17 Defense Mechanisms in Mental Health

A large part of mental health nursing is recognizing defense mechanisms, which are mostly unconscious psychological processes used to cope with reality and its stresses. By helping the patient recognize when these defenses are in use, you can help them gain self awareness and a better understanding of their behavior. Recognizing defense mechanisms, especially some of the maladaptive ones, can help prevent you from being manipulated by others as well. Defense mechanisms can be grouped into two categories – adaptive and maladaptive. Review defense mechanisms on-the-go in episode 372 of the Straight A Nursing podcast.

Adaptive defense mechanisms

The adaptive defense mechanisms (also called “mature defenses”) can be more helpful than others and involve accepting reality rather than denying it. Adaptive defense mechanisms include altruism, humor, sublimation and suppression.

Altruism – An individual using altruism as a defense mechanism will do good deeds as a way to overcome hardship. For example, the parent of a child who died from cancer hosts an annual fundraiser to benefit cancer research. A defining characteristic of altruism is that the individual does not expect anything in return. Using altruism as a defense mechanism can have several benefits including reduced stress, personal growth through expression of empathy or compassion, a sense of connection that comes with reaching out to others, and an overall enhanced sense of well-being that comes with the endorphin boost of doing a good thing.

Humor – Many individuals use humor to diffuse tension in uncomfortable or stressful situations. For example, a nursing student who is nervous about the final exam makes jokes about how sweaty their palms are.

Sublimation – An individual who uses sublimation as a defense mechanism compensates for an inadequacy or an emotion by focusing their energy in another way. For example, a woman who just went through a tough breakup focuses her attention on remodeling her house.

Suppression – The act of suppression involves consciously pushing unpleasant emotions or thoughts out of our conscious awareness. For example, an individual who survived a car crash may find they are regularly pushing these uncomfortable and scary thoughts from their mind. Note that if the unpleasant emotions or thoughts are not ultimately recognized and dealt with, suppression can become maladaptive.

Maladaptive defense mechanisms

Maladaptive defense mechanisms are more harmful and include a wide range of strategies to avoid reality.

Denial – Denial occurs when the individual refuses to accept facts or reality as a way to lessen their emotional impact. For example, a patient may deny they have diabetes even though their A1C is 8.5%. 

Projection – Attributing your own troubling faults to someone else is projection. For example, a nursing student who regularly makes mistakes in the clinical setting spreads rumors that others in her clinical group are incompetent.

Repression – Repression is the act of completely putting traumatic past events out of your mind as a way to cope. For example, a person comes to terms years later with the fact that she had been assaulted as a child and had repressed those memories for many years. Repression can also be used to hide unpleasant thoughts or beliefs from the individual’s own consciousness.

Regression – Going back to a child-like or low functioning state as a way to not deal with problems or the rigors of life is regression. This is typically most evident in young children who regress to things like bed wetting or thumb sucking when faced with stressful events. However, adults can regress also.

Displacement – Transferring an emotion to someone or something that is not threatening is the act of displacement. For example, a student gets a failing grade on an assignment and is angry at their spouse when they get home.

Reaction Formation – Reaction formation is a defense mechanism that involves doing the opposite of your convictions or feelings. For example, a person with negative feelings toward their spouse reacts to them in an overtly affectionate way.  

Somatization – Somatization is an unconscious way of expressing psychological distress through physical manifestations. An example is the student who throws up prior to an exam, or the individual who feels physically weak after learning their child has been arrested for a DUI.

Rationalization – Explaining your behavior or justifying your actions with unreasonable explanations is rationalization. For example, a nurse who bombs his interview for a managerial position states he didn’t want to work those hours anyway.

Passive aggression – An individual using passive aggression deals with negative feelings in a covert or unassertive way. For example, a nursing student “loses” the work she did on a group project because she doesn’t like the individuals in her group.

Dissociation – Dissociation is mentally “going somewhere else” or feeling disconnected as a way to cope with severe trauma, either while it’s happening or after the event. In some cases, dissociation affects the individual’s ability to remember past traumatic events. For example, a nursing student is mugged after class and says, “It just felt so unreal, like it was happening to someone else.”

Devaluation – Devaluation assigns exaggerated negative qualities to a person, place or thing while ignoring the good qualities. For example, an envious mother-in-law may describe her son’s wife as totally worthless and lazy despite the fact that she works full time and contributes equally to child rearing and household duties. 

Idealization – Idealization is the opposite of devaluation. With idealization, individuals assign overly exaggerated positive qualities to a person, place or thing. Individuals who partake in idealization may not see others for who they truly are and this can lead to unrealistic expectations. For example, a man idealizes his girlfriend and thinks she’s absolutely perfect despite the fact that she’s cheating on him.

Splitting – Splitting is the act of cycling between devaluation and idealization. It is typically utilized with individuals with borderline personality disorder and places individuals on extreme sides of the spectrum with shifts happening rapidly. It can be very disorienting for those on the receiving end if they’re not aware of what is happening. For example, when you bring your patient a snack you are “the most amazing nurse ever!” But when you later tell them they need to be NPO for an upcoming procedure, you are “the worst nurse they’ve ever had.”

I hope this quick overview of defense mechanisms has helped you understand how these are used and how to recognize them. For more help with mental health nursing, click here.

_____________________________________

The information, including but not limited to, audio, video, text, and graphics contained on this website are for educational purposes only. No content on this website is intended to guide nursing practice and does not supersede any individual healthcare provider’s scope of practice or any nursing school curriculum. Additionally, no content on this website is intended to be a substitute for professional medical advice, diagnosis or treatment.

References:

Bailey, R., & Pico, J. (2024). Defense Mechanisms. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK559106/

Cornell (PhD), D., & Drew (PhD), C. (2024, June 15). 25 Defense Mechanisms Examples (2024). https://helpfulprofessor.com/defense-mechanisms-examples/

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, 12, 718440. https://doi.org/10.3389/fpsyg.2021.718440

Holland, K. (2022, June 21). Top 10 Defense Mechanisms and Why We Use Them. Healthline. https://www.healthline.com/health/mental-health/defense-mechanisms

Metzger, J. A. (2014). Adaptive Defense Mechanisms: Function and Transcendence. Journal of Clinical Psychology, 70(5), 478–488. https://doi.org/10.1002/jclp.22091

Murphy, T. F. (2023, December 9). Altruism: A Defense Mechanism. Psychology Fanatic. https://psychologyfanatic.com/altruism-a-defense-mechanism/

Nortje, A. (2021, April 12). Defense Mechanisms in Psychology Explained (+ Examples). PositivePsychology.Com. https://positivepsychology.com/defense-mechanisms-in-psychology/

Ohwovoriole, T. (2023, November 20). What to Know About Defense Mechanisms. Verywell Mind. https://www.verywellmind.com/what-are-defense-mechanisms-5213880

Picmonic. (n.d.). Passive Aggression – Ego Defenses – Psychiatry – Picmonic for Medicine. Picmonic. https://www.picmonic.com/pathways/medicine/courses/standard/psychiatry-10707/ego-defenses-39132/passive-aggression_50142

Salters-Pedneault, K. (2023, February 21). Idealization and Devaluation as Defense Mechanisms in BPD. Verywell Mind. https://www.verywellmind.com/devaluation-and-idealization-in-bpd-425291

Sissons, C. (2020, July 31). Defense mechanisms in psychology: what are they? MedicalNewsToday. https://www.medicalnewstoday.com/articles/defense-mechanisms

Vaillant, G. E. (2000). Adaptive mental mechanisms: Their role in a positive psychology. American Psychologist, 55(1), 89–98. https://psycnet.apa.org/doiLanding?doi=10.1037%2F0003-066X.55.1.89

Last Updated on November 11, 2024 by Maureen Osuna, MSN, RN