USMLE Step 1/2CK Question (Behavioral)
Find the correct ego defense mechanism.
The following is a high-yield USMLE Step 1 & 2CK behavioral medicine question.
It is followed by a deep dive into each answer choice—the answer can be found at the bottom of the post.
Good luck!
QUESTION:
A 28-year-old man becomes verbally abusive towards his wife shortly after they get married. He has no medical or psychiatric illness history and works as an electrician for his family’s business. Throughout his youth, he witnessed his father being verbally abusive towards his mother. Which of the following is the man demonstrating?
A. Projection
B. Identification
C. Reaction formation
D. Primitive idealization
E. Distortion
F. Regression
To see the answer, scroll to the bottom of the post. See the DEEP-DIVE below if you’re unsure or want to learn more about the answer choices.
DEEP-DIVE:
The man’s verbally abusive behavior towards his wife, especially given a history of witnessing his father’s verbal abuse towards his mother, closely aligns with one of the listed defense mechanisms.
A. PROJECTION
Projection is a defense mechanism in which an individual attributes their unwanted thoughts, feelings, or motivations to someone else instead of admitting to or dealing with their own unwanted traits. This mechanism is used unconsciously to avoid the anxiety or discomfort that comes from acknowledging one's own negative attributes or desires.
Example: Your co-resident, Steven, is often insecure about his own work performance. Instead of acknowledging his insecurities, Steven frequently criticizes and questions the competence of another co-worker, Peter, asserting that Peter is not up to the task and is likely to fail in his responsibilities. In reality, Steven is projecting his own fears and inadequacies onto Peter, perhaps unconsciously, to deflect from his own feelings of inadequacy and to cope with the anxiety those feelings produce.
In this scenario, Steven’s criticisms of Peter are not genuinely about Peter’s performance but are a manifestation of Steven’s own internal struggles with insecurity and self-doubt.
Projection works as a defense mechanism to protect individuals from facing their own uncomfortable truths by attributing those feelings or traits to others.
B. IDENTIFICATION
Identification is a defense mechanism whereby an individual subconsciously adopts another person's ideas, behaviors, and traits. The behavior often comes from someone the user has been in close contact with or someone they perceive as a role model.
Example: Stephanie is a 15-year-old high school student who feels insecure and uncertain about her own identity. She greatly admires a popular student, Pauline, who is confident and well-liked. Stephanie starts to mimic Pauline’s clothing style, picks up similar hobbies, and even adopts similar mannerisms and speech patterns. This identification with Pauline might help Stephanie feel more confident and accepted, reducing her feelings of insecurity and anxiety.
In this example, Stephanie’s adoption of Pauline’s traits is a subconscious effort to deal with personal insecurities and to feel a part of a group.
C. REACTION FORMATION
Reaction formation is a defense mechanism where a person behaves in the opposite way to their true feelings or impulses, often due to anxiety or guilt associated with those feelings. This can lead to exaggerated expressions of the opposite behavior.
Example: Theodore is a 22-year-old who harbors hostile feelings towards a colleague. Instead of showing hostility, he goes out of his way to be overly friendly and supportive towards the colleague in question. His actions are driven by an unconscious need to suppress his true hostile feelings, leading him to adopt a facade that is diametrically opposed to how he genuinely feels.
In this scenario, Theodore’s exaggerated friendliness does not reflect his true emotions but serves as a protective barrier against the anxiety or guilt he would experience if he were to acknowledge or act upon his actual hostile impulses. This defense mechanism helps the individual maintain their self-image and avoid conflict, but it may also lead to confusion among those around them who sense the incongruence between the person's behavior and their underlying emotions.
D. PRIMITIVE IDEALIZATION
Primitive idealization is a defense mechanism in which an individual attributes exaggeratedly positive qualities to others or objects, often seeing them as perfect or infallible. This mechanism is considered primitive because it reminisces early developmental stages when the world was viewed in a somewhat simplistic, all-good, or all-bad manner.
Example: An example of someone using primitive idealization could involve a person who has just entered a new romantic relationship. Let's call this person Stan. In the throes of new love, Stan might idealize his partner, Josephine, seeing her as the epitome of perfection, without flaws, and capable of doing no wrong. This idealization isn't just a typical romantic infatuation; it's an extreme elevation of Josephine to an almost superhuman status in Stan’s eyes.
This form of idealization can serve as a psychological shield against anxiety and disappointment for Stan, as it temporarily wards off any negative feelings or realities about the relationship. However, such idealization can lead to issues down the line when Josephine’s inevitable human flaws and complexities emerge, challenging Stan’s idealized perception.
E. DISTORTION
Distortion is a defense mechanism where an individual reshapes reality to suit their internal needs, often by changing the perception of an event or situation to make it less threatening or more acceptable.
Example: An example of distortion could involve someone who fails the USMLE exam. Let’s say a medical student named Apollo has failed his exam twice. Instead of acknowledging the failure and considering the need for more study or understanding where he went wrong, Apollo convinces himself that the exam was unfairly difficult and that the questions were unreasonable. He might also believe that the exam questions were biased or that external factors, such as noise outside the exam hall, were solely to blame for his poor performance. This distorted perception allows Apollo to protect his self-esteem by externalizing the failure, thereby avoiding the internal conflict associated with acknowledging his lack of preparation or understanding.
In this case, distortion helps Apollo cope with the anxiety and disappointment of failure by reshaping the reality of the situation into one in which he is not at fault. Thus, distortion reduces the immediate emotional distress but potentially hinders personal growth and learning from the experience.
F. REGRESSION
Regression is a defense mechanism where an individual reverts to an earlier stage of development in their behavior, thoughts, or emotions, often as a way to cope with stress or anxiety.
Example: Steve, a 45-year-old accountant, had been looking forward to a weekend camping trip with his group of high school buddies. He had meticulously planned every detail and was excited to share his ideas, expecting his friends to be equally enthusiastic. However, when he presented his plans, his friends suggested an entirely different location and set of activities, reasoning that it would be more budget-friendly and accessible for everyone.
Instead of engaging in a mature discussion to reach a compromise, Steve sulked and became withdrawn, much like a sulky teenager who didn't get his way. At one point, he stomped his foot and exclaimed, "You never listen to me!" reverting to behaviors more typical of a much younger person. This regression to childlike tactics was a subconscious attempt to elicit sympathy and sway his friends' decisions in his favor, driven by the frustration of his needs and desires not being prioritized by the group.
This scenario exemplifies regression as Steve, faced with stress and disappointment from not having his plans accepted, resorts to age-inappropriate behaviors as a defense mechanism to cope with the emotional discomfort.
VERDICT: The psychological defense mechanism whereby an individual subconsciously adopts another person's ideas, behaviors, and/or traits is known as ‘identification.’ Identification is often linked to someone with whom the user has been in close contact or someone they perceive as a role model. In this case, the man has likely internalized the behavior he observed in his father during his youth, leading him to replicate this behavior in his relationship.
FINAL ANSWER: B. Identification
