Bereavement and complicated grief US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Bereavement and complicated grief. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Bereavement and complicated grief US Medical PG Question 1: A 30-year-old woman comes to the physician because of difficulty sleeping. She is afraid of falling asleep and gets up earlier than desired. Four months ago, she was the driver in a car accident that resulted in the death of her unborn child. She has vivid nightmares of the event and reports that she frequently re-experiences the accident. She blames herself for the death of her child, has stopped working as an accountant, avoids driving in cars, and has withdrawn from her parents and close friends. Which of the following is the most likely diagnosis?
- A. Acute stress disorder
- B. Normal grief
- C. Major depressive disorder
- D. Adjustment disorder
- E. Post-traumatic stress disorder (Correct Answer)
Bereavement and complicated grief Explanation: ***Post-traumatic stress disorder***
- The patient's symptoms, including **re-experiencing the trauma** (nightmares, flashbacks), avoidance behaviors (avoiding driving, withdrawing from social interactions), and negative alterations in cognition and mood (difficulty sleeping, self-blame), persisting for **four months** after a traumatic event, are characteristic of PTSD.
- The severity and chronicity of these symptoms, significantly impacting her daily functioning, align with the diagnostic criteria for PTSD.
*Acute stress disorder*
- This diagnosis also involves exposure to a traumatic event and similar symptoms (intrusive thoughts, negative mood, avoidance) but is diagnosed only when symptoms last for a minimum of **3 days and a maximum of 1 month** after the trauma.
- Since the patient's symptoms have persisted for **four months**, acute stress disorder is ruled out.
*Normal grief*
- While grief is a natural response to loss, the patient's symptoms extend beyond typical grief, involving specific **trauma-related re-experiencing** and **avoidance behaviors** that are not primarily focused on the deceased, but rather on the traumatic event itself.
- Normal grief typically does not involve the severe, persistent avoidance and intrusive symptoms of a traumatic nature seen here.
*Major depressive disorder*
- Although the patient exhibits symptoms that could overlap with depression (difficulty sleeping, withdrawal, loss of interest), the primary driver of her symptoms is the **traumatic event** and its associated re-experiencing and avoidance.
- A diagnosis of MDD would be considered if the depressive symptoms are paramount and not better explained by the trauma response, but in this case, the **trauma-specific symptoms** are central.
*Adjustment disorder*
- This disorder is characterized by the development of emotional or behavioral symptoms in response to an identifiable stressor, occurring within **3 months of the stressor**.
- While a traumatic event could be a stressor, adjustment disorder is diagnosed when the symptoms **do not meet the criteria for another specific mental disorder**, like PTSD, and are generally less severe and pervasive than what is described in this patient.
Bereavement and complicated grief US Medical PG Question 2: A 42-year-old man presents to his primary care provider complaining of insomnia. He describes 3 months of frequent nighttime awakenings and nightmares. Per chart review, he is a combat veteran and was on a military tour in Afghanistan 4 months ago when a car bomb exploded, injuring him and killing his friend; however, when the physician asks about this, the patient states that he “does not talk about that” and changes the subject. He reports anxiety, irritability and feeling detached from his friends and family, which he believes is harming his relationships. Physical exam reveals an overweight, anxious appearing man with normal vital signs and an exaggerated startle response. Which of the following medications might have helped prevent this patient’s current disorder?
- A. Buspirone
- B. Zolpidem
- C. Sertraline
- D. Prazosin
- E. Propranolol (Correct Answer)
Bereavement and complicated grief Explanation: ***Propranolol***
- **Propranolol**, a **non-selective beta-blocker**, administered shortly after a traumatic event, may **reduce the risk** of developing **post-traumatic stress disorder (PTSD)**.
- It works by blocking the **neurobiological effects of stress hormones** like norepinephrine on memory **consolidation**, potentially mitigating the formation of traumatic memories.
*Buspirone*
- **Buspirone** is an **anxiolytic medication** primarily used for **generalized anxiety disorder (GAD)** but is not effective in preventing or acutely treating PTSD.
- It has a delayed onset of action and is not typically used in situations requiring rapid intervention for trauma.
*Zolpidem*
- **Zolpidem** is a **sedative-hypnotic** primarily used for **insomnia** by affecting GABA receptors.
- It does not address the underlying pathology of PTSD or prevent its development.
*Sertraline*
- **Sertraline**, an **SSRI**, is a first-line treatment for established PTSD symptoms.
- However, it is not typically used as a **preventative measure immediately following a traumatic event** to avert the development of the disorder.
*Prazosin*
- **Prazosin**, an **alpha-1 adrenergic antagonist**, is often used to treat **PTSD-related nightmares** and sleep disturbances.
- While effective for managing specific symptoms of PTSD, it is not considered a primary preventative agent administered immediately post-trauma to inhibit disorder development.
Bereavement and complicated grief US Medical PG Question 3: A 5-year-old boy is brought to the physician by his mother because he claims to have spoken to his recently-deceased grandfather. The grandfather, who lived with the family and frequently watched the boy for his parents, died 2 months ago. The boy was taken out of preschool for 3 days after his grandfather's death but has since returned. His teachers report that the boy is currently doing well, completing his assignments, and engaging in play with other children. When asked about how he feels, the boy becomes tearful and says, “I miss my grandpa. I sometimes talk to him when my mom is not around.” Which of the following is the most likely diagnosis?
- A. Normal grief (Correct Answer)
- B. Major depressive disorder
- C. Brief psychotic disorder
- D. Adjustment disorder
- E. Schizophreniform disorder
Bereavement and complicated grief Explanation: ***Normal grief***
- The boy's reaction, including talking to his deceased grandfather and expressing sadness, is a **common and normal part of the grief process in children**, especially given his close relationship with his grandfather and the recent timing of the death.
- His continued functioning at school, engaging with peers, and the absence of significant functional impairment indicate that these are likely **age-appropriate coping mechanisms** rather than a pathological condition.
*Major depressive disorder*
- This diagnosis typically involves **persistent sadness, anhedonia, significant changes in appetite or sleep, fatigue, feelings of worthlessness, or recurrent thoughts of death**, lasting for at least two weeks.
- The boy's ability to engage in play and complete schoolwork, along with the episodic nature of his sadness, suggests he does not meet the criteria for **major depressive disorder**.
*Brief psychotic disorder*
- This disorder is characterized by the sudden onset of **psychotic symptoms** such as delusions, hallucinations, disorganized speech, or grossly disorganized behavior, lasting from one day to one month.
- While the boy reports "speaking" to his grandfather, this is more indicative of a **grief-related fantasy or coping mechanism** rather than a true hallucination, especially since he understands his grandfather is deceased and it does not impair his daily functioning.
*Adjustment disorder*
- This involves **emotional or behavioral symptoms** that develop within three months of an identifiable stressor and cause significant distress or functional impairment.
- Although there is a stressor (grandfather's death), the boy's symptoms are part of a **normal grieving process** and do not appear to cause significant impairment in his social or academic functioning.
*Schizophreniform disorder*
- This is a psychotic disorder with symptoms similar to **schizophrenia** (delusions, hallucinations, disorganized speech, negative symptoms) but lasting between one and six months.
- The boy's claims of speaking to his grandfather are more consistent with **grief-induced fantasy** rather than a true psychotic symptom, and he lacks other hallmark features of a psychotic disorder.
Bereavement and complicated grief US Medical PG Question 4: A 27-year-old woman is brought to the physician by her parents because they are concerned about her mood. They say that she has “not been herself” since the death of her friend, who was killed 3 weeks ago when the fighter jet he piloted was shot down overseas. She says that since the incident, she feels sad and alone. She reports having repeated nightmares about her friend's death. Her appetite has decreased, but she is still eating regularly and is otherwise able to take care of herself. She does not leave her home for any social activities and avoids visits from friends. She went back to work after taking 1 week off after the incident. Her vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she appears sad, has a full range of affect, and is cooperative. In addition to taking measures to evaluate this patient's anxiety, which of the following is the most appropriate statement by the physician at this time?
- A. I can see that you have gone through a lot recently, but I think that your reaction is especially severe and has persisted for longer than normal. Would you be open to therapy or medication to help you manage better?
- B. I am worried that you may be having an abnormally severe reaction to what is an understandably stressful event. I recommend attending behavioral therapy sessions to help you deal with this challenge.
- C. Your grief over the loss of your friend appears to have a negative effect on your social and functional capabilities. I recommend starting antidepressants to help you deal with this challenge.
- D. I'm so sorry, but the loss of loved ones is a part of life. Let's try to find better ways for you to deal with this event.
- E. I understand that the sudden loss of your friend has affected you deeply. Sometimes in situations like yours, people have thoughts that life is not worth living; have you had such thoughts? (Correct Answer)
Bereavement and complicated grief Explanation: ***I understand that the sudden loss of your friend has affected you deeply. Sometimes in situations like yours, people have thoughts that life is not worth living; have you had such thoughts?***
- This statement empathetically acknowledges the patient's grief while **directly assessing for suicidal ideation**, which is crucial in any evaluation of a patient experiencing significant emotional distress, especially after a recent loss.
- The patient's presentation, including sadness, social withdrawal, decreased appetite, and nightmares, is consistent with **grief**, but the physician must rule out more severe conditions like **major depressive disorder (MDD)**, for which suicidal thoughts are a key diagnostic criterion and safety concern.
*I can see that you have gone through a lot recently, but I think that your reaction is especially severe and has persisted for longer than normal. Would you be open to therapy or medication to help you manage better?*
- This statement is somewhat judgmental ("especially severe and has persisted for longer than normal") for a patient only three weeks out from a traumatic loss, which could invalidate her feelings.
- While therapy or medication might be considered, it's generally too early to classify her normal grief response as an abnormal or prolonged reaction without first screening for immediate safety concerns like suicidal ideation.
*I am worried that you may be having an abnormally severe reaction to what is an understandably stressful event. I recommend attending behavioral therapy sessions to help you deal with this challenge.*
- Similar to the previous option, labeling her reaction as "abnormally severe" at this early stage (3 weeks post-loss) can be perceived as invalidating and may make the patient less open to further discussion or treatment.
- Recommending therapy without first assessing for suicidal ideation or a more comprehensive diagnostic evaluation is premature and misses a critical screening step.
*Your grief over the loss of your friend appears to have a negative effect on your social and functional capabilities. I recommend starting antidepressants to help you deal with this challenge.*
- While her social and functional capabilities are affected, grief is a normal human response, and recommending antidepressants after only 3 weeks post-loss, without a full psychiatric evaluation or ruling out suicidal ideation, is often premature.
- **Antidepressants** are typically considered for **MDD** or **prolonged grief disorder**, usually after a longer period (e.g., 6 months for adults) or if symptoms are markedly severe and debilitating, especially with an immediate safety concern.
*I'm so sorry, but the loss of loved ones is a part of life. Let's try to find better ways for you to deal with this event.*
- This statement, particularly "the loss of loved ones is a part of life," can come across as dismissive and insensitive to the patient's individual pain and trauma.
- It minimizes her experience and does not create an empathetic environment necessary for a patient to open up about potentially sensitive topics, such as suicidal thoughts.
Bereavement and complicated grief US Medical PG Question 5: A 24-year-old woman presents to her primary care physician for a wellness exam. She currently has no acute concerns but has been feeling hopeless, has a poor appetite, difficulty with concentration, and trouble with sleep. She says that she has poor self-esteem and that her symptoms have been occurring for the past 3 years. She has had moments where she felt better, but it lasted a few weeks out of the year. She currently lives alone and does not pursue romantic relationships because she feels she is not attractive. She has a past medical history of asthma. Her mother is alive and healthy. Her father committed suicide and suffered from major depressive disorder. On physical exam, the patient has a gloomy demeanor and appears restless and anxious. Which of the following is the most likely diagnosis?
- A. Major depressive disorder
- B. Cyclothymia
- C. Persistent depressive disorder (Correct Answer)
- D. Seasonal affective disorder
- E. Disruptive mood dysregulation disorder
Bereavement and complicated grief Explanation: ***Persistent depressive disorder***
- The patient exhibits chronic symptoms of depression (poor appetite, poor self-esteem, difficulty with concentration, trouble with sleep, hopelessness) lasting for at least **2 years**, with symptom-free periods lasting no more than **2 months**.
- Her long-standing symptoms (3 years) and the intermittent improvement, but never full resolution for extended periods, are characteristic of **persistent depressive disorder** (formerly dysthymia).
*Major depressive disorder*
- While the patient has many symptoms of depression, **major depressive disorder** is characterized by distinct episodes of at least 2 weeks, with significant functional impairment. The chronic, fluctuating course over 3 years is less typical.
- The presence of depressive symptoms for 3 years, with only brief periods of improvement, points away from episodic major depressive disorder alone and more towards a chronic form.
*Cyclothymia*
- **Cyclothymia** involves numerous periods of hypomanic symptoms and numerous periods of depressive symptoms for at least 2 years, with periods of stability lasting no more than 2 months. The patient describes only depressive symptoms, not hypomanic episodes.
- There is no mention of elevated mood, increased energy, or decreased need for sleep, which are characteristic of **hypomanic episodes** in cyclothymia.
*Seasonal affective disorder*
- **Seasonal affective disorder** is a type of depressive disorder that occurs during a specific season (most commonly winter) and resolves during other seasons; the patient's symptoms are year-round and chronic.
- The patient's symptoms are not described as tied to a particular season, making this diagnosis less likely.
*Disruptive mood dysregulation disorder*
- Predominantly diagnosed in **children and adolescents**, this disorder is characterized by severe recurrent temper outbursts and persistently irritable or angry mood between outbursts.
- The patient's age (24 years old) and the absence of temper outbursts make this diagnosis inappropriate.
Bereavement and complicated grief US Medical PG Question 6: A 43-year-old woman is brought to the physician by her daughter because she has been intermittently crying for 6 hours and does not want to get out of bed. Her symptoms started after she was fired yesterday from her job of 20 years. She says she feels sad and does not understand what she will do with her life now. She uses an over-the-counter inhaler as needed for exercise-induced asthma, and recently started oral isotretinoin for acne. She used to smoke a pack of cigarettes per day, but for the last year she has decreased to 2 cigarettes daily. She appears sad and very upset. Her temperature is 37°C (98.6°F), pulse is 110/min, respirations are 20/min, and blood pressure is 140/80 mm Hg. Physical examination shows no other abnormalities. On mental status examination, she is oriented to person, place, and time. She maintains eye contact and follows instructions. She denies suicidal ideation. Which of the following is the most likely explanation for this finding?
- A. Drug-related depression
- B. Acute stress disorder
- C. Adjustment disorder
- D. Major depressive disorder
- E. Normal stress reaction (Correct Answer)
Bereavement and complicated grief Explanation: ***Normal stress reaction***
- The patient's symptoms (crying, sadness, not wanting to get out of bed) are a direct, understandable emotional response to a significant recent stressor (being fired from a 20-year job). This type of reaction is **expected and transient** in response to acute life changes.
- The duration of symptoms is short (6 hours), and there is **no evidence of significant functional impairment** beyond the initial emotional distress, nor does she meet criteria for a mental disorder.
*Drug-related depression*
- While **isotretinoin has been associated with mood changes**, including depression, the acute onset and direct temporal relationship to a significant psychosocial stressor make a drug-related cause less likely as the primary explanation.
- There are no other features pointing to drug-induced etiology, and her symptoms are clearly linked to the job loss.
*Acute stress disorder*
- Acute stress disorder symptoms (e.g., intrusive thoughts, negative mood, dissociation, avoidance, arousal) typically involve exposure to an **actual or threatened traumatic event**, such as death or serious injury, which is not the case here.
- The symptom duration for acute stress disorder is also typically 3 days to 1 month, and the patient's symptoms are of much shorter duration and less severe.
*Adjustment disorder*
- Adjustment disorder involves significant emotional or behavioral symptoms in response to an identifiable stressor, but these symptoms must cause **marked distress in excess of what would be expected** or significant impairment in social or occupational functioning.
- Given the magnitude of the stressor (losing a 20-year job), the patient's reaction is within the range of a normal and expected emotional response, rather than excessive or impairing functionality long-term.
*Major depressive disorder*
- Major depressive disorder requires a cluster of specific symptoms (e.g., anhedonia, sleep disturbance, appetite changes, low energy, feelings of worthlessness) lasting for at least **two weeks**, causing clinically significant distress or impairment.
- The patient's symptoms are acute (6 hours), directly linked to an external event, and do not yet meet the duration or full criteria for a major depressive episode.
Bereavement and complicated grief US Medical PG Question 7: A previously healthy 56-year-old woman comes to the family physician for a 1-month history of sleep disturbance and sadness. The symptoms have been occurring since her husband died in a car accident. Before eventually falling asleep, she stays awake for multiple hours and has crying spells. Several times she has been woken up by the sound of her husband calling her name. She has lost 3 kg (6.6 lb) over the past month. She has 3 children with whom she still keeps regular contact and regularly attends church services with her friends. She expresses feeling a great feeling of loss over the death of her husband. She has no suicidal ideation. She is alert and oriented. Neurological exam shows no abnormalities. Which of the following is the most likely diagnosis for this patient's symptoms?
- A. Adjustment disorder with depressed mood
- B. Acute stress disorder
- C. Major depressive disorder
- D. Normal bereavement (Correct Answer)
- E. Schizoaffective disorder
Bereavement and complicated grief Explanation: ***Normal bereavement***
- The patient's symptoms (sleep disturbance, sadness, weight loss, crying spells, auditory hallucinations of a loved one) are all **common and expected responses to the death of a loved one** within a short timeframe (1 month).
- Her continued social engagement and lack of suicidal ideation suggest that her grief, while intense, is within the range of **normal bereavement**, especially given the recent and traumatic loss.
*Adjustment disorder with depressed mood*
- This diagnosis is considered when symptoms in response to a stressor are **clinically significant** but do not meet criteria for a major depressive episode and cause significant impairment.
- However, in this case, the symptoms are directly related to the death of her husband, making **bereavement a more specific and appropriate diagnosis** if the symptoms are within normal grief.
*Acute stress disorder*
- This disorder typically involves exposure to actual or threatened **death, serious injury, or sexual violence**, followed by intrusive symptoms, negative mood, dissociation, avoidance, and arousal symptoms, and lasts from 3 days to 1 month.
- While there is a significant stressor (husband's death), her symptoms are more indicative of **grief and loss** rather than the specific dissociative, avoidance, and arousal symptom clusters required for acute stress disorder.
*Major depressive disorder*
- While some symptoms overlap (depressed mood, sleep disturbance, weight loss), several factors argue against MDD, such as the direct and recent link to a **major loss**, her **intact social functioning**, and the **absence of suicidal ideation** or pervasive anhedonia beyond grief.
- The **auditory hallucinations of her husband's voice** are also common in normal bereavement, especially shortly after a loss, and do not necessarily indicate a psychotic disorder or MDD with psychotic features in this context.
*Schizoaffective disorder*
- This diagnosis requires a **period of illness during which a major mood episode is present concurrently with Criterion A of schizophrenia** (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms) and delusions or hallucinations for 2 or more weeks in the absence of a major mood episode.
- The patient's isolated auditory hallucination, occurring in the context of profound grief, does not meet the extensive criteria for schizophrenia or schizoaffective disorder, and there are **no other psychotic symptoms** or a history of such.
Bereavement and complicated grief US Medical PG Question 8: A 23-year-old woman is brought to the physician by her father because of strange behavior for the past 6 months. The father reports that his daughter has increasingly isolated herself in college and received poor grades. She has told her father that aliens are trying to infiltrate her mind and that she has to continuously listen to the radio to monitor these activities. She appears anxious. Her vital signs are within normal limits. Physical examination shows no abnormalities. Neurologic examination shows no focal findings. Mental status examination shows psychomotor agitation. She says: “I can describe how the aliens chase me except for my car which is parked in the garage. You know, the sky is beautiful today. Why does my mother have a cat?” Which of the following best describes this patient's thought process?
- A. Circumstantial speech
- B. Clang associations
- C. Flight of ideas
- D. Thought-blocking
- E. Loose associations (Correct Answer)
Bereavement and complicated grief Explanation: ***Loose associations***
- This is characterized by a **lack of logical connection** between thoughts or ideas, leading to a disorganized and incoherent flow of speech. The patient's statements about aliens, her car, the sky, and her mother's cat are **unrelated and lack a clear thematic thread**.
- It is a key feature of **thought disorganization** and is commonly seen in psychotic disorders like **schizophrenia**.
*Circumstantial speech*
- This involves including a **multitude of unnecessary details** before finally arriving at the point or answering the question.
- While the patient's speech is disorganized, it does not demonstrate the characteristic meandering yet goal-directed nature of circumstantiality.
*Clang associations*
- This refers to the **association of words based on their sound** rather than their meaning, often involving rhyming or alliteration.
- The patient's statements do not exhibit a pattern of rhyming or sound-based word choices.
*Flight of ideas*
- This is a rapid, continuous progression from one thought to another, with thoughts often **connected by tangential associations** but still having some discernable link.
- Although the patient's thoughts shift rapidly, the connections are not simply tangential; they are largely absent, suggesting a more severe form of disorganization than flight of ideas typically entails.
*Thought-blocking*
- This is an **abrupt cessation of thought or speech** in the middle of a sentence, often followed by a new and unrelated thought.
- The patient's speech flows continuously, albeit incoherently, without sudden stops or breaks.
Bereavement and complicated grief US Medical PG Question 9: A 21-year-old woman is brought to the emergency room 1 hour after she ingested 12 pills of acetaminophen. She had a fight with her boyfriend immediately prior to the ingestion, during which she threatened to kill herself if he broke up with her. She has been hospitalized 4 times for overdoses in the past 3 years following breakups with her partners. On the way to the hospital, she screamed and then assaulted the paramedic who attempted to take her temperature. Physical examination shows multiple rows of well-healed scars bilaterally on the wrists. This patient is most likely to display which of the following defense mechanisms?
- A. Fantasy
- B. Controlling
- C. Displacement
- D. Splitting (Correct Answer)
- E. Sublimation
Bereavement and complicated grief Explanation: ***Splitting***
- Splitting describes **inability to integrate positive and negative qualities** of self and others into a cohesive whole, leading to abrupt, alternating shifts between idealization and devaluation. This is characteristic of **borderline personality disorder (BPD)**, which is strongly suggested by the patient's history of impulsive acts (overdoses, assault, self-harm), unstable relationships, and suicidal threats.
- The patient's immediate shift from threatening suicide to assaulting a paramedic, along with the history of repeated overdoses after relationship breakups, indicates an extreme "all good" or "all bad" perception of situations and people, a hallmark of splitting.
*Fantasy*
- Fantasy involves retreating into a **private mental world** to escape uncomfortable thoughts, feelings, or situations. While the patient may use fantasy at times, it is not the primary defense mechanism explaining her overt behaviors like assault and repeated overdose threats in real-life situations.
- It often manifests as **daydreaming** or imaginatively creating alternative realities, which is not depicted as the leading defense in this scenario.
*Controlling*
- Controlling is a defense mechanism involving the **attempt to manage or regulate events or others** to minimize discomfort or anxiety. While the patient's behaviors might seem manipulative or an attempt to control her relationships, "controlling" in this context is a broader concept that is less specific than "splitting" for explaining the abrupt shifts in her perceptions and actions.
- While aspects of her behavior may appear controlling (e.g., threatening suicide to prevent a breakup), it doesn't capture the underlying psychological mechanism of idealization and devaluation as effectively as splitting does.
*Displacement*
- Displacement involves redirecting an **emotion or impulse from its original source to a safer, more acceptable target**. While assaulting the paramedic could be seen as displacement of anger from her boyfriend, the broader pattern of her behavior (repeated overdoses, suicidal threats, and the "all good"/"all bad" framework) points more strongly to splitting.
- The primary emotion (anger at her boyfriend) is redirected, but this single act doesn't explain the full spectrum of her unstable relationships and self-harm, which are characteristic of splitting.
*Sublimation*
- Sublimation is a **mature defense mechanism** where unacceptable impulses are transformed into socially acceptable and productive behaviors. This patient's actions, such as repeated overdoses, self-harm, and assault, are clearly maladaptive and destructive, not socially acceptable or constructive.
- It involves channeling urges into creative or beneficial activities, which is the opposite of the impulsive and destructive behaviors exhibited by the patient.
Bereavement and complicated grief US Medical PG Question 10: A 48-year-old man and his wife present to a psychologist's office for a therapy session. He was encouraged to visit the psychiatrist 6 months ago by his wife and they have been meeting with the psychologist several times a month ever since. Initially, she was concerned about behavioral changes she observed after he was passed up for a promotion at work. She felt he was taking on a new personality and was acting like his coworker, who actually did get the promotion. He would also talk about his coworker and praise his intelligence and strategic character. Over the course of several months, the patient bought new clothes that looked like the other man's clothes. He changed his hairstyle and started using phrases that were similar to his coworker. Today, they both seem well. The patient still does not seem to think there is a problem and requests to stop therapy. His wife was frustrated because her husband recently bought a new car of the exact make and model of his coworker. Which of the following defense mechanisms best describes this patient's condition?
- A. Sublimation
- B. Conversion
- C. Regression
- D. Splitting
- E. Introjection (Correct Answer)
Bereavement and complicated grief Explanation: ***Introjection***
- **Introjection** (also known as identification in some classification systems) is a defense mechanism where an individual unconsciously adopts the characteristics, attitudes, or behaviors of another person, particularly someone perceived as successful or threatening.
- In this case, the patient responds to feelings of inadequacy after being passed over for promotion by adopting his coworker's external characteristics—clothes, hairstyle, speech patterns, and even purchasing the same car model.
- This represents an attempt to cope with envy and feelings of inferiority by incorporating the perceived superior qualities of the coworker into his own identity.
- **Clinical note**: Some classification systems distinguish between "identification" (behavioral imitation) and "introjection" (deeper internalization of values), though these terms are often used interchangeably in defense mechanism literature.
*Sublimation*
- **Sublimation** is a mature defense mechanism where unacceptable impulses or feelings are redirected into socially acceptable and productive behaviors (e.g., channeling aggressive urges into competitive sports).
- The patient's behavior does not involve transforming an unacceptable urge into a constructive outlet; rather, it involves adopting another person's characteristics.
*Conversion*
- **Conversion disorder** (Functional Neurological Symptom Disorder) involves psychological distress manifesting as neurological symptoms without an identifiable medical cause, such as paralysis, blindness, or seizures.
- The patient's presentation involves behavioral and personality changes, not the development of physical or neurological symptoms.
*Regression*
- **Regression** is a defense mechanism where an individual reverts to behaviors characteristic of an earlier developmental stage in response to stress (e.g., thumb-sucking, tantrums, excessive dependence).
- The patient's behavior does not represent a return to childhood patterns but rather emulation of another successful adult.
*Splitting*
- **Splitting** is a primitive defense mechanism, commonly seen in borderline personality disorder, where individuals view people or situations as entirely good or entirely bad, unable to integrate both positive and negative qualities.
- The patient's actions do not involve dichotomous thinking about people but rather an attempt to model himself after someone he perceives as successful.
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