Defence mechanism

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In psychoanalytic theory, a defence mechanism is an unconscious psychological operation that functions to protect a person from anxiety-producing thoughts and feelings related to internal conflicts and outer stressors. [1] [2] [3]

Contents

According to this theory, healthy people normally use different defence mechanisms throughout life. A defence mechanism can potentially 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 ego defence mechanisms is to protect the mind/self/ego from anxiety or social sanctions or to provide a refuge from a situation with which one cannot currently cope. [4]

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; [5] 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; [6] 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. [7]

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. [8]

Theories and classifications

In the first definitive book on defence mechanisms, The Ego and the Mechanisms of Defence (1936), [9] 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. [10]

Sigmund Freud posited that defence mechanisms work by distorting id impulses into acceptable forms, or by unconscious or conscious blockage of these impulses. [9] 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. [11]

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". [9] 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. [12]

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. [13]

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). [14]

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. [15] 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. [16]

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) [17] and Cramer (1991). [18] The Journal of Personality published a special issue on defence mechanisms (1998). [19]

Vaillant's categorization

Psychiatrist George Eman Vaillant introduced a four-level classification of defence mechanisms: [20] [21] 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. [22] The focus of the study is to define mental health rather than disorder.

Level 1: pathological

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. [23] They include:

Level 2: immature

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. [23] They include:

Level 3: neurotic

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. [23] They include:

Level 4: mature

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. [23] Mature defences include:

Perry's defence mechanism rating scale (DMRS)

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." [30] Additions have been made to modify and add to the scale over the years, creating the DMRS self report and DMRS-Q sort. [31]

Level 1: Action defences

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

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

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

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

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

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

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. [32] [33] [34]

Relation with coping

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 ration to stabilize negative emotions and stressors. This differs from defence, which is driven by impulse and urges. [35] [36]

Similarities between coping and defense mechanisms have been extensively studied in relation to various mental health conditions, such as depression, anxiety, and personality disorders. [37] Research indicates that these mechanisms often follow specific patterns within different disorders, with some, like avoidant coping, potentially exacerbating future symptoms. [38] This aligns with the vulnerability-stress psychopathology model, which involves two core components: vulnerability (non-adaptive mechanisms and processes) and stress (life events). [39] 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. [40] Coping and defence mechanisms work in tandem to balance out feelings of anxiety or guilt, categorizing them both as a "mechanisms of adaptation." [41]

See also

Related Research Articles

Psychoanalysis is a set of theories and therapeutic techniques that deal in part with the unconscious mind, and which together form a method of treatment for mental disorders. The discipline was established in the early 1890s by Sigmund Freud, whose work stemmed partly from the clinical work of Josef Breuer and others. Freud developed and refined the theory and practice of psychoanalysis until his death in 1939. In an encyclopedic article, he identified the cornerstones of psychoanalysis as "the assumption that there are unconscious mental processes, the recognition of the theory of repression and resistance, the appreciation of the importance of sexuality and of the Oedipus complex." Freud's colleagues Alfred Adler and Carl Gustav Jung developed offshoots of psychoanalysis which they called individual psychology (Adler) and analytical psychology (Jung), although Freud himself wrote a number of criticisms of them and emphatically denied that they were forms of psychoanalysis. Psychoanalysis was later developed in different directions by neo-Freudian thinkers, such as Erich Fromm, Karen Horney, and Harry Stack Sullivan.

Neurosis is a term mainly used today by followers of Freudian thinking to describe mental disorders caused by past anxiety, often that has been repressed. In recent history, the term has been used to refer to anxiety-related conditions more generally.

In psychoanalytic theory, the id, ego and superego are three distinct, interacting agents in the psychic apparatus, defined in Sigmund Freud's structural model of the psyche. The three agents are theoretical constructs that Freud employed to describe the basic structure of mental life as it was encountered in psychoanalytic practice. Freud himself used the German terms das Es, Ich, and Über-Ich, which literally translate as "the it", "I", and "over-I". The Latin terms id, ego and superego were chosen by his original translators and have remained in use.

Psychoanalytic theory is the theory of personality organization and the dynamics of personality development relating to the practice of psychoanalysis, a clinical method for treating psychopathology. First laid out by Sigmund Freud in the late 19th century, psychoanalytic theory has undergone many refinements since his work. The psychoanalytic theory came to full prominence in the last third of the twentieth century as part of the flow of critical discourse regarding psychological treatments after the 1960s, long after Freud's death in 1939. Freud had ceased his analysis of the brain and his physiological studies and shifted his focus to the study of the psyche, and on treatment using free association and the phenomena of transference. His study emphasized the recognition of childhood events that could influence the mental functioning of adults. His examination of the genetic and then the developmental aspects gave the psychoanalytic theory its characteristics.

Psychology is an academic and applied discipline involving the scientific study of human mental functions and behavior. Occasionally, in addition or opposition to employing the scientific method, it also relies on symbolic interpretation and critical analysis, although these traditions have tended to be less pronounced than in other social sciences, such as sociology. Psychologists study phenomena such as perception, cognition, emotion, personality, behavior, and interpersonal relationships. Some, especially depth psychologists, also study the unconscious mind.

Psychological projection is a defence mechanism of alterity concerning "inside" content mistaken to be coming from the "outside" Other. It forms the basis of empathy by the projection of personal experiences to understand someone else's subjective world. In its malignant forms, it is a defense mechanism in which the ego defends itself against disowned and highly negative parts of the self by denying their existence in themselves and attributing them to others, breeding misunderstanding and causing untold interpersonal damage. Projection incorporates blame shifting and can manifest as shame dumping. Projection has been described as an early phase of introjection.

<span class="mw-page-title-main">Sublimation (psychology)</span> Psychological defense mechanism

In psychology, sublimation is a mature type of defense mechanism, in which socially unacceptable impulses or idealizations are transformed into socially acceptable actions or behavior, possibly resulting in a long-term conversion of the initial impulse.

In psychology, displacement is an unconscious defence mechanism whereby the mind substitutes either a new aim or a new object for things felt in their original form to be dangerous or unacceptable.

In psychology, introjection is the unconscious adoption of the thoughts or personality traits of others. It occurs as a normal part of development, such as a child taking on parental values and attitudes. It can also be a defense mechanism in situations that arouse anxiety. It has been associated with both normal and pathological development.

Coping refers to conscious or unconscious strategies used to reduce and manage unpleasant emotions. Coping strategies can be cognitions or behaviors and can be individual or social. To cope is to deal with struggles and difficulties in life. It is a way for people to maintain their mental and emotional well-being. Everybody has ways of handling difficult events that occur in life, and that is what it means to cope. Coping can be healthy and productive, or destructive and unhealthy. It is recommended that an individual cope in ways that will be beneficial and healthy. "Managing your stress well can help you feel better physically and psychologically and it can impact your ability to perform your best."

Isolation is a defence mechanism in psychoanalytic theory, first proposed by Sigmund Freud. While related to repression, the concept distinguishes itself in several ways. It is characterized as a mental process involving the creation of a gap between an unpleasant or threatening cognition and other thoughts and feelings. By minimizing associative connections with other thoughts, the threatening cognition is remembered less often and is less likely to affect self-esteem or self concept. Freud illustrated the concept with the example of a person beginning a train of thought and then pausing for a moment before continuing to a different subject. His theory stated that by inserting an interval, the person was "letting it be understood symbolically that he will not allow his thoughts about that impression or activity to come into associative contact with other thoughts." As a defense against harmful thoughts, isolation prevents the self from allowing these cognitions to become recurrent and possibly damaging to the self-concept.

Repression is a key concept of psychoanalysis, where it is understood as a defense mechanism that "ensures that what is unacceptable to the conscious mind, and would if recalled arouse anxiety, is prevented from entering into it." According to psychoanalytic theory, repression plays a major role in many mental illnesses, and in the psyche of the average person.

Ego psychology is a school of psychoanalysis rooted in Sigmund Freud's structural id-ego-superego model of the mind.

In psychology, intellectualization (intellectualisation) is a defense mechanism by which reasoning is used to block confrontation with an unconscious conflict and its associated emotional stress – where thinking is used to avoid feeling. It involves emotionally removing one's self from a stressful event. Intellectualization may accompany, but is different from, rationalization, the pseudo-rational justification of irrational acts.

<span class="mw-page-title-main">Self-destructive behavior</span> Behaviours that are harmful to the individual engaging in them

Self-destructive behavior is any behavior that is harmful or potentially harmful towards the person who engages in the behavior.

Splitting is the failure in a person's thinking to bring together the dichotomy of both perceived positive and negative qualities of something into a cohesive, realistic whole. It is a common defense mechanism wherein the individual tends to think in extremes. This kind of dichotomous interpretation is contrasted by an acknowledgement of certain nuances known as "shades of gray".

Stress-related disorders constitute a category of mental disorders. They are maladaptive, biological and psychological responses to short- or long-term exposures to physical or emotional stressors. The National Institute of Environmental Health Sciences categorizes Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) as stress-related disorders. However, the World Health Organization's ICD-11 excludes OCD but categorizes PTSD, Complex Post-Traumatic Stress Disorder (CPTSD), adjustment disorder as stress-related disorders.

Narcissistic defenses are those processes whereby the idealized aspects of the self are preserved, and its limitations denied. They tend to be rigid and totalistic. They are often driven by feelings of shame and guilt, conscious or unconscious.

<span class="mw-page-title-main">Freud's psychoanalytic theories</span> Look to unconscious drives to explain human behavior

Sigmund Freud is considered to be the founder of the psychodynamic approach to psychology, which looks to unconscious drives to explain human behavior. Freud believed that the mind is responsible for both conscious and unconscious decisions that it makes on the basis of psychological drives. The id, ego, and super-ego are three aspects of the mind Freud believed to comprise a person's personality. Freud believed people are "simply actors in the drama of [their] own minds, pushed by desire, pulled by coincidence. Underneath the surface, our personalities represent the power struggle going on deep within us".

Denial or abnegation is a psychological defense mechanism postulated by psychoanalyst Sigmund Freud, in which a person is faced with a fact that is too uncomfortable to accept and rejects it instead, insisting that it is not true despite what may be overwhelming evidence.

References

  1. ↑ Mariagrazia DG, John CP, Ciro C, Omar CG, Alessandro G (December 2020). "Defense Mechanisms, Gender, and Adaptiveness in Emerging Personality Disorders in Adolescent Outpatients". The Journal of Nervous and Mental Disease. 12 (208): 933–941. doi:10.1097/NMD.0000000000001230. PMID   32947450. S2CID   221797283.
  2. ↑ American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Press
  3. ↑ Schacter, Daniel L. (2011). Psychology (2 ed.). New York: Worth Publishers. pp. 482–483]. ISBN   978-1-4292-3719-2.
  4. ↑ "defence mechanisms -- Britannica Online Encyclopedia". www.britannica.com. Retrieved 2008-03-11.
  5. ↑ Chalquist, Craig. "A Glossary of Freudian Terms" Archived 2018-12-28 at the Wayback Machine 2001. Retrieved on 05 October 2013.
  6. ↑ "Rationalization". American Psychological Association.
  7. ↑ "Sublimation". American Psychological Association.
  8. ↑ 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
  9. 1 2 3 Freud, A. (1936). The Ego and the Mechanisms of Defence, London: Hogarth Press and Institute of Psycho-Analysis. (Revised edition: 1966 (US), 1968 (UK))
  10. ↑ Lipot Szondi (1956) Ego Analysis Ch. XIX, translated by Arthur C. Johnston, p. 268
  11. ↑ Romanov, E.S. (1996). Mechanisms of psychological defense: genesis, functioning, diagnostics.
  12. 1 2 3 4 5 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.
  13. ↑ Kernberg O (July 1967). "Borderline personality organization". J Am Psychoanal Assoc. 15 (3): 641–85. doi:10.1177/000306516701500309. PMID   4861171. S2CID   32199139.
  14. ↑ 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.
  15. ↑ American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
  16. ↑ "On the Distortion of Time: An Unexplored Ego Defense Mechanism". International Research Journal of Modernization in Engineering Technology and Science. 2023-10-01. ISSN   2582-5208.
  17. ↑ 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.
  18. ↑ Cramer, P. (1991). The Development of Defense Mechanisms: Theory, Research, and Assessment. New York, Springer-Verlag.
  19. ↑ Special issue [on defense mechanisms], Journal of Personality (1998), 66 (6): 879–1157
  20. ↑ Cramer, Phebe (May 2006). Protecting the Self. The Guilford Press. p.  17. ISBN   9781593855284.
  21. ↑ 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.
  22. ↑ Vailant, George (1977). Adaptation to Life. Boston: Little Brown. ISBN   0-316-89520-2.
  23. 1 2 3 4 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
  24. ↑ 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.
  25. ↑ Bailey, Ryan; Pico, Jose (2022), "Defense Mechanisms", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   32644532 , retrieved 2022-06-28
  26. ↑ "isolation of affect". Oxford Reference. Retrieved 2022-06-28.
  27. ↑ Laplanche pp. 390, 392[ full citation needed ]
  28. ↑ Psychological Defenses from DSM-IV (see Repression), Virginia Commonwealth University. Retrieved on December 12, 2014.
  29. ↑ Schacter, Gilbert, Wegner (2011), Psychology (2nd edition), Worth Publishers, p. 483
  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, Elsevier, pp. 165–192, doi:10.1016/s0166-4115(04)80034-7, ISBN   978-0-444-51263-5 , retrieved 2024-05-02
  31. ↑ 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.
  32. ↑ 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.
  33. ↑ "APA PsycNet". psycnet.apa.org. Retrieved 2024-05-02.
  34. ↑ User, Super. "The DMRS-Q". dmrs-q.com (in Italian). Retrieved 2024-05-02.{{cite web}}: |last= has generic name (help)
  35. ↑ Haan, Norma (1977). Coping and defending : processes of self-environment organization. Internet Archive. New York : Academic Press. ISBN   978-0-12-312350-3.
  36. ↑ 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.
  37. ↑ 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.
  38. ↑ 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.
  39. ↑ 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.
  40. ↑ 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.
  41. ↑ 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.
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