1. Coping mechanisms and ego defense
Jeffrey Clothier, M.D.

2. Objectives Student will be able to describe the defense mechanisms
Student will be able to identify defense mechanisms from short vignettes

3. Study of ego defense mechanisms - psychodynamics
Describes the dynamic interactions of unconscious and conscious forces in the mental life of a person
The dynamic interactions are often interpreted as conflicts in unconscious drives and forces which in turn become expressed in the relationships of the individual

4. Ego defenses
When the conflicts in the unconscious rise to a heightened level the the conflicts threaten to become manifested in the conscious life of the person
This is a way to discharge the anxiety created between the unconscious conflicts

5. The tripartite model of the mind
Freud
Ego ID
Superego
The id is need gratifying and impulsive, instinctual
Hedonic drives for instance
Superego is roughly eq. to conscience
Determines that some needs are not consistent with an underlying view of one’s self (Ego ideal)

6. Ego
Ego is the mediator between the unconscious world of the Id and Superego and the conscious world of reality
The ego’s job is to mediate the struggle between the superego and id
When superego and id are in conflict the person experiences ‘signal anxiety’
Ego must convert the signal anxiety to defuse it and make it less threatening.

7. Ego Defenses
If the signal anxiety cannot be defused it may overwhelm the ego and allow the primitive primary process thinking of the unconscious to become manifested in the conscious life of the person

8. Developmental aspects
The Id is the earliest component of the psychodynamic apparatus
The infant is basically in a pleasure seeking mode of operating (sometimes this is confused with ‘sexuality’)
The infant also conceives of the world in a narcissistic fashion. Things exist only as they relate to him or her
At times the pleasure seeking runs into barriers in the outside world
This result in infants being confronted with reality
New skills and coping mechanisms develop

9. Orderly sequence of development
Normally there is an orderly sequence as the child matures
If significant trauma occurs the child may have difficulty learning the mechanisms that are normally learned at these times
Fixated – uneven development of ego function which results in a part of the ego retaining more primitive or immature function
Repetition compulsion – replay of events related to significant traumas

10. Stages
Oral
Anal
Phallic
Latency
Genital

11. There are characteristic defense mechanisms used in specifc stages
It is possible to describe defense mechanisms along a hierarchy of maturation- actually done first by Freud’s Daughter (Anna)
The defenses used provide some evidence for stages where there are fixations

12. Defense mechanism classification
Narcissistic
Immature
Neurotic
Mature
Denial
Acting out
Displacement
Altruism
Projection
Regression
Dissociation
Humor
Distortion
Passive-aggressive behavior
Reaction formation
Sublimation
Splitting
Schizoid fantasy
Repression
Anticipation
Somatization
Isolation
Suppression
Introjection
Rationalization
Asceticism
Hypochondriasis
Sexualization
Blocking
Intellectualization
Denial-avoiding awareness of some painful aspect of reality by canceling sensory data
Projection- attributing your thoughts or feelings to someone else because they are uncomfortable
Distortion-Grossly reshaping reality to suit your inner needs. Delusions, hallucinations, etc.
Acting out-expressing an unconscious wish through action to avoid becoming consciously aware of it. Impulsively giving in to an unconscious impulse to avoid the tension that builds up when you avoid it.
Regression- a return to an earlier period of libidinal gratification. Normally important for relaxation and other normal aspects of behavior such as sex, sleep, etc
Passive-aggressive behavior- Expressing hostility toward others indirectly by passive avoidance, masochism, procrastination etc.
Schizoid fantasy- Indulging in an autistic belief system in order to resolve conflict and obtain gratification. Intamacy is avoided. Appears eccentric.
Somatization-Converting signal anxiety into bodily symptoms to express internal conflicts
Introjection- internalizing the qualities of another person. Identification with the aggressor is a classic example.
Blocking-temporary blocking of thinking. May resemble repression.
Hypochondriasis- Exagerating or overemphasizing an illness for the purpose of avoiding an uncomfortable internal conflict
Displacement- Shifting an emotion or characteristic from one idea to another. Displacement allows the symbolic representation of the original unconscious idea in a less threatening fashion. Becoming a surgeon instead of a murderer.
Dissociation- Temproary but drastic modificantion of a person’s character or sense of identity to avoid distress. Ex: Multiple personality, fugues, etc.
Reaction formation- transforming an unacceptable impulse into the opposite. (obsessional characters) Paranoia
Repression- expelling an idea or feeling from conscious awareness. NOT SUPPRESSION
Isolation- splitting an idea from the affect that accompanies it. The affect remains repressed. (Common defense in antisocial PD)
Rationalization- Offer rational explanations to justify thoughts ideas, feelings and behaviors that may otherwise be unacceptable
Sexualization- Endowing an object or function with sexual significance.
Intellectualization- excessively using intellectual explanations to avoid affective expression or experience
Altruism- Using constructive and instinctually gratifying service to others to undergo a vicarious experience
Humor-Using comedy to overtly express feelings and thoughts without personal discomfort or immobilization and without producing an unpleasant effect on others
Sublimation- Achieving impulse gratification and retention of goals but altering a socially objectionable aim or object to a socially acceptable one.
Anticipation-Realistically anticipaing or planning for future inner discomfort
Suppression- conscious postponing attention to a conscious impulse or conflict.
Asceticism- eliminating the pleasurable effects of experiences. Moral element assigning values to specific pleasures.

13. Other immature defense mechanisms
Splitting-the tendency to see things as either black or white
The rigidity prevents the normal flexibility which is necessary in dealing with ambiguity
Borderline and narcissitic PD use this
Magical thinking-
Undoing

14. Some characteristic defenses used in specific stages
Oral- narcissistic defenses
Projection, denial, distortion
Anal-
Identification, undoing, reaction formation, isolation, regression
Phallic / oedipal
Intellectualization
Latency
Symbolization, sublimation

15. Examples
After a difficult day on Internal medicine a Medical student returns home to his wife. He recounts every thing he encountered in meticulous detail without apparent emotional display.
Name that defense mechanism

16. #2
When his wife mentions that he seemed to not have much emotion about all that happened the student becomes irate and belittles his wife.
Name that defense mechanism

17. #3
At work the next day the student reports his outbursts to his colleagues and states “she deserved it after-all she should know better than to bother him after a long day”

18. #4
Maria is a song writer. She reports her best work is done when she feels near despair. It is as though her grief is expressed through her music.

19. #5
After Christmas you notice you over spent. You ‘decide to forget’ to pay one of your credit card bills. Throughout the next month you periodic remember it needs to be paid but do not.

20. #6
You have just received the pathology report on one of your patients. It is cancer. When you inform the patient she becomes withdrawn and noncommunicative

21. #7
With time, 2 days, she begins to respond but becomes more dependent on her family for things she previously did even 2 days before.

22. #8
“The lady doth protest too much, methinks”

23. #9
Molly is in love with Bob. She describes him as her soul mate. On Saturday night he is sick and cancels their date. On Sunday she gets up and is extremely angry with Bob and breaks up.

24. #10
Molly misses Bob after 7 days and then goes out on Saturday night to a singles bar. She then ends up with a one night fling which she regrets.