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What is a psychiatric crisis?

A person with Bi-polar stops taking their medications. A person with substance abuse problem unintentionally overdoses on painkillers.

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What is the Baker act?



Involuntary placement up to 72 hoursfor evaluation or treatment because pt is a danger to himself or others.

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What is the bible of psychiatric disorders?

DSM V


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What are the 3 most common dx given to individuals who experience trauma or crisis events? 


Which comes first Acute or PTSD? How long does it last?

PTSD, Acute stress disorder, and Adjustment disorder. 


Acute stress disorder; 1 month after that it becomes PTSD.

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What do we want to do with people in crisis?

Bring them back to their PRE-crisis level.

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What happens physically during crisis? Which system?



Sympathetic Nervous system (Fight or Flight) Pupils dilate, heart rate and BP increase, digestion is inhibited, Epinephrine/Norepinephrine is secreted.

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What does the chinese symbol for crisis mean?

Danger & Opportunity

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What does LAPC stand for? Listen Ass People Commit



Listen, Assess, Plan, Commit

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What is the primary distinction made between abuse and neglect?
How many children die each day from abuse or neglect?

The distinction between commission of a behavior (abuse) and omission of a behavior (neglect). 3

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Are children that live with the father only compared to just the mother more likely to be abused?



Yes

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How much more likely is neglect or abuse if the parents use drugs and alcohol?

Neglect 4*


Abuse 3*

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Do children behavior disorders contribute to child abuse and neglect?

Yes


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Where and what are some things to look for in children that are abused? Do children have resilient tissue? How quickly check them?

Linear or loop (a possible object seen before), Behind the pinna for possible bruising or marks behind back and neck, tongue could be purple, horsness of throat, burns, a child that flinches, child becomes parent.
Yes; within 72 hours.

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What are some physical signs of abuse or neglect?

Burns, bites, bruises, broken bones, black eyes, fading bruises, reported injury by parent, difficulty walking.


No one home to provide care, dirty or poor hygiene, lacks sufficent clothing for weather.

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What are some behavioral signs of abuse or neglect?

Will cry when it's time to leave, always watching their surroundings, nightmares, bedwetting, overly compliant, abuses alcohol or drugs, doesn't want to go home

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What types of behavior do abused children display?



EXTREME, crying often or not at all, excessively fearful or fearless, aggresive or destructive, return to thumb sucking, bed wetting, or clinging.

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What are some behavioral consequences of abuse and neglect?

Developmental delay, drug & alcohol abuse, suicide, decline in academic performance.

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What are some specific points to remember when conducting an interview for a child reported of abuse?


Is there one correct way?

Be clear about confidentiality with child, 


Respect their privacy; be calm; use good listening; avoid blaming or guilt; tell the child what you are going to do when you do it. 
The interview should begin with general, informal, and nonthreatening subjects before addressing problems directly. 
Avoid notepads and clipboards to not frighten child.
No; many different

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Is it common for battered women to have grown up in homes where they were abused?

One of the most common characteristics.

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What is learned helplessness?



This develops as a result of attempting to leave or escape the abuse, but having no success. The abused partner learns to survive rather than try to escape the battering.

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What is external locus of control?

Feeling that you are not in control of own destiny, or are being controlled by luck or chance, or external factors. Outside of individuals control; someone is telling you what to do.

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Three Dx you may find in battered woman's syndrome?



PTSD, Learned helplessness, Self-destructive coping response to violence (cutting, suicide, homicide)

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What are some reasons women stay in abusive relationships?

Religious beliefs, child needs a father, fear of death or retaliation, lack of financial resources, hope that he will change, insecurity, fears of being alone, influences by pro-family societal messages.

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What are the 3 subtypes of batterers? SNP



Schizoid/borderline; moody and sensitive to interpersonal criticism, think Dr jekl/hyde. 
Narcissistic/antisocial; self centered, out for self, cold and calculating uses intimidation, threats, violence; not impulsive.
Passive-dependent/compulsive; described as passive, also rigid and tense, his way or the highway, tend to be insecure and jealous.

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What are the 2 abusive styles?

Cobra; escalates slower, enjoys the role more. Makes them get all angry, he is in control, then he calms down and "goes in for the kill" Sadistic, think sleeping with the enemy movie. 


Pitbulls; manifest less severe tendencies, which tend to manifest only in the intimate relationship. BP increases as violence does, tend to be more insecure and dependent, can be all in your face like a pitbull but not always.

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What is a TRO?

Temporary restraining order

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Explain the Power & Control wheel? 8 types of power and control used...



Using coercion and threats, using intimidation, using emotional abuse, using economic abuse, using male priviledge, using children, using isolation, minimizing denying and blaming.

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T/F Alcohol and Drugs do not cause the violence, but they alter their reality and cause them to do things they normally wouldn't do.

True


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What are the 3 phases in the cycle of violence? T/F Sometimes it doesn't end in honeymoon but in murder.

Tension-Building phase: Cycle of violence is gradual but the tension is escalating; verbal abuse, name calling, intimidating remarks. She will do everything to keep it from escalating or please him try to diffuse situation. She may begin to withdrawl, but he will pursue vehemently.
Acute battering phase: Police may be called, pinnacle of the crisis, usually physical injury. Victim feels bruised and battered, hopeless, and helpless.
Loving contrition phase - "Honeymoon" phase: Final phase, batterer apologizes and is acting love. Promises he will never do it again. 
True

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True or False Statements
Make sure when you interview the female that the batterer is in the room. It's okay to leave her alone.
Must report if you feel its domestic violence. 
If children are involved, some states mandates the abuse be reported.
Women who were battered do not become re-involved with batterers.

FALSE; TRUE; TRUE; FALSE

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Where are commonplaces for substance abusing individuals to present in crisis?



Hospitals, Schools, mental health clinics, court system.

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Is it common for pts that have psychiatric disorders to also have substance abuse dx as well? How much? What about gender/age and race?

YES; 1/3 


Males are more likely to manifest problems late teens & 20's. Women are at higher risk in their 30's. Native Americans/English/Irish decent higher rates of alcohol abuse and dependence.

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What are Valium, Librium, Xanax, Tranxene? Seconal, Pentobarbitol?
Heroin, Codeine, OxyContin, Percocet, Methadone?
What do they affect? What do they have in common with Alcohol? Effects?

Benzodiazepines 


Barbitturates
Opiods
CNS
Depressants
Intoxicating effects, slowed speech & movement, unstable gait, slower everything.

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What do drugs like cocaine, amphetamines, crystal meth, or ritalin do?

Stimulate, excitation, rapid speech, agitation, decreased need for sleep.

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What happens with withdrawls of depressants? Stimulates?



Usually opposite effect, Stimulates = depressed w/d; Depressants = agitation or stimulation

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Can alcohol withdrawls range from mild agitation to tremors to hallucinations? Most severe withdrawl?

YES; DT delirium tremors

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What are the 4 different crisis (substance) for alcohol or drugs?



Substance intoxification (under the influence); Substance withdrawl (state of alcohol or drug withdrawl); Substance dependence (unable to stop using or gets in trouble); Substance abuse (intermittent problems related to drug or alcohol use)

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What is the Marchmann Act?

Baker Act related to Alcohol and Drugs

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What is Exparte?



Talking to a judge to issue a baker act.

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What is a tarrasoff?

A duty to warn. IF someone tells you, I am going to kill so and so. You have the duty to tell them.

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4 recommendations for crisis counselors working with substance use disorder patients?



1. Alcoholic and drug addicted pts minimize or outright deny the seriousness; DON'T BE PUT OFF!
2. DON'T be JUDGEMENTAL or BLAME 
3. When in DOUBT, get a TOX SCREEN!
4. Don't leave an intoxicated person unattended!

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What is a paradoxical reaction? 2 examples

When we give a medication and we think it will have a specific effect but it has the opposite effect. Examples: ADHD meds on people without it, Ativan- antianxiety but makes more agitated.

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T/F Important to listen to distress and offer support. (This must be difficult for you) DO NOT state That you'll get someone back, and I know how you feel.



TRUE

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What is Iatrogenic addiction?

Caused by medical intervention. Someone who injures themselves and they have back issues, now they are addicted to their drug given.

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What is Triangulation?



A third party is dragged into a conflict. Child wants a new sneaker. Goes to dad, dad says no. goes to mom, mom says no.

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What is Collusion?

A parent might collude with or confide in a son or daughter who then takes sides against the other parent.

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3 most commonpsychiatric disorders common with suicide?



Depression, schizophrenia, substance use disorder.

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T/F Men have a higher suicide completion rate then women?
Women, young and older attempt suicide at a higher rate & more depressed?

TRUE; TRUE

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3 THREE THINGS related to psychosis or schizophrenia



DELUSIONS, HALLUCINATIONS, OUT OF CONTACT W REALITY

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Possible suicide?

If you see someone becoming overly compliant, they have an anterior motive. You need to ask: Are you thinking about killing yourself and do you have a plan.

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What is dual dx?



When someone has schizophrenia and using polysubstances

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What is the Mnemonic for Assessing suicide risk? Stand for?

SAD PERSONS 


Sex, Age, Depression, Previous suicide attempts, Ethanol, Rational thinking loss, Social supports lacking, Organized plan to commit suicide, No spouse, Sickness

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What are some statements that feel suicidal?

Nobody needs me, the world is better without me, you don't have to worry about me much longer

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T/F Once the depression has lifted, the suicide is decreased.



FALSE When you have more energy, you have more energy to act on the suicide.

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What do you do about suicide risk?

You need to assess, ask, discuss it, you are going to look at lethal items (weapons) they might have and maintain contact. Focus on problem solving. Then commit to a plan of action.

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What is Post-Partum Depression? Can dad's have it too?



After you have a child, you don't feel the same. Hormones are in disarray. They can start to feel the blues to heavy duty depression. Can also go into psychosis
Dads can also go through PPD

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T/F Assessing Homicidal Risk
PCP- Super human strength and insensitivity to pain?
The best predictor of future violence is prior violence?

TRUE; TRUE

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3 types of mental disorders associated with violence or homicidal behavior?



Intermittent Explossive Disorder, Paranoid Schizophrenia, Antisocial Personality disorder

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Do men who rape have many different characteristics?

YES


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Define Rape

Rape is defined as unwanted sexual contact with or without the use of force, fondling, and verbal threats.

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Most frequent form of rape?

Acquaintance date rape is the most frequent form of rape. Within a friendship or date; big problem in college.

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Some reasons only reported 16% of the time.



It embarrasses the victim, not all of them are violent. A lot of reasons people do not report: fear, a one-time thing, shame, police not listening to them, want to protect the attacker.

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T/F No single theory holds the key to the question of why men rape, rather a combination of societal, relational, and individual factors.

TRUE


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What is the most common dx for someone who would rape?

Antisocial personality Disorder

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4 main characteristics of someone that rapes.

Sexually aggressive; bad attitudes towards women; high arousal to rape stimuli; loss of control or aggression to women

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What is the feminist perspective view of rape?



An act of men's social control over women.

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Four main characteristics of rapists?

Sexually aggressive previously;


Bad attitudes towards women;
High arousal to rape stimuli;
Depression or hostility lead to loss of control or aggression to women

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What are the Psych components of a rape? T/F Sometimes the factors are more devastating than the rape itself.

Acute Stress Disorder and PTSD result


TRUE

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If you have been a victim of domestic violence, and are a female, what would one of the most lethal comments you could make that could alert that something needs to be done?

I think he will kill me and I believe it.

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Difference between Compazine, Haldol, Clozaril, Risperdol, Abilify.


What reaction or syndrome can any of these meds combined cause?

Compazine- antipsychotic- given for nausea and vomiting 


Worried about SE
Haldol- given for individuals who are acutely psychotic or who are dying, used to calm down, given instead of the benzos
Clozaril- need a CBC and look at WBC
Risperdol- endo system. 
Abilify- one of the meds that people prescribe for everything. It assists with depacote if they are bipolar. Sleep, anxiety, for schizophrenia.
Acute dystonic reaction and neurolytic malignant syndrome will be for any one of these.

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What are Acute Distonic Reaction & Neuroleptic malignant syndrome?

Acute Distonic Reaction; you give the shot and they go paralyzed in arms and eyes. They can't swallow and they have muscle rigidity. 


eyeballs can roll up and look at brain
Neuroleptic malignant syndrome
temperature elevation, vitals are all over the place. Muscle rigidity, change in level of consciousness.

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Difference between Bipolar & Schizophrenia?

Bipolar = Mood Disorder 


Schizophrenia = Thought disorder

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T/F Antipsychotic meds: After WWII; thorazine; antipsychotic. Used for Schizophrenia
3 things; delusions, hallucinations, and out of contact w reality?

TRUE


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What does SSRI stand for?

SSRI stands for Selective Serotonin Reuptake Inhibitor

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What Pathological grief reactions are often characterized by major psychiatric symptoms?

Pathological grief reaction often characterized by major psychiatric symptoms, such as severe depression, suicidal ideation, extreme agitation, or restlessness, coping, ability, level of maturity.

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T/F Coping with grief will be determined by how people have dealt with crises in the past.



TRUE

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Sudden death vs expected death

Sudden death is more difficult for some people; can be immobilizing. Expected death people have had to grieve or come to grips with the loss before hand; some people don't even cry.

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Does everyone grieve differently?



YES; Children, adolescents, and adults all grieve differently

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5 stages of acceptance of medical illness or grieveing process.

Denial, Anger, Bargaining, Depression, Acceptance

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Component to depression.


Depression is in ___ range, Bi-polar is in ___ & ____ range?

They do not always look depressed.


They sleep a lot or have insomnia.
Depression is in the Sad range
Bipolar is in sad and happy range

Anxiety & Fear

• universal human experience 
• Anxiety: feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat. 
• Fear: reaction to a specific danger
• Anxiety: vague sense of dread related to an unspecified or unknown danger; affects at a deeper level than fear → invades the central core of the personality and erodes feelings of self-esteem and personal worth.
• The body physiologically reacts in similar ways to both anxiety and fear.

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Levels of Anxiety

• Four levels: mild, moderate, severe, and panic (Peplau, • boundaries between these levels are not distinct


• the behaviors and characteristics of individuals experiencing anxiety can and often overlap.

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Mild Anxiety

• occurs in the normal experience of everyday living


• allows an individual to perceive reality in sharp focus
• person sees, hears, and grasps more information
• problem solving becomes more effective
• physical symptoms may include slight discomfort, restlessness, irritability, or mild tension-relieving behaviors (e.g., nail biting, foot or finger tapping, fidgeting).

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Moderate Anxiety

• As anxiety increases, the perceptual field narrows → some details are excluded from observation


• person sees, hears, and grasps less information and may demonstrate selective inattention, in which only certain things in the environment are seen or heard unless they are pointed out. 
• ability to think clearly is hampered
• learning and problem solving can still take place, although not at an optimal level
• Physical symptoms include tension, pounding heart, increased pulse and respiratory rate, perspiration, and mild somatic symptoms (gastric discomfort, headache, urinary urgency). 
• Voice tremors and shaking may be noticed.
• Mild or moderate anxiety levels can be constructive, because anxiety may be a signal that something in the person's life needs attention or is dangerous.

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Severe Anxiety

• The perceptual field of a person experiencing severe anxiety is greatly reduced. 


• person may focus on one particular detail or many scattered details and have difficulty noticing what is going on in the environment, even when it is pointed out by another. 
• Learning and problem solving are not possible at this level
• Person may be dazed and confused.
• Behavior is automatic and aimed at reducing or relieving anxiety. 
• Somatic symptoms (headache, nausea, dizziness, insomnia) often increase; trembling and a pounding heart are common, and the person may experience hyperventilation and a sense of impending doom or dread

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Panic

• most extreme level of anxiety


• results in markedly disturbed behavior
• Person is unable to process what is going on in the environment and may lose touch with reality. 
• The behavior that results may be manifested as pacing, running, shouting, screaming, or withdrawal. 
Hallucinations, or false sensory perceptions (e.g., seeing people or objects not really there), may be experienced. 
• Physical behavior may become erratic, uncoordinated, and impulsive. 
• Automatic behaviors are used to reduce and relieve anxiety, although such efforts may be ineffective. 
• Acute panic may lead to exhaustion.

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Defense Mechanisms

• automatic coping styles that protect people from anxiety and maintain self-image by blocking feelings, conflicts, and memories.


• Although they operate all the time, defense mechanisms are not always apparent to the individual using them. 
• Adaptive use of defense mechanisms helps people lower anxiety to achieve goals in acceptable ways. 
• Maladaptive use of defense mechanisms occurs when one or several are used in excess, particularly in the overuse of immature defenses. 
• With the exception of sublimation and altruism, which are always healthy coping mechanisms, all defense mechanisms can be used in both healthy and unhealthy ways. 
• evaluating whether the use of defense mechanisms is adaptive or maladaptive is determined for the most part by their frequency, intensity, and duration of use.

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Compensation

• used to make up for perceived deficiencies and cover up shortcomings related to these deficiencies to protect the conscious mind from recognizing them.

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Conversion



• the unconscious transformation of anxiety into a physical symptom with no organic cause.
• often the symptom functions to gain attention or as an excuse.

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Denial

• escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence.

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Displacement



• the transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation.

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Dissociation

• a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment.


• may result in a separation between feeling and thought. 
• can also manifest itself in compartmentalizing uncomfortable or unpleasant aspects of oneself.

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Identification

• attributing to oneself the characteristics of another person or group. 


• may be done consciously or unconsciously.

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Intellectualization

• process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing.

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Introjection



• process by which the outside world is incorporated or absorbed into a person's view of the self.

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Projection

• refers to the unconscious rejection of emotionally unacceptable features and attributing them to other people, objects, or situations.


• "What you say is what you are."

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Rationalization

• consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener.

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