“His relationships are all distant, online, and one time, one of his online girlfriends visited him, but then broke up with him soon after; and he was devastated. Ever since, he has been decompensating.” Janet narrated this to Evelyn, her clinical supervisor and was alluding to Joel, who had stopped his medications, relapsed to substance use, became suicidal, and had displayed aggressive behavior.
This paragraph introduced the first article in this series, explaining the basics of defense mechanisms. The second article provided an overview of the mature defenses, followed by the third article that illustrated sublimation, one of the mature defense mechanisms. In these previous articles, I started by categorizing the defense mechanisms in a simplified way, mature and immature. After some elaboration on the mature defense mechanisms, it is now time to start delving into the world of the immature defense mechanisms.
As previously stated, the defense mechanisms used by “healthy individuals” to help them cope with the anxieties that come with repressed thoughts and feelings are known as mature.
Examples of mature defense mechanisms include:
Those defense mechanisms used by “less healthy individuals,” are known as “unhealthy.” Below is one way in which they are categorized.
George Vaillant has a four-level classification of defense mechanisms, one level categorized as mature. The remaining three defense mechanisms are classified as “neurotic,” “immature,” and “psychotic.”
A. “Neurotic” Defenses
“Neurotic” defenses may be the closest to the mature defenses, but they can cause pain to either the individual employing them or to those around him or her, subjected to these defense mechanisms. Examples of “neurotic” defenses are displacement, intellectualization, repression, and reaction formation.
B. “Immature” Defenses
The “immature” defenses can lead to more serious problems than the “neurotic” defenses. They are often found in people with substance use disorders and personality disorders. Some examples include passive-aggression, dissociation, acting out, and projection.
C. “Psychotic” Defenses
I said that the “immature” defenses cause serious problems; the problems caused by the “psychotic” defenses are rather obvious and often considered or seen as pathological. Those who use these types of defenses often have some form of reality impairment. Denial and distortion are two examples of these types of defenses.
“His relationships are all distant, online, and one time, one of his online girlfriends visited him, but then broke up with him soon after; and he was devastated. Ever since, he has been decompensating.”
Which defense mechanisms are likely to be present in someone like Joel; what about in your patients and clients, how are they coping overall?
For more in this series of articles, check below!
Dr. Sidor is quadruple board certified in psychiatry, with vast clinical, teaching, supervision, mentorship, and management experience. He also has extensive experience in public speaking, leadership, business, and research, in addition to a passion for program development and project management. His overall goal is to empower all health care professionals throughout the United States and globally, towards ensuring the continuity of excellent patient care, while balancing the need to take care of themselves. Dr. Sidor is the main instructor for the SWEET Institute, and he is currently an Assistant Professor of Psychiatry at Columbia University. He is also the past Medical Director and Chief Medical Officer for CASES (Center for Alternative Sentencing and employment Services), where he continues to see patients and consult on challenging cases. He speaks and writes fluently in six (6) languages—French, English, Spanish, Portuguese, Creole and Italian.
Vaillant, G. E., Bond, M., & Vaillant, C. O. (1986). An empirically validated hierarchy of defense mechanisms. Archives of General Psychiatry, 73, 786–794. George Eman Valliant.
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McWilliams, Nancy (2011). Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, Second Edition. New York, NY: The Guilford Press. pp. 60,63,103.
Kernberg O (July 1967). "Borderline personality organization". J Am Psychoanal Assoc. 15 (3): 641–85.
Vaillant, G. E. (2011). Involuntary coping mechanisms: a psychodynamic perspective. Dialogues in Clinical Neuroscience, 13(3), 366–370.