Defence Mechanisms — MRCPsych Paper B MCQ

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ModeratePsychotherapyDefence MechanismsMRCPsych Paper B

A 35-year-old woman in psychodynamic psychotherapy reports that, during periods of emotional distress, she repeatedly devotes herself to meeting other people's needs. She gains indirect gratification from helping them but consistently neglects her own needs. The therapist understands this as an unconscious way of managing her internal needs. Which defence mechanism is illustrated?

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Correct answer: E — Altruism

The correct answer is E, altruism. As a mature defence, altruism manages distress or unconscious internal needs through constructive dedication to other people's needs, with indirect or vicarious gratification. The recurrent self-neglect in the stem indicates that helping is serving a defensive function rather than simply representing conscious generosity. Sublimation instead transforms a socially unacceptable impulse, such as aggression, into a constructive activity; no such impulse is described. Reaction formation involves adopting an attitude or behaviour opposite to an unacceptable impulse. Projection attributes one's own unwanted feelings to another person, whereas displacement redirects an emotion from its original target to a safer substitute.

Reference: Gibbons R. The mourning process and its importance in mental illness: a psychoanalytic understanding of psychiatric diagnosis and classification. Table 1: Psychic defences. BJPsych Advances. 2024;30:80–88. https://www.rcpsych.ac.uk/docs/default-source/events/2025-events/faculties/psychodynamic-psychiatry-day-2025/article---the-mourning-process---rachel-gibbons.pdf?sfvrsn=1e044d20_3