medical forms of treatment began to be investigated. • Today, the medical model continues to be a driving force in the diagnosing and treatment of psychopathology, although research has shown the powerful effects that psychology has on a person's behavior, emotion, and cognitions. This chapter will discuss the various ways mental illness is classified as well as the effects of mental illness on the individual and society.
Classifying Psychopathology • Mental illness is classified today according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV), published by the American Psychiatric Association (1994). • The DSM uses a multiaxial or multidimensional approach to diagnosing because rarely do other factors in a person's life not impact their mental health. It assesses five dimensions as described below:
The DSM • Axis I: Clinical Syndromes • This is what we typically think of as the diagnosis (e.g., depression, schizophrenia, social phobia) • Axis II: Developmental Disorders and Personality Disorders • Developmental disorders include autism and mental retardation, disorders which are typically first evident in childhood • Personality disorders are clinical syndromes which have a more long lasting symptoms and encompass the individual's way of interacting with the world. They include Paranoid, Antisocial, and Borderline Personality Disorders.
The DSM • Axis III: Physical Conditions which play a role in the development, continuance, or exacerbation of Axis I and II Disorders • Physical conditions such as brain injury or HIV/AIDS that can result in symptoms of mental illness are included here. • Axis IV: Severity of Psychosocial Stressors • Events in a persons life, such as death of a loved one, starting a new job, college, unemployment, and even marriage can impact the disorders listed in Axis I and II. These events are both listed and rated for this axis. • Axis V: Highest Level of Functioning • On the final axis, the clinician rates the person's level of functioning both at the present time and the highest level within the previous year. This helps the clinician understand how the above four axes are affecting the person and what type of changes could be expected
Psychiatric Disorders • Let's discuss the first two axes in more detail now as these are what we typically think of when we think of mental illness or psychopathology. • The DSM IV (American Psychiatric Association, 1994) identifies 15 general areas of adult mental illness. We'll discuss each one briefly. For more information about a specific category, open Psychiatric Disorders on the Main Menu and follow the links provided.
1. Delirium, Dementia, Amnestic, and Other Cognitive Disorders • The primary symptoms of these disorders include significant negative changes in the way a person thinks and/or remembers. • All of these disorders have either a medical or substance related cause and are therefore not discussed in detail in this chapter.
2. Mental Disorders Due to a Medical Condition • Like those above, all disorders in this category are directly related to a medical condition. • If symptoms of anxiety, depression, etc are a direct result of a medical condition, this is the classification used.
3. Substance Related Disorders • There are two disorders listed in this category: Substance Abuse and Substance Dependence. Both involve the ingestion of a substance (alcohol, drug, chemical) which alters either cognitions, emotions, or behavior. • Abuserefers to the use of the substance to the point that it has a negative impact on the person's life. This can mean receiving a DUI for drinking and driving, being arrested for public intoxication, missing work or school, getting into fights, or struggling with relationships because of the substance. • Dependencerefers to what we typically think of as 'addicted.' This occurs when (a) the use of the substance is increased in order to get the same effect because the person has developed a tolerance, (b) the substance is taken more frequently and in more dangerous situations such as drinking and driving, or (c) the person continues to take the substance despite negative results and/or the desire to quit, or (d) withdrawal symptoms are present when the substance is stopped, such as delirium tremors (DTs), amnesia, anxiety, headaches, etc.
4. Schizophrenia and other Psychotic Disorders • The major symptom of these disorders is psychosis, or delusions and hallucinations. The major disorders include schizophrenia and schizoaffective disorder. • Schizophreniais probably the most recognized term in the study of psychopathology, and it is probably the most misunderstood. First of all, it does not mean that the person has multiple personalities. The prefix 'schiz' does mean split, but it refers to a splitting from reality. The predominant features of schizophrenia include hallucinations and delusions and disorganized speech and behavior, inappropriate affect, and avolition. There is no known cure for schizophrenia and is without doubt the most debilitating of all the mental illnesses. • Schizoaffective Disorderis characterized by a combination of the psychotic symptoms such as in Schizophrenia and the mood symptoms common in Major Depression and/or Bipolar Disorder. The symptoms are typically not as severe although when combined together in this disorder, they can be quite debilitating as well.
5. Mood Disorders • The disorders in this category include those where the primary symptom is a disturbance in mood. The disorders include Major Depression, Dysthymic Disorder, Bipolar Disorder, and Cyclothymia. • Major Depression(also known as depression or clinical depression) is characterized by depressed mood, diminished interest in activities previously enjoyed, weight disturbance, sleep disturbance, loss of energy, difficulty concentrating, and often includes feelings of hopelessness and thoughts of suicide.
5. Mood Disorders • Dysthymiais often considered a lesser, but more persistent form of depression. Many of the symptoms are similar except to a lesser degree. Also, dysthymia, as opposed to Major Depression is more steady rather than periods of normal feelings and extreme lows. • Bipolar Disorder(previously known as Manic-Depression) is characterized by periods of extreme highs (called mania) and extreme lows as in Major Depression. Bipolar Disorder is subtyped either I (extreme or hypermanic episodes) or II (moderate or hypomanic episodes). • Like Dysthymia and Major Depression, Cyclothymia is considered a lesser form of Bipolar Disorder.
6. Anxiety Disorders • Anxiety Disorders categorize a large number of disorders where the primary feature is abnormal or inappropriate anxiety. The disorders in this category include Panic Disorder, Agoraphobia, Specific Phobias, Social Phobia, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, and Generalized Anxiety Disorder. • Panic Disorderis characterized by a series of panic attacks. A panic attack is an inappropriate intense feeling of fear or discomfort including many of the following symptoms: heart palpitations, trembling, shortness of breath, chest pain, dizziness. These symptoms are so severe that the person may actually believe he or she is having a heart attack. In fact, many, if not most of the diagnoses of Panic Disorder are made by a physician in a hospital emergency room.
6. Anxiety Disorders • Agoraphobialiterally means fear of the marketplace. It refers to a series of symptoms where the person fears, and often avoids, situations where escape or help might not be available, such as shopping centers, grocery stores, or other public place. Agoraphobia is often a part of panic disorder if the panic attacks are severe enough to result in an avoidance of these types of places. • Specific or Simple Phobiaand Social Phobia represents an intense fear and often an avoidance of a specific situation, person, place, or thing. To be diagnosed with a phobia, the person must have suffered significant negative consequences because of this fear and it must be disruptive to their everyday life.
6. Anxiety Disorders • Obsessive-Compulsive Disorderis characterized by obsessions (thoughts which seem uncontrollable) and compulsions (behaviors which act to reduce the obsession). Most people think of compulsive hand washers or people with an intense fear of dirt or of being infected. • These obsessions and compulsions are disruptive to the person's everyday life, with sometimes hours being spent each day repeating things which were completed successfully already such as checking, counting, cleaning, or bathing.
6. Anxiety Disorders • Posttraumatic Stress Disorder(PTSD) occurs only after a person is exposed to a traumatic event where their life or someone else's life is threatened. The most common examples are war, natural disasters, major accidents, and severe child abuse. • Once exposed to an incident such as this, the disorder develops into an intense fear of related situations, avoidance of these situations, reoccurring nightmares, flashbacks, and heightened anxiety to the point that it significantly disrupts their everyday life.
6. Anxiety Disorders • Generalized Anxiety Disorderis diagnosed when a person has extreme anxiety in nearly every part of their life. It is not associated with just open places (as in agoraphobia), specific situations (as in specific phobia), or a traumatic event (as in PTSD). • The anxiety must be significant enough to disrupt the person's everyday life for a diagnosis to be made.
7. Somatoform Disorders • Disorders in this category include those where the symptoms suggest a medical condition but where no medical condition can be found by a physician. Major disorders in this category include Somatization Disorder, Pain Disorder, Hypochondriasis. • Somatization Disorder refers to generalized or vague symptoms such as stomach aches, sexual pain, gastrointestinal problems, and neurological symptoms which have no found medical cause. • Pain Disorder refers to significant pain over an extended period of time without medical support. • Hypochondriasis is a disorder characterized by significant and persistent fear that one has a serious or life-threatening illness despite medical reassurance that this is not true.
8. Factitious Disorder • Factitious Disorder is characterized by the intentionally produced or feigned symptoms in order to assume the 'sick role.' • These people will often ingest medication and/or toxins to produce symptoms and there is often a great secondary gain in being placed in the sick role and being either supported, taken care of, or otherwise shown pity and given special rights.
9. Dissociative Disorders • The main symptom cluster for dissociative disorders include a disruption in consciousness, memory, identity, or perception. In other words, one of these areas is not working correctly causing significant distress within the individual. The major diagnoses in this category include Dissociative Amnesia, Dissociative Fugue, Depersonalization Disorder, and Dissociative Identity Disorder. • Dissociative Amnesiais characterized by memory gaps related to traumatic or stressful events which are too extreme to be accounted for by normal forgetting. A traumatic event is typically a precursor to this disorder and memory is often restored.
9. Dissociative Disorders • Dissociative Fuguerepresents an illness where an individual, after an extremely traumatic event, abruptly moves to a new location and assumes a new identity. This disorder is very rare and typically runs its course within a month. • Depersonalization Disorder, occurring after an extreme stressor, includes feelings of unreality, that your body does not belong to you, or that you are constantly in a dreamlike state. • Dissociative Identity Disorder (DID) is most widely known as Multiple Personality Disorder or MPD. DID is the presence of two or more distinct personalities within an individual. These personalities must each take control of the individual at varying times and there is typically a gap in memory between personalities or "alters." This disorder is quite rare and a significant trauma such as extended sexual abuse is usually the precursor.
10. Sexual Dysfunctions, Paraphilias, and Gender Identity Disorders • These disorders are all related to sexuality, either in terms of functioning (Sexual Dysfunctions), distressing and often irresistible sexual urges (Paraphilias), and gender confusion or identity (Gender Identity Disorder. • It should be noted that for these, as well as many other categories, a medical reason should always be ruled out before making a psychological diagnosis.
10. Sexual Dysfunctions, Paraphilias, and Gender Identity Disorders • Sexual Dysfunctions include Hypoactive Sexual Desire Disorder (deficiency or absence of sexual fantasies and desire for sexual activity), Sexual Aversion Disorder (persistent or recurring aversion to or avoidance of sexual activity), Sexual Arousal and Male Erectile Disorder (Inability to attain or maintain until completion of sexual activity adequate lubrication (in women) or erection (in men) in response to sexual excitement), • Orgasmic Disorder [male] [female] (delay or absence of orgasm following normal excitement and sexual activity), and Premature Ejaculation (ejaculation with minimal sexual stimulation before or shortly after penetration and before the person wishes it).
10. Sexual Dysfunctions, Paraphilias, and Gender Identity Disorders • Paraphilias include Exhibitionism (the intense urge to expose oneself to an unsuspecting stranger), Voyeurism (the intense urge to watch an unsuspecting person in various states of undress or sexual activity), Fetishism (intense sexual fantasies, urges, and behaviors involving an inanimate object), Pedophilia (sexually arousing fantasies. urges, and behavior involving a prepubescent child), Sexual Masochism (intense sexual fantasies, urges, and behavior involving the act of being beaten, humiliated, and/or bound), and Sexual Sadism (intense sexual fantasies, urges, and behavior involving the infliction of pain and/or humiliation on another person). • The final category, Gender Identity Disorder, is characterized by a strong and persistent identification with the opposite sex and the belief that one is actually the opposite sex due to an extreme discomfort in one's present sexual identity.
11. Eating Disorders • Eating disorders are characterized by disturbances in eating behavior. There are two types: Anorexia Nervosa and Bulimia Nervosa. • Anorexiais characterized by failure to maintain body weight of at least 85% of what is expected, fear of losing control over your weight or of becoming 'fat.' There is typically a distorted body image, where the individual sees themselves as overweight despite overwhelming evidence to the contrary. • The key characteristics of Bulimia include bingeing (the intake of large quantities of food) and purging (elimination of the food through artificial means such as forced vomiting, excessive use of laxatives, periods of fasting, or excessive exercise).
