01.02 Defense Mechanisms

So, one more thing to understand before we dive into various mental health disorders is that many clients will exhibit behaviors known as defense mechanisms or coping mechanisms. It’s important that you understand what they are and why they exist.

These behaviors are specifically used as a way to cope with increasing anxiety. We will see anxiety as a common component of most mental health diagnoses, but even in those not officially diagnosed with a mental health disorder, you will see these behaviors used as a way to decrease anxiety. Since we know that the purpose of these defense mechanisms is to decrease anxiety, the number one priority should be to help the client identify that source of anxiety. What is going on deep down that is causing them to behave the way they are? It’s important that this is where our focus is, not on the behavior itself. This can be very challenging, especially for a new nurse - we need to learn how to de-code their behavior. But if you at least recognize that there is some source of anxiety at the root of it, it helps you to approach the situation differently.

Now, there are dozens of examples of coping mechanisms. In your outline, we’ve given you 12 more common ones, and here I just want to touch on some of the most common ones you’ll see. First is compensation, this is when they’re trying to make up for a deficiency - someone who’s anxious about their intelligence may compensate by trying to be super funny. Conversion is when physical symptoms are used to express emotional issues, like getting a headache or a tummy ache. Denial is when a client refuses to acknowledge something as truth so they don’t have to deal with the anxiety or emotions of that situation.

Undoing is when someone tries to do the exact opposite of a past unacceptable behavior, almost to try to make up for it. So, for example, if someone had very bad thoughts about a person, or even if they were mean towards them - they’ll try to decrease their anxiety about that by being overly nice to them. We see this a lot in abusers who buy their victim flowers or gifts after a bad episode. Regression is when someone reverts to an earlier stage of maturity or development to avoid having to deal with the emotions. Repression is the involuntary loss of a painful thought or memory - this is seen frequently in abuse victims who may not even remember being abused or will ‘lose’ years of their lives. And finally, one that is extremely common even in people without mental health disorders - rationalization. This is when someone tries to give a socially acceptable or somewhat logical explanation for something, instead of acknowledging the truth. My mother always says “there’s a fine line between rational and rationalization”. Let me give you an example. A woman goes out and spends $200 on a new outfit for a job interview. When confronted with her bank statement she says “But, I had an interview and I had absolutely nothing to wear”. Except she has plenty of clothes! Turns out, she’s rationalizing her behavior because the truth is that she was feeling anxious about her upcoming interview and worried she wouldn’t be good enough.

So those are some of the major defense mechanisms. Just remember that the #1 priority is to address the source of anxiety. Now, go out and be your best selves today. And, as always, happy nursing!