USMLE Step 1 Question

TOPIC: Defense Mechanisms

A 45-year-old man is facing significant stress at work due to a recent promotion. He finds himself becoming increasingly irritable and short-tempered at home. However, he is unable to recognize that his behavior is a result of the stress from work and instead believes that his family is being difficult and annoying. Which of the following ego defense mechanisms best describes this man's behavior?

A. Rationalization

B. Repression

C. Projection

D. Displacement

E. Reaction formation

F. Sublimation

G. Denial

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Discussion: This scenario involves a man who is experiencing significant stress at work and is exhibiting irritability and short-tempered behavior at home, which he unjustly attributes to his family being difficult rather than recognizing the true source of his stress.

Let’s analyze each option:

A) Rationalization

Rationalization involves justifying one's behaviors or feelings with seemingly logical explanations, often to avoid confronting the true, uncomfortable reasons. While this man is misattributing his stress, he is not necessarily providing logical justifications for his behavior; instead, he is misplacing the source of his feelings.

B) Repression

Repression involves unconsciously blocking unpleasant feelings, thoughts, or memories from conscious awareness. This option doesn't fit well because the man is aware of his irritability.

C) Projection

Projection involves attributing one's unacceptable thoughts, feelings, or motives to another person. The man is doing this by blaming his family for being difficult and annoying rather than acknowledging that his irritability is a result of his own stress.

D) Displacement

Displacement involves transferring feelings about one object or person to another, less threatening object or person. Although it might seem similar to what the man is doing, displacement typically involves shifting emotional components, such as anger or frustration, rather than attributing one's own characteristics or reactions to someone else, as is the case with projection.

E) Reaction Formation

Reaction formation involves unconsciously replacing threatening inner wishes and fantasies with an exaggerated version of their opposite. For example, expressing love and affection to someone they actually harbor negative feelings for. This doesn't apply to the man's situation.

F) Sublimation

Sublimation is a defense mechanism where socially unacceptable impulses are transformed into socially acceptable actions or behavior, possibly resulting in a long-term conversion of the initial impulse. This man's behavior doesn't involve channeling his stress into a socially acceptable outlet.

G) Denial

Denial involves refusing to accept reality or fact, acting as if a painful event, thought, or feeling did not exist. While the man is failing to acknowledge the true source of his stress, he is not denying the stress itself or the resultant behavior, making denial less fitting than projection.

Correct Answer: C) Projection

Projection best describes the man's behavior, as he is attributing his own feelings of irritability and stress to his family, blaming them for being difficult rather than recognizing these feelings as a consequence of his own stress. It's crucial for medical students to understand not only the definition but also the application of psychological concepts like defense mechanisms, as they often present subtly in patient behaviors and histories.