DEFENSE MECHANISM

INTRODUCTION
Healthy people desire, work towards and function best when they think positively & feel
good about themselves & their accomplishments, goal &relationships. They want to be
content with the environment, accepting of self & accepted & loved by others. At same
time, they also desire & work toward avoidance of anxiety, discomfort distress & mental
or physical pain. All of these at one time or another are an inevitable part of the human
condition.
People use numerous ways to avoid anxiety & contend with stress. Some of these
are conscious methods or techniques that may be learned & may be adaptive or
maladaptive, where another are unconscious & operate automatically. The unconscious
mechanisms are sometimes referred to as protective ego defenses.

DEFINITION
Acc. to FREUD, in 1904 used the term “defense mechanism” to refer to the unconscious
process that defends the person against anxiety.

THEORY OF SIGMUND FREUD

Sigmund Freud (1856 – 1939), an Austrian psychiatrist & founder of psychoanalysis,
develop a complex theoretical formulation of the nature of the human personality. The
following major components of this theory:
1) Levels of awareness
2) Personality structures
3) The concept of anxiety & defense mechanism
4) Psychosexual stages of development

LEVELS OF AWARENESS
Essentially, Freud’s level of awareness provides a mental typography that is divided
into three parts.
1) the conscious 2) the preconscious 3)the unconscious
CONCIOUS - the conscious includes all experiences that are within a person’s
awareness at any given time. For example all intellectual, emotional & interpersonal
aspects of a person’s behavior that a person is aware of & is able to control & within
conscious awareness. All information that is easily remembered & immediately
available to an individual is in the conscious mind.
PRECONCIOUS – The preconscious includes experiences, thoughts, feelings, or
desires that might not be in immediate awareness but can be recalled to
consciousness. The preconscious (sometimes called subconscious) can help screen
out extraneous information & can enhance concentration. The preconscious can
censor certain wishes & thinking & helps repress unpleasant thoughts or feelings.

UNCONCIOUS- Freud described the mind as iceberg to convey the relationship

between the conscious & the unconscious .The water’s surface represents the
boundary between the conscious & the unconscious.

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 The unconscious refers to all the memories, feelings, thoughts or wishes that are
not available to the conscious mind. Often these repressed memories, thoughts,
feelings or wishes could if made prematurely conscious, trigger enormous
anxiety.However, unconscious material often does become manifest in dreams, slips
of the tongue or jokes or thought the use of hypnosis, therapy or certain drugs.

PERSONALITY STRUCTURES
FREUD organized the structure of personality into three major components: the id,
ego & superego. They are distinguish by their unique functions & different
characteristics.

ID- The id the locus of instinctual drives – the “pleasure principle”. Present at birth, it
endows the infant with instinctual drives that seek to satisfy needs & achieve
immediate gratification.Id- driven behaviors are impulsive & may be irrational.

EGO-the ego, also called the rational self or the “reality principle” begins to develop
between the ages of 4&6 months. The ego experiences the reality of he external
world, adapts to it, & responds to it. As the ego develops & gain strength, it seeks to
bring the influences of the external world to bear upon the id & to substitute the
reality principle. A primary function of the ego is one of mediator, that is, to maintain
harmony among the external world, the id & the superego.

SUPEREGO-If the id is identified as the pleasure principle & the ego the reality
principle, the superego might be referred to as the “perfection principle”. The
superego which develops between ages 3&6 years, internalizes the values & morals
set forth by the primary care givers. Derived out of a system of rewards &
punishments, the superego is composed of 2 major components: the egoideal & the
coscience.When a child is consistently rewarded for “good” behavior, the self-esteem
is enhanced & the behavior becomes part of the egoideal; that is, it is internalized as
part of child’s value system. The conscience is formed when the child is punished
consistently for “bad” behaviors. The child learns what is considered morally right or
wrong from feedback received from parental figures &from society or culture. When
moral or ethical principles or even internalized ideals & values are disregarded, the
conscience generates a feeling of guilt within the individual. The superego is
important in the socialization of the individual because it assists the ego in the control
of id impulses. When the superego becomes rigid & punitive problems with low self
– confidence & low self esteem arise.

DEFENSE MECHANISM
Defense mechanisms are unconscious responses used by person to protect
themselves from internal conflicts and external stressors.
There are many situations when we fail in our attempts & get frustrated. Our
failures and frustrations may bring injury to our ego and causes anxiety & feeling of
inferiority. Some methods of developing a compromise & relieving that tension &
anxiety in needed. The human being is usually able to relieve the conflict by utilizing

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 certain forms of adaptations which are called ego defense mechanisms, adjustment
mechanisms or mental mechanisms,
Defense mechanisms enable a person to “resolve the conflict” and reduce the
“stress & anxiety” associated with it.
All of us use defense mechanisms some time or the other in our normal
behavior .when use moderately, they are harmless & help us face conflicts &
frustrations easily &protect our ego. However, excessive & persistent use of these
mechanisms is harmful as they do not solve conflicts & frustrations basically, but
only help the individual to make adaptations to distressing experiences.
Ego defense mechanisms are meant to maintain psychological integration & to
protect our self concept from devaluation. If they are used beyond certain limits, they
become the symptoms of abnormality & interfere with the resolution of adjustive
demands. Some of the ego defense mechanisms are:-

1) REPRESSIONS- Acc.to Freud, repression is basic to all other forms of defense

mechanisms. Repression refers to the process by which an individual strives to
keep unacceptable, painful, unpalatable & anxiety provoking needs, urges &
feelings associated with them in the unconscious layer of the mind.
Repression is the sort of “burying alive” mechanism. The
repressed material is always active in the unconscious memories or urges continue to
seek expression & may emerge in the form of accidents such as slips of the pen or
tongue, dreams, sleep walking & sleep talking, unconscious mannerisms, phobias &
psychosomatic illness. Many painful experiences are repressed during early childhood &
become unconscious sources of emotional conflict in later life.
The repressed material forms part of the unconscious level of the mind & may affect
behavior without the person being aware (unconscious motivation) for example a child
may feel angry with his mother because she had punished him. If he feels too guilty about
his anger, he may repress it & may still be unconsciously angry. This may be shown by
accidental breaking of his mother’s favorite things or in his bed wetting or refusal of food
or in stubborn behavior.

2) REACTION FORMATION- It is acting opposite of what one thinks or feels.

It is sometimes possible to conceal a motive from ourselves by giving strong expression
to its opposite. Such a tendency is called reaction formation.
EXAMPLE-the mother of unwanted child may feel guilty & so becomes over indulged &
over protective of the child to assure herself that she is a good mother.
People who are extremely friendly, overtly polite & very socially correct frequently have
unconscious feelings of anger & hatred towards many people.

3) PROJECTION- Projection is a frequently used unconscious mechanism that relieves

tension & anxiety by transferring the relieves tension & anxiety by transferring the
thoughts to another person. It is an attempt to deal with our own short comings, by seeing
them in others & denying them in ourselves.
EXAMPLE-the student who believes that everybody cheats in examinations may
also cheat in same way.
• People who are dishonest often attribute dishonesty to others.

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 • The boy fails in a test says that the teacher has not been teaching properly.
• A doctor who has done a mistake in the operation may insist that it happens
because the nurse & ward boy did their task poorly.

4) RATIOALISATION- Here we “MAKE EXCUSES” giving a reason different

from the real one for what we are doing. Excusing on behavior to avoid guilt
responsibility, conflict, anxiety or loss of self respect. It operates in two forms :
A) sour grapes b) sweet lemon
Sour grapes- the individual gives the demerits example
• A young man who fails to get a beautiful wife may remark that a beautiful
wife is a liability.
• A doctor without a vehicle does not want to risk his life by driving a
scooter or a car.
• An unskilled worker always quarrels about tools.

Sweet lemon- the individual justifies his lower achievements by pointing out their
merits.
Example -A poor ideal man “does not want to earn more money because”
• Money is the root cause of many evils”.
• People living in small houses due to limited financial resources may point out
many virtues of small houses.

5) INTELLECTULAISATION- It is similar to a rationalization. Intellectualization

is the distancing from an emotional or threatening situation by talking or thinking
about it in intellectual terms. A nurse, doctor or paramedical worker cannot afford to
become emotionally attached to each patient. So they speak calmly & intelligently
rather than emotionally with patients & their families.
Example- if there is a patient who is actually ill, calmly tell the family members
rather than saying “I am sorry”.

6) DISPLACEMENT- Ventilation of intense feelings towards persons less

threatening than the one who aroused those feelings.
EXAMPLE- A person who is angry with his boss, but cannot show it for fear of
losing the job may fight with his wife & children on return from the job may fight
with his wife & children on return from the office or kick his dog.
 When a new baby is the centre of attraction, an older child may become jealous,
prevented from harming the baby; the child may damage a doll or a toy.

7) REGRESSION- Moving back to a previous developmental stage in order to feel

safe or have needs met. An adult behaving like a child is particular regression.
When faced with difficulties of life, the individual reverts a less mature from of
behavior, where he finds less conflict & hence less anxiety.
Regression is manifested in several ways such as crying on someone’s shoulder,
baby talk, nail biting, thumb sucking, crying etc.

8) SUBLIMATION –Channeling of socially acceptable activities.

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 EXAMPLE-A young men who has lost his lover may turn to write poetry about
love.
 A person who has aggressive feelings may not be able to express these in society
but can become a boxer or solider.
 One positive result of sublimation is personal satisfaction experienced by the
individual. Society also profits as activities like creative writing, music, painting
results of sublimation.

9) IDENTIFICATION- Incorporation of the image of an emulated person than

acting, thinking & feeling like that person (unconscious mental mimicry)
EXAMPLE-Thus, the little boy takes the masculine attributes that he admires in
his father. Girls identify with their mother, later perhaps with their teacher & later
still perhaps with a film star.

10) COMPENSATION- Compensation is counter balance for deficiency

in one area by excelling in another area. Just as nature compensate for diseases in
our bodies (as when a blind person develops extra ordinarily keen hearing), so we
develop personality trade to compensate favors inadequacies.
Example:- A student who fails in his study may compensate becoming the college
champion in athletes.
• A not a beautiful girl can compensate by studying hard and coming first in her
class.

11) Denial:- Denial of reality is when we refuse to accept or believe the

existence of some thing that is very unpleasant to us. We use denial most often when
faced with death, serious illness or something painful and threatening.
Example: Non acceptance of fatal diagnosis such as AIDS.
• -When some near or dear one die in the family, some people try to keep up the
pretence that he is still alive.

12) Fantasy or day dreaming:-It is kind of withdrawal when faced with real
problems of life. We retire to make belief world, where everything is possible. Where
we are victor or conqueror. The tendency to day dream is most pronounced during
adolescence.
Example:- Patient who are very ill may fantasies that when they recover, many good
things will happen to them.

13)Withdrawal:- Whenever an individual suspects that he is likely to be criticized,

ridiculed or disgraced on account of some prior unfortunate experience or failure, he
restored to withdrawal. Such a person is seen as avoiding all the work saying that he
can not do this or he can not do that. It may occur as a temporary pattern. They make
no real friends.

14) Conversion:- Hear an emotional conflict is expressed as physical symptom for

which there is no organic basis.
Example:- A student Nurse, very anxious about her exam, may develop a headache.

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• A woman invited for a party which presents an unsetting situation to her may
develop G.I. symptom and may excuse herself from the party. Usually, when
party time is over her symptom resolve themselves.

15) Suppression:- Suppression is an intentional pushing away from awareness of

certain unwelcome ideas, memories or feeling. We merely push them in to the
background, into our subconscious mind. Where they are accessible to us whenever
we wish to remember them.
EXAMPLE: - A student decides not to think about a parent’s illness in order to study
for a test.
• A patient may refuse to consider his difficulties by saying that he does not
want to talk about it.
.
16) Undoing:- Exhibiting acceptable behavior to make up for negative unacceptable
behavior. Apologizing for wrong done to other, repentance and undoing punishment
are the difference forms of undoing. This is to resolve the guilt feeling and make a
new beginning.
EXAMPLE: -The unfaithful husband may bring his wife present.
• A man who is ruthless in business donates large amount of money to charity.

17) Introjections: - Introjections is closely related to identification. Accepting

another person’s attitude, believe and values as ones own.
EXAMPLE: - a person who dislikes guns becomes an avid hunter, just like a best
friend.

18) Depersonalization- a destruction of personal identity is depersonalization. It is

characterized by the feelings of unreality & estrangement from the self body or
surrounding. Some people with depersonalization feels as though they arte become
cut off from themselves & are blaming themselves from outside. Some feel that their
body is dead.

19) ISOLATION- isolation is the separation of a thought or a memory from the

feeling tone or emotions associated with it.
EXAMPLE- a young woman describes bring attacked and raped by a street gang. She
displays an apathetic expression & no emotional tone.
• -A physician is able to isolate her feelings about the eventual death of a terminally
ill cancer client by focusing her attention instead on the chemotherapy that will be
given
.
20) Symbolization- the use of words, ideas or objects to symbolically represent
repressed thoughts, feelings & impulses that are relegated to the unconsciousness.
EXAMPLE: A Patient has a panic attack when he loses a good luck charm because
he believes that he is safe only if the object is in his possession.

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 FREUD’S STAGES OF PERSONALITY DEVELOPMENT
FREUD described formation of the personality through five stages ofsycho sexual
development. He placed much emphasis on first five years of life & believed that
characteristics developed during these early years Fixation in an early stage of
development almost certainly results in psychopathology..
s.no. Phase Age Normal development Ego defenses
1/
1. Oral 1-1 2 major site of gratification is the
phase years Oral region. It consists of 2 phases: - denial
1. oral erotic phase (sucking) -displacement
2. oral sadistic phase(biting) -compensation

2. Anal 11/2 – 3 Major site of gratification is the anal -Undoing

phase years & peri-anal area, major achievement -Reaction
is the toilet training (sphincter formation
control) -isolation
It consists of 2 stages -identification
1. anal erotic phase(excretion)
2. anal sadistic phase(‘holding
&
letting go’ at will)

3. Phallic 3–5 Major site of gratification is the Intellectualization

(oedipal) years genital area; masturbation is -Repression
phase common at this stage. During this -Regression
stage boys experience Oedipus Rationalization
complex & girls experience Electra
complex. He describes this as the
child’s unconscious desire to
eliminate the parents of the same sex
& to posses the parents of the
opposite sex for himself or herself.
Guilt feeling result with the
emergence of the superego during
these years. Resolution occurs by
identification with parents of the
same sex.
4. Latency 6 – 12 Oedipus complex is usually resolved -Sublimation
phase years at the beginning of this stage. This is - projection
a stage of relative sexual quiescence.
Superego is formed at this stage.
Sexual drive is channelized into
socially appropriate goals like
development of interpersonal
relationship, sports, school work,
etc.

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5. Genital 12 years Adult sexuality develops with Symbolization
phase onwards capacity for intimacy. Puberty &
respect for others. Gradual release
from parental controls with more
influence of peer group. True self
identity develops.
EGO COMPITENCE SKILL

SKILL 1; ESTABLISHING CLOSNESS AND TUSTING RELATIONSHIPS.

A basic skill for positive growth and development is the child’s ability to establish close
and trusting relationship with others. Children with the medical diagnosis of generalized
anxiety disorders may have difficulty establishing trusting relationship because they are
very concerned about their perceived competency. The following questions are used to
evaluate this skill:
• Does the child enjoy making friends?
• Does the child often feel picked on by other people?
• Does the child not know what to say when getting to know someone?
To reinforce the skill, nursing staff should encourage interaction and be attentive to the
child without being intrusive. Talking with child in a face to face position & offering
nurturance are beginning nursing action. Trust can then be demonstrated by the Staff in
their interaction with the child. If a child violates trust, a discussion of the issue should
take place, allowing trust to be reestablished. In this way children learn about
acknowledging mistakes and the importance of forgiveness in developing trusting
relationship.

SKILL 2: HANDLING SEPERATION & INDEPENDENT DECISION MAKING.

Children who has separation anxiety have great difficulty tolerating separation from their
mother or home. Yet individuation is an important mental health process. Being able to
identify and express feeling and make independent decisions is critical to becoming a
component individual. The following questions are used to evaluate this skill:
• Does the child get upset or worry when away from his or her mother?
• Does the child get upset or worry if he or she thinks someone does not like him or
her?
• When upset, is there something the child can do to feel better?
Nursing intervention that focus on helping the child identify and clarify the aspects of
the self are critical exercises for promoting individuation. This may be done in many
ways such as by encouraging children to draw self – portraits, interviewing staff members
regarding their opinions on an issue, or identifying personality differences between
themselves & others. In the therapeutic milieu, opportunities also can be provided for the
child to make choices& decisions, further supporting the child’s growing sense of
individuality & ego competency.

SKILL 3: HANDLING JOINT DECSION MAKING AND INTERPERSONAL

CONFLICT.
Children who have not been allowed to participate in joint decision making or who have
not been rewarded for cooperating may be deficient in skill. A child with oppositional

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defiant disorder may use aggression instead of negotiation to respond to internal conflict.
However, learning the skill of joint decision making is critical for success in interpersonal
relationships. The following question are used to evaluate the skills:
• When the child has a problem, can he or she usually think of several solutions?
• Does the child get angry if he or she does not get his or her way?
• Do other people make the child agitated or easily upset?
The therapeutic milieu can provide an opportunity for the child to learn and practice
these skills. For example, the nurse can set up opportunities for problem solving.
Exercises may be developed for making group decision in which cooperation &
collaboration are rewarded. The child should helped to identify fears related to
cooperating with others, and assertiveness can be modeled and taught. It is important that
the nurse not resolve conflict for the child. Rather, these situations should be used to
teach negotiating skills and shape appropriate socialization through the use of
reinforcement.

SKILL4:DEALING WITH FRUSTRATION AND UNFAVORABLE EVENTS.

Tolerating frustration, although difficult, is critical to becoming a component adult,
children with conduct disorders often have difficulty understanding a situation from
another’s perspective. The following questions are used to evaluate this skill:
• Does the child feel bad if he or she has hurt someone’s feelings?
• If someone disagrees with the child, does it make him or her angry?
• Does the child not like playing a game if he or she loses?
Children who have little frustration tolerance become angry easily and are often unable
to complete tasks. Children typically learn this skill through cooperation and competition
in playing childhood games. However , if the child has not had the opportunities to play
games in this way & if the tolerance has not been modulated for child, he or she probably
has not developed this skill. The child will face numerous frustration during the course of
treatment. The nurse should use this opportunities to think through the process with the
child & help increases the child’s frustration tolerance & anger control.

SKIL5: CELEBRATING GOOD FEELING & FEELING PLEASURE

Healthy children raised in a nurturing environment naturally experiences good feelings &
pleasure. However the children who are depressed or anxious are not able to celebrate
good feelings or experiences spontaneous pleasure. Also ,in a maladaptive environment
shame is often used to control the children’s behavior, with the result they feel guilty for
having angry or unacceptable thoughts. Consequently, they may lose the ability to
celebrate the life and feel pleasure. The following questions are used to evaluate this
skill:
• Does the child worry about the future a lot?
• Does the child not like it when people say good things about him or her?
• Does the child feel good about the things he or she does well?
A healthy environment is one in which celebrating the good feelings & feeling
pleasure are natural, spontaneous occurrences. Celebrating & have fun are the important
nursing interventions. These activities should not be confined to holidays but should be
the part of Childs daily activities. Children’s families can be invited to celebrate in these

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celebrations, where nursing staff model having fun with the children. In this way ,
children & their families learn the skill of celebrating good feelings & feeling pleasure.

SKILL 6:WORKING FOR DELAYED GRATIFICATION

As the children grow they are expected to delay needed gratification by following rules &
waiting their run. This skill is often difficult for impulsive children with conduct disorder
to achieve. The following questions are used to evaluate this skill;
• Does the child believe that most rules are responsible & does he or she not mind
following them?
• Does the child find it difficult to be honest & think that the lying is the only think
to do?
• Does the child get angry if his or her mother does not give what he or she wants?
Delayed gratification can be taught by the nurse through the earning of points for daily
expectations, such as tidying one’s room or completing homework assignments.
Children’s games, such as red light, in which they respond to “stop” & “wait” commands,
are also useful in teaching this skill to younger children. As a child’s behavior improves
the reward for the points earned can require the accumulation of many points or tokens.
Thus the child is given the opportunity to delay the reinforced for a reward of higher
value to be received at a later time. As the child learns greater self control, he or she will
be better able to delay gratification for longer periods of time.

SKILL 7: RELAXING AND PLAYING

Given the stressful environment of current family life, many children may have little
opportunity to learn the skill of relaxing and playing. For children with mood , anxiety, or
behavior disorders, learning to relax & play is an important skill. The following questions
are used to evaluate this skill:
• Are there some things the child really enjoys doing?
• Can the child have lots of fun?
• Does the child enjoy sitting around & thinking about things?
Time should be devoted to learning skill. Children should be given unstructured play
time in which the staff participate with them in playing games. Having spontaneous talent
shows or other forms of fun can contribute to a child’s well- being. In this way, relaxing
& playing become part of the therapeutic experience & children learn to value & master
this skill.

SKILL 8: CONGNITIVE PROCESSING THROUGH WORDS, SYMBOLS, AND

IMAGES
Children with psychiatric illnesses may not have developed the important skill of
cognitive processing. The following questions are used to evaluate this skill:
• Is it difficult for the child to describe how he or she fees?
• Does the child feel as if he or she never knows how something is going to turn
out?
• Can the child identify his or her strengths?
A responsive environment should be created to stimulate children’s cognitive
development. Furnishings & toys, communications & interactions, and group experiences
should all be designed to support the child’s cognitive processing. The nurse can help the

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child learn this skill by encouraging abstract thinking whenever possible, such as by
asking “ what is the moral of the story?” or “what point do you want to think the movie
was communicate ?”
Children who are encouraged to express themselves in a responsive environment will
gain greater competency in this important area of development.

SKILL 9: ADAPTIVE SENSE OF DIRECTION AND PURPOSE

Children who experience symptoms of mental illness may feel hopeless about their
purpose in life. As they view adult life from watching those around them, they being to
draw conclusions about themselves in the world. The following questions are used to
evaluate this skill:
• Does the child feel that his or her life going to get better?
• Is the child confused about growing up & doesn’t know what to do about it?
• Does the child believe that school is important & see it as his or her job in life at
present?
Having role models for healthy, meaningful adult experiences is essential to healthy
growth & development. Feeling valued as an individual provides the child with an
opportunity to learn to value others. Nurses should actively listen to children in their
interactions, and even young children should be encouraged to express their needs c&
feelings. The child’s importance as a person can be shown through the approach the nurse
uses in providing basic
care. The nurses should actively help all children realistically assess their & potential to
contribute to a better world.

USE OF DEFENSE MECHANISM IN PERSONALITY DISODERS

1. PARANOID: A personality disorder with essential feature of pervasive distrust &

suspiciousness of others interpreted as being deliberately demeaning, threatening,
or malevolent.
PROJECTION: actively disown undesirable personal traits & motives & attributes
them to others; remain blind to one’s own unattractive behaviors & characteristics,
yet is over alert to & hypercritical of similar features in others.

2. SCHIZOID: A personality disorder with the essential feature of the lack of

enjoyment of close relationships & lack of desire for social or sexual
involvement.
INTELLLECTUALIZATION: Describes interpersonal & affective experiences in a
matter of fact, abstract, impersonal, or mechanical manner; pays primary attention to
formal aspects of social & emotional events.

3. SCHIZOTYPAL: A personality disorder with excessive introversion, pervasive &

social interpersonal deficits, cognitive & perceptual distortions & eccentricities in
communication & behavior.

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 UNDOING: Bizarre mannerisms & idiosyncratic thoughts appear to represent a
retraction or reversal of previous acts or ideas that have stirred feelings of anxiety,
conflict, or guilt, ritualistic or “magical” behavior serve to repent for or nullify
assumed misdeeds or “evil” thoughts

4. ANTISOCIAL: a personality disorder with the essential feature of a pattern of

disregard for & violation of the rights of others beginning at 5 years of age.
ACTING OUT: Rarely constrained inner tensions that might accrue by postponing
the expression of offensive thoughts and malevolent actions, socially repugnant
impulses are not sublimated , but are discharged directly in perception ways, usually
without guilt.

5. BORDELINE: a personality disorder with essential features of a pervasive pattern

of unstable interpersonal relationships, self image & moods along with impulsive
behavior beginning in early adulthood.
REGRESSION: Retreats under stress to developmentally earlier levels of anxiety
tolerance, impulse control, & social adaptation ; among adolescents, is unable to cope
with adult demands & conflicts; as evident in immature, if not increasingly infantile,
behaviors.

6. HISTRIONIC: a personality disorder with the essential feature of a pervasive &

excessive & emotionality & attention seeking behavior beginning in early
adulthood.
DISSOCIATION: Regular alerts self presentations to create a succession of socially
attractive but changing facades; engages in self- distracting activities to avoid
reflecting on and integrating unpleasant thoughts & emotions.

7. NARCIASSISTIC: a personality disorder with exaggerated sense of self

importance preoccupation with being admired, & lack of empathy for the feelings of
others.
RATIONALIZATION: Is self deceptive in devising plausible reasons to justify self
centered & socially inconsiderate behaviors; offer alibis to place oneself in the best
possible light, despite evident shortcomings or failures.

8. AVOIDANT: A personality disorder with extreme social inhibition & introversion,

hypersensitivity to criticism & rejection, limited social relations, & low self esteem
FANTASY: Depends excessively on imagination to achieve need gratification &
conflict resolution, withdraws into reveries as a means of safely discharging
affectionate as well as aggressive impulses.

9. DEPENDENT: a personality disorder with extreme dependence on others,

particularly the need to be taken care of, leading to clinging & submissive behavior.
INTROJECTION: Is firmly devoted to another, wanting to believe an inseparable
bond exist between them; submits any independent views in favor of others to
preclude conflicts and threats to the relationship.

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 10. OBSESSIVE COMPULSIVE: A personality disorder with the essential feature of
preoccupation with orderliness, perfection & mental & interpersonal control, at
the expense of flexibility, openness & efficiency that begins by early adulthood.
REACTION FORMATION: Repeatedly presents positive thoughts & socially
commendable behaviors that are diametrically opposite to the deeper, contrary, and
forbidden feelings within; displays reasonableness and maturity when faced with
circumstances that evoke anger or dismay in others.

11. PASSIVE AGGRESSIVE ( NEGATIVISTIC ): provisional category of

personality disorder characterized by a pattern of passive resistance to demands in
social or work situations, which may take such forms as simple resistance to
fulfilling routine tasks, being submission.
ISOLATION: Can be cold blooded & remarkably detached from the impact of one’s
destructive acts; views objects of violation impersonally, as symbols of devalued
groups devoid of human sensibilities.

HUMAN RESPONSES TO ANXIETY

PHYSIOLOGICAL

CARDIOVASCULAR NEUROMUSCULAR
Palpitation Increased reflexes
Racing heart eyelid twitching
Increased blood pressure insomnia
Faintness rigidity
Decreased blood pressure startle reaction
Decreased pulse rate pacing
Strained face
RESPIRATORY generalized weakness
Rapid breathing wobbly legs
Shortness of breath clumsy movement
Pressure on chest
Shallow breathing URINARY TRACT
Lump in throat pressure to urinate
Choking sensation frequent urination
Gasping

GASTROINTESTINAL SKIN
Loss of appetite flushed face
Revulsion toward food localized sweating
Abdominal discomfort itching
Abdominal pain hot and cold spells
Nausea pale face
Heartburn generalized sweating
Diarrhea

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BEHAVIORL
Restlessness
Tremors
Startle reaction
Rapid speech
Blocking of thought
Interpersonal withdrawal
Inhibition
Flight
Avoidance
Hyper ventilation
Accident proneness

COGNITIVE AFFECTIVE
Impaired attention Impatience
Forgetfulness uneasiness
Errors in judgment tension
Preoccupation nervousness
Blocking of thoughts fear
Decreased perceptional fright
Field frustration
Reduced creativity helplessness
Diminished production alarm
Confusion terror
Self consciousness jitteriness
Loss of objectivity jumpiness
Fear of losing control numbing
Frightening visual images guilt
Flash back shame
Nightmare frustration
Injury or death helplessness

NURSING STRATEGIES TO REDUCE PATIENTS ANXIEY

 Active listening to show acceptance
 Honesty, answering all questions at the client’s level of understanding.
 Clearly explaining procedures, surgery & policies & giving appropriate reassurance
based on data.
 Acting in calm, unhurried manner
 Speaking clearly, firmly (but not loudly)
 Giving information about laboratory test, medication, treatments, and rationale for
restrictions on activity.
 Setting reasonable limits & providing structure
 Encouraging patients to explore reasons for the anxiety.
 Encouraging self affirmation through positive statements such as “I will” “I can”

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 Using play therapy with dolls, puppets, games, drawing for young patients.
 Using touch, giving warm baths, back rubs
 Initiating recreational activities such as physical exercise, music, card games, board
games, crafts, readings.

NURSE’S ROLE IN HELPING THE PATIENT TO HANDLE ANXIETY

1) Help the patient to recognize his anxiety- In order to do this the nurse should be
observant & should be able to identify the behavior that indicates that the patient
is anxious. The patient may show increased psychomotor activity such as
agitation, pacing & restlessness.
Other behaviors that may be seen are anger or withdrawal demanding, tearfulness
or complaining of aches & pains. Each individual may differ in the way he
behaves in an anxiety attack.

2) Help the patient to gain insight into his anxiety- the patient himself is unable to do
this at that time but the nurse can help him to examine his feelings & thoughts &
any particular incident in the environment or in his life that immediately help him
to recognize his own patterns of the behaviors by helping him to observe, describe
& analyze the connection between what led to his anxiety& what happened after
the attack. Thus he can be helped to understand & verbalize the cause.
3) Help the patient to cope with threat behind his anxiety- once he is able to
verbalize that cause of anxiety he will be able to recognize similar situations &
formulate the usual incidents or situations that make him anxious. Thus he may be
helped to have a realistic feeling about various life situations.
4) Help the patient to develop better coping mechanisms- the nurse should help the
patient to identify & label the coping & defense mechanisms & discourage its
unhealthy use.

BIBLIOGRAPHY
1. Townsend C. Mary “psychiatric mental health nursing”
Edition 4th p no. 18 – 22, 34- 36
2. Boynd Ann Mary “psychiatric nursing” 2nd edition
p no. 70-73
3. Fortinash M. Katherine “psychiatric mental health nursing”
Edition 3rd p no. 9-11
4. Morgan t. Clifford etal “introduction to psychology”
Edition 7th p no. 588-591
5. Stuart W. Gali “Psychiatric Nursing” Edition 7th
P. No. 278, 758-762
6. Varcorolis M. Elizabeth “Foundation of Mental Health Nursing”
Edition 2nd P. No. 14

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