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Emis Assessment Part 1 Home HiYield Paper A(1) Assessment EMIs Assessment Part 1 HiYield Paper A(1) Started on Saturday, 3 October 2015, 2:24 AM State Finished Completed on Saturday, 3 October 2015, 3:03 AM Time taken 38 mins 47 secs Marks 0.00/228.00 Grade 0.00 out of 100.00 Question 1 HiY Assessment CXEMI001 Not answered Self harm and defence mechanisms Marked out of 5.00 A 22­year­old woman was admitted to the psychiatric ward with history of depression and recurrent attempts to harm herself using razors. She is complaining of chronic feelings of emptiness and constant fear of abandonment. She has no friends and is not in any relationship. From the list above, Flag question match the most likely defence mechanisms being described below. Each option can be used once, more than once or not at all. 1. She tells that the consultant who wants her to stay on the ward is an excellent professional, but the nurses are being irrational and insist that she should be discharged. (Choose THREE) 2. Her arms and legs show superficial lacerations of self­cutting (Choose ONE) 3. She has had psychotherapy in the past. The trainee therapist started feeling depressed and went off sick after seeing her for a few sessions, the (Choose ONE) Check The diagnosis is borderline personality disorder. The defence mechanisms used in borderline PD patients are splitting, idealisation and denigration. Splitting is often seen in patients with borderline personality disorder. Here qualities of an object or person are split into black and white i.e. either good or bad without any middle ground or grey area in between. Idealisation and denigration: This is often accompanied by splitting in those with borderline traits. Here an object is either glorified, and supremacy is ascribed (idealised, omnipotence ascribed) or considered very negatively and cursed! (Denigration). The defence mechanism used here is 'Turning against the self' which is unconscious deflection of hostility towards another person onto oneself resulting in lowered self­esteem, self­criticism and at times injury to self. It is seen in patients with severe depression, deliberate self­harm and suicide. Projective identification occurs when an aspect of self is projected onto someone else. The projector influences the recipient to identify with what has been projected and projector herself now believes that the aspect originated from the reactor. This process may result in the recipient behaving in a manner similar to the projector. Here the therapist is the recipient, and the patient is the projector. The feelings of depression have now been projected onto the therapist. The correct answer is: She tells that the consultant who wants her to stay on the ward is an excellent professional, but the nurses are being irrational and insist that she should be discharged. (Choose THREE) ­ Splitting, Denigration, Idealisation, Her arms and legs show superficial lacerations of self­cutting (Choose ONE) ­ Turning against the self, She has had psychotherapy in the past. The trainee therapist started feeling depressed, helpless and went on protracted medical leave after seeing her for a few sessions. (Choose ONE) ­ Projective identification Question 2 HiY Assessment EMI002 Not answered Disorders and Freudian defences Match the following condition with the most likely defence mechanisms provided in the list. Each option can be used once, more than once or not at all. Marked out of 8.00 Flag question Obsessive compulsive disorder Choose... Impulse control disorders Choose... Grief Choose... Suicide Choose... Fugue Choose... Check Isolation: Splitting or separating an idea from the affect that accompanies it but is repressed. Splitting is the defence mechanism used in patients with obsessional thoughts. Isolation of affect is also seen in grief reaction, and the patient can discuss a major loss or stressful events without the associated disturbing emotions, with the passage of time. Patients with OCD exhibit isolation (of affect), reaction formation and undoing. Reaction formation involves transforming an unacceptable impulse into its exact opposite. If these defenses are frequently used at any early stage of ego development, it can become a permanent character trait, contributing to an obsessional personality. Acting out refers to an expression of an unconscious wish or impulse through action to avoid being conscious of an accompanying affect; it is seen in impulse control disorders. Introjection refers to unconscious internalization of qualities of an object or person. It is seen in depression, grief reaction and is featured by identification with the aggressor (e.g. in victims kidnapped by terrorists, also called as Stockholm syndrome). Turning against the self is unconscious deflection of hostility towards another person onto oneself resulting in lowered self­esteem, self­criticism and at times injury to self. It is seen in patients with severe depression, deliberate self­harm and suicide. Both fugue states and conversion reactions are seen as manifestations of dissociation. Dissociation also accompanies a counterphobic behaviour; here a person with fear of heights takes up parachute diving and experiences dissociation during the act. The correct answer is: Obsessive compulsive disorder – Isolation, Impulse control disorders – Acting out, Grief – Introjection, Suicide – Turning against the self, Fugue – Dissociation Question 3 HiY Assessment EMI003 Not answered Defence mechanisms in clinical practice From the list given here, match the most likely defence mechanisms being described below Marked out of 5.00 Flag question A 45­year­old man was frustrated caused by problems at work. He became violent at home towards his wife Choose... and children A 65­year­old woman has been diagnosed with breast cancer. She is refusing to accept that she has cancer Choose... A 25­year­old man tells 'I find gardening a good outlet for my pent­up aggression.' Choose... Since the death of her long­term partner, a 45­year­old woman has been acting like a child. She is losing Choose... her temper and is eating excessively for comfort A 55­year old woman was talking about her car accident when she lost her partner, without any display of Choose... emotions Check 1. This scenario refers to a displacement­ transferring our feelings from their true target onto a harmless substitute target. 2. This scenario refers to Denial, which is failing/refusing to acknowledge/perceive some aspect of reality. In this case, refusing to accept that they have a serious illness. 3. Sublimation is a mature defence mechanism in which a socially positive substitute activity is found for expressing some unacceptable impulse. 4. Regression is reverting to behaviour characteristic of an earlier stage of development such as losing your temper; comfort eating, sleeping more when depressed. 5. Isolation is separating contradictory thoughts and feelings into logic­tight compartments like the example above talking about some traumatic experience without any display of emotions or even giggling about it. The correct answer is: A 45­year­old man was frustrated caused by problems at work. He became violent at home towards his wife and children – Displacement, A 65­year­old woman has been diagnosed with breast cancer. She is refusing to accept that she has cancer – Denial, A 25­year­old man tells 'I find gardening a good outlet for my pent­up aggression.' – Sublimation, Since the death of her long­term partner, a 45­year­old woman has been acting like a child. She is losing her temper and is eating excessively for comfort – Regression, A 55­year old woman was talking about her car accident when she lost her partner, without any display of emotions – Isolation Question 4 HiY Assessment EMI004 Not answered Defence mechanisms in daily life From the list above, match the most likely defence mechanisms being described below Marked out of 5.00 Flag question A 27­year old man made a voluntary decision to not to think about an argument with his girlfriend he had earlier when Choose... going for an interview A 45­year­old man hit his wife and tells he is cruel 'for her own sake'. 'I only did it because I love you.' Choose... A 16­year­old girl hated her classmate and disliked him. However, she is very polite and even went out of her way to being Choose... nice to him. A 24­year­old woman with personality disorder tells her distress is the fault of others whom she blames and has never Choose... done anyone any harm. A 5­year­old boy started to behave like his father and seemed to have acquired the mannerisms and qualities of his dad. Choose... Check 1. This is suppression, which is "consciously or semiconsciously postponing the attention to a conscious impulse or conflict. Issues may be deliberately cut off, but they are not avoided. Discomfort is acknowledged but minimised" (DSM­IV). 2. The defence mechanism used here is rationalisation, which involves the use of rational explanations in order to justify one's otherwise unacceptable attitudes or behaviours. Such underlying motives are usually instinctually determined. It often involves finding excuses that will justify unacceptable behaviours when self­esteem is threatened, often seen in teenagers and those who abuse alcohol and drugs. 3. This scenario describes reaction formation which is being considerate/polite to someone you strongly dislike and even going out of her way to be nice to them. Reaction formation involves transforming an unacceptable impulse into its exact opposite. 4. The defence mechanism used here is projection, which is displacing your unacceptable feelings/characteristics onto someone else. 5. This scenario refers to identification, which is incorporating another person into one's personality and making them part of oneself The correct answer is: A 27­year old man made a voluntary decision to not to think about an argument with his girlfriend he had earlier when going for an interview – Suppression, A 45­year­old man hit his wife and tells he is cruel 'for her own sake'.
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