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Defense mechanisms are a type of

process or coping that results in

automatic psychological responses
exhibited as a means of protecting the
individual against anxiety (Dziegielewski
Identification and notation of defense
mechanisms can be an important part of
the psychological assessment and
influence on the treatment process
Since it is believed that many individuals
either consciously or unconsciously
develop defense mechanisms that can
influence the diagnostic condition and
impede progress, these psychological
occurrences, when noted in a client should
be listed in Axis II.

It is very important for the practitioner to

be aware and recognize how they
influence treatment (APA, 2000).
Unconscious mental processes
employed by the ego to
reduce anxiety
What is the relation between defense
mechanisms and diagnosis DSM IV - TR
Freud's Defense Mechanisms include:
Denial: claiming/believing that what is true to be
actually false.
Displacement: redirecting emotions to a substitute
Intellectualization: taking an objective viewpoint.
Projection: attributing uncomfortable feelings to others.
Rationalization: creating false but credible justifications.
Reaction Formation: overacting in the opposite way to
the fear.
Regression: going back to acting as a child.
Repression: pushing uncomfortable thoughts into the
Sublimation: redirecting 'wrong' urges into socially
acceptable actions.
DSM-III was the first to included a
multiaxial system for assessment of the
client as an individual as well as a family
and community member.
Although widely accepted, DSM-III and DSM-III-R were also
widely criticized.
The Multiaxial system prevented efficiency in diagnosis.
Additionally, DSM offered a different amount of support
and direction for each axis.
While there were 300 pages of description for Axis I and 39
pages for Axis II, Axes IV and V were given only 2 pages each
(Blashfield, 1998).
The rating scale format of IV and V was also foreign to
many professionals.
The axes themselves were problematic for many
practitioners because no one seemed to know how
those particular areas were chosen.
Psychoanalysts began to argue for an axis on
defense mechanisms, and nurses wanted an axis
for level of care.
Like its predecessors, DSM-IV was
criticized. The axes problem remained
unsolved, with 3 candidates (defense
mechanisms, interpersonal functioning,
and occupational functioning) still in the
running (Blashfield, 1998.)
What will DSM-V be like regarding axis?
Fogel (in Brendel, 2001) suggests that it
might become more descriptive. This
might lend support for the arguments of
inclusion of defense mechanisms.
The controversies over social diagnoses
and the multiaxial system must also be
addressed in DSM-V (Blashfield, 1998,
DSM-IV-TR, Scotti and Morris, 2000).
Defense mechanisms (or coping styles)
taken from Appendix B in DSM IV TR
are automatic psychological processes
that protect the individual against anxiety
and from the awareness of internal or
external dangers or stressors. Individuals
are often unaware of these processes as
they operate.
Defense mechanisms can be classified
into groups or levels that indicate how
they affect an individual's functioning
High Adaptive Level
Mental Inhibition Level
Minor Image-distorting Level
Disavowal Level
Major Image-distorting Level
Action Level
High Adaptive Level: Defense
mechanisms in this group result in
optimal adaptation to stress.
The defenses usually maximize
feelings of well being and
Allow the conscious awareness of
feelings, ideas, and their
promote an optimum balance among
conflicting motives
Mental Inhibition Level: Defense
mechanisms in this group keep potentially
threatening ideas, feelings, memories,
wishes, or fears out of awareness.
Diminished awareness can affect the
person's ability to relate to others.
isolation of affect
reaction formation
Minor image-distorting level. This
level is characterized by distortions
in the image of the self, body, or
others that may be employed to
regulate self-esteem. Examples are
Disavowal level. This level is
characterized by keeping unpleasant
or unacceptable stressors, impulses,
ideas, affects, or responsibility out
of awareness with or without a
misattribution of these to external
causes. Examples are
Major image-distorting level. This
level is characterized by gross distortion
or misattribution of the image of self or
others. Examples are
autistic fantasy
projective identification
splitting of self-image or image of others
Action Level: This level is
characterized by defenses that deal
with internal or external stressors by
action or withdrawal.
acting out
apathetic withdrawal
help-rejecting complaining
passive aggression
Level of defensive dysregulation.
This level is characterized by failure of
defensive regulation to contain the
individual's reaction to stressors,
lead ins to a pronounced break with
objective reality. Examples are
delusional projection
psychotic denial
psychotic distortion
Affiliation - involves dealing with stressors by turning to others for help or support.
This involves sharing problems with others but not trying to make someone else
responsible for them.

Altruism - involves dealing with stressors by dedicating yourself to meeting the

needs of others. The individual receives satisfaction vicariously or from the response
of others.

Anticipation - involves dealing with stressors by anticipating the consequences and

feelings associated with possible future events and considering realistic solutions.

Humor - involves dealing with stress by emphasizing the amusing or ironic aspects
of the situation.

Self-Assertion - involves dealing with stress by expressing your feelings and

thoughts directly in a way that is not aggressive, coercive, or manipulative.

Self-Observation - involves dealing with stress by reflecting on your own thoughts,

feelings, motivation, and behavior, and then responding appropriately.

Sublimation - involves dealing with stress by channeling potentially disruptive

feelings or impulses into socially acceptable behavior (e.g., playing rugby to channel
angry impulses).

Suppression involves dealing with stress by intentionally avoiding thinking about

disturbing problems, wishes, feelings, or experiences.
Displacement - involves dealing with stress by transferring strong
feelings about on situation onto another (usually less threatening)
substitute situation.

Dissociation - involves dealing with stress by breaking off part of memory,

consciousness, or perception of self or the environment to avoid a problem
situation (e.g., amnesia).

Intellectualization - involves dealing with stress by excessively using

abstract thinking and generalizations to avoid or minimize unpleasant

Reaction - Formation involves dealing with stress by substituting

behavior, thoughts, or feelings that are the exact opposite of your own
unacceptable thoughts or feelings (which the person is usually not aware

Repression - involves dealing with stress by removing disturbing wishes,

thoughts, or experiences from conscious awareness. The person may still
be aware of the feelings associated with the repressed issue, but will not
know where the feelings come from.

Undoing - involves dealing with stress by using words or behaviors

designed to negate or make amends symbolically for unacceptable
thoughts, feelings, or actions.
Devaluation - Involves dealing with emotional
conflict or internal or external stressors by
attributing exaggerated negative qualities to self or

Idealization - Involves dealing with emotional

conflict or internal or external stressors by
attributing exaggerated positive qualities to others.

Omnipotence - Involves dealing with emotional

conflict or internal or external stressors by feeling
or acting as if he or she possesses special powers
or abilities and is superior to others.
Denial - involves dealing with stress by
refusing to acknowledge some painful aspect of
reality or experience that is apparent to others.

Projection - involves dealing with stress by

falsely attributing your own unacceptable
feelings, impulses, or thoughts to another

Rationalization - involves dealing with stress

by concealing the true motivations for a
thought, action, or feeling by using elaborate,
reassuring, and self-serving (but incorrect)
Autistic fantasy - Involves dealing with emotional conflict or internal or
external stressors by excessive daydreaming as a substitute for human
relationships, more effective action, or problem solving.

Projective identification - As in projection, the individual deals with

emotional conflict or internal or external stressors by falsely attributing to
another his or her own unacceptable feelings, impulses, or thoughts.
Unlike simple projection, the individual does not fully disavow what is
projected. Instead, the individual remains aware of his or her own affects
or impulses but misattributes them as justifiable reactions to the other
person. Not infrequently, the individual induces the very feelings in others
that were first mistakenly believed to be there, making it difficult to clarify
who did what to whom first.

Splitting - Involves dealing with emotional conflict or internal or external

stressors by compartmentalizing opposite affect states and failing to
integrate the positive and negative qualities of the self or others into
cohesive images. Because ambivalent affects cannot be experienced
simultaneously, more balanced views and expectations of self or others
are excluded from emotional awareness. Self and object images tend to
alternate between polar opposites: exclusively loving, powerful, worthy,
nurturing, and kind or exclusively bad, hateful, angry, destructive,
rejecting, or worthless.
Acting Out - involves dealing with stress by using action
rather than reflection or feeling. Defensive acting out is
often associated with "bad behavior" when there are
underlying emotional conflicts.

Help-Rejecting Complaining - involves dealing with

stress by complaining and making repeated requests for
help that disguise hidden feelings of hostility toward
others, which is then expressed by rejecting the
suggestions, advice, or help that others offer. The
complaints may involve physical or psychological
symptoms or life problems.

Passive Aggression - involves dealing with stress by

indirectly and unassertively expressing aggression
toward others. The person displays an outward
superficial cooperativeness that masks the underlying
resistance, resentment, and hostility. This defense may
be adaptive in situations where direct and assertive
communication is punished (e.g., abusive relationships).
A. Current Defenses or Coping Styles:
List in order, beginning with most
prominent defenses or coping styles.
1. __________________________________________
2. __________________________________________
3. __________________________________________
4. __________________________________________
5. __________________________________________
6. __________________________________________
7. __________________________________________
B. Predominant Current Defense Level:
A. Current Defenses or Coping
projection identification
acting out
omnipotence denial
B. Predominant Current Defense
Level: major image-distorting level
A variety of instruments to help in the
diagnosis and assessment of Anxiety and
One new approach that is becoming
popular is the use of RAIs.
Becoming popular as they are
standardized instruments that allow
greater accuracy and objectivity in
attempts to measure clinical problems
(Dziegielewski 2010)
Common characteristics:
Brief -Most are done in 15 minutes
Easy to administer
Easy to score
Easy to interpret
Little knowledge of testing procedure needed
Most are self-report
Most are done in 15 minutes
Reliability and Validity measures are usually
Easily accessible and generally free or
available at low cost
They are generally free of any theoretical
orientation so they can be used in a
variety of intervention methods
The score that is generated can provide
an operational index of the frequency,
duration and intensity of the problem
which is good for progress measures
along the course of the treatment.
The Measures for Clinical Practice by
Fischer and Corcoran (2007a, 2007b)