Denial — MRCPsych Paper B MCQ

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During psychotherapy, a 40-year-old man discusses a formal workplace investigation that documented repeated bullying of him by his manager. He insists that no bullying occurred and that his relationship with the manager is entirely satisfactory. His therapist judges that he is not deliberately concealing the problem but is unconsciously unable to acknowledge it. Which defence mechanism is operating?

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Correct answer: D — Denial

The correct answer is **A. Denial**. Denial is the unconscious refusal to accept a threatening aspect of external reality. The bullying has been independently documented, but the man remains genuinely unable to acknowledge that it occurred. Projection would involve attributing his own unacceptable feelings or characteristics to someone else. Reaction formation would involve adopting an attitude opposite to an unacceptable unconscious feeling. Sublimation redirects unacceptable impulses into constructive activity. Intellectualisation uses abstract reasoning or factual analysis to avoid the associated emotional experience; it does not involve rejecting the event itself. Denial is unconscious, whereas knowingly concealing or consciously setting aside the problem would not constitute denial.

Reference: Gibbons R. The mourning process and mental illness. BJPsych Advances. 2024;30:80–88, Table 1: Psychic defences. 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