Which defense mechanism is used by a patient with obsessive compulsive disorder?

Daman & Diu Staff Nurse - 2018

Mental Health Nursing

Easy

Appeared in: Daman & Diu Staff Nurse - 2018

Explanation

Undoing is a primary defense mechanism seen in Obsessive-Compulsive Disorder (OCD).
It involves performing a repetitive, ritualistic action (a compulsion) to 'undo' or neutralize the anxiety caused by an intrusive, unacceptable thought (an obsession).
For example, a person with an obsessive fear of contamination may engage in compulsive handwashing to symbolically cleanse themselves and cancel out the distressing thought.
Psychoanalytic theory directly links undoing, isolation, displacement, and reaction formation to the psychopathology of OCD.

Option A: Denial is the refusal to accept an external reality. In OCD, the individual is typically aware that their thoughts and behaviors are irrational but feels powerless to stop them; they are not denying reality.
Option C: Repression is the unconscious and involuntary blocking of memories or feelings. The thoughts in OCD are intrusive and conscious, causing significant distress to the individual.
Option D: Suppression is the conscious and voluntary act of pushing thoughts out of awareness. The compulsions in OCD are involuntary and feel subjectively necessary to prevent distress, which is the opposite of voluntary suppression.

Clinical Relevance

Nursing practice connection: Use the key finding related to Defense Mechanisms in Obsessive-Compulsive Disorder (OCD) to guide bedside assessment, documentation, and the next nursing action.
Recognizing 'undoing' helps nurses understand that a patient's compulsive rituals are not random but are a coping mechanism for intense anxiety, guiding a more empathetic and therapeutic approach.
This understanding is crucial for implementing effective nursing interventions, such as supporting Cognitive Behavioral Therapy (CBT), specifically Exposure and Response Prevention (ERP), where patients are gradually exposed to their fears without being allowed to perform the 'undoing' ritual.
What if? If a patient were simply avoiding thinking about a stressful work project, the defense mechanism would be suppression, a more mature and less pathological defense than the 'undoing' seen in OCD.

How to Approach the Question

First, identify the key terms in the question: 'defense mechanism' and 'obsessive compulsive disorder (OCD)'.
Recall the core features of OCD: intrusive, anxiety-provoking thoughts (obsessions) and repetitive, ritualistic behaviors (compulsions).
Analyze the function of the compulsion. In OCD, the compulsion serves to 'cancel out' or 'neutralize' the obsession.
Evaluate the options. 'Undoing' is the defense mechanism that specifically describes an act performed to nullify a previous thought or act.
Compare this to other defenses. Denial (refusing reality), repression (unconscious blocking), and suppression (conscious blocking) do not fit the classic obsession-compulsion cycle of OCD.

Concept Tested & Keywords

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E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 1 (pp 26-289 of 579) p. 241-243