Daily Archives: September 6, 2010

Defense mechanisms

Defense mechanisms are a key component of behaviors that are perceived to be maladaptive.  Rationalization, repression, displacement, regression, projection, identification, reaction formation, and sublimation are among the most prevalent defense mechanisms.  This article will attempt to briefly highlight and underscore a few of those defense mechanisms as they have been empirically observed first hand.  Names have been changed to protect the anonymity of persons involved in the vignettes.

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Rationalization generally implies that an individual gives a false but potentially plausible reason to justify behavior.  For example, in my sales career it was not uncommon for an individual to call and inquire about a product or service… and subsequently say something like “thanks for the information; I need to speak to my spouse.”  There are a number of different canned rebuttals that are designed to overcome that objection, but the point of this story is that statistically it is very unlikely that the individual really needs to speak to the spouse to make a purchasing decision.  The more likely scenario is that the individual has some underlying objection that remains uncovered… like budget, or a competitive offer.

Repression isn’t an uncommon reaction for individuals who have gone through serious trauma.  One specific example I recall was a friend of mine who came back from Iraq.  We were having a pretty in-depth conversation about some of what he had seen while he was deployed, and at one point in the conversation he said “I’d gladly tell you if I remembered, but I remember almost nothing about that day.”  I asked him what he meant by that… and all he said was “out of sight, out of mind.”  Now I know, he was repressing the event… it was obviously painful for him to talk about it.

Displacement is something that happens in lots of different situations, but a recent example involved an individual whom I support.  In part because the individual is developmentally disabled, they get persistently picked on and ridiculed at school.  Although I am fully aware that it’s just “kids stuff” this particular individual really takes it personal… it’s a pretty frequent complaint and some of the statements are downright cruel.  On one occasion, I had asked this individual to help me with a simple task around the house and the individual burst out in a fit of anger and rage… I know now that they behavior had almost nothing to do with my request, or with me at all… the anger or rage was displaced from a peer whom had demeaned the individual I work on the bus ride home.

Identification is very common, especially among men who associate themselves with one or more sports teams.  I am one of those guys… fortunately, or unfortunately… depending on how you see it.  I take a good deal of pride in being a Texas Longhorns fan, despite the fact that I never attended UT.  I’m not entirely sure why the Longhorns… I guess I like the heritage and tradition that goes with cheering for a team with that kind of history.  Bevo makes me smile… I mean, how could he not… the Texas Longhorns tote a steak to every game.  Most of all, I really like that the Texas program focuses on recruiting players with integrity.  Aside from an occasional Ricky Williams, very rarely do you hear about serious character questions from the men and woman who play for the University of Texas.  The bond is entirely imaginary… but the bond is real to me.  HOOK EM’ HORNS~!

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Bergen, D. (2008). Human development: Traditional and contemporary theories. Upper Saddle River, NJ: Pearson Prentice Hall.

Comparing and Contrasting Dissociative Identity Disorder (DID, Multiple Personality Disorder) with Conversion Disorder (CD)

Dissociative Identity Disorder and Conversion Disorder are similar in that they both stem from stressful events.  In Dissociative Identity Disorder a personality is formed when extreme child abuse or sexual abuse is experienced.  With Conversion Disorder it is a more recent event like a rape or physical or emotional abuse. Other than this similarity the two disorders are quite different.

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Dissociative Identity Disorder is a disorder in which the person affected suffers from as little as 2 distinct personalities and can suffer from as many as 100 or more.  Each personality has a very distinct identity, and will often take control of the person and how they act.  Because of the different identities taking over the people lose time.  They don’t remember the period of time that they were not in control and then have a hard time understanding why everything is different, especially in extreme cases when the other identity takes over for years at a time.  Usually an alternate identity takes over when the primary identity experiences something overly stressful.  It is common for people with this disorder to have other disorders or to have problems with substance abuse.  While DID has been known to last a lifetime, treatment can help.  Treatment usually involves psychotherapy and helps the person to integrate the identities into one.  It can be a painful process as well as time consuming, but according to people who have been able to achieve integration, it is definitely worth it.

Alternatively Conversion Disorder affects people in their sensory areas or physically where voluntary movement is concerned.  It is known to be a somatoform disorder and is said to be a large part of why people visit their primary care physicians.  Basically when people shove their emotions and stress too far inward they turn into physical symptoms.  This is called converting.  The conversion of these symptoms can cause a patient to contact their caregiver nine times as often.  The patient does not control the symptoms and can have a surprisingly painful beginning, and diagnosis can become complicated by a true physical illness.

Conversion Disorder has specific risk factors which include the fact that someone is female, men are less likely to receive this diagnosis.  This diagnosis is more common in the teen years, if there is someone in the family who is already receiving treatment for Conversion Disorder, it is likely to continue in the family line.

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Substance Abuse: Diagnosis, Comorbidity, and Psychopathology

Because substance abuse disorders (SUDs) are among the most common psychiatric conditions in the United States, approaching 9% prevalence of individuals aged 12 or older, I anticipate that it would be extremely difficult to function as a Licensed Mental Health Professional (LMHP) without being a Licensed Alcohol and Drug Counselor (LADC) as well.  (Blaney & Millon, 2009, p. 280)  Just out of curiosity, are most of the people in my cohort also going to pursue the LADC license?

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I was surprised to see a lack of diagnostic distinction for individuals at different developmental points in life.  Early onset (Type 2, or Type B) SUDs are typically associated with very different etiologies and outcomes, but the treatment options for the two types are similar.  Is there any speculation where there is a lack of a specific treatment options for these divergent types of SUDs?  As was suggested in the text, it seems self evident that engaging in preventative measures on behalf of people whom “are not yet symptomatic but evidence various characteristics of a known subtype” seems to be in order.  (Blaney & Millon, 2009, p. 282)

“The familial link for alcohol use disorders is widely established in the research literature.”  (Blaney & Millon, 2009, p. 282)  It remains unclear which familial association is most responsible for the increased risk, because both genetic and environmental factors play significant roles.  Exposure to parental SUDs, for example, exerts both a genetic and environmental predisposition that can reliably predict development of SUDs in the children.

I expected more discussion regarding multiculturalism when it came to alcohol and expectancies.   Differences in family structures (nuclear vs. extended) and media influences, in particular, have a great deal of impact on the development of expectations regarding the effects of alcohol and other substances.  The admission that expectancies are modifiable gives us some hope for cognitive-behavioral treatments.

I was suitably surprised that the gender gap is narrowing for both alcohol and illicit drugs over time.  (Blaney & Millon, 2009, p. 284)  “Telescoping” refers to the fact that women experience problems faster, meet criteria for abuse and dependence in a shorter time, and present for treatment earlier (at similar levels of consumption).  This would appear to suggest that women are more vulnerable to the physical and mental consequences of alcohol use and abuse.  Women experience more psychiatric comorbity when compared to men.  (Blaney & Millon, 2009, p. 285)

I disagree with the statement that “substance use does not directly lead to violence or criminal behavior.”  (Blaney & Millon, 2009, p. 285)  Here is just one example… http://www.youtube.com/watch?v=RbwSwvUaRqc I think this particular example is an excessive use of force, but the reality is this gentleman would have had no issues if he kept his hand out of the cookie jar.

Comorbidity is the rule not the exception when it comes to SUDs.  There are several factors that may contribute to this astonishing fact, among them the fact that “base rates of common psychiatric disorders naturally result in co-occurrence.”  (Blaney & Millon, 2009, p. 287)  Additional support may be found in the likelihood of seeking treatment (due to the comorbid disorder, exacerbation of sub-clinical symptoms, common genetic factors, and/or shared environmental risk factors.  Comorbid disorders, especially SUDs, complicate diagnosis and treatment.  Substance use and abuse can decrease medication adherence, cause side effects, and “potentiate some psychotropic medications increasing the potential for overdose.”  (Blaney & Millon, 2009, p. 287)  Mood disorders, anxiety disorders, eating disorders, ADHD, and ASPD (as well as schizophrenia and other psychoses) were all implicated as being “highly comorbid” with SUDs.

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Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.