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
2010).
 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).
 Freud
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 target.
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
subconscious.
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 consequences.
promote an optimum balance among
conflicting motives
 anticipation
affiliation
altruism
humor
self-assertion
self-observation
sublimation
suppression
 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.
displacement
dissociation
intellectualization
isolation of affect
reaction formation
repression
undoing
 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
devaluation
idealization
omnipotence
 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
denial
projection
rationalization
 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 feelings.

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 of).

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 others.

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 person.

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) explanations.
 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 Styles:
splitting
projection identification
acting out
devaluation
omnipotence denial
projection

B. Predominant Current Defense Level: major

image-distorting level
 A variety of instruments to help in the
diagnosis and assessment of Anxiety and
Depression
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

presented
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)