Defense mechanisms (ego defense mechanisms or mental mechanisms) consist of all the coping means used unconsciously by individuals to seek relief from emotional conflict and to ward off excessive anxiety.

1. DEFINITIONS
   blockinga disturbance in the rate of speech when a person's thoughts and speech are proceeding at an average rate but are suddenly and completely interrupted, perhaps even in the middle of a sentence. The gap may last from several seconds up to a minute. Blocking is often a part of the thought disorder found in schizophrenic disorders.
   compensationmaking up for real or imagined handicap, limitation, or lack of gratification in one area of personality by overemphasis in another area to counter the effects of failure, frustration, and limitation (e.g., the person who is blind compensates by increased sensitivity in hearing; the student who is unpopular compensates by becoming an outstanding scholar; men who are small compensate for short stature by demanding a great deal of attention and respect; a nurse who does not have optimal manual dexterity chooses to go into psychiatric nursing).
   confabulating filling in gaps of memory by inventing what appear to be suitable memories as replacements. This symptom may occur in various amnestic disorders but is most often seen in Korsakoff's syndrome (deterioration due to alcohol) and in dementia.
   conversion psychological difficulties are translated into physical symptoms without conscious will or knowledge (e.g., pain and immobility on moving your writing arm the day of the examination).
   denialan intolerable thought, wish, need, or reality factor is disowned automatically (e.g., a student, when told of a failing grade, acts as if he never heard of such a possibility).
   displacementtransferring the emotional component from one idea, object, or situation to another, more acceptable one. Displacement occurs because these are painful or dangerous feelings that cannot be expressed toward the original object (e.g., kicking the dog after a bad day at school or work; anger with a clinical instructor gets transferred to a classmate who was late to meet you for lunch).
   dissociationsplitting off or separation of differing elements of the mind from each other. There can be separation of ideas, concepts, emotions, or experiences from the rest of the mind. Dissociated material is deeply repressed and becomes encapsulated and inaccessible to the rest of the mind. This usually occurs as a result of some very painful experience (e.g., split of affect from idea in anxiety disorders and schizophrenia).
   fixationa state in which personality development is arrested in one or more aspects at a level short of maturity (e.g., "She is anally fixated" [controlling, stingy, holding onto things and memories]).
   idealizationoverestimation of some admired aspect or attribute of another person (e.g., "She was a perfect human being").
   ideas of referencefixed, false ideas and interpretations of external events as though they had direct reference to self (e.g., client thinks that TV news announcer is reporting a story about client).
   identificationthe wish to be like another person; situation in which qualities of another are unconsciously transferred to oneself (e.g., boy identifies with his father and learns to become a man; a woman may fear she will die in childbirth because her mother did; a student adopts attitudes and behavior of her favorite teacher).
   introjectionincorporation into the personality, without assimilation, of emotionally charged impulses or objects; a quality or an attribute of another person is taken into and made part of self (e.g., a girl in love introjects the personality of her lover into herself—his ideas become hers, his tastes and wishes are hers; this is also seen in severe depression following death of someone close—client may assume many of deceased's characteristics; similarly, working in a psychiatric unit with a suicidal person brings out depression in the nurse).
   isolation temporary or long-term splitting off of certain feelings or ideas from others; separating emotional and intellectual content (e.g., talking emotionlessly about a traumatic accident).
   projectionattributes and transfers own feelings, attitudes, impulses, wishes, or thoughts to another person or object in the environment, especially when ideas or impulses are too painful to be acknowledged as belonging to oneself (e.g., in hallucinations and delusions by people who use/abuse alcohol; or, "I flunked the course because the teacher doesn't know how to teach"; "I hate him" reversed into "He hates me"; or a student impatiently accusing an instructor of being intolerant).
   rationalizationjustification of behavior by formulating a logical, socially approved reason for past, present, or proposed behavior. Commonly used, conscious or unconscious, with false or real reason (e.g., after losing a class election, a student states that she really did not want all the extra work and is glad she lost).
   reaction formationgoing to the opposite extreme from what one wishes to do or is afraid one might do (e.g., being overly concerned with cleanliness when one wishes to be messy; being a mother who is overly protective through fear of own hostility to child; or showing great concern for a person whom you dislike by going out of your way to do special favors).
   regressionwhen individuals fail to solve a problem with the usual methods at their command, they may resort to modes of behavior that they have outgrown but that proved successful at an earlier stage of development; retracing developmental steps; going back to earlier interests or modes of gratification (e.g., a senior nursing student about to graduate becomes dependent on a clinical instructor for directions).
   repressioninvoluntary exclusion of painful and unacceptable thoughts and impulses from awareness. Forgetting these things solves the situation by not solving it (e.g., by not remembering what was on the difficult examination after it was over).
   sublimationchanneling a destructive or instinctual impulse that cannot be realized into a socially acceptable, practical, and less dangerous outlet, with some relation to the original impulse for emotional satisfaction to be obtained (e.g., sublimation of sexual energy into other creative activities [art, music, literature], or hostility and aggression into sports or business competition; or a person who is infertile puts all energies into pediatric nursing).
   substitutionwhen individuals cannot have what they wish and accept something else in its place for symbolic satisfaction (e.g., pin-up pictures in absence of sexual object; or a person who failed an RN examination signs up for an LVN/LPN examination).
   suppressiona deliberate process of blocking from the conscious mind thoughts, feelings, acts, or impulses that are undesirable (e.g., "I don't want to talk about it," "Don't mention his name to me," or "I'll think about it some other time"; or willfully refusing to think about or discuss disappointment with examination results).
   symbolismsign language that stands for related ideas and feelings, conscious and unconscious. Used extensively by children, people from primitive cultures, and clients who are psychotic. There is meaning attached to this sign language that makes it very important to the individual (e.g., a student wears dark, somber clothing to the examination site).
   undoinga mechanism against anxiety, usually unconscious, designed to negate or neutralize a previous act (e.g., Lady Macbeth's attempt to wash her hands [of guilt] after the murder). A repetitious, symbolic acting out, in reverse of an unacceptable act already completed. Responsible for compulsions and magical thinking.
2. CHARACTERISTICS of defense mechanisms:
1. Defense mechanisms are used to some degree by everyone occasionally; they are normal processes by which the ego reestablishes equilibrium—unless they are used to an extreme degree, in which case they interfere with maintenance of self-integrity.
2. Much overlapping:
1. Same behavior can be explained by more than one mechanism.
2. May be used in combination (e.g., isolation and repression, denial and projection).
3. Common defense mechanisms compatible with mental well-being:
1. Compensation.
2. Compromise.
3. Identification.
4. Rationalization.
5. Sublimation.
6. Substitution.
4. Typical defense mechanisms in:
1. Paranoid disorders—denial, projection.
2. Dissociative disorders—denial, repression, dissociation.
3. Obsessive-compulsive behaviors—displacement, reaction formation, isolation, denial, repression, undoing.
4. Phobic disorders—displacement, rationalization, repression.
5. Conversion disorders—symbolization, dissociation, repression, isolation, denial.
6. Major depression—displacement.
7. Bipolar disorder, manic episode—reaction formation, denial, projection, introjection.
8. Schizophrenic disorders—symbolization, repression, dissociation, denial, fantasy, regression, projection, isolation.
9. Dementia—regression.
3. CONCEPTS AND PRINCIPLES RELATED TO DEFENSE MECHANISMS:
1. Unconscious process—defense mechanisms are used as a substitute for more effective problem-solving behavior.
2. Main functions—increase self-esteem; decrease, inhibit, minimize, alleviate, avoid, or eliminate anxiety; maintain feelings of personal worth and adequacy and soften failures; protect the ego; increase security.
3. Drawbacks—involve high degree of self-deception and reality distortion; may be maladaptive because they superficially eliminate or disguise conflicts, leaving conflicts unresolved but still influencing behavior.
4. NURSING CARE PLAN/IMPLEMENTATION with defense mechanisms:
1. Accept defense mechanisms as normal, but not when overused.
2. Look beyond the behavior to the need that is expressed by the use of the defense mechanism.
3. Discuss alternative defense mechanisms that may be more compatible with mental health.
4. Assist the person to translate defensive thinking into nondefensive, direct thinking; a problemsolving approach to conflicts minimizes the need to use defense mechanisms.