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A 54-year-old man with a history of poorly con- trolled hypertension complains of new-onset headaches. His mother passed away at an early age due to a stroke, and his father died of a myocardial infarction. When asked why he does not take better care of his blood pressure, he states that he is so busy with work and with the church that, by the end of the day, he often forgets to take his pills. He states that he “feels fine, anyway.” What ego defense mechanism is this patient using?

  1. (A) Denial
    (B) Displacement 

  2. (C) Projection
    (D) Rationalization 

  3. (E) Repression

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1 Answer

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The correct answer is A. The mechanism of denial is when one fails to recognize the obvi- ous implications or consequences of a thought, act, or situation. This ego defense mechanism is often seen in patients with recently diag- nosed HIV or cancer.

Answer B is incorrect. Displacement is a de- fense mechanism whereby ideas and feelings that a patient wishes to avoid are transferred to another person or object; for example, a pa- tient who yells at the nurse because he is angry at news he has just received from the doctor.

Answer C is incorrect. Projection is the pro- cess of attributing one’s thoughts or impulses, usually ones that are unacceptable or undesir- able, to another person.

Answer D is incorrect. Rationalization pro- duces a more socially acceptable and apparently more or less logical explanation for an act or decision actually produced by uncon- scious impulses. This patient’s assertion that he “feels fine, anyway” may be a form of rational- ization, but the primary ego defense mecha- nism that he is using is denial.

Answer E is incorrect. Repression is the un- conscious exclusion of a painful or anxiety- provoking thought, impulse, or memory from awareness.

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