A husband returns from a three-month long business trip from Thailand, where he also engaged in extramarital affairs. He arrives back at home to find that his wife is distant and not as affectionate as she used to be. He then proceeds to argue with his wife stating that she must be cheating on him since she is so distant. Which of the following best explains the ego defense of the husband?
Q22
An 8-year-old boy is brought to his pediatrician by his mother because she is worried about whether he is becoming ill. Specifically, he has been sent home from school six times in the past month because of headaches and abdominal pain. In fact, he has been in the nurse's office almost every day with various symptoms. These symptoms started when the family moved to an old house in another state about 2 months ago. Furthermore, whenever he is taken care of by a babysitter he also has these symptoms. Despite these occurrences, the boy never seems to have any problems at home with his parents. Which of the following treatments would likely be effective for this patient?
Q23
A 67-year-old man comes to the physician for a routine examination. He does not take any medications. He drinks 6 to 7 bottles of beer every night, and says he often has a shot of whiskey in the morning “for my headache.” He was recently fired from his job for arriving late. He says there is nothing wrong with his drinking but expresses frustration at his best friend no longer returning his calls. Which of the following is the most appropriate initial response by the physician?
Q24
A 28-year-old male intern is currently on a trauma surgery service. After a busy overnight shift, the intern did not have enough time to prepare to present all of the patients on the team’s list. At morning rounds, the chief resident made a sarcastic comment that the intern “really put a lot of effort into preparing for rounds.” After rounds, while managing the floor with the third year medical student, the intern berates the student that she “needs to step up her game and do a better job helping with pre-rounding in the morning.” What type of ego defense is most relevant in this situation?
Q25
A 27-year-old woman with cystic fibrosis comes to the physician for a follow-up examination. She has been hospitalized frequently for pneumonia and nephrolithiasis and is on chronic antibiotic therapy for recurrent sinusitis. The patient and her husband would like to have a child but have been unable to conceive. She feels that she can never achieve a full and happy life due to her disease and says that she is “totally frustrated” with the barriers of her illness. Although her family is supportive, she doesn't want to feel like a burden and tries to shield them from her struggles. Which of the following is the most appropriate statement by the physician?
Q26
A 25-year-old man comes to the physician for severe back pain. He describes the pain as shooting and stabbing. On a 10-point scale, he rates the pain as a 9 to 10. The pain started after he lifted a heavy box at work; he works at a supermarket and recently switched from being a cashier to a storekeeper. The patient appears to be in severe distress. Vital signs are within normal limits. On physical examination, the spine is nontender without paravertebral muscle spasms. Range of motion is normal. A straight-leg raise test is negative. After the physical examination has been completed, the patient asks for a letter to his employer attesting to his inability to work as a storekeeper. Which of the following is the most appropriate response?
Q27
A 35-year-old man presents to his primary care physician for a routine visit. He is in good health but has a 15 pack-year smoking history. He has tried to quit multiple times and expresses frustration in his inability to do so. He states that he has a 6-year-old son that was recently diagnosed with asthma and that he is ready to quit smoking. What is the most effective method of smoking cessation?
Q28
A 52-year-old man is on a week-long cruise vacation with his family to celebrate his mother's 80th birthday. He has a very important presentation at work to give in one month, which will in part determine whether he receives a promotion. He decides to focus on enjoying the vacation and not to worry about the presentation until the cruise is over. Which of the following psychological defense mechanisms is he demonstrating?
Q29
A resident doctor was reprimanded by the attending physician for making medication errors during morning rounds. Later that day, when a medical student asked a simple question about drug dosages during the evening rounds, the resident responded with excessive criticism and harsh comments, making the student visibly uncomfortable and embarrassed. Which of the following ego defense mechanisms is the resident demonstrating?
Q30
Several years after a teenage boy and his younger brother witnessed a gang related murder, they both decided to come forward and report it to authorities. The older brother describes the horrific decapitation of the gang member without displaying any emotion; but when the younger brother was asked about the crime, he had no recollection of the event. Which two ego defenses are being displayed by these brothers, respectively?
Ethics/Biostatistics US Medical PG Practice Questions and MCQs
Question 21: A husband returns from a three-month long business trip from Thailand, where he also engaged in extramarital affairs. He arrives back at home to find that his wife is distant and not as affectionate as she used to be. He then proceeds to argue with his wife stating that she must be cheating on him since she is so distant. Which of the following best explains the ego defense of the husband?
A. Regression
B. Rationalization
C. Projection (Correct Answer)
D. Passive aggression
E. Reaction formation
Explanation: **_Projection_**
- **Projection** involves attributing one's own unacceptable thoughts, feelings, or urges to another person.
- The husband, guilty of **infidelity**, accuses his wife of cheating, thereby transferring his own unacceptable behavior onto her.
- This is the **classic example** of projection in psychological defense mechanisms.
*Regression*
- **Regression** is a defense mechanism where an individual reverts to an earlier, less mature stage of development.
- This typically involves behaviors like temper tantrums or increased dependency, which are not depicted in the husband's actions.
*Rationalization*
- **Rationalization** involves explaining an unacceptable behavior or feeling in a rational, logically plausible way, avoiding the true explanation.
- The husband is not trying to justify his own affair but rather attributing infidelity to his wife, which is distinct from rationalization.
*Passive aggression*
- **Passive aggression** is an indirect expression of hostility, often through non-cooperation, stubbornness, or intentional inefficiency.
- The husband's accusation is a direct confrontation, not an indirect, hostile act.
*Reaction formation*
- **Reaction formation** is when an individual consciously adopts behaviors, thoughts, or feelings that are the opposite of their true, unacceptable ones.
- The husband's accusation does not involve him acting loving or faithful to conceal his own infidelity; instead, he directly asserts his wife is unfaithful.
Question 22: An 8-year-old boy is brought to his pediatrician by his mother because she is worried about whether he is becoming ill. Specifically, he has been sent home from school six times in the past month because of headaches and abdominal pain. In fact, he has been in the nurse's office almost every day with various symptoms. These symptoms started when the family moved to an old house in another state about 2 months ago. Furthermore, whenever he is taken care of by a babysitter he also has these symptoms. Despite these occurrences, the boy never seems to have any problems at home with his parents. Which of the following treatments would likely be effective for this patient?
A. Play therapy (Correct Answer)
B. Succimer
C. Supportive only
D. Clonidine
E. Methylphenidate
Explanation: ***Play therapy***
- The boy's symptoms are likely **psychosomatic**, triggered by **stressors** like moving and separation from parents, as they resolve at home.
- **Play therapy** is an effective treatment for children experiencing emotional or behavioral difficulties due to stress, allowing them to express feelings in a non-threatening environment.
*Succimer*
- **Succimer** is a chelating agent used to treat **lead poisoning**.
- While the family moved to an old house, symptoms like headaches and abdominal pain could be associated with lead exposure, but the **situational nature** of his symptoms (occurring only outside the home or with babysitters) makes lead poisoning less likely.
*Supportive only*
- While supportive care is generally helpful, the severity and persistence of the symptoms suggest that a **more targeted intervention** like therapy is needed to address the underlying psychological distress.
- Simply observing or offering general support would likely not resolve the **situational anxiety** contributing to his somatic complaints.
*Clonidine*
- **Clonidine** is typically used to treat conditions like **ADHD**, **hypertension**, or tics, and is not a primary treatment for psychosomatic complaints in children.
- The patient's symptoms are linked to specific psychological triggers rather than a primary medical or neurological condition usually targeted by clonidine.
*Methylphenidate*
- **Methylphenidate** is a stimulant medication commonly used to treat **Attention-Deficit/Hyperactivity Disorder (ADHD)**.
- There is no indication from the provided symptoms (headaches, abdominal pain, situational nature) that the child has ADHD.
Question 23: A 67-year-old man comes to the physician for a routine examination. He does not take any medications. He drinks 6 to 7 bottles of beer every night, and says he often has a shot of whiskey in the morning “for my headache.” He was recently fired from his job for arriving late. He says there is nothing wrong with his drinking but expresses frustration at his best friend no longer returning his calls. Which of the following is the most appropriate initial response by the physician?
A. I'm sorry that your friend no longer returns your calls. What do you think your friend is worried about? (Correct Answer)
B. I'm sorry to hear you lost your job. I am concerned about the amount of alcohol you are drinking.
C. I'm sorry to hear you lost your job. Drinking the amount of alcohol that you do can have very negative effects on your health.
D. I'm sorry that your friend no longer returns your calls. It seems like your drinking is affecting your close relationships.
E. I'm sorry that your friend no longer returns your calls. Do you feel that your drinking has affected your relationship with your friend?
Explanation: ***"I'm sorry that your friend no longer returns your calls. What do you think your friend is worried about?"***
- This response acknowledges the patient's expressed **frustration** about his friend, which is a point of **distress** he has brought up.
- By asking what the friend is worried about, the physician invites the patient to reflect on the potential impact of his drinking from an external perspective, fostering **insight** without being confrontational.
*"I'm sorry to hear you lost your job. I am concerned about the amount of alcohol you are drinking."*
- While addressing the job loss is empathetic, immediately stating concern about his drinking can be confrontational and may lead the patient to become **defensive**, especially since he denies a problem.
- This approach might **shut down** further discussion rather than encourage it, as the patient has already stated "there is nothing wrong with his drinking."
*"I'm sorry to hear you lost your job. Drinking the amount of alcohol that you do can have very negative effects on your health."*
- This response is **judgmental** and directly highlights the negative consequences of his drinking, which the patient has already dismissed.
- Presenting medical facts about health effects at this stage, before establishing rapport and insight, is likely to be met with **resistance** and make the patient less receptive to further conversation.
*"I'm sorry that your friend no longer returns your calls. It seems like your drinking is affecting your close relationships."*
- This statement is a direct accusation, implying the physician knows the cause of the friend's actions and directly links it to the patient's drinking.
- Such a direct link is likely to be perceived as **judgmental** and can make the patient feel attacked, leading to defensiveness and a breakdown in communication.
*"I'm sorry that your friend no longer returns your calls. Do you feel that your drinking has affected your relationship with your friend?"*
- While this question is good, asking directly if his drinking has affected the relationship may elicit a **denial**, as the patient has already shown **lack of insight** regarding his drinking problem.
- A more open-ended question about what the friend is "worried about" is less threatening and more likely to encourage the patient to consider the connection himself.
Question 24: A 28-year-old male intern is currently on a trauma surgery service. After a busy overnight shift, the intern did not have enough time to prepare to present all of the patients on the team’s list. At morning rounds, the chief resident made a sarcastic comment that the intern “really put a lot of effort into preparing for rounds.” After rounds, while managing the floor with the third year medical student, the intern berates the student that she “needs to step up her game and do a better job helping with pre-rounding in the morning.” What type of ego defense is most relevant in this situation?
A. Projection
B. Denial
C. Passive aggression
D. Reaction formation
E. Displacement (Correct Answer)
Explanation: ***Displacement***
- **Displacement** occurs when a person redirects an impulse, usually aggression, from a threatening or unacceptable target to a safer, less threatening one. The intern, unable to confront the chief resident, redirects their frustration onto the medical student.
- The intern's anger and frustration stemmed from the chief resident's sarcastic comment, and instead of addressing the chief resident, the intern inappropriately vented these feelings towards the medical student.
*Projection*
- **Projection** involves attributing one's own unacceptable thoughts or feelings to another person. For example, if the intern felt lazy but accused the medical student of being lazy, that would be projection.
- The intern is not attributing their own feelings of inadequacy to the student; rather, they are expressing directed anger that originated elsewhere.
*Denial*
- **Denial** is refusing to accept reality or fact, acting as if a painful event, thought, or feeling did not exist. The intern is aware of the situation and their feelings, not denying them.
- The intern is actively acknowledging the criticism (by being upset) and reacting to it, rather than ignoring or disbelieving the situation.
*Passive aggression*
- **Passive aggression** is expressing negative feelings indirectly instead of openly addressing them. The intern's berating of the medical student is a direct, albeit misdirected, expression of aggression.
- While there is aggression, it's not "passive"; the intern directly confronts and criticizes the student, even if the underlying cause of frustration is external.
*Reaction formation*
- **Reaction formation** converts an unacceptable impulse into its opposite. For example, if the intern secretly disliked the chief resident but praised them excessively, that would be reaction formation.
- The intern is expressing anger, not masking an unacceptable impulse by acting in an opposite, overly positive, or agreeable manner.
Question 25: A 27-year-old woman with cystic fibrosis comes to the physician for a follow-up examination. She has been hospitalized frequently for pneumonia and nephrolithiasis and is on chronic antibiotic therapy for recurrent sinusitis. The patient and her husband would like to have a child but have been unable to conceive. She feels that she can never achieve a full and happy life due to her disease and says that she is “totally frustrated” with the barriers of her illness. Although her family is supportive, she doesn't want to feel like a burden and tries to shield them from her struggles. Which of the following is the most appropriate statement by the physician?
A. You should educate yourself about your disease or condition using credible, current sources. Knowledge can help dispel fear and anxiety.
B. I understand that living with cystic fibrosis is not easy. You are not alone in this. I would like to recommend a support group. (Correct Answer)
C. I see that you are frustrated, but this illness has its ups and downs. I am sure you will feel much better soon.
D. I understand your frustration with your situation. I would like to refer you to a therapist.
E. I think it's really important that you talk to your family more about this. I'm sure they can help you out.
Explanation: ***"I understand that living with cystic fibrosis is not easy. You are not alone in this. I would like to recommend a support group."***
- This statement offers **empathy** and validates the patient's feelings, which is crucial for building rapport and trust.
- Recommending a support group provides a **concrete, helpful resource** for emotional support and shared experiences, addressing her feelings of isolation and burden.
*"I think it's really important that you talk to your family more about this. I'm sure they can help you out."*
- This statement can be perceived as **dismissive** of her efforts to shield her family and might add to her feeling of being a burden.
- While family support is important, simply telling her to talk to them does not offer **new strategies** or specific guidance for her unique struggles.
*"You should educate yourself about your disease or condition using credible, current sources. Knowledge can help dispel fear and anxiety."*
- This response is **intellectualizing** and does not directly address her expressed emotional distress, frustration, and feelings of being overwhelmed.
- Given her chronic illness and frequent hospitalizations, it's highly likely she is **already well-educated** about her condition; this advice might come across as belittling.
*"I see that you are frustrated, but this illness has its ups and downs. I am sure you will feel much better soon."*
- This statement **minimizes her current suffering** and offers false reassurance, which can invalidate her feelings and erode trust in the physician.
- It lacks **empathy** and does not provide any actionable advice or support for her long-term chronic condition.
*"I understand your frustration with your situation. I would like to refer you to a therapist."*
- While a therapist can be helpful, suggesting it immediately might make the patient feel her frustration is being **medicalized as a mental health issue** before exploring other avenues of support.
- Recommending a support group first can be a gentler, less stigmatizing approach that allows her to connect with others facing similar challenges.
Question 26: A 25-year-old man comes to the physician for severe back pain. He describes the pain as shooting and stabbing. On a 10-point scale, he rates the pain as a 9 to 10. The pain started after he lifted a heavy box at work; he works at a supermarket and recently switched from being a cashier to a storekeeper. The patient appears to be in severe distress. Vital signs are within normal limits. On physical examination, the spine is nontender without paravertebral muscle spasms. Range of motion is normal. A straight-leg raise test is negative. After the physical examination has been completed, the patient asks for a letter to his employer attesting to his inability to work as a storekeeper. Which of the following is the most appropriate response?
A. “Yes. Since work may worsen your condition, I would prefer that you stay home a few days. I will write a letter to your employer to explain the situation.”
B. You say you are in severe pain. However, the physical examination findings do not suggest a physical problem that can be addressed with medications or surgery. I'd like to meet on a regular basis to see how you're doing.
C. I understand that you are uncomfortable, but the findings do not match the severity of your symptoms. Let's talk about the recent changes at your job. (Correct Answer)
D. The physical exam findings do not match your symptoms, which suggests a psychological problem. I would be happy to refer you to a mental health professional.
E. The physical exam findings suggest a psychological rather than a physical problem. But there is a good chance that we can address it with cognitive-behavioral therapy.
Explanation: ***"I understand that you are uncomfortable, but the findings do not match the severity of your symptoms. Let's talk about the recent changes at your job."***
- This response acknowledges the patient's reported discomfort while gently highlighting the **discrepancy between symptoms and objective findings**, which is crucial in cases of suspected **somatoform or functional pain**.
- It also opens communication about potential **psychosocial stressors** related to his job change, which could be contributing to his symptoms, without dismissing his pain or making a premature diagnosis.
*"You say you are in severe pain. However, the physical examination findings do not suggest a physical problem that can be addressed with medications or surgery. I'd like to meet on a regular basis to see how you're doing."*
- While this option correctly identifies the lack of physical findings, it can be perceived as dismissive of the patient's pain, potentially damaging the **physician-patient relationship**.
- Suggesting regular meetings without a clear plan for addressing his immediate concerns or exploring underlying issues might not be the most effective initial approach.
*“Yes. Since work may worsen your condition, I would prefer that you stay home a few days. I will write a letter to your employer to explain the situation.”*
- This response would **validate the patient's claim of severe pain** without objective evidence, potentially reinforcing illness behavior and avoiding addressing the underlying issue.
- Providing a doctor's note for inability to work without a clear diagnostic basis or understanding of the pain's origin is **medically inappropriate** and could set a precedent for future such requests.
*"The physical exam findings do not match your symptoms, which suggests a psychological problem. I would be happy to refer you to a mental health professional."*
- Directly labeling the problem as "psychological" can be **stigmatizing and alienating** to the patient, leading to distrust and resistance to care.
- While a psychological component might be present, immediately referring to mental health without further exploration of the patient's situation or current stressors is premature and lacks empathy.
*"The physical exam findings suggest a psychological rather than a physical problem. But there is a good chance that we can address it with cognitive-behavioral therapy."*
- Similar to the previous option, explicitly stating a "psychological problem" can be **stigmatizing**.
- Jumping directly to recommending **cognitive-behavioral therapy (CBT)** without a comprehensive discussion and patient buy-in is premature and may lead to non-compliance.
Question 27: A 35-year-old man presents to his primary care physician for a routine visit. He is in good health but has a 15 pack-year smoking history. He has tried to quit multiple times and expresses frustration in his inability to do so. He states that he has a 6-year-old son that was recently diagnosed with asthma and that he is ready to quit smoking. What is the most effective method of smoking cessation?
A. Nicotine replacement therapy alone
B. Quitting cold turkey
C. Bupropion in conjunction with nicotine replacement therapy and cognitive behavioral therapy (Correct Answer)
D. Participating in a smoking-cessation support group
E. Bupropion alone
Explanation: ***Bupropion in conjunction with nicotine replacement therapy and cognitive behavioral therapy***
- The combination of **pharmacological therapies** (Bupropion and NRT) with **behavioral support** (CBT) is consistently shown to be the most effective strategy for smoking cessation. This approach addresses both the physiological addiction and the psychological habits associated with smoking.
- **Bupropion** helps reduce cravings and withdrawal symptoms, while **nicotine replacement therapy (NRT)** manages nicotine withdrawal. **Cognitive behavioral therapy (CBT)** provides coping mechanisms and strategies to deal with triggers and prevent relapse.
*Nicotine replacement therapy alone*
- While **nicotine replacement therapy (NRT)** is an effective treatment, its efficacy significantly increases when combined with behavioral therapy or other pharmacotherapies.
- NRT alone primarily addresses the **physical dependence** on nicotine but may not fully address the psychological and behavioral aspects of addiction.
*Quitting 'cold-turkey'*
- **Quitting cold turkey** has a very low success rate, with only about 3-5% of individuals managing to quit long-term using this method.
- This method provides no support for severe **withdrawal symptoms** or cravings, making relapse highly likely, especially for heavy smokers.
*Participating in a smoking-cessation support group*
- **Support groups** provide valuable behavioral and social support, which is an important component of successful cessation.
- However, behavioral support alone is often less effective than when combined with **pharmacological interventions** that address the physiological addiction.
*Bupropion alone*
- **Bupropion** is an effective pharmacotherapy that helps reduce cravings and withdrawal symptoms and has been shown to improve cessation rates.
- While effective, its success rate is typically lower than when used in combination with **nicotine replacement therapy** and comprehensive behavioral support.
Question 28: A 52-year-old man is on a week-long cruise vacation with his family to celebrate his mother's 80th birthday. He has a very important presentation at work to give in one month, which will in part determine whether he receives a promotion. He decides to focus on enjoying the vacation and not to worry about the presentation until the cruise is over. Which of the following psychological defense mechanisms is he demonstrating?
A. Introjection
B. Regression
C. Suppression (Correct Answer)
D. Inhibition
E. Isolation of affect
Explanation: ***Suppression***
- **Suppression** is a **conscious** defense mechanism where an individual intentionally puts disturbing thoughts or feelings out of mind to deal with them later.
- The man is aware of the upcoming presentation but *consciously chooses* to defer worrying about it until his vacation is over, fitting the definition of suppression.
*Introjection*
- **Introjection** involves unconsciously internalizing the ideas or voices of others, often resulting in adopting their beliefs or behaviors as one's own.
- This mechanism is not about consciously delaying a stressful thought but rather about incorporating external influences into one's internal world.
*Regression*
- **Regression** is an ego defense mechanism where an individual reverts to an earlier, more immature, or childish stage of development in response to stress or anxiety.
- This mechanism typically involves a return to coping strategies or behaviors from childhood and does not describe the conscious decision to postpone dealing with an adult responsibility.
*Inhibition*
- **Inhibition** typically refers to a **restraint** or **blockage** of an impulse, behavior, or thought, often due to anxiety or conflict.
- It often manifests as an inability to perform certain actions or express specific feelings, which is not the case here; the individual is actively and consciously choosing to defer thoughts rather than being unable to access them.
*Isolation of affect*
- **Isolation of affect** is an unconscious defense mechanism where the emotional component of an idea or experience is separated from the intellectual component.
- The individual can discuss the event or thought without feeling its associated emotions, which is distinct from consciously choosing to postpone thinking about a known stressor.
Question 29: A resident doctor was reprimanded by the attending physician for making medication errors during morning rounds. Later that day, when a medical student asked a simple question about drug dosages during the evening rounds, the resident responded with excessive criticism and harsh comments, making the student visibly uncomfortable and embarrassed. Which of the following ego defense mechanisms is the resident demonstrating?
A. Displacement (Correct Answer)
B. Reaction formation
C. Projection
D. Passive aggression
E. Acting out
Explanation: ***Displacement***
- **Displacement** involves redirecting unacceptable feelings and impulses from their original source to a safer, less threatening recipient.
- The resident, unable to express anger towards the attending physician (a threatening figure), directs it at the medical student (a safer target).
*Reaction formation*
- **Reaction formation** is transforming an unacceptable impulse or feeling into its opposite.
- This would involve the resident being overly kind or solicitous towards the medical student, rather than critical, to mask their underlying anger or insecurity.
*Projection*
- **Projection** involves attributing one's own unacceptable thoughts or feelings to someone else.
- In this scenario, projection would mean the resident accusing the medical student of being incompetent or prone to errors, rather than simply criticizing them in response to prior reprimand.
*Passive aggression*
- **Passive aggression** is an indirect expression of hostility, often characterized by procrastination, stubbornness, intentional inefficiency, or forgotten commitments.
- While the criticism was harsh, it was a direct expression of anger, not an indirect, subversive act.
*Acting out*
- **Acting out** involves expressing unconscious emotional conflicts or stressors through actions rather than words.
- This mechanism typically involves impulsive behavior that could be harmful to oneself or others, which is not primarily what occurred with the verbal criticism.
Question 30: Several years after a teenage boy and his younger brother witnessed a gang related murder, they both decided to come forward and report it to authorities. The older brother describes the horrific decapitation of the gang member without displaying any emotion; but when the younger brother was asked about the crime, he had no recollection of the event. Which two ego defenses are being displayed by these brothers, respectively?
A. Denial; Dissociation
B. Suppression; Repression
C. Isolation of affect; Displacement
D. Splitting; Regression
E. Isolation of affect; Repression (Correct Answer)
Explanation: ***Isolation of affect; Repression***
- The older brother describes the horrific event **without displaying any emotion**, which is characteristic of **isolation of affect**, a defense mechanism where the emotional component of an experience is separated from the cognitive component.
- The younger brother has **no recollection** of the traumatic event, indicating **repression**, an unconscious mechanism where distressing thoughts or memories are pushed out of conscious awareness.
*Denial; Dissociation*
- **Denial** involves refusing to accept reality, which is not what the older brother is doing as he clearly describes the event.
- **Dissociation** involves a disruption of consciousness, memory, identity, or perception; while the younger brother's lack of recollection could be a form of dissociation, repression is a more specific and fitting term for the unconscious forgetting of a traumatic event.
*Suppression; Repression*
- **Suppression** is a conscious effort to push thoughts away, whereas the older brother's lack of emotion is an unconscious separation.
- While the younger brother's amnesia is **repression**, the older brother's symptom is not suppression.
*Isolation of affect; Displacement*
- **Isolation of affect** accurately describes the older brother's response.
- However, **displacement** involves redirecting impulses or emotions from the original target to a safer, more acceptable one, which does not describe the younger brother's lack of recollection.
*Splitting; Regression*
- **Splitting** involves seeing things as all good or all bad, which neither brother demonstrates.
- **Regression** is returning to an earlier stage of development in response to stress, which is not what the younger brother's amnesia represents.