We all have thoughts feelings impulses and memories that can be difficult to deal with

Overview

Defense mechanisms are psychological strategies that are used by our unconscious mind to maintain our psychological well-being. They often distort or manipulate our experiences, perceptions, and thoughts to reduce feelings of anxiety.

Sigmund Freud first described this phenomenon in his 1894 publication, The Neuro-Psychosis of Defense. He theorized that defense mechanisms were the result of a disagreement between the ID and the superego. Freud and his followers believed that the human psyche was made up of three distinct areas. First was the ID that harbors our unconscious and biological drives. The second was the superego, which represents social requirements. And finally, the Ego that manages disparities between the Id and Superego. Freud theorized that defense mechanisms were employed by the Ego to mitigate or block the urges of the ID[1]. Modern research has (mostly) dismissed this conceptualization of brain structures. However, it was the first theory that recognized the presence of our unconscious - making it imperative in the development of psychoanalytic theory and understanding of defense mechanisms.

Freud's daughter, Anna Freud, further developed her father's ideas on defense mechanisms. She believed that defenses were used to mask three distinct types of anxiety. These included: internal anxiety that feared not meeting one's instinctual needs; objective anxiety that feared not meeting the requirements of the social world; and superego anxiety that fears the internal turmoil of managing internal and social obligations[2]. In response to this theory, Otto Fenichel argued that instead of relieving different types of anxiety, defense mechanisms were used by the psyche to maintain an instinctual need for safety and security. Fenichel's theory is still accepted today. Defense mechanisms make our understanding of the world more concrete, stable, and safe. With this established, it is much easier to maintain self-esteem and stability[3]. 

The 1930s and 1940s saw a dismissal of defense mechanisms altogether, with many theorists proposing that defense mechanisms should be replaced with an understanding of coping mechanisms[4]. Coping mechanisms are conscious implementations of protective strategies. There was growing disbelief in the idea that our unconscious brain had an active role in who we are as people and many psychologists wanted to focus on observing our behaviors to make the study of psychology more 'scientific.' Today, most psychologists and researchers acknowledge the importance of behaviors, unconscious thoughts, and conscious thoughts. With this, psychoanalytic theorists have added, redefined, and categorized defense mechanisms into the 21st century.

The idea of distorting our reality may seem a maladaptive and maybe even a little extreme. And initially, this was the popular belief. Freud's earliest writings saw all defense mechanisms and their multitude of uses as pathological contributors to psychological disorders such as depression and hysteria[4]. Theories published in the early 1960s began to recognize the dual nature of defense mechanisms. Specifically, that defenses could be adaptive if they contributed to psychological growth and mastery, but pathological if their purpose was to deflect anxiety and internal conflict[5]. This theory is pretty well accepted today, with defense mechanisms being categorized on a continuum from adaptive to maladaptive. Less adaptive defense mechanisms are more common in children, but in adults are associated with a range of psychological disorders and distress symptoms. Lower defense functioning or excessive use of defense mechanisms is associated with higher instances of depression, anxiety, bipolar, alcohol abuse, eating disorders, and personality disorders such as narcissistic, schizotypal, and borderline personality disorder[6],[7]. Further, defense mechanisms are categorized as successful and unsuccessful. These categorizations are based on the individual rather than the mechanism, itself. Successful defense mechanisms deter anxiety and work towards personal progression almost instantly, while ineffective defense mechanisms fail to do this[8].    

George Vaillant introduced a four-level classification of defense mechanisms in 1986[9]. His original list consisted of 18 defense mechanisms; however, multiple sources have contributed their defense mechanisms, totaling the list to 25. Since the original publication, numerous studies have been able to validate the four categorizations[3]. Reviews of these categorizations have shown that the defenses are valid. Further, lower-level defenses are related to poorer functioning, and higher-level defenses are associated with more adaptive functioning[3]. 

Level 1: Pathological Defenses

Pathological defenses are the most basic harmful category of defense mechanisms when adults use them. These defenses are rigid, distort reality beyond what is present, and are associated with psychological illness and distress. Pathological defenses have been described by other theorists as narcissistic defense mechanisms, as they preserve the most idealistic version of the self without any acknowledgment of limitations.

These defenses are also the first defense mechanisms we implement as children. When faced with an anxiety-provoking situation, children often do not know how to manage their surroundings unless assisted by an adult effectively. Until this occurs, children are likely to engage in early defenses such as avoidance, fighting, or freezing to deal with stressful situations. While freezing and avoidance are present from infancy, fighting starts to occur around the 2-year mark. For children, 'fighting' involves acting out, throwing temper tantrums, and being hyperactive. These defense mechanisms would be (somewhat) acceptable for a child but entirely inappropriate for an adult[10].

Individuals with narcissistic personality disorder often employ pathological defenses to maintain a strict positive view of the self[11]. On the flip side, these defenses are also used by people who have borderline personality disorder, which maladaptively support their negative social interactions[12]. These strategies do not often allow for variability, making the situation seem black-or-white, and it is difficult to convince the person that their perception is misinformed.

Apart from avoidance, freezing, and fighting, other narcissistic or pathological defense mechanisms include:

Denial as a defense mechanism is the inability to accept reality or fact and acting as if a painful event, thought, or feeling did not exist. This is most common in children and people dealing with severe psychological disorders. For example, a person with narcissistic personality disorder may actively deny negative aspects about themselves despite being repeatedly presented with evidence that suggests otherwise.

Distortion (also noted as a delusion) is the misinterpretation of your environment, to see what you want to be seeing. Your unconscious brain may be more aware of objects in your surroundings that align with your beliefs and ignore the evidence against it. Delusion is defined in psychiatry as a firm or fixed belief based on inadequate grounds. We all do this a little bit. If we are having a bad day, we may have an easier time picking out all of the negativity in our surroundings. However, distortion and delusion can also be used to maintain some seriously harmful beliefs and psychological disorders. While Freud and Vaillant were not aware of this while they were developing their theories, delusions themselves are an essential contributor to schizophrenia, paraphrenia, narcissistic personality disorder, borderline personality disorder, and bipolar disorder. For example, someone with borderline personality disorder likely to pick out the negative aspects of their social interactions, while not observing the positive. This distortion contributes to the maintenance of their social disruption and isolation. On the other hand, individuals with narcissistic personality disorder ignore the negative aspects of themselves, which supports the narcissistic delusion. 

Of course, all distortions occur in a range from adaptive to maladaptive and are commonly used by well-adjusted individuals in maintaining their sense of self. One small way this happens is when we read and believe horoscopes. We may feel a sense of amazement when the horoscope correctly lines up our current situation but ignore or modify what it says when it is not perfect. We are picking out positive aspects of our environment in a pretty standard (and not really harmful) way.

Many different types of distortions and delusions contribute to a range of behaviors. Bizarre delusions are impossible to understand and are not derived from a typical experience (given the person's cultural exposure). Non-bizarre delusions are false in the immediate situation but plausibly true. The typical example of this is believing that you are under police surveillance at all time. Mood congruent delusions are any delusion that is consistent with a depressed or manic state. For example, a person with depression may believe that people passing them on a busy street disprove of their existence when, in reality, this is not true.

Vaillant also categorized delusional projection, which exclusively refers to delusions of external reality, rather than just delusions about yourself. Delusional projection occurs when you are noticing things about your environment (whether they are actually present or not) that lead to making concrete assumptions about your reality[13],[14].

Projection is the attribution of a person's undesired thoughts, feelings, or impulses to another person or object. This occurs when the individual considers their ideas unacceptable to express directly. Projection could be as simple as noticing a characteristic in other people that you do not like in yourself (without consciously realizing that this is what you are doing).

Conversion is the expression of an intrapsychic conflict as a physical symptom, such as blindness, deafness, paralysis, or numbness. The symptoms do not align with an organic cause that could be observable by a medical professional (i.e., brain damage, degenerative illness, etc). Instances of conversion are rare, and their validity is consistently under question.

Level 2: Immature Defenses

These defense mechanisms are most prevalent when we are trying to suppress our emotional awareness. While adults use these defense mechanisms, when they are overused, we can link them to severe issues such as major depressive disorder and personality disorders. A 2013 study found that the use of immature defense mechanisms was related to other maladaptive emotion-suppressing behaviors. Such behaviors included binge eating, television viewing, and alcohol consumption. The authors did not explore the direct mechanisms of this relationship but hypothesized that it was a plethora of behaviors that assisted the participants in denying or avoiding an emotional expression of feeling[15].

Acting out as a defense mechanism is the expression of an unconscious wish or impulse, without conscious awareness of the emotion that drives this behavior. This defense mechanism is a component of an impulse control disorder. Impulse control disorder is precisely what it sounds like: the failure to resist a temptation or inappropriate reaction. These kinds of behaviors are also in everyday contexts, like someone who becomes physically aggressive rather than expressing their negative feelings verbally.

Hypochondriasis (or more commonly known as hypochondria, and now labeled in the DSM-5 as somatic symptom disorder and illness anxiety disorder) is an excessive preoccupation with or worry about having severe illness. Most commonly, it is the belief that slight variations in physical symptoms of subjective feelings are evidence of a severe illness. A doctor's reassurance of the harmlessness of their symptoms is often un-reassuring and may lead to a skepticism surrounding medicine. Hypochondria and somatic symptom disorder can exist independent of being a defense mechanism but may be used to displace anxiety away from something even more anxiety-provoking. For example, intensely focusing on physical symptoms and their potential manifestation may be a relief from feeling dissatisfied in your life.

Passive-aggressive behavior: we all are familiar with this one. Someone might try to let you know how they are feeling indirectly because they are too anxious about the outcome of expressing themselves directly.

A schizoid fantasy is the tendency to retreat into fantasy to avoid the present issue. On a minor end, this could be casual daydreaming while you are bored at work, or on the extreme end, completely losing a sense of reality.

Level 3: Neurotic Defense Mechanisms

Neuroticism is a personality trait that causes people to behave with anxiety, depression, and anger. It is typically related to someone being unstable, distressed, mentally disturbed, and maladjusted. It also encapsulates many psychological disorders, such as schizophrenia, bipolar, or borderline personality disorder. However, these strategies are used by a range of individuals to manage negative feelings, thoughts, or impulses.

Displacement is the redirecting of thoughts and feelings to an unrelated object or person. A typical example is bullying in school. Often bullies are not inherently mean children. However, they may have a difficult home life or underlying trauma, which causes them to be mean or lash out at other children. This action is done to relieve thoughts and feelings on an easier target.

Dissociation is a drastic modification of one's identity or character to avoid emotional distress. This could range from minor instances of disengagement to complete detachment from physical and emotional experiences.  Imagine the company you work for goes under because of fraudulent activity. You may choose to no longer see yourself as a part of that company (as well as yourself that you were not involved) to manage your self-identity. Dissociative disorders such as a dissociative fugue and depersonalization disorder include a complete loss of memory of your past self or different identities within yourself, respectively. All of which are related to extreme trauma in childhood. Dissociating helps protect part of the person from the debilitating effects of this trauma.

Compartmentalization is a lesser form of dissociation, where parts of oneself are separated from the awareness of other components. Two value systems are distinct and do not overlap.

Intellectualization is the process of understanding a situation completely in intellectual terms to avoid the experience of the emotion. This assists the person to avoid the emotional expectations of the experience and rationalize, thereby protecting themselves from the experience.

Reaction formation involves converting unwanted or dangerous thoughts, feelings, or impulses into their opposites. For instance, a typical example in childhood is being mean to the person you may have a crush on.

Repression is the unconscious blocking of unacceptable thoughts, feelings, and impulses. Repressed memories, in recent years, have become a very heated topic. Could someone forget details of a crime but remember them years later? Is there trauma that you were unaware of, all until it was brought forward by a therapist? (See Defense Mechanisms and Trauma)

Isolation and withdrawal as defense mechanisms involve completely separating oneself from the negative aspects of their life. This could be something like refusing to see a loved one in the hospital because seeing them there would be too intense of an emotional experience. 

Regression is when someone moves backwards in their development. For example, an adolescent may begin to act out or throw temper tantrums.    

Level 4: Mature Defense Mechanisms

These are the most common defense mechanisms used among well adjusted, healthy adults. While they still assist the person in avoiding the source of anxiety, they may be necessary for helping someone to get through their everyday activities or maintaining a strong sense of self despite feelings of anxiety. Use of these defense mechanisms is associated with emotional intelligence, IQ scores, and life satisfaction[16].

Altruism, as a defense mechanism, involves doing things for others for personal satisfaction.

Anticipation as a defense mechanism is the realistic planning for future discomfort and learning ways to mitigate this discomfort. 

Using humor to express negative thoughts and feelings, rather than speaking about them directly.

Sublimation is the practice of transforming unhelpful emotions or instincts into healthy actions, behaviors, or feelings. This could include using a contact sport or journaling to relieve negative emotions, or using exercise rather than aggression when you are stressed out.

Suppression is the conscious decision to avoid paying attention to a thought, emotion or need to cope with the present reality. This is not to be confused with repression, which is an unconscious action.

Undoing is an attempt to take back an unconscious behavior or thought that is unacceptable or hurtful.

Compensation is when you dismiss perceived weakness while emphasizing your strengths in other areas, therefore relieving potential anxiety surrounding your shortcomings.

Repression, False Memories, and Trauma

When you do a quick search on repression, you are bound to find hundreds of news stories or personal accounts of trauma victims recovering repressed memories years after the incident occurred. The exploration of repression began with Sigmund Freud, who noted that with psychoanalysis, he could recover traumatic memories from his patient's past[17]. However, today, there is little clinical or experimental evidence which suggests that an individual could have a traumatic memory eliminated from their mind[18]. Details of the traumatic event may be difficult to recall, but this is possibly due to how the memory was formed at the time rather than being repressed after the fact[19]. For example, if you were in a robbery, you may not remember what the robber was wearing if you were focused on making sure your family was ok.

There has been much debate regarding repression. It has been argued that repression is possible and that the memory is only recalled years later when it is safe to do so. Others say that this could be a result of therapists encouraging patients to exaggerate their traumatic experience or people doing this on their own[20] – what is now called the false memory hypothesis[21]. And of course, there are centrist theories between these two hypotheses. A 2009 study that looked at how people interpreted their childhood sexual abuse. The authors found that a few participants did not register the experience as traumatic and therefore, did not give it a second thought until encouraged to discuss in in therapy[22]. In this case, it was not a question of if the memory was accurate or not; it was reinterpreting the impact that the event may have had on their development. Another theory is that individuals fill in details of a traumatic event as time progresses, and it is eventually recalled as something much different than the fact. The phenomena of false memories have been well studied and able to be replicated in both experimental and observational studies[23]. Researchers can plant false memories in the minds of their participants, just for their participants to recall the situation (and believe it is true!) weeks later. In the early 1990s, Elizabeth Loftus developed the 'lost in the mall' paradigm, where they attempted to implant a false memory of being lost in a mall during a therapy session[24]. 25% of subjects came to develop a precious false memory for an event that had never taken place. This all happened at an interesting time for memory research. In 1990 George Franklin was accused of first-degree murder, but the only evidence against him was a repressed memory that his daughter recovered during a therapy session. Loftus (as mentioned above) was asked to provide expert testimony, suggesting that memories could be implanted but that she was unable to definitively say if this was the case for this particular memory. Franklin was convicted but released on appeal in 1998.

While most academic research denies the presence of false memories, there is a consensus for the existence of false, fragmented, distorted, or misinterpreted memories. However, further research is always encouraged. As for right now, if you are seeking therapy, there is no need to worry about false memories being brought up or implanted in your mind. The 1990s saw a quick upswing and decline in 'memory retrieval therapy.' This and other fringe therapies have primarily been replaced by cognitive behavioral therapy for trauma[25].

Childhood Trauma and Defense Mechanisms

Avoidance as a defense mechanism is present from birth and can have long-standing impacts on how the individual interacts in future relationships[26]. When interacting with our caregivers, we can go on to develop one of three attachment styles: secure, anxious, or avoidant. Children with caregivers who consistently do not tend to their needs or evoke negative emotions learn not to use their mothers for comfort. This is to adapt and avoid the anxiety that would typically occur without a comforting caregiver present. The infant learns to be self-reliant for emotion regulation. In adulthood, the defense mechanism against the disappointment of interacting with others may cause the person to be avoidant or dismissive of close relationships[27].

Defense Mechanisms and Therapy

Some evidence has suggested that those who employ the use of defense mechanisms in the context of severe psychological disorders are more difficult to treat than that those who do not use defense mechanisms[28]. Individuals with strong positive illusions are some of the most challenging patients to treat, making it necessary to unpack the use of the defense mechanism to resolve the issue. Avoidant, dependent, and compulsive disorders are likely to engage in passive aggression and hypochondriasis. Meanwhile, anti-social, narcissistic, borderline, and impulse control disorders are most likely to engage in splitting, devaluation, and dissociation[29]. It is essential to pay special attention to managing these defense mechanisms to get to the root of the problem. Studies have shown that defense functioning can improve throughout brief and longer psychotherapy, especially among therapists who directly address the origin of the individuals' defense mechanisms[29].

Additionally, improvement in defense functioning during treatment was associated with a decrease in distress during treatment and at a 2-year follow up[29]. The use of adaptive defense mechanisms does not protect people from developing a psychological illness. However, their use often predicts more favorable treatment outcome for both anxious and depress patients. Further, directly addressing the origin and purpose behind someone's maladaptive defense mechanisms can be used to establish a stronger therapeutic alliance throughout treatment.

Gender

Early psychoanalytic theories suggest that women were biologically inclined to use internally focused defense mechanisms such as denial and reaction formation, while men were inclined to use external defense mechanisms such as sublimation and projection[29]. Further, research indicates that any observable differences can be attributed mainly to socialization. There may be different social implications for the use of defense mechanisms between men and women. For example, women using projection is seen as relatively healthy, while it is seen as manipulative and distrustful in men[29].

Age

As we develop, we learn to use more adaptive defense mechanisms. Specific defense mechanisms seem to arise at different ages. One study found denial was most common around the ages of 5-6, while projection was most common at age 11. It is hypothesized that well-adjusted adults are less likely to accept a distorted reality, causing them to cease using immature and neurotic defense mechanisms[29].

Defense mechanisms are a natural way for us to maintain our psychological well-being and appear in different forms throughout our development. They are subtle, sneaky ways of our psyche to take care of us. Psychoanalysts emphasize that the use of defense mechanisms is a normal part of personality function and is not itself a sign of a psychological disorder. However, certain disorders can be categorized by their ridged use of specific or developmentally-inappropriate defense mechanisms.

Contributed by: Molly Rooyakkers

references

[1] Freud, S. (1962). Further remarks on the neuro-psychoses of defence. In The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume III (1893-1899): Early Psycho-Analytic Publications (pp. 157-185).

[2] Freud, A. (2018). The ego and the mechanisms of defence. Routledge.

[3] Cramer, P. (2015). Understanding defense mechanisms. Psychodynamic psychiatry, 43(4), 523-552.

[4] Cramer, P. (2000). Defense mechanisms in psychology today: Further processes for adaptation. American Psychologist, 55(6), 637.

[5] Cooper, S. H. (1998). Changing notions of defense within psychoanalytic theory. Journal of personality, 66(6), 947-964.

[6] Perry, J. C., & Bond, M. (2017). Addressing defenses in psychotherapy to improve adaptation. Psychoanalytic Inquiry, 37(3), 153-166.

[7] Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. Psychiatry: Interpersonal & Biological Processes, 76(1), 32-52.

[8] Cramer, P. (1998). Coping and defense mechanisms: What's the difference?. Journal of Personality, 66(6), 919-946.

[9] Vaillant, G. E., Bond, M., & Vaillant, C. O. (1986). An empirically validated hierarchy of defense mechanisms. Archives of General Psychiatry, 43(8), 786-794.

[10] Sandstrom, M. J., & Cramer, P. (2003). Defense mechanisms and psychological adjustment in childhood. The Journal of nervous and mental disease, 191(8), 487-495.

[11]  Lingiardi, V., Lonati, C., Delucchi, F., Fossati, A., Vanzulli, L., & Maffei, C. (1999). Defense mechanisms and personality disorders. The Journal of nervous and mental disease, 187(4), 224-228.

[12] Kernberg, O. F. (1985). Borderline conditions and pathological narcissism. Rowman & Littlefield.

[13] Vaillant, G. E. (1994). Ego mechanisms of defense and personality psychopathology. Journal of abnormal psychology, 103(1), 44.

[14] Costa, R. M., & Brody, S. (2013). Immature psychological defense mechanisms are associated with greater personal importance of junk food, alcohol, and television. Psychiatry research, 209(3), 535-539.

[15] Vaillant, G. E. (2000). Adaptive mental mechanisms: Their role in a positive psychology. American psychologist, 55(1), 89.

[16] Boag, S. (2006). Freudian repression, the common view, and pathological science. Review of General Psychology, 10(1), 74-86.

[17] Engelhard, I. M., McNally, R. J., & van Schie, K. (2019). Retrieving and modifying traumatic memories: Recent research relevant to three controversies. Current Directions in Psychological Science, 28(1), 91-96.

[18] Maddox, S. A., Hartmann, J., Ross, R. A., & Ressler, K. J. (2019). Deconstructing the gestalt: Mechanisms of fear, threat, and trauma memory encoding. Neuron, 102(1), 60-74.

[19] Pezdek, K. (1994). The illusion of illusory memory. Applied Cognitive Psychology, 8(4), 339-350.

[20] Storbeck, J., & Clore, G. L. (2005). With sadness comes accuracy; with happiness, false memory: Mood and the false memory effect. Psychological Science, 16(10), 785-791.

[21] McNally, R. J., & Geraerts, E. (2009). A new solution to the recovered memory debate. Perspectives on Psychological Science, 4(2), 126-134.

[22] Loftus, E. F., & Pickrell, J. E. (1995). The formation of false memories. Psychiatric annals, 25(12), 720-725.

[23] Loftus EF, Coan J., Pickrell, JE. Manufacturing false memories using bits of reality. In Reder, Lynne M., ed. (1996). Implicit Memory and Metacognition. Lawrence Erlbaum.

[24] Mataix-Cols, D., De La Cruz, L. F., Monzani, B., Rosenfield, D., Andersson, E., Pérez-Vigil, A., ... & Farrell, L. J. (2017). D-cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders: a systematic review and meta-analysis of individual participant data. JAMA psychiatry, 74(5), 501-510.

[25] Sandstrom, M. J., & Cramer, P. (2003). Defense mechanisms and psychological adjustment in childhood. The Journal of nervous and mental disease, 191(8), 487-495.

[26] Simpson, J. A., & Rholes, W. S. (2017). Adult attachment, stress, and romantic relationships. Current opinion in psychology, 13, 19-24.

[27] Bond, M., & Perry, J. C. (2004). Long-term changes in defense styles with psychodynamic psychotherapy for depressive, anxiety, and personality disorders. American Journal of Psychiatry, 161(9), 1665-1671

[28] Vaillant, G. E. (1994). Ego mechanisms of defense and personality psychopathology. Journal of abnormal psychology, 103(1), 44.

[29] Johansen, P. Ø., Krebs, T. S., Svartberg, M., Stiles, T. C., & Holen, A. (2011). Change in defense mechanisms during short-term dynamic and cognitive therapy in patients with cluster C personality disorders. The Journal of nervous and mental disease, 199(9), 712-715.

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