Defence mechanism

Unconscious psychological mechanism

For the biological concept, see Biological defense.

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In psychoanalytic theory, defence mechanisms are unconscious psychological processes that protect the self from anxiety-producing thoughts and feelings related to internal conflicts and external stressors.[1]

According to this theory, healthy people use different defence mechanisms throughout life. A defence mechanism can become pathological when its persistent use leads to maladaptive behaviour such that the physical or mental health of the individual is adversely affected. Among the purposes of defence mechanisms is to protect the mind/self/ego from anxiety or to provide a refuge from a situation with which one cannot cope at that moment.[2]

Examples of defence mechanisms include: repression, the exclusion of unacceptable desires and ideas from consciousness; identification, the incorporation of some aspects of an object into oneself;[3] rationalization, the justification of one's behaviour by using apparently logical reasons that are acceptable to the ego, thereby further suppressing awareness of the unconscious motivations;[4] and sublimation, the process of channeling libido into "socially useful" disciplines, such as artistic, cultural, and intellectual pursuits, which indirectly provide gratification for the original drives.[5]

Some psychologists follow a system that ranks defence mechanisms into seven levels, ranging from a high-adaptive defence level to a psychotic defence level. Assessments carried out when analyzing patients such as the Defence Mechanism Rating Scale (DMRS) and Vaillant's hierarchy of defense mechanisms have been used and modified for over 40 years to provide numerical data on the state of a person's defensive functioning.[6]

## Theories and classifications

[edit]

In the first definitive book on defence mechanisms, The Ego and the Mechanisms of Defence (1936),[7] Anna Freud enumerated the ten defence mechanisms that appear in the works of her father, Sigmund Freud: repression, regression, reaction formation, isolation, undoing, projection, introjection, turning against one's own person, reversal into the opposite, and sublimation or displacement.[8]

Sigmund Freud posited that defence mechanisms work by distorting id impulses into acceptable forms, or by unconscious or conscious blockage of these impulses.[7] Anna Freud considered defense mechanisms as intellectual and motor automatisms of various degrees of complexity, that arose in the process of involuntary and voluntary learning.[9]

Anna Freud introduced the concept of signal anxiety; she stated that it was "not directly a conflicted instinctual tension but a signal occurring in the ego of an anticipated instinctual tension".[7] The signalling function of anxiety was thus seen as crucial, and biologically adapted to warn the organism of danger or a threat to its equilibrium. The anxiety is felt as an increase in bodily or mental tension, and the signal that the organism receives in this way allows for the possibility of taking defensive action regarding the perceived danger.

Both Freuds studied defence mechanisms, but Anna spent more of her time and research on five main mechanisms: repression, regression, projection, reaction formation, and sublimation. All defence mechanisms are responses to anxiety and how the consciousness and unconscious manage the stress of a social situation.[10]

* Repression: the exclusion of unacceptable desires and ideas from consciousness, though in certain circumstances they may resurface in a disguised or distorted form
* Regression: falling back into an early state of mental/physical development seen as "less demanding and safer"[10]
* Projection: possessing a feeling that is deemed as socially unacceptable and instead of facing it, that feeling or "unconscious urge" is seen in the actions of other people[10]
* Reaction formation: acting the opposite way that the unconscious instructs a person to behave, "often exaggerated and obsessive". For example, if a wife is infatuated with a man who is not her husband, reaction formation may cause her to – rather than cheat – become obsessed with showing her husband signs of love and affection.[10]
* Sublimation: seen as the most acceptable of the mechanisms, an expression of anxiety in socially acceptable ways[10]

Otto F. Kernberg (1967) developed a theory of borderline personality organization of which one consequence may be borderline personality disorder. His theory is based on ego psychological object relations theory. Borderline personality organization develops when the child cannot integrate helpful and harmful mental objects together. Kernberg views the use of primitive defence mechanisms as central to this personality organization. Primitive psychological defences are projection, denial, dissociation or splitting and they are called borderline defence mechanisms. Also, devaluation and projective identification are seen as borderline defences.[11]

Robert Plutchik's (1979) theory views defences as derivatives of basic emotions, which in turn relate to particular diagnostic structures. According to his theory, reaction formation relates to joy (and manic features), denial relates to acceptance (and histrionic features), repression to fear (and passivity), regression to surprise (and borderline traits), compensation to sadness (and depression), projection to disgust (and paranoia), displacement to anger (and hostility) and intellectualization to anticipation (and obsessionality).[12]

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association (1994) includes a tentative diagnostic axis for defence mechanisms.[13] This classification is largely based on Vaillant's hierarchical view of defences, but has some modifications. Examples include: denial, fantasy, rationalization, regression, isolation, projection, and displacement. However, additional defense mechanisms are still proposed and investigated by different authors. For instance, in 2023, time distortion was proposed in a publication as a newly identified ego defense.[14]

Different theorists have different categorizations and conceptualizations of defence mechanisms. Large reviews of theories of defence mechanisms are available from Paulhus, Fridhandler and Hayes (1997)[15] and Cramer (1991).[16] The Journal of Personality published a special issue on defence mechanisms (1998).[17]

## Vaillant's categorization

[edit]

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Psychiatrist George Eman Vaillant introduced a four-level classification of defence mechanisms:[18][19] Much of this is derived from his observations while overseeing the Grant study that began in 1937 and is on-going. In monitoring a group of men from their freshman year at Harvard until their deaths, the purpose of the study was to see longitudinally what psychological mechanisms proved to have impact over the course of a lifetime. The hierarchy was seen to correlate well with the capacity to adapt to life. His most comprehensive summary of the on-going study was published in 1977.[20] The focus of the study is to define mental health rather than disorder.

* Level I – pathological defences (psychotic denial, delusional projection)
* Level II – immature defences (fantasy, projection, passive aggression, acting out)
* Level III – neurotic defences (intellectualization, reaction formation, dissociation, displacement, repression)
* Level IV – mature defences (humour, sublimation, suppression, altruism, anticipation)

### Level 1: pathological

[edit]

When predominant, the mechanisms on this level are almost always severely pathological. These defences, in conjunction, permit one effectively to rearrange external experiences to eliminate the need to cope with reality. Pathological users of these mechanisms frequently appear irrational or insane to others. These are the "pathological" defences, common in overt psychosis. However, they are normally found in dreams and throughout childhood as well.[21] They include:

* Delusional projection: Delusions about external reality, usually of a persecutory nature
* Denial: Refusal to accept external reality because it is too threatening; arguing against an anxiety-provoking stimulus by stating it does not exist; resolution of emotional conflict and reduction of anxiety by refusing to perceive or consciously acknowledge the more unpleasant aspects of external reality
* Distortion: A gross reshaping of external reality to meet internal needs

### Level 2: immature

[edit]

These mechanisms are often present in adults. These mechanisms lessen distress and anxiety produced by threatening people or by an uncomfortable reality. Excessive use of such defences is seen as socially undesirable, in that they are immature, difficult to deal with and seriously out of touch with reality. These are the so-called "immature" defences and overuse almost always leads to serious problems in a person's ability to cope effectively. These defences are often seen in major depression and personality disorders.[21] They include:

* Acting out: Direct expression of an unconscious wish or impulse in action, without conscious awareness of the emotion that drives the expressive behavior
* Hypochondriasis: An excessive preoccupation or worry about having a serious illness
* Passive-aggressive behavior: Indirect expression of hostility
* Projection: A primitive form of paranoia. Projection reduces anxiety by allowing the expression of the undesirable impulses or desires without becoming consciously aware of them; attributing one's own unacknowledged, unacceptable, or unwanted thoughts and emotions to another; includes severe prejudice and jealousy, hypervigilance to external danger, and "injustice collecting", all with the aim of shifting one's unacceptable thoughts, feelings and impulses onto someone else, such that those same thoughts, feelings, beliefs and motivations are perceived as being possessed by the other.
* Schizoid fantasy: Tendency to retreat into fantasy in order to resolve inner and outer conflicts
* Splitting: A primitive defence. Both harmful and helpful impulses are split off and segregated, frequently projected onto someone else. The defended individual segregates experiences into all-good and all-bad categories, with no room for ambiguity and ambivalence. When "splitting" is combined with "projecting", the undesirable qualities that one unconsciously perceives oneself as possessing, one consciously attributes to another.[22]

### Level 3: neurotic

[edit]

These mechanisms are considered neurotic, but fairly common in adults. Such defences have short-term advantages in coping, but can often cause long-term problems in relationships, work and in enjoying life when used as one's primary style of coping with the world.[21] They include:

* Displacement: Defence mechanism that shifts sexual or aggressive impulses to a more acceptable or less threatening target; redirecting emotion to a safer outlet; separation of emotion from its real object and redirection of the intense emotion toward someone or something that is less offensive or threatening in order to avoid dealing directly with what is frightening or threatening.
* Dissociation: Temporary drastic modification of one's personal identity or character to avoid emotional distress; separation or postponement of a feeling that normally would accompany a situation or thought.
* Intellectualization: Excessively analytical or abstract thought patterns, potentially leading to increased distance from one's emotions. Used to block out conflicting or disturbing feelings or thoughts.[23]
* Isolation of affect: The detachment of emotion from an idea, making it "flat." Frequently observed in obsessive–compulsive disorder, and in non-disordered people following traumatic events.[24]
* Reaction formation: Converting unconscious wishes or impulses that are perceived to be dangerous or unacceptable into their opposites; behaviour that is completely the opposite of what one really wants or feels; taking the opposite belief because the true belief causes anxiety
* Repression: The process of attempting to repel desires towards pleasurable instincts, caused by a threat of suffering if the desire is satisfied; the desire is moved to the unconscious in the attempt to prevent it from entering consciousness;[25] seemingly unexplainable naivety, memory lapse or lack of awareness of one's own situation and condition; the emotion is conscious, but the idea behind it is absent[26]

### Level 4: mature

[edit]

These are commonly found among emotionally healthy adults and are considered mature, even though many have their origins in an immature stage of development. They are conscious processes, adapted through the years in order to optimise success in human society and relationships. The use of these defences enhances pleasure and feelings of control. These defences help to integrate conflicting emotions and thoughts, whilst still remaining effective. Those who use these mechanisms are usually considered virtuous.[21] Mature defences include:

* Altruism: Constructive service to others that brings pleasure and personal satisfaction
* Anticipation: Realistic planning for future discomfort
* Humour: Overt expression of ideas and feelings (especially those that are unpleasant to focus on or too terrible to talk about directly) that gives pleasure to others. The thoughts retain a portion of their innate distress, but they are "skirted around" by witticism, for example, self-deprecation.
* Sublimation: Transformation of unhelpful emotions or instincts into healthy actions, behaviours, or emotions; for example, playing a heavy contact sport such as football or rugby can transform aggression into a game[27]
* Suppression: The conscious decision to delay paying attention to a thought, emotion, or need in order to cope with the present reality; making it possible later to access uncomfortable or distressing emotions whilst accepting them

## Perry's defence mechanism rating scale (DMRS)

[edit]

The defence Mechanism Rating Scale (DMRS) includes thirty processes of defence that are divided into 7 categories. Starting from the highest level of adaptiveness these levels include: high-adaptive, obsessional, neurotic, minor image-distorting, disavowal, major image-distorting, and action. The scale was originally created by J. Christopher Perry for the purpose of being able to provide patients with a "defence diagnosis."[6] Additions have been made by Mariagrazia Di Giuseppe and colleagues to enlarge the application of the DMRS, creating the DMRS self report and DMRS-Q sort.[28]

### Level 1: Action defences

[edit]

Action defence mechanisms are used unconsciously to help reduce stress. Examples include passive aggression, help-rejecting complaining, and acting out, which channel impulses into appropriate behaviors. These processes offer short-term relief but may prevent lasting improvements in the root causes.

### Level 2: Major image-distorting defences

[edit]

Major image-distorting mechanisms are used to guard a person's own image and their ego from perceived dangers, conflicts, or fears. These processes involve simplifying the way a person sees themselves and others. Splitting of one's self or other's image and projective identification both work on an unconscious level and help to alter reality, enabling these individuals to uphold a more positive view of their lives or situations.

### Level 3: Disavowal defences

[edit]

Disavowal defence mechanisms include the rejection or denial of unpleasant ideas, emotions, or events. People sometimes distance themselves from certain parts of their identity, whether they are aware of it or not, in order to avoid feelings of unease or discomfort. Mechanisms such as autistic fantasy, rationalization, denial, and projection, can help shield one's ego from feelings of stress or guilt that arise when facing reality.

### Level 4: Minor image-distorting defences

[edit]

Level four defence mechanisms serve the purpose of protecting an individual's self-esteem. There are several processes that people may use, such as devaluation and idealization of self-image and others-image, as well as omnipotence. These mechanisms assist in preserving a healthy self-perception during times of psychological instability.

### Level 5: Neurotic

[edit]

These defences are strategies that the mind uses without conscious awareness in order to manage anxiety, which is often a result of ongoing conflicts. There are several mechanisms that people use to cope with distressing thoughts and emotions. These include repression, displacement, dissociation, and reaction formation. These defences may offer brief relief; however, they can inhibit development in oneself and contribute to harmful habits.

### Level 6: Obsessional defences

[edit]

Obsessional defences refer to mental techniques that individuals utilize to cope with anxiety by exerting control over their thoughts, emotions, or behaviors. People may rely on strict routines, a desire for perfection, or a strong need for order to maintain a sense of control and avoid facing uncertainty or undesirable impulses. These defences, such as isolation of affects, intellectualization, and undoing, provide a short-term solution but can result in the development of obsessive-compulsive behaviors and hinder one's capacity to express and adapt to emotions.

### Level 7: High-adaptative defences

[edit]

This level of defences allow individuals to cope with stressors, challenges, and trauma. Mechanisms, such as sublimation, affiliation, self-assertion, suppression, altruism, anticipation, humor, and self-observation play a role in building resilience. They allow individuals to redefine challenges in a beneficial way that maximizes positivity. In doing so, they enhance their psychological well-being and encourage adaptation.[29][30][31]

## Relation with coping

[edit]

See also: Coping (psychology)

This section needs expansion. You can help by adding to it. (August 2016)

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There are multiple different perspectives on how the construct of defence relates to the construct of coping. While the two concepts share multiple similarities, there is a distinct difference between them that depends on the state of consciousness the process is carried out in. The process of coping involves using logic and reason to stabilize negative emotions and stressors. This differs from defence, which is driven by impulse and urges.[32][33]

Similarities between coping and defense mechanisms have been extensively studied in relation to various mental health conditions, such as depression, anxiety, and personality disorders.[34] Research indicates that these mechanisms often follow specific patterns within different disorders, with some, like avoidant coping, potentially exacerbating future symptoms.[35] This aligns with the vulnerability-stress psychopathology model, which involves two core components: vulnerability (non-adaptive mechanisms and processes) and stress (life events).[36] These factors interact to create a threshold for the development of mental disorders. The types of coping and defense mechanisms used can either contribute to vulnerability or act as protective factors.[37] Coping and defence mechanisms work in tandem to balance out feelings of anxiety or guilt, categorizing them both as a "mechanisms of adaptation."[33]

## Criticism

[edit]

Criticism regarding defence mechanisms focus on the lack of empirical evidence as most of the evidence for defence mechanisms comes from clinical observations and subjective interpretations. [38]

Critics have stated that due to the difficult nature of studying defence mechanisms that future research should distinguish more between the theoretical constructs of defence mechanisms and actual behaviors.[39]

## See also

[edit]

* Coherence therapy § Symptom coherence
* Personality disorder – Maladaptive patterns of behavior
* Cognitive dissonance – Mental phenomenon of holding contradictory beliefs
* Experiential avoidance – Attempts to avoid internal experiences
* List of cognitive biases
* List of maladaptive schemas – List on psychotherapy topic
* Motivated forgetting – Psychological defense mechanism
* Motivated reasoning – Processing personal/social information
* Narcissistic defences – Mental processes which preserve the self
* Psychological resistance – Phenomenon in clinical psychology
* Self-enhancement – Type of motivation

## References

[edit]

1. ^ American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Press
2. ^ "defence mechanisms -- Britannica Online Encyclopedia". www.britannica.com. Retrieved 2008-03-11.
3. ^ Chalquist, Craig. "A Glossary of Freudian Terms" Archived 2018-12-28 at the Wayback Machine 2001\. Retrieved on 05 October 2013.
4. ^ "Rationalization". American Psychological Association.
5. ^ "Sublimation". American Psychological Association.
6. ^ a b Perry, J. Christopher; Henry, Melissa (2004), "Studying Defense Mechanisms in Psychotherapy using the Defense Mechanism Rating Scales", Defense Mechanisms - Theoretical, Research and Clinical Perspectives, Advances in Psychology, vol. 136, Elsevier, pp. 165–192, doi:10.1016/s0166-4115(04)80034-7, ISBN 978-0-444-51263-5, retrieved 2024-05-02
7. ^ a b c Freud, A. (1936). The Ego and the Mechanisms of Defence, London: Hogarth Press and Institute of Psycho-Analysis. (Revised edition: 1966 (US), 1968 (UK))
8. ^ Lipot Szondi (1956) Ego Analysis Ch. XIX, translated by Arthur C. Johnston, p. 268
9. ^ Romanov, E.S. (1996). Mechanisms of psychological defense: genesis, functioning, diagnostics.
10. ^ a b c d e Hock, Roger R. "Reading 30: You're Getting Defensive Again!" Forty Studies That Changed Psychology. 7th ed. Upper Saddle River: Pearson Education, 2013. 233–38. Print.
11. ^ Kernberg O (July 1967). "Borderline personality organization". J Am Psychoanal Assoc. 15 (3): 641–85\. doi:10.1177/000306516701500309. PMID 4861171. S2CID 32199139.
12. ^ Plutchik, R., Kellerman, H., & Conte, H. R. (1979). A structural theory of ego defences and emotions. In C. E. Izard (Ed.), Emotions in personality and psychopathology (pp. 229–-257). New York: Plenum Press.
13. ^ American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
14. ^ Fowler, Alexander (2023). "On the Distortion of Time: An Unexplored Ego Defense Mechanism". International Research Journal of Modernization in Engineering, Technology, and Science. ISSN 2582-5208.
15. ^ Paulhus, D.L., Fridhandler B., and Hayes S. (1997). Psychological defense: Contemporary theory and research. In Briggs, Stephen; Hogan, Robert Goode; Johnson, John W. (1997). Handbook of personality psychology. Boston: Academic Press. pp. 543–579\. ISBN 978-0-12-134646-1.
16. ^ Cramer, P. (1991). The Development of Defense Mechanisms: Theory, Research, and Assessment. New York, Springer-Verlag.
17. ^ Special issue [on defense mechanisms], Journal of Personality (1998), 66 (6): 879–1157
18. ^ Cramer, Phebe (May 2006). Protecting the Self. The Guilford Press. p. 17. ISBN 9781593855284.
19. ^ Vaillant, George (1994). "Ego mechanisms of defense and personality psychopathology" (PDF). Journal of Abnormal Psychology. 103 (1): 44–50\. doi:10.1037/0021-843X.103.1.44. PMID 8040479.
20. ^ Vailant, George (1977). Adaptation to Life. Boston: Little Brown. ISBN 0-316-89520-2.
21. ^ a b c d Vaillant, G. E., Bond, M., & Vaillant, C. O. (1986). An empirically validated hierarchy of defence mechanisms. Archives of General Psychiatry, 73, 786–794. George Eman Valillant
22. ^ McWilliams, Nancy (2011). Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, Second Edition. New York, NY: The Guilford Press. pp. 60, 63, 103. ISBN 978-1609184940.
23. ^ Bailey, Ryan; Pico, Jose (2022), "Defense Mechanisms", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32644532, retrieved 2022-06-28
24. ^ "isolation of affect". Oxford Reference. Retrieved 2022-06-28.
25. ^ Laplanche pp. 390, 392[full citation needed]
26. ^ Psychological Defenses from DSM-IV (see Repression), Virginia Commonwealth University. Retrieved on December 12, 2014.
27. ^ Schacter, Gilbert, Wegner (2011), Psychology (2nd edition), Worth Publishers, p. 483
28. ^ Di Giuseppe, Mariagrazia; Perry, John Christopher; Lucchesi, Matilde; Michelini, Monica; Vitiello, Sara; Piantanida, Aurora; Fabiani, Matilde; Maffei, Sara; Conversano, Ciro (2020). "Preliminary Reliability and Validity of the DMRS-SR-30, a Novel Self-Report Measure Based on the Defense Mechanisms Rating Scales". Frontiers in Psychiatry. 11: 870. doi:10.3389/fpsyt.2020.00870. ISSN 1664-0640. PMC 7479239. PMID 33005160.
29. ^ Di Giuseppe, Mariagrazia; Perry, J. Christopher (2021). "The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning With the Defense Mechanisms Rating Scales Q-Sort". Frontiers in Psychology. 12. doi:10.3389/fpsyg.2021.718440. ISSN 1664-1078. PMC 8555762. PMID 34721167.
30. ^ Perry, J. Christopher; Henry, Melissa (2004). "Studying Defense Mechanisms in Psychotherapy using the Defense Mechanism Rating Scales". Defense Mechanisms - Theoretical, Research and Clinical Perspectives. Advances in Psychology. Vol. 136\. pp. 165–192\. doi:10.1016/S0166-4115(04)80034-7. ISBN 978-0-444-51263-5.
31. ^ "The DMRS-Q". dmrs-q.com (in Italian). Retrieved 2024-05-02.
32. ^ Haan, Norma (1977). Coping and defending : processes of self-environment organization. Internet Archive. New York : Academic Press. ISBN 978-0-12-312350-3.`{{cite book}}`: CS1 maint: publisher location (link)
33. ^ a b Cramer, Phebe (1998). "Coping and Defense Mechanisms: What's the Difference?". Journal of Personality. 66 (6): 919–946\. doi:10.1111/1467-6494.00037. ISSN 0022-3506.
34. ^ Felton, Barbara J.; Revenson, Tracey A. (1984). "Coping with chronic illness: A study of illness controllability and the influence of coping strategies on psychological adjustment". Journal of Consulting and Clinical Psychology. 52 (3): 343–353\. doi:10.1037/0022-006X.52.3.343. ISSN 0022-006X. PMID 6747054.
35. ^ Bornstein, Robert F.; Bianucci, Violeta; Fishman, Daniel P.; Biars, Julia W. (2014-04-01). "Toward a Firmer Foundation for DSM-5.1 : Domains of Impairment in DSM-IV/DSM-5 Personality Disorders". Journal of Personality Disorders. 28 (2): 212–224\. doi:10.1521/pedi_2013_27_116. ISSN 0885-579X. PMID 23786269.
36. ^ Nuechterlein, K. H.; Dawson, M. E. (1984-01-01). "A Heuristic Vulnerability/Stress Model of Schizophrenic Episodes". Schizophrenia Bulletin. 10 (2): 300–312\. doi:10.1093/schbul/10.2.300. ISSN 0586-7614. PMID 6729414.
37. ^ Yank, Glenn R.; Bentley, Kia J.; Hargrove, David S. (1993). "The vulnerability-stress model of schizophrenia: Advances in psychosocial treatment". American Journal of Orthopsychiatry. 63 (1): 55–69\. doi:10.1037/h0079401. ISSN 1939-0025. PMID 8427312.
38. ^ "Defense Mechanisms - The Behavioral Scientist". www.thebehavioralscientist.com. Retrieved 2024-12-06.
39. ^ Mihalits, Dominik Stefan; Codenotti, Marco (June 2020). "The Conceptual Tragedy in Studying Defense Mechanisms". Integrative Psychological and Behavioral Science. 54 (2): 354–369\. doi:10.1007/s12124-020-09515-6. ISSN 1932-4502. PMID 31955367.

## External links

[edit]

* Media related to Defence mechanisms at Wikimedia Commons
* David McCandless. "Being Defensive: How psychotherapy sees you". Information is Beautiful (Figure). Retrieved 2023-10-07.

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Defence mechanisms

Level 1: Pathological|

* Delusional projection
* Denial or abnegation (German: Verneinung)
* Psychotic denial or disavowal (German: Verleugnung)
* Distortion
* Foreclosure or repudiation (German: Verwerfung)
* Extreme projection
* Identification with the Aggressor
* Splitting (Black-and-white thinking)

Level 2: Immature|

* Acting out
* Fantasy
* Idealization
* Introjection (Internalization)
* Passive-aggression
* Projection
* Projective identification
* Somatization

Level 3: Neurotic|

* Displacement
* Dissociation
* Hypochondriasis
* Intellectualization
* Isolation
* Rationalization
* Reaction formation
* Regression
* Repression (German: Verdrängung)
* Undoing

Level 4: Mature|

* Altruism
* Anticipation
* Humour
* Identification
* Sublimation
* Suppression

Other|

* Compartmentalization
* Defensive pessimism
* Minimisation
* Postponement of affect

Authority control databases

National|

* Germany
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Other|

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