NCM 117 NUR1218

MALADAPTIVE PATTERNS
OF BEHAVIOR
Acute and Chronic

First Semester, AY 2025-2026

Course Title CARE OF CLIENT WITH MALADAPTIVE PATTERNS OF
BEHAVIOR, ACUTE AND CHRONIC

Course Code NCM 117

Course Description This course deals with concepts, principles, theories and
techniques of nursing care management of clients with maladaptive patterns of
behavior of individuals, families, population groups and communities across the
lifespan, in any health care settings. The learners are expected to provide safe,
appropriate evidence-based holistic and individualized care to meet the full range of
needs of the client experiencing psychiatric emergency and those with mental health
alterations through the principles and cultural/ethnic sensitivities.

Course Credit 4 units (72 hrs.) Lecture, 4 units RLE (Skills Lab -1 unit 51 hours;
Clinical 3 units- 153 hours)
Placement 4th year 1st Semester
For calculation of Lecture grade (4 units) :
Formative Assessment (FA) – 60 %
Summative Assessment (SA) – 40 %

The calculation for the grades will be based on the formula below:
Calculation of RLE CE and Skills Lab
Lecture X 67% + RLE X 33% = NUR1218 Grade
Grade Points will be based on standards
4
GROUP ASSIGNMENT

INSTRUCTION: Discuss the following mental health illness. Include a

clinical vignette (research articles from legitimate research engines) in the
discussion. Submit your clinical vignettes to your lecturer on week 3. Be
guided by the Study Plan.

Presentations will start on Week 4.

1: Personality Disorder and Somatic Illness Disorder

2. Eating Disorders, Sleep Disorders
3. Schizophrenia , ALL Forms
4. Mood Disorders
5. Dissociative Disorders
6. Psychosexual Disorders
7. Cognitive Disorders, Substance and Non-substance Abuse Disorders
REMINDERS!

During your Clinical Exposure, save all your patients’

outputs on ART THERAPY/ MUSIC THERAPY/
BIBLIOTHERAPY, Process Recording and Remotivation
therapy.

These will be presented and GRADED during your MAD

Skills Lab.
RESOURCE BOOK:

PSYCHIATRIC-MENTAL HEALTH NURSING BY

SHEILA VIDEBECK
9TH ED.
 Learning Objectives:

 Given an advance reading assignment and

activities, the student will be able to:
 Define terms related to psychiatric
nursing.
 Describe a mentally healthy individual

 Differentiate mental health from mental

illness
Q: It is most helpful to the nurse who is attempting to
apply the principles of positive mental health to
understand that:
A. emotionally ill people can empathize easily with
others
B. psychologically healthy people function optimally
in all settings
C. a sense of mastery of self and environment is
crucial to emotional health
D. mental illness is characterized by observable signs
of socially inappropriate behavior
Overview of Psychiatric Nursing
 In 2017, the two most common mental health
conditions, anxiety and depression, accounted
for over 800 000 years of life lived with disability in
the country, leading not only to vast human suffering
but also to economic losses due to the impact on the
workforce productivity.
 1 in 10 young Filipino adults has moderate to
severe depression, which is associated with
suicidal ideation.
 Philippine Statistics Authority reported that deaths
caused by intentional self-harm or suicide rose by
57.3%. (NMH Summit, 2022)
 15.08% of youth (age 12-17) report suffering from at
least one major depressive episode (MDE) in the past
year. Childhood depression is more likely to persist
into adulthood if gone untreated. The number of
youth experiencing MDE increased by 306,000
(1.24%) from last year's dataset. (WHO)
 The DOH estimates that at least 3.6 million Filipinos
are facing mental health issues during the pandemic,
including depression, substance use disorders such
as alcohol use disorder, and mood disorders like
bipolar disorder. (DOH, 2021)
 Mental Health
 A state of (E)emotional, (S)social and
(P)psychological wellness as evidenced
by:
E -effective behavior and coping,
S -satisfying interpersonal relationships,
P -positive self-concept and
E -emotional stability.
(WHO)
 FACTORS INFLUENCING MENTAL HEALTH

 Individual / Personal Factors (Inherited

characteristics)
 Intrapersonal
 Social/Cultural

 Nurturing during childhood

NATURE vs. NURTURE
 COMPONENTS OF MENTAL HEALTH
M -Maximization of One’s Potential-oriented
towards growth and self-actualization
S -Self-esteem-has realistic awareness of her abilities
and limitations
M -Mastery of the Environment-can deal with and
influence the environment
A -Autonomy and Independence-can work
interdependently without losing autonomy
R -Reality Orientation-can distinguish the real world
from a dream, fact from fantasy
T -Tolerance of Life’s Uncertainties-can face the
challenges of day-to-day living with hope & positive
outlook in life
S - Stress Management – ability to tolerate anxiety
and frustrations
 MENTAL ILLNESS/MENTAL DISORDER

 Mental illness is a condition that impacts a person's

thinking, feeling or mood may affect and his or her ability
to relate to others and function on a daily basis. Each
person will have different experiences, even people with the
same diagnosis. http://www.nami.org
 Mental Disorder as “a clinically significant behavioral or
psychological syndrome or pattern that occurs in an
individual and that is associated with present distress or
disability or with a significantly increased risk of suffering,
death, pain, disability, or an important loss of freedom”.
(APA)
Q: Linda reviews her notes in Psychiatric
nursing before the first day of her
assignment in a psychiatric unit. She
recalls that a near accurate definition of
mental health is:
A. absence of mental illness
B. presence of mental organization
C. absence of negative ways of dealing with
problems
D. presence of mental stability
 Learning Objectives:

Given a scenario, the student will be

able to:
▪ Discuss how psychiatric disorders are
diagnosed.
▪ Discuss the evolution of mental health
psychiatric nursing from the ancient to recent
time.
▪ Identify the roles and essential qualities of a
psychiatric nurse.
 Criteria to Diagnose Mental
Disorders
L -Lack of personal growth
D -Dissatisfactions with one’s
characteristics, accomplishments, abilities
I -Ineffective or dissatisfying relationships
D -Dissatisfaction with one’s place in the
world
I -Ineffective coping with life’s events
The Mental Health Nurse
 PSYCHIATRIC NURSING
Psychiatric nursing pertains to:
A. Assessment of behavior, planning and evaluation of
care for individuals with mental disorders
B. Promotion of optimal mental health for individual,
through early diagnosis, treatment and
rehabilitation
C. Use of therapeutic interactions between the nurse
and the individual
 PSYCHIATRIC NURSING
Interpersonal process
 whereby the nurse through the therapeutic
use of self
 assist an individual, family, group or
community to promote mental health
 help prevent mental illness and suffering
 participate in the treatment and
rehabilitation of the mentally ill
 Help find meaning in these experiences
Mental Health Psychiatric Nursing

 is a specialized area of nursing that uses

the theories of human behavior and the
purposeful use of self, as its art. It is an
interpersonal process whereby it
promotes mental health, prevents mental
illness, early identification and
intervention of emotional problems, and
follow-up care to minimize long term
effects of mental disturbance.
 3 LEVELS of CARE
1. Primary Prevention Altering the causative or risk factors Interventions
to hinder development of illness a. Client and family teaching
b. stress reduction
c. psychosocial support
2. Secondary Prevention Reducing the effects of mental Interventions
illness a. screening
b. crisis intervention
c. suicide prevention
d. short term counseling
e. emergency counseling & short
term hospitalization
3. Tertiary Prevention Minimizing long term residual Interventions
effect a. rehabilitation program
b. vocational training
c. after care support
d. partial hospitalization options
 Goals of Psychiatric Nursing

 To help the client accepts himself

 To promote relationship with other
people
 To learn to function independently
on a realistic basis
 PSYCHIATRIC NURSING

 Roles of a  Essential Qualities of

Psychiatric Nurse a Psychiatric Nurse
 Roles of a Psychiatric Nurse
(Peplau)
 Creator of the  Socializing Agent
Therapeutic  Counselor
Environment  Teacher
 Technical Nursing  Parent
Role Surrogate
 Therapist
 DRILL!!!

ROLES OF A
PSYCHIATRIC NURSE
 Roles of a Psychiatric Nurse

• Performs functions such as bathing,

Roles feeding, backrubs

• Assist the client to participate in group

Roles activities

• Shows active listening, assisting client in

Roles identifying stresses that causes anxiety
 Roles of a Psychiatric Nurse

• Checks vital signs

Roles

• Assist client in finding solutions

Roles to his problem

• Performs treatments and

Roles procedures
 Learning Objectives
Given scenarios, the student will be able to
 Review the theoretical and conceptual models
used in psychiatric care
a. Neurobiologic theories
b. Developmental Theories
c. Interpersonal Theories
d. Humanistic Theories
e. Behavioral Theories
f. Existential Theories
DEVELOPMENTAL
THEORIES
Psychosexual Theory
psychoanalytic theory

SIGMUND FREUD
 Psychosexual theory
psychoanalytic theory

 1. Human behavior is motivated by

repressed sexual impulses and
desires.

STRUCTURE OF PERSONALITY
 Psychosexual Development
Sigmund Freud
Id Sexual and aggressive drive
Inborn
Operates on pleasure principle
Primary thinking process: Imagery
Irrational and not based on reality
Ego Chief executive officer
Operates on reality principle
Secondary thinking process: logical and reality-oriented
Major functions: adaptation to reality, modulation of anxiety, problem
solving, control and regulates instinctual dives. Use Reality Testing and
Defense Mechanisms
Superego CONSCIENCE, punishes one for something wrong that was done.
EGO-Ideal, rewards one for something good that was done.
Residue of internalized values and moral training of early childhood.
 DRILLS
STRUCTURE OF
PERSONALITY
 Structure of Personality

• Operates on reality principle

• Without sense of right & wrong

• Governed by Pleasure Principle

 Structure of Personality

• Acts as mediator / integrator

• Angel / Perfectionist

• Use of defense mechanism to

protect self
 Structure of Personality

• Incorporates taboos, prohibitions,

ideals of parents

• Fully developed at age 7

• Responsible for image formation,

wish fulfillment
 Psychosexual Development
Sigmund Freud
Effeminate/Emasculate
Gay / Lesbian (Homosexuality)
Regression (Oral Behavior)
Phases Age Ranges Developmental Focus
Oral Mouth is the major site of tension and gratification including
Birth – 18 biting and sucking activities.
months Id is present at birth.
Anal Anus and surrounding area are major source of interest.
1 1/2 yrs – 3 yrs Voluntary sphincter control is the goal.
Ego develops gradually.
Phallic Genital is the focus.
3 – 5 years Penis envy & Elektra Complex (girls).
Castration fear & Oedipus Complex (boys).
Latency Complexes are resolved. Genital focus is turned to social
5-11 extended to activities.
13 years Formation of Superego.
Genital 11-13 over Development of biologic capacity for orgasm.
lapping with
Starts to appreciate capacity for True Intimacy.
previous
2. Behavior is motivated by
Subconscious thoughts and
feelings:
“A Freudian slip (slips of the tongue)
were not accidents or coincidence but
rather were indicators of subconscious
feelings or thoughts that accidentally
emerged in casual day to day
conversation”.

3. Human Personality was believed

to function at Three Levels of
Awareness
 Three Levels of Awareness
Conscious Pre-conscious Unconscious
Subconscious
➢functions ➢Ideas and reactions are ➢ largest part of the mind
when the person stored and partially ➢serves as storage or
is awake, aware forgotten reservoir of painful
of himself, his ➢acts as WATCHMAN memories & experiences
thoughts, it prevents unacceptable, which are difficult to recall
feelings, disturbing unconscious ➢realm of thoughts and
perceptions and memories from reaching feelings that motivate a
what is going on the conscious mind
in the person even he is totally
environment ➢Brought into unaware of them.
consciousness by recall ➢can be recalled by
psychoanalysis
 DRILLS
LEVEL OF
CONSCIOUSNESS
 Level of Consciousness

• Can be recalled by psychoanalysis

1

• Serves as storage or reservoir of painful

2 stimuli

• Acts as watchman – prevents unacceptable

3 memories to comes to awareness
 Level of Consciousness

• Functions when the person is fully

4 awake

• Ideas are stored and partially

5 forgotten

• Slips of the tongue

6
4. Believed that a person’s dreams is reflected
more of the subconscious and had significant
meaning (Gabbard, 2000)
Dream analysis is a primary method used in
psychoanalysis. It involves discussing a client’s
dreams to discover their true meaning and
significance.
Free association is another method used to
gain access to subconscious thoughts and
feelings. The therapist tries to uncover the
client’s true thoughts and feelings by saying a
word and asking the client to respond quickly
with the first thing that comes to mind.
5. Believed that self or ego used ego defense
mechanisms methods of attempting to protect
the self and cope with basic drives or
emotionally painful thoughts, feelings and
events. These mechanisms operates at the
unconscious level of awareness
Psychosocial Theory

ERIK ERIKSON
 Erikson maintained that personality develops in a
predetermined order through eight stages of
psychosocial development, from infancy to
adulthood.
During each stage, the person experiences a
psychosocial crisis which could have a positive or
negative outcome for personality development.
 According to the theory, successful completion of
each stage results in a healthy personality and the
acquisition of basic virtues. Basic virtues are
characteristic strengths which the ego can use to
resolve subsequent crises.
 Failure to successfully complete a stage can result in
a reduced ability to complete further stages and
therefore a more unhealthy personality and sense of
self. These stages, however, can be resolved
successfully at a later time.
Moral Development Theory

LAWRENCE
KOHLBERG
Cognitive in nature, Kohlberg's theory focuses
on the thinking process that occurs when one
decides whether a behaviour is right or
wrong. Thus, the theoretical emphasis is on how
one decides to respond to a moral dilemma, not what
one decides or what one actually does.
Kohlberg identified three distinct levels of moral
reasoning: preconventional, conventional, and
postconventional.
Harry Stack Sullivan

INTERPERSONAL
THEORY
 Interpersonal Theory

➢ Deals with people's characteristic interaction

patterns
➢ Sullivan insisted personality is shaped almost
entirely by the relationships we have with people
➢ He believed that a close interpersonal relationship
has the power to transform an immature
preadolescent into a psychologically healthy
individual
 Interpersonal Theory

Dynamism
➢ A typical pattern of behavior
➢ Specific dynamisms include:
o Malevolence
o Intimacy
o Lust
o The self-system
 Interpersonal Theory

The Self-System
➢ Most inclusive of all dynamisms
➢ Patterns of behaviour:
o Protects us against anxiety and maintains our interpersonal
security
o Tends to stifle personality change
o Experiences that are inconsistent with our self-system
threaten our security and necessitate our use of security
operations such as dissociation or selective inattention
 Interpersonal Theory

Personifications
➢ People acquire certain images of self and others
throughout the developmental stages
➢ These subjective perceptions are personifications
➢ Bad Mother, Good Mother personification
➢ Me Personification
➢ Eidetic Personification
 Interpersonal Relationship

Bad Mother, Good Mother

➢ Bad mother personification grows out of infants'
experiences with a nipple that does not satisfy their
hunger needs
➢ All infants experience this even though their real
mother may be loving and nurturing
➢ Infants later acquire a good mother personification
o become mature enough to recognize the tender and
cooperative behavior of their mother
➢ These two personifications combine to form a
complex and contrasting image of the real mother
 Interpersonal Theory

Me Personification
➢ During infancy, children acquire three "me"
personifications
o The bad-me, which grows from experiences of punishment
and disapproval
o The good-me, which results from experiences with rewards
and approval
o The not-me, which allows a person to disassociate or
selectively inattend the experiences related to anxiety
 Interpersonal Theory

Eidetic Personification
➢ People often create imaginary traits that they
project onto others
➢ Included in these eidetic personifications are the
imaginary playmates that pre-school aged children
often have
➢ These imaginary friends enable children to have a
safe and secure relationship with another person
even though that person is imaginary
 Interpersonal Theory

Stages of Development
➢ Sullivan saw interpersonal development as taking
place over seven stages, from infancy to mature
adulthood
➢ Personality changes can take place at any time are
more likely to occur during transitions between
stages
 Interpersonal Theory

Infancy Period
➢ from birth until emergence of syntaxic language
➢ Child receives tenderness from mother
o learns anxiety through an empathic linkage with the mother
 Interpersonal Theory

Childhood
➢ Lasts from the beginning of syntaxic language until
the need for playmates of equal status
➢ Primary interpersonal relationship continues to be
with the mother
o Mother now differentiated from other persons who nurture
the child
 Interpersonal Theory

Juvenile Era
➢ Begins with the need for peers of equal status and
continues until the child develops a need for an
intimate relationship with a friend
➢ Children should learn how to compete,
compromise, and cooperate
o These abilities, as well as an orientation toward living, help a
child develop intimacy
 Interpersonal Theory

Preadolescence
➢ Perhaps the most crucial stage
➢ Mistakes made earlier can be corrected during
preadolescence
➢ Mistakes made during preadolescence are nearly
impossible to overcome later in life
➢ Spans the time from the need for a single best
friend until puberty
➢ Children who do not learn intimacy during
preadolescence have added difficulties relating to
potential sexual partners during later stages
 Interpersonal Theory

Early Adolescence
➢ With puberty comes the lust dynamism and the
beginning of early adolescence
➢ Development during this stage marked by a
coexistence of intimacy with a single friend of the
same gender sexual interest in many persons of the
opposite gender
➢ If children have no preexisting capacity for
intimacy, they may confuse lust with love and
develop sexual relationships that are devoid of true
intimacy
 Interpersonal Theory

Late Adolescence
➢ May start at any time after age 16
➢ Psychologically, it begins when a person is able to
feel both intimacy and lust toward the same person
➢ Characterized by a stable pattern of sexual activity
the growth of the syntaxic mode
Adulthood
➢ Late adolescence flows into adulthood
➢ A time when a person establishes a stable
relationship with a significant other person and
develops a consistent pattern of viewing the world
Ego Defense Mechanisms
EGO DEFENSE MECHANISMS
Functions:
1. To ward off anxiety
2. To resolve a conflict
3. To protect self-esteem
4. To protect one’s sense of security
*without defense mechanisms, anxiety might
overwhelm and paralyze and interfere with daily
living
*can be therapeutic or pathologic
*supposedly in action by 10 years of age
 Coping / Defense Mechanism
 Level 1: Psychotic Mechanisms
 Level 3: Neurotic Defenses
(common to healthy individuals before
(common to individuals aged
age of 5)
teenagers and early adult)
 Delusional Projection
 Intellectualization
 Denial
 Repression
 Distortion
 Displacement
 Level 2: Immature Mechanisms
 Reaction Formation
(common in ages 3-15)
 Dissociation
 Projection
 Level 4: Mature Mechanisms
 Schizoid fantasy
 common well-adjusted persons)
 Hypochondriasis
 Altruism
 Passive-aggressive behavior
 Humor
 Acting out
 Sublimation
 General Nature of Coping Strategies
• Adaptive coping – for MILD form of
disorder
• Pallative coping – for MODERATE form of
disorder
• Maladaptive coping – for SEVERE form of
disorder
• Dysfunctional coping – for HIGH LEVEL of
form of disorder;
 EGO DEFENSE MECHANISMS

D (3)– Displacement, Denial, Dissociation

R (4) –Rationalization, Repression, Reaction
Formation, Regression
I (3) - Introjection, Intellectualization,
Identification
F (2) – Fixation, Fantasy
C (2) – Compensation, Conversion
U (1) –Undoing
P (1) – Projection
S (5) – Splitting, Sublimation, Suppression,
Substitution, Symbolization
 EGO DEFENSE MECHANISMS

 DISPLACEMENT
 Feelings are transferred or redirect to other
person or object that is less threatening
 Negative DM; 3 entities involved
Common Example: A husband comes home
and yells at his wife after a bad day at work
Patient Example: Mrs. Faust screams at
another patient after being told by her
psychiatrist that she cannot have a weekend
pass.
 EGO DEFENSE MECHANISMS

 DISSOCIATION
 Separating and detaching a strong
emotionally charged conflict from one’s
consciousness
 “traumatic amnesia”

Example: Amnesia that prevents recall of

yesterday’s auto accident
 EGO DEFENSE MECHANISMS

 DENIAL
 Failure to acknowledge an unacceptable
trait or situation
Common Example: A student refuses to
admit that she is flunking a course despite
an F on the 1st exam.
Patient Example: Mr. Davis, who is alcohol
dependent, states that he can control his
drinking.
 EGO DEFENSE MECHANISMS

 REGRESSION
 Returning to an earlier developmental
stage
Common Example: a 6-year-old wets the bed
at night since the birth of his baby sister
Patient example: Mr. Hivey has isolated
himself in his room and has lain in a fetal
position since his admission
 EGO DEFENSE MECHANISMS

 RATIONALIZATION
 Self-saving with incorrect illogical
explanation
 Look for reasoning or “because”
Common Example: A student states, “I got a
C on the test because the teacher asked
poor questions.”
Patient Example: Mr. Jones, a paranoid
schizophrenic, states that he cannot go to
work because he is afraid of his co-workers
instead of admitting that he is mentally ill.
 EGO DEFENSE MECHANISMS

 REPRESSION
 Unconscious forgetting of an anxiety
provoking situation
Common Example: A car accident victim is
unable to remember details of the impact,
but was aware at the time.
Patient example: Mrs. Yong, a victim of
incest, does not know why she has always
hated her uncle
 EGO DEFENSE MECHANISMS

 REACTION FORMATION
 Opposite of intention
 1 feeling (-) and 1 action (+) or 1
feeling(+) and 1 action (-)
Common Example: An older brother who
dislikes his younger brother sends him
gifts for every holiday.
Patient Example: Miss Marla, who
unconsciously hates her mother,
continuously tells staff how wonderful
her mother is.
 EGO DEFENSE MECHANISMS

 INTELLECTUALIZATION
 Excessive use of abstract thinking;
technical explanation
 No emotions involved
Common Example: A wife states to her
husband that a dented car fender is much
better than a completely wrecked car and
garage door.
Patient Example: Mrs. Mann talks about
her son’s death and bout with cancer as
being mercifully short without showing
signs of sadness.
 EGO DEFENSE MECHANISMS

 INTROJECTION
 Acceptance of another’s values and
opinions as one’s own
 Imitation but no admiration, “like”
Common Example: While her mother is
gone, a young girl disciplines her brother
just like her mother would.
Patient Example: Without realizing it, a
patient talks and acts like his therapist,
analyzing other patients.
 EGO DEFENSE MECHANISMS

 IDENTIFICATION
A conscious or unconscious attempt to
model oneself after a respected person
 Superficial, imitation with admiration,
“like”
Common Example: When a little girl
dresses up like her mother to play house,
she tries to talk and act like her mother.
Patient example: Sheila states to the nurse,
“When I get out of the hospital, I want to
be a nurse just like you.”
 EGO DEFENSE MECHANISMS

 FANTASY
 Magicalthinking
Example: Daydreaming
 EGO DEFENSE MECHANISMS

 FIXATION
occurs when a person is stuck in a certain
developmental stage
Example: Lack of a clear sense of identity as an adult.
Oral fixations
 EGO DEFENSE MECHANISMS

 CONVERSION
 Anxiety converted to physical symptoms
 Presence of physical complaints
Common Example: A student awakens with a
migraine the morning of a final examination
and feels ill to take it.
Patient example: Mr. Jenson suddenly
develops impotence after his wife discovers
he is having an affair with his secretary.
 EGO DEFENSE MECHANISMS

 COMPENSATION
 Overachievement in one area to overpower
weaknesses or defective area.
 Can also be compensating for another’s
weaknesses
 No relatedness on the weakness
compensated with strength.
Common Example: An academically weak high
school student becomes a star in the school
play.
Patient Example: A schizophrenic patient who
is unable to talk to other patients becomes
known for his expressive poetry.
 EGO DEFENSE MECHANISMS

 UNDOING
 Doing the opposite of what have done
 1 (-) action, then 1 (+) action; this is constant
Common Example: After spanking her son, a
mother bakes his favorite cookies.
Patient Example: After eating another
patient’s cookies, Mrs. Donnelly apologizes
to the patients, cleans the refrigerator, and
labels everyone’s snack with their names.
 EGO DEFENSE MECHANISMS

 PROJECTION
 Blaming; Falsely attributing to another
his/her own unacceptable feelings.
 2 entities involved always; (Adam to God)
Common Example: A teenager comes home
late from a date and states that her friend
did not bring her home on time.
Patient Example: Katrina states that she used
marijuana while her boyfriend made her
smoke it.
 EGO DEFENSE MECHANISMS

 SUBLIMATION
 Channeling instinctual drives to a more
productive activity.
 Positive; 3 entities involved
 Common Example: An adolescent
arrested once for stealing later opens a
business installing security systems in
banks.
 Patient Example: A former perpetrator of
incest who fears relapse initiates a local
chapter of Parents United.
 EGO DEFENSE MECHANISMS

 SUBSTITUTION
 Replaces a goal that can’t be achieved for
another that is more realistic.
 Weakness has relatedness to strength
Example: A student nurse decides to be a
teacher because he or she is unable to
master clinical competencies
 EGO DEFENSE MECHANISMS

 SYMBOLIZATION
 Creates a representation to an anxiety
provoking thing or concept
 Use of tangible things as symbols
Example: An engagement ring symbolizes
love and a commitment to another
person
 EGO DEFENSE MECHANISMS

SUPPRESSION
 Voluntary or conscious exclusion from
awareness, anxiety-producing feelings,
ideas and situations
Common Example: A student states, “ I
cannot think about my wedding tonight. I
have to study.”
Patient Example: Michelle states to the
nurse that she is not ready to talk about
her recent divorce.
 EGO DEFENSE MECHANISMS

 SPLITTING
 Labile emotions; all bad – all good
EGO DEFENSE MECHANISMS
DEFENSE MECHANISMS COMMONLY USED IN EACH
RESPECTIVE DISORDERS
 Paranoid – Projection
 Phobia – Displacement
 Amnesia – Dissociation
 Anorexia – Suppression
 Bipolar Disorder – Reaction Formation
 Borderline – Splitting
 Schizophrenia – Regression
 Substance Abuse – Denial
 Depression – Introjection
 OC – Undoing
 Catatonic - Repression
 DRILLS
EGO DEFENSE
MECHANISM
 Defense Mechanism

 A college student academically weak

becomes a beauty queen in her school
 Defense Mechanism

 A client is angry about the attention and care

he is receiving, but behaves in a calm and
collected manner
 Defense Mechanism

 A father was very angry and hit his child

with a stick but the next day he brought
home a fried chicken
 Defense Mechanism

 A father who lost his child in a fire, joined an

organization that educates the public on fire
prevention
 Defense Mechanism

 A husband and wife are fighting, and as the

husband becomes angrier, he hit his dog
instead of his wife
 Defense Mechanism

 A nurse, alone in her room, delivering a

lecture she imitates from her mentor
 Defense Mechanism

 A student is pouting when he is not the

lecturer’s center of attention
 Defense Mechanism

 A woman told her father she has cancer but

continues to plan a family reunion 2 years in
advance
 Defense Mechanism

 Not thinking of problems back home to

study for the test
 Defense Mechanism

 Without knowing it, a student delivers a

speech, acting like her professor in a speech
class