Coping and Defense Mechanism in Psychiatry

Coping Mechanism involves any effort to decrease the stress response. It can be constructive or destructive, task oriented, or defense oriented, regulating the response to protect oneself. If destructive coping mechanism is happened, it often cause a mental health disorder because the person avoids the problem or stress that causes the disorder. And neurotic or psychotic behaviors can result when coping mechanism become destructive.

Defense mechanism is coping mechanism of the ego that attempts to protect the person from feelings of inadequacy and worthlessness.

Practically a Nurse should have a knowledge of Coping Mechanism or Defense Mechanism in caring of psychiatry client whether in primary psychiatry health care of secondary psychiatry health care.

Knowing of Coping or Defense Mechanism also will be a key point in preparing of NCLEX or CGFNS test. Some question in NCLEX - CGFNS will ask coping - defense mechanism as a comprehensive client care.

Here are types of defense mechanism :

COMPENSATION
Putting fort extra effort to achieve in areas where one has a real or imagined dificiency.

CONVERSION
It is a expression of emotional conflicts or stress through physical symptoms

DENIAL
Keep anxiety-producing realities out of conscious awareness

DIPLACEMENT
Transfers an emotion from the original to a different idea. Feeling toward one person are directed to another who is less threatening

DISSOCIATION
The blocking off of an anxiety event or period of time from the conscious mind

FANTASY
Escapes stress by focusing on unreal mental images in which his or her wishes are fulfilled

FIXATION
Never advancing to the next level of emotional development and organization.

IDENTIFICATION
Pattern himself or herself after another person

INSULATION
Withdrawing into passivity and becoming inaccessible so as to avoid further threating situation

INTELLECTUALIZATION
Deals with problem or stress on an intellectual basis to avoid discomfort of emotions

INTROJECTION
The person incorporates the traits or values of another into self

ISOLATION
The person block feeling associated with an unpleasant experience or stress

PROJECTION
The person displaces own undesirable actions or feeling to another person

RATIONALIZATION
Attempt to make unacceptable feeling, emotion or behavior by justifying the behavior

REACTION FORMATION
The person act in a way that is the opposite of her or his actual feelings

REGRESSION
Returning to an earlier developmental stage to express an impulse to deal with reality

REPRESSION
Unconsciously inhibits an idea or desire

SUBLIMATION
Replacement of an unacceptable need, attitude, or emotion with one more socially acceptable

SUBSTITUTION
The replacement of a valued unacceptable object with an object that is more acceptable to the ego

SUPRESSION
Consciously inhibits or forgetting of unacceptable or painful thoughts or idea or desire

SYMBOLIZATION
Consciously using an idea or object to represent another actual event or object

UNDOING or RESTITUTION
Attempts to engage behavior that is considered to be opposite of a previous unacceptable thought or feeling

Mental Health & Illness

DSM-IV-TR: Mental Illness/Disorder is defined as a clinically significant behavioral or psychological syndrome or pattern associated with distress or disability......with increased risk of death, pain, disability and is not a reasonable (expectable) response to a particular situation (APA 2000).

On the other hand Mental Health is defined as a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and cope with adversity. (US Surgeon General Report, Dec 1999).



There are six major categories of positive mental health (Marie Jahoda in 1958) :

1. Attitudes of individual toward self
2. Presence of growth and development, or actualization
3. Personality integration
4. Autonomy and independence
5. Perception of reality
6. Environmental mastery

The health person will accepts the self, self-reliant, and self-confident.