5.01 Ego Defenses

Psychiatry review for the USMLE Step 1 Exam

• Defense mechanisms protect the unconscious part of our personality from anxiety caused by unacceptable thoughts or feelings.
• Ego defenses are categorized into three groups: mature, neurotic, and immature.
• Immature defense mechanisms include projection, regression, denial, acting out, and splitting.
• Projection involves attributing objectionable thoughts or emotions to others.
• Regression is behaving in an age-inappropriate way to avoid tension associated with the current phase of development.
• Denial is not accepting or believing something to protect one's ego.
• Acting out involves giving in to socially inappropriate impulses to avoid anxiety.
• Splitting is viewing people as either all good or all bad, without considering the middle ground.
• Neurotic defense mechanisms include intellectualization, isolation of affect, displacement, rationalization, reaction formation, and repression.
• Intellectualization is overanalyzing situations or focusing on irrelevant details to avoid negative feelings.
• Isolation of affect is unconsciously limiting the experience of emotions associated with a stressful event.
• Displacement involves shifting emotions from one thing to another, which is deemed more acceptable.
• Rationalization is justifying one's behavior or negative feelings through rational explanations.
• Reaction formation is unconsciously acting opposite to an unacceptable impulse.
• Repression involves preventing thoughts or feelings from entering consciousness to avoid negative emotions.
• Mature defense mechanisms include humor, altruism, suppression, and sublimation.
• Humor is used to relieve anxiety and negative thoughts.
• Altruism involves performing beneficial acts for others to experience pleasure and relieve anxiety.
• Suppression is consciously blocking undesirable ideas, thoughts, or impulses.
• Sublimation is transforming anxiety or emotions into socially valued pursuits.
• Sublimation involves channeling negative emotions into productive and socially desirable actions.