When providing clients with stress management techniques and effective coping strategies, nurses must be aware of common defense mechanisms. Defense mechanisms are reaction patterns used by individuals to protect themselves from anxiety that arises from stress and conflict.[1] Excessive use of defense mechanisms is associated with specific mental health disorders. With the exception of suppression, all other defense mechanisms are unconscious and out of the awareness of the individual. See Table 3.4 for a description of common defense mechanisms.

Table 3.4 Common Defense Mechanisms

Defense Mechanisms Definitions Examples
Conversion  Anxiety caused by repressed impulses and feelings are converted into a physical symptoms.[2] An individual scheduled to see their therapist to discuss a past sexual assault experiences a severe headache and cancels the appointment.
Denial Unpleasant thoughts, feelings, wishes, or events are ignored or excluded from conscious awareness to protect themselves from overwhelming worry or anxiety.[3],[4] A client recently diagnosed with cancer states there was an error in diagnosis and they don’t have cancer.

Other examples include denial of a financial problem, an addiction, or a partner’s infidelity.
Dissociation A feeling of being disconnected from a stressful or traumatic event – or feeling that the event is not really happening – to block out mental trauma and protect the mind from too much stress.[5] A person experiencing physical abuse may feel as if they are floating above their bodies observing the situation.
Displacement Unconscious transfer of one’s emotions or reaction from an original object to a less-threatening target to discharge tension.[6] An individual who is angry with their partner kicks the family dog. An angry child breaks a toy or yells at a sibling instead of attacking their father. A frustrated employee criticizes their spouse instead of their boss.[7]
Introjection Unconsciously incorporating the attitudes, values, and qualities of another person’s personality.[8] A client talks and acts like one of the nurses they admire.
Projection A process when one attributes their individual positive or negative characteristics, affects, and impulses to another person or group.[9] A person conflicted over expressing anger changes “I hate him” to “He hates me.”[10]
Rationalization Logical reasons are given to justify unacceptable behavior to defend against feelings of guilt, maintain self-respect, and protect oneself from criticism.[11] A client who is overextended on several credit cards rationalizes it is okay to buy more clothes to be in style when spending money that was set aside to pay for the monthly rent and utilities. A student caught cheating on a test rationalizes, “Everybody cheats.”
Reaction Formation Unacceptable or threatening impulses are denied and consciously replaced with an opposite, acceptable impulse.[12] A client who hates their mother writes in their journal that their mom is a wonderful mother.
Regression A return to a prior, lower state of cognitive, emotional, or behavioral functioning when threatened with overwhelming external problems or internal conflicts.[13] A child who was toilet trained reverts to wetting their pants after their parents’ divorce.
Repression Painful experiences and unacceptable impulses are unconsciously excluded from consciousness as a protection against anxiety.[14] A victim of incest indicates they have always hated their brother (the molester) but cannot remember why.
Splitting Objects provoking anxiety and ambivalence are viewed as either all good or all bad.[15] A client tells the nurse they are the most wonderful person in the world, but after the nurse enforces the unit rules with them, the client tells the nurse they are the worst person they have ever met.
Suppression A conscious effort to keep disturbing thoughts and experiences out of mind or to control and inhibit the expression of unacceptable impulses and feelings. Suppression is similar to repression, but it is a conscious process.[16],[17] An individual has an impulse to tell their boss what they think about them and their unacceptable behavior, but the impulse is suppressed because of the need to keep the job.
Sublimation Unacceptable sexual or aggressive drives are unconsciously channeled into socially acceptable modes of expression that indirectly provide some satisfaction for the original drives and protect individuals from anxiety induced by the original drive.[18] An individual with an exhibitionistic impulse channels this impulse into creating dance choreography. A person with a voyeuristic urge completes scientific research and observes research subjects. An individual with an aggressive drive joins the football team.[19]
Symbolization The substitution of a symbol for a repressed impulse, affect, or idea.[20] A client unconsciously wears red clothing due a repressed impulse to physically harm someone.
  1. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  2. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  3. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  4. Sissons, C. (2020, July 31). Defense mechanisms in psychology: What are they? MedicalNewsToday. https://www.medicalnewstoday.com/articles/defense-mechanisms ↵
  5. Sissons, C. (2020, July 31). Defense mechanisms in psychology: What are they? MedicalNewsToday. https://www.medicalnewstoday.com/articles/defense-mechanisms ↵
  6. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  7. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  8. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  9. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  10. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  11. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  12. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  13. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  14. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  15. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  16. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  17. Sissons, C. (2020, July 31). Defense mechanisms in psychology: What are they? MedicalNewsToday. https://www.medicalnewstoday.com/articles/defense-mechanisms ↵
  18. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  19. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
  20. American Psychological Association. (n.d.). Stressor. APA Dictionary of Psychology.  https://dictionary.apa.org ↵
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