WBR0402

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::A 32 year male patient is brought by his wife to his psychiatrist because she says he is abusing her. When asking the patient, he confirms because he says she “deserves it”. Upon further questioning of the patient’s social history, the psychiatrist learns that the patient ‘s was in fact abused when he was a child by his parents . Which form of immature defense is the patient demonstrating?]]
Answer A	AnswerA::Acting out
Answer A Explanation	AnswerAExp::Acting out is when the patient expresses his feelings through actions.
Answer B	AnswerB::Denial
Answer B Explanation	AnswerBExp::Denial is when the patient refuses to confront a certain undesirable reality.
Answer C	AnswerC::Identification
Answer C Explanation	AnswerCExp::Secondary identification is when the patient can associate himself with an authority figure
Answer D	AnswerD::Projection
Answer D Explanation	AnswerDExp::Projection is when the patient attributes to an external source an improper personal desire or inclination.
Answer E	AnswerE::Displacement
Answer E Explanation	AnswerEExp::Displacement is when the patient shifts his feelings from one object to another totally neutral and unrelated object.
Right Answer	RightAnswer::C
Explanation	[[Explanation::The patient in the vignette is demonstrating a form of secondary identification, a form of immature defense where he identifies himself as an abuser with a history of personal child abuse by his own father, who the patient considers an authority figure. There are in fact 2 forms of identification. Primary identification is when a person is attached to a person or object before developing any relation with other objects or persons. Secondary or partial identification is when the patient feels he has something in common with someone who he considers a leader, such as the patient in this vignette. Educational Objective: Identification has primary and secondary forms. The primary form is when the patient is attached to an object without developing relations to other objects. Secondary identification is when the patient feels he has something in common with someone who he considers a leader. Reference: Meissner WW. Notes of Identification: I. Origins in Freud. The Psychoanalytic Quarterly.1970; 39(4):563-589. Educational Objective: References: ]]
Approved	Approved::No
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