A 32-year-old man is in twice-weekly insight-oriented psycho

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A 32-year-old man is in twice-weekly insight-oriented psychotherapy with a psychiatrist. Recently, the patient has been exploring his thoughts and feelings around his wife's complaint that he is too restricted and inhibited in their sexual activity. The patient admits that he wishes to be more sexually available for his wife, but finds himself maintaining a restricted stance. Which of the following defense mechanisms would best describe this patient's tendency in his sexual relationship with his wife?

A. Projection
B. Reaction formation
C. Sexualization
D. Somatization
E. Sublimation

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Explanation:
The answer is B. Reaction formation, often seen in obsessional characters, is the term for the defense mechanism in which an unacceptable impulse is transformed into its opposite. In this case, during insight-oriented psychotherapy, the patient realizes his wish to be freer in his sexual relationship with his wife (an impulse which he finds unacceptable on some level) but finds himself responding in the opposite way (maintaining a restricted stance). Inhibition may also partly account for this man's difficulty, in that a renunciation is used to evade anxiety arising out of impulses. Projection (choice A) occurs when an unacceptable inner impulse is perceived and reacted to as though it was outside oneself. On the psychotic level, this takes the form of delusions and hallucinations. Sexualization (choice C) occurs when an object or function is endowed with sexual significance that it did not previously have in order to ward off anxieties associated with prohibited impulses. Somatization (choice D) describes the defense mechanism that occurs when emotional concerns are converted into bodily symptoms, and the person tends to react with somatic manifestations. If the patient in this case had a tendency to use somatization, he might unconsciously use physical symptoms to get rid of the anxiety around his conflicted sexual thoughts. Sublimation (choice E) is a mature defense mechanism that occurs when a socially acceptable means of expressing an impulse replaces one that would be socially unacceptable. Sublimation allows instincts to be channeled, rather than blocked or diverted. Feelings are acknowledged, modified, and directed toward a significant object or goal, and modest instinctual satisfaction occurs.