The nurse is caring for a patient with narcissistic personality disorder in a long-term care facility. The patient says that a fellow patient “always talks and thinks about nothing but himself.” The nurse’s experience with this patient has been different. He always seems very humble and self-effacing. Which defense mechanism is this patient displaying?

Question

The nurse is caring for a patient with narcissistic personality disorder in a long-term care facility.  The patient says that a fellow patient &ldquo;always talks and thinks about nothing but himself.&rdquo;  The nurse&rsquo;s experience with this patient has been different. He always seems very humble and self-effacing.  Which defense mechanism is this patient displaying?

Accepted Answer

Projection. Patients with narcissistic personality disorder thinks and talks about nothing but himself.  When this narcissistic patient categorizes a self-effacing fellow patient as someone who is concerned only with himself, then he is displaying projection.  Projection is the misattribution of one&rsquo;s own faults, impulses, character traits onto those who do not exhibit those traits or have those impulses.  Sublimation is a mature defense mechanism and is the channeling of unacceptable impulses, thoughts and emotions into more acceptable ones.  Denial, a primitive defense mechanism, is the refusal to acknowledge or admit a situation or reality.  Regression is the retreat into earlier stages of development when confronted by unacceptable thoughts or emotions.

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