Question:

A 14-year-old boy is brought to the office by his parents, who are worried about his reaction to their recent decision to divorce. Despite their efforts to be supportive and engage him, he has not expressed any feelings directly about the divorce. When the patient is evaluated alone, he shares that he feels his parents are angry with him, although he cannot think of any instances when they expressed any anger toward him. On examination, the patient appears sullen and reports his mood is "fine." This patient is most likely using which of the following defense mechanisms?

Acting out

Displacement

Identification

Projection

Reaction formation

Regression

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Explanation:

Key defense mechanisms
Immature	Acting out: Expressing unacceptable feelings through actions Denial: Behaving as if an aspect of reality does not exist Displacement: Transferring feelings to less threatening object/person Intellectualization: Focusing on nonemotional aspects to avoid distressing feelings Passive aggression: Avoiding conflict by expressing hostility covertly Projection: Attributing one’s own feelings to others Rationalization: Justifying behavior to avoid difficult truths Reaction formation: Transforming unacceptable feelings/impulses into the opposite Regression: Reverting to earlier developmental stage Splitting: Experiencing a person/situation as either all positive or all negative
Mature	Sublimation: Channeling impulses into socially acceptable behaviors Suppression: Putting unwanted feelings aside to cope with reality

Projection is an immature defense mechanism that involves misattributing undesired thoughts or feelings to another person who does not actually have them to avoid acknowledgement in oneself. This patient is likely angry with his parents about the divorce, and, due to his inability to acknowledge these feelings, he projects them onto his parents. As a result, he perceives that his parents are angry with him, even though there is little evidence that they feel this way. Projection commonly occurs in patients who lack insight into their own motivations and feelings.

(Choice A) Acting out refers to expressing unwanted thoughts or impulses through actions (eg, if the boy expressed his anger by destroying his parents' wedding photographs).

(Choice B) Displacement involves redirecting unacceptable thoughts, feelings, and impulses intended for one person to a more neutral person or object (eg, if this patient redirected his anger at his parents toward a sibling).

(Choice C) Identification refers to modeling one's behavior after someone who is perceived to be more powerful or prestigious. A classic example is the child of an abusive father who becomes a child abuser himself.

(Choice E) Reaction formation is the transformation of an unacceptable feeling to its opposite (eg, if instead of expressing anger, this patient behaved in an overly affectionate way toward his parents and enthusiastically supported their decision to divorce).

(Choice F) Regression refers to reverting to a less mature way of coping with difficulties (eg, if this patient began sleeping in his parents' room due to anxiety about being alone, which is more characteristic of an earlier developmental stage).

Educational objective:
Projection is an immature defense mechanism involving the misattribution of one's unacceptable feelings or thoughts to another person who does not actually have them.