WBR0402

Author	[[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]]
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 the expression of unacceptable feelings through actions.
Answer B	AnswerB::Denial
Answer B Explanation	AnswerBExp::Denial is the refusal to confront an undesirable aspect of reality.
Answer C	AnswerC::Identification
Answer C Explanation	AnswerCExp::Secondary identification refers to modeling one's behavior after a figure of authority.
Answer D	AnswerD::Projection
Answer D Explanation	AnswerDExp::Projection refers to the attribution of an improper personal desire or inclination to an external source.
Answer E	AnswerE::Displacement
Answer E Explanation	AnswerEExp::Displacement is the transferral of undesirable feelings to a neutral person or object.
Right Answer	RightAnswer::C
Explanation	[[Explanation::In this scenario the husband is exhibiting a form of immature defense, termed as secondary identification. He models his abusive behavior after his father, whom the patient considers an authority figure. Educational Objective: Secondary identification refers to modeling one's behavior after a figure of authority. References: Meissner WW. Notes of Identification: I. Origins in Freud. The Psychoanalytic Quarterly. 1970; 39(4):563-589.]]
Approved	Approved::Yes
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