Defense Mechanism

These are 15 Common Defense Mechanism 

an article by John M. Groho, Psy. D.

In some areas of psychology (especially in psychodynamic theory), psychologists talk about “defense mechanisms,” or manners in which we behave or think in certain ways to better protect or “defend” ourselves. Defense mechanisms are one way of looking at how people distance themselves from a full awareness of unpleasant thoughts, feelings and behaviors.

Psychologists have categorized defense mechanisms based upon how primitive they are. The more primitive a defense mechanism, the less effective it works for a person over the long-term. However, more primitive defense mechanisms are usually very effective short-term, and hence are favored by many people and children especially (when such primitive defense mechanisms are first learned). Adults who don’t learn better ways of coping with stress or traumatic events in their lives will often resort to such primitive defense mechanisms as well.

Most defense mechanisms are fairly unconscious – that means most of us don’t realize we’re using them in the moment. Some types of psychotherapy can help a person become aware of what defense mechanisms they are using, how effective they are, and how to use less primitive and more effective mechanisms in the future.

Primitive Defense Mechanisms

1. Denial

Denial is the refusal to accept reality or fact, acting as if a painful event, thought or feeling did not exist. It is considered one of the most primitive of the defense mechanisms because it is characteristic of early childhood development. Many people use denial in their everyday lives to avoid dealing with painful feelings or areas of their life they don’t wish to admit. For instance, a person who is a functioning alcoholic will often simply deny they have a drinking problem, pointing to how well they function in their job and relationships.

2. Regression

Regression is the reversion to an earlier stage of development in the face of unacceptable thoughts or impulses. For an example an adolescent who is overwhelmed with fear, anger and growing sexual impulses might become clingy and start exhibiting earlier childhood behaviors he has long since overcome, such as bedwetting. An adult may regress when under a great deal of stress, refusing to leave their bed and engage in normal, everyday activities.

3. Acting Out

Acting Out is performing an extreme behavior in order to express thoughts or feelings the person feels incapable of otherwise expressing. Instead of saying, “I’m angry with you,” a person who acts out may instead throw a book at the person, or punch a hole through a wall. When a person acts out, it can act as a pressure release, and often helps the individual feel calmer and peaceful once again. For instance, a child’s temper tantrum is a form of acting out when he or she doesn’t get his or her way with a parent. Self-injury may also be a form of acting-out, expressing in physical pain what one cannot stand to feel emotionally.

4. Dissociation

Dissociation is when a person loses track of time and/or person, and instead finds another representation of their self in order to continue in the moment. A person who dissociates often loses track of time or themselves and their usual thought processes and memories. People who have a history of any kind of childhood abuse often suffer from some form of dissociation. In extreme cases, dissociation can lead to a person believing they have multiple selves (“multiple personality disorder”). People who use dissociation often have a disconnected view of themselves in their world. Time and their own self-image may not flow continuously, as it does for most people. In this manner, a person who dissociates can “disconnect” from the real world for a time, and live in a different world that is not cluttered with thoughts, feelings or memories that are unbearable.

5. Compartmentalization

Compartmentalization is a lesser form of dissociation, wherein parts of oneself are separated from awareness of other parts and behaving as if one had separate sets of values. An example might be an honest person who cheats on their income tax return and keeps their two value systems distinct and un-integrated while remaining unconscious of the cognitive dissonance.

6. Projection

Projection is the misattribution of a person’s undesired thoughts, feelings or impulses onto another person who does not have those thoughts, feelings or impulses. Projection is used especially when the thoughts are considered unacceptable for the person to express, or they feel completely ill at ease with having them. For example, a spouse may be angry at their significant other for not listening, when in fact it is the angry spouse who does not listen. Projection is often the result of a lack of insight and acknowledgement of one’s own motivations and feelings. 

7. Reaction Formation

Reaction Formation is the converting of unwanted or dangerous thoughts, feelings or impulses into their opposites. For instance, a woman who is very angry with her boss and would like to quit her job may instead be overly kind and generous toward her boss and express a desire to keep working there forever. She is incapable of expressing the negative emotions of anger and unhappiness with her job, and instead becomes overly kind to publicly demonstrate her lack of anger and unhappiness.

Less Primitive, More Mature Defense Mechanisms

Less primitive defense mechanisms are a step up from the primitive defense mechanisms in the previous section. Many people employ these defenses as adults, and while they work okay for many, they are not ideal ways of dealing with our feelings, stress and anxiety. If you recognize yourself using a few of these, don’t feel bad – everybody does.

8. Repression

Repression is the unconscious blocking of unacceptable thoughts, feelings and impulses. The key to repression is that people do it unconsciously, so they often have very little control over it. “Repressed memories” are memories that have been unconsciously blocked from access or view. But because memory is very malleable and ever-changing, it is not like playing back a DVD of your life. The DVD has been filtered and even altered by your life experiences, even by what you’ve read or viewed. 

9. Displacement

Displacement is the redirecting of thoughts feelings and impulses directed at one person or object, but taken out upon another person or object. People often use displacement when they cannot express their feelings in a safe manner to the person they are directed at. The classic example is the man who gets angry at his boss, but can’t express his anger to his boss for fear of being fired. He instead comes home and kicks the dog or starts an argument with his wife. The man is redirecting his anger from his boss to his dog or wife. Naturally, this is a pretty ineffective defense mechanism, because while the anger finds a route for expression, it’s misapplication to other harmless people or objects will cause additional problems for most people.

10. Intellectualization

Intellectualization is the overemphasis on thinking when confronted with an unacceptable impulse, situation or behavior without employing any emotions whatsoever to help mediate and place the thoughts into an emotional, human context. Rather than deal with the painful associated emotions, a person might employ intellectualization to distance themselves from the impulse, event or behavior. For instance, a person who has just been given a terminal medical diagnosis, instead of expressing their sadness and grief, focuses instead on the details of all possible fruitless medical procedures.

11. Rationalization

Rationalization is putting something into a different light or offering a different explanation for one’s perceptions or behaviors in the face of a changing reality. For instance, a woman who starts dating a man she really, really likes and thinks the world of is suddenly dumped by the man for no reason. She reframes the situation in her mind with, “I suspected he was a loser all along.”

12. Undoing

Undoing is the attempt to take back an unconscious behavior or thought that is unacceptable or hurtful. For instance, after realizing you just insulted your significant other unintentionally, you might spend then next hour praising their beauty, charm and intellect. By “undoing” the previous action, the person is attempting to counteract the damage done by the original comment, hoping the two will balance one another out.

Mature Defense Mechanisms

Mature defense mechanisms are often the most constructive and helpful to most adults, but may require practice and effort to put into daily use. While primitive defense mechanisms do little to try and resolve underlying issues or problems, mature defenses are more focused on helping a person be a more constructive component of their environment. People with more mature defenses tend to be more at peace with themselves and those around them.

13. Sublimation

Sublimation is simply the channeling of unacceptable impulses, thoughts and emotions into more acceptable ones. For instance, when a person has sexual impulses they would like not to act upon, they may instead focus on rigorous exercise. Refocusing such unacceptable or harmful impulses into productive use helps a person channel energy that otherwise would be lost or used in a manner that might cause the person more anxiety.

Sublimation can also be done with humor or fantasy. Humor, when used as a defense mechanism, is the channeling of unacceptable impulses or thoughts into a light-hearted story or joke. Humor reduces the intensity of a situation, and places a cushion of laughter between the person and the impulses. Fantasy, when used as a defense mechanism, is the channeling of unacceptable or unattainable desires into imagination. For example, imagining one’s ultimate career goals can be helpful when one experiences temporary setbacks in academic achievement. Both can help a person look at a situation in a different way, or focus on aspects of the situation not previously explored.

14. Compensation

Compensation is a process of psychologically counterbalancing perceived weaknesses by emphasizing strength in other arenas. By emphasizing and focusing on one’s strengths, a person is recognizing they cannot be strong at all things and in all areas in their lives. For instance, when a person says, “I may not know how to cook, but I can sure do the dishes!,” they’re trying to compensate for their lack of cooking skills by emphasizing their cleaning skills instead. When done appropriately and not in an attempt to over-compensate, compensation is defense mechanism that helps reinforce a person’s self-esteem and self-image.

15. Assertiveness

Assertiveness is the emphasis of a person’s needs or thoughts in a manner that is respectful, direct and firm. Communication styles exist on a continuum, ranging from passive to aggressive, with assertiveness falling neatly inbetween. People who are passive and communicate in a passive manner tend to be good listeners, but rarely speak up for themselves or their own needs in a relationship. People who are aggressive and communicate in an aggressive manner tend to be good leaders, but often at the expense of being able to listen empathetically to others and their ideas and needs. People who are assertive strike a balance where they speak up for themselves, express their opinions or needs in a respectful yet firm manner, and listen when they are being spoken to. Becoming more assertive is one of the most desired communication skills and helpful defense mechanisms most people want to learn, and would benefit in doing so.

* * *

Remember, defense mechanisms are most often learned behaviors, most of which we learned during childhood. That’s a good thing, because it means that, as an adult, you can choose to learn some new behaviors and new defense mechanisms that may be more beneficial to you in your life. Many psychotherapists will help you work on these things, if you’d like. But even becoming more aware of when you’re using one of the less primitive types of defense mechanisms above can be helpful in identifying behaviors you’d like to reduce.

Acne...

This article is for my son, thanks Dra. Khaye for the info...

What is acne?

Acne (acne vulgaris, common acne) is a disease of the hair follicles of the face, chest, and back that affects almost all males and females during puberty; the only exception being teenage members of a few primitive isolated tribes living in Neolithic societies. It is not caused by bacteria, although bacteria play a role in its development. It is not unusual for some women to develop acne in their mid- to late-20s.
Acne appears on the skin as...

• congested pores ("comedones"), also known as blackheads or whiteheads,
• tender red bumps also known as pimples or zits,
• pustules, and occasionally as
• Cysts (deep pimples, boils).

You can do a lot to treat your acne using products available at a drugstore or cosmetic counter that do not require a prescription. However, for tougher cases of acne, you should consult a physician for treatment options.

What causes acne?

No one factor causes acne. Acne happens when sebaceous (oil) glands attached to the hair follicles are stimulated at the time of puberty by elevated levels of male hormones. Sebum (oil) is a natural substance which lubricates and protects the skin. Associated with increased oil production is a change in the manner in which the skin cells mature so that they are predisposed to clog the follicular openings or pores. The clogged hair follicle gradually enlarges, producing a bump. As the follicle enlarges, the wall may rupture, allowing irritating substances and normal skin bacteria access into the deeper layers of the skin, ultimately producing inflammation.

Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); deeper still and it's a cyst. If the oil breaks through to the surface, the result is a "whitehead." If the oil accumulates melanin pigment or becomes oxidized, the oil changes from white to black, and the result is a "blackhead." Blackheads are therefore not dirt and do not reflect poor hygiene.

Here are some factors that don't usually play a role in acne:

• Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.
• Food: Parents often tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Although some recent studies have implicated milk and pure chocolate in aggravating acne, these findings are very far from established.
• Dirt: As mentioned above, "blackheads" are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin.
• Stress: Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.

In occasional patients, the following may be contributing factors:

• Pressure: In some patients, pressure from helmets, chin straps, collars, suspenders, and the like can aggravate acne.
• Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium (Eskalith, Lithobid), which is used to treat bipolar disorder. Most cases of acne, however, are not drug related.
• Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne.
• Cosmetics: Some cosmetics and skin-care products are pore clogging ("comedogenic"). Of the many available brands of skin-care products, it is important to read the list of ingredients and choose those which have water listed first or second if you are concerned about acne. These "water-based" products are usually safe.

What other skin conditions can mimic acne?

• Rosacea: This condition is characterized by pimples but not comedones and occurs in the middle third of the face, along with redness, flushing, and superficial blood vessels. It generally affects people in their 30s and 40s and older.
• Pseudofolliculitis: This is sometimes called "razor bumps" or "razor rash." When cut close to the skin, curly neck hairs bend under the skin and produce pimples. This is a mechanical problem, and treatment involves shaving less (growing a beard, laser hair removal). Pseudofolliculitis can, of course, occur in patients who have acne, too.
• Folliculitis: Pimples can occur on other parts of the body, such as the abdomen, buttocks, or legs. These represent not acne but inflamed follicles. If these don't go away on their own, doctors can prescribe oral or external antibiotics, generally not the same ones used for acne.
• Gram-negative folliculitis: Some patients who have been treated with oral antibiotics for long periods develop pustules filled with bacteria resistant to the antibiotics which have previously been used. Bacterial culture tests can identify these germs, leading the doctor to prescribe different antibiotics or other forms of treatment.

When should you start acne treatment?

Since everyone gets acne at some time, the right time to treat it is when it bothers you or when the potential for scarring develops. This can be when severe acne flares suddenly, for mild acne that just won't go away, or even when a single pimple decides to show up the week before your prom or wedding. The decision is yours.

What can you do about acne on your own?

Think back to the three basic causes of acne and you can understand why the focus of both home treatment and prescription therapy is to (1) unclog pores, (2) kill bacteria, and (3) minimize oil. But first a word about...

Lifestyle: Moderation and regularity are good things, but not everyone can sleep eight hours, eat three good meals, and drink eight glasses of water a day. You can, however, still control your acne even if your routine is frantic and unpredictable. Probably the most useful lifestyle changes you can make are to never to pick or squeeze pimples. Playing with or popping pimples, no matter how careful and clean you are, nearly always makes bumps stay redder and bumpier longer. People often refer to redness as "scarring," but fortunately it usually isn't in the permanent sense. It's just a mark that takes months to fade if left entirely alone.

Open the pores

Cleansing and skin care: Despite what you read in popular style and fashion magazines, there is no magic product or regimen that is right for every person and situation.

• Mild cleansers: Washing once or twice a day with a mild cleansing bar or liquid (for example, Dove, Neutrogena, Basis, Purpose, and Cetaphil are all inexpensive and popular) will keep the skin clean and minimize sensitivity and irritation.
• Exfoliating cleansers and masques: A variety of mild scrubs, exfoliants, and masks can be used. These products contain either fine granules or salicylic acid in a concentration that makes it a very mild peeling agent. These products remove the outer layer of the skin and thus open pores. Products containing glycolic or alpha hydroxy acids are also gentle skin exfoliants.
• Retinol: Not to be confused with the prescription medication Retin-A, this derivative of vitamin A can help promote skin peeling.

Kill the bacteria

• Antibacterial cleansers: The most popular ingredient in over-the-counter antibacterial cleansers is benzoyl peroxide.
• Topical (external) applications: These products come in the form of gels, creams, and lotions, which are applied to the affected area. The active ingredients that kill surface bacteria include benzoyl peroxide, sulfur, and resorcinol. Some brands promoted on the Internet and cable TV (such as ProActiv) are much more costly than identical products you can buy in the drugstore.

Benzoyl peroxide causes red and scaly skin irritation in a small number of people, which goes away as soon as you stop using the product. Keep in mind that benzoyl peroxide is a bleach, so do not let products containing benzoyl peroxide leave unsightly blotching on colored clothes, shirts, towels, and carpets.

Reduce the oil

You cannot stop your oil glands from producing oil (unless you mess with your hormones or metabolism in ways you shouldn't). Even isotretinoin (Accutane, see below) only slows down oil glands for a while; they come back to life later. What you can do is to get rid of oil on the surface of the skin and reduce the embarrassing shine.

• Use a gentle astringent/toner to wipe away oil. (There are many brands available in pharmacies, as well as from manufacturers of cosmetic lines.)
• Products containing glycolic acid or one of the other alpha hydroxy acids are also mildly helpful in clearing the skin by causing the superficial layer of the skin to peel (exfoliate).
• Masks containing sulfur and other ingredients draw out facial oil.
• Antibacterial pads containing benzoyl peroxide have the additional benefit of helping you wipe away oil

What are other things you can do for acne?

• Cosmetics: Don't be afraid to hide blemishes with flesh-tinted coverups or even foundation, as long at it is water-based (which makes it noncomedogenic). There are many quality products available.
• Facials: While not absolutely essential, steaming and "deep-cleaning" pores is useful, both alone and in addition to medical treatment, especially for people with "whiteheads" or "blackheads." Having these pores unclogged by a professional also reduces the temptation to do it yourself.
• Pore strips: Pharmacies now carry, under a variety of brand names, strips which you put on your nose, forehead, chin, etc., to "pull out" oil from your pores. These are, in effect, a do-it-yourself facial. They are inexpensive, safe, and work reasonably well if used properly.
• Toothpaste? One popular home remedy is to put toothpaste on zits. There is no medical basis for this. Ditto for vinegar.

What is a good basic skin regimen?

These are all good basic skin regimens that may help with the acne battle:

1.     Cleanse twice daily with a 5% benzoyl peroxide wash. An alternative for those who are allergic to benzoyl peroxide is 2% salicylic acid.

2.     Apply a gel or cream containing 5% benzoyl peroxide; an alternative is sulfur or resorcinol.

3.     At night, apply a spot cream containing sulfur to the affected areas.

4.     Use a light skin moisturizer and water-based oil-free makeup.

What can the doctor do for acne?

If you haven't been able to control your acne adequately, you may want to consult a primary-care physician or dermatologist. The goal of treatment should be the prevention of scarring (not a flawless complexion) so that after the condition spontaneously resolves there is no lasting sign of the affliction. Here are some of the options available:

• Topical (externally applied) antibiotics and antibacterials: These include erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), clindamycin (BenzaClin, Duac), sulfacetamide (Klaron), and azelaic acid (Azelex or Finacea).
• Retinoids: Retin-A (tretinoin) has been around for years, and preparations have become milder and gentler while still maintaining its effectiveness. Newer retinoids include adapalene (Differin) and tazarotene (Tazorac). These medications are especially helpful for unclogging pores. Side effects may include irritation and a mild increase in sensitivity to the sun. With proper sun protection, however, they can be used even during sunny periods. In December 2008, the U.S. FDA approved the combination medication known as Epiduo gel, which contains the retinoid adapalene along with the antibacterial cleanser benzoyl peroxide. This once-daily prescription treatment was approved for use in patients 12 years of age and older.
• Oral antibiotics: Doctors may start treatment with tetracycline (Sumycin) or one of the related "cyclines," such as doxycycline (Vibramycin, Oracea, Adoxa, Atridox and others) and minocycline (Dynacin, Minocin). Other oral antibiotics that are useful for treating acne are cefadroxil (Duricef), amoxicillin (Amoxil, DisperMox, Trimox), and the sulfa drugs.
• Problems with these drugs can include allergic reactions (especially sulfa), gastrointestinal upset, and increased sun sensitivity. Doxycycline, in particular, is generally safe but can sometime cause esophagitis (irritation of the esophagus, producing discomfort when swallowing) and an increased tendency to sunburn.
• Despite many people's concerns about using oral antibiotics for several months or longer, such use does not "weaken the immune system" and make them more susceptible to infections or unable to use other antibiotics when necessary.
• Recently published reports that long-term antibiotic use may increase the risk of breast cancer will require further study, but at present they are not substantiated. In general, doctors prescribe oral antibiotic therapy for acne only when necessary and for as short a time as possible.
• Oral contraceptives: Oral contraceptives, which are low in estrogen to promote safety, have little effect on acne one way or the other. Some contraceptive pills have been to shown to have modest effectiveness in treating acne. Those FDA approved for treating acne are Estrostep, Ortho Tri-Cyclen, and Yaz. Most dermatologists work together with primary physicians or gynecologists when recommending these medications.
• Spironolactone (Aldactone): This drug blocks androgen (hormone) receptors. It can cause breast tenderness, menstrual irregularities, and increased potassium levels in the bloodstream. It can help some women with resistant acne, however, and is generally well-tolerated in the young women who need it.
• Cortisone injections: To make large pimples and cysts flatten out fast, doctors inject them with a form of cortisone.
• Isotretinoin: (Accutane was the original brand name; there are now several generic versions in common use, including Sotret, Claravis, and Amnesteem.) Isotretinoin is an excellent treatment for severe, resistant acne and has been used on millions of patients since it was introduced in Europe in 1971 and in the U.S. in 1982. It should be used for people with severe acne, chiefly of the cystic variety, which has been unresponsive to conventional therapies like those listed above. The drug has many potential serious side effects and requires a number of unique controls before it is prescribed. This means that isotretinoin is not a good choice for people whose acne is not that bad but who are frustrated and want "something that will knock acne out once and for all."
• Used properly, isotretinoin is safe and produces few side effects beyond dry lips and occasional muscle aches. This drug is prescribed for five to six months. Fasting blood tests are monitored monthly to check liver function and the level of triglycerides, substances related to cholesterol, which often rise a bit during treatment, but rarely to the point where treatment has to be modified or stopped.
• Even though isotretinoin does not remain in the body after therapy is stopped, improvement is often long-lasting. It is safe to take two or three courses of the drug if unresponsive acne makes a comeback. It is, however, best to wait at least several months and to try other methods before using isotretinoin again.
• Isotretinoin has a high risk of inducing birth defects if taken by pregnant women. Women of childbearing age who take isotretinoin need two negative pregnancy tests (blood or urine) before starting the drug, monthly tests while they take it, and another after they are done. Those who are sexually active must use two forms of contraception, one of which is usually the oral contraceptive pill. Isotretinoin leaves the body completely when treatment is done; women must be sure to avoid pregnancy for one month after therapy is stopped. There is, however, no risk to childbearing after that time.
• Other concerns include inflammatory bowel disease and the risk of depression and suicide in patients taking isotretinoin. Government oversight has resulted in a highly publicized and very burdensome national registration system for those taking the drug. This has reinforced concerns in many patients and their families have that isotretinoin is dangerous. In fact, large-scale studies so far have shown no convincing evidence of increased risk for those taking isotretinoin compared with the general population. It is important for those taking this drug to report changes in mood or bowel habits (or any other symptoms) to their doctors. Even patients who are being treated for depression are not barred from taking isotretinoin, whose striking success often improves the mood and outlook of patients with severe disease.
• Laser treatments: Recent years have brought reports of success in treating acne using lasers and similar devices, alone or in conjunction with photosensitizing dyes. It appears that these treatments are safe and can be effective, but it is not clear that their success is lasting. At this point, laser treatment of acne is best thought of as an adjunct to conventional therapy, rather than as a substitute.
• Chemical peels: Whether the superficial peels (like glycolic acid) performed by aestheticians or deeper ones performed in the doctor's office, chemical peels are of modest, supportive benefit only, and in general, they do not substitute for regular therapy.
• Treatment of acne scars: For those patients whose acne has gone away but left them with permanent scarring, several options are available. These include surgical procedures to elevate deep, depressed acne scars and laser resurfacing to smooth out shallow acne scars. Newer forms of laser resurfacing ("fractional resurfacing") are less invasive and heal faster than older methods, although results are less complete and they may need to be repeated three or more times. These treatments can help, but they are never completely successful at eliminating acne scars.

How would you sum up current-day acne treatment?

Treating acne requires patience and perseverance. Any of the treatments listed above may take two or three months to start working (even isotretinoin). Unless there are side effects such as dryness or allergy, it is important to give each regimen or drug enough time to work before giving up on it and moving on to other methods. Using modern methods, doctors can help clear up the skin of just about everyone.

Just hang in there. And don't pick. Please.