WBR0402

Author	[[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::A 32-year-old husband and wife attend marital counseling. During their first individual sessions, the wife states that her husband has been been abusing her ever since she had their first child. When approached by the counselor, the husband reluctantly confirms his wife's accusation. He attempts to validate his abusive behavior by claiming that she “deserves it". Upon further questioning, the psychologist learns that the husband was abused by his father when he was a child. Which of the following forms of defense is the husband exhibiting?]]
Answer A	AnswerA::Acting out
Answer A Explanation	AnswerAExp::Acting out is an immature defense mechanism in which the individual expresses unacceptable feelings through actions that are usually anti-social and are done to garner attention (e.g. tantrums).
Answer B	AnswerB::Denial
Answer B Explanation	AnswerBExp::Denial is an immature defense mechanism in which the individual refuses to confront an undesirable aspect of reality. Classically, these persons avoid a stressful or anxiety provoking idea or situation by disavowing their very existence.
Answer C	AnswerC::Identification
Answer C Explanation	AnswerCExp::Identification is an immature defense mechanism in which the individual models his/her behavior after a figure of authority.
Answer D	AnswerD::Projection
Answer D Explanation	AnswerDExp::Projection is an immature defense mechanism in which the individual attributes an improper personal desire or inclination to an external source.
Answer E	AnswerE::Displacement
Answer E Explanation	AnswerEExp::Displacement an immature defense mechanism in which the individual transfers undesirable feelings towards a someone to a neutral person or object.
Right Answer	RightAnswer::C
Explanation	[[Explanation::Identification is an immature psychological defense mechanism in which an individual subconsciously integrates characteristics of someone else into his/her own personality. Classically, patients model their behavior after someone they either admire or they perceive as more powerful. Similarly to other immature defense mechanisms, patients with features of identification have no insight and are not usually aware of this modeled behavior. This can sometimes complicate therapy, as it becomes difficult to separate the person's identity from the image they identify themselves with. Identification is also considered a subconscious attempt to boost one's self-esteem by taking on the characteristics of someone they consider is superior to them in depending on the social context. In this scenario the husband is exhibiting this form of immature defense. He models his abusive behavior after his father, and identifies himself as an abuser. Educational Objective: Identification is an immature psychological defense mechanism in which an individual subconsciously integrates characteristics of someone else (usually a figure of authority) into his/her own personality. References: Meissner WW. Notes of Identification: I. Origins in Freud. The Psychoanalytic Quarterly. 1970; 39(4):563-589.]]
Approved	Approved::Yes
Keyword	WBRKeyword::Defense mechanisms, WBRKeyword::displacement, WBRKeyword::projection, WBRKeyword::identification, WBRKeyword::acing out, WBRKeyword::denial
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::