A 54-year-old man arrives for an appointment with a new physician. At the front desk, the receptionist tells him that the physician is running behind schedule and gives him several forms to complete regarding his personal and family medical history. The patient politely agrees to fill them out and has a seat in the waiting area. However, when his paperwork is reviewed by the physician, it contains only the patient's signature. The patient says, "I'm sure a doctor with your education can take a good history." When asked if anything is wrong he says, "Oh, nothing, I'm fine." Which of the following best describes this patient's behavior?

Question

A 54-year-old man arrives for an appointment with a new physician.  At the front desk, the receptionist tells him that the physician is running behind schedule and gives him several forms to complete regarding his personal and family medical history.  The patient politely agrees to fill them out and has a seat in the waiting area.  However, when his paperwork is reviewed by the physician, it contains only the patient's signature.  The patient says, "I'm sure a doctor with your education can take a good history."  When asked if anything is wrong he says, "Oh, nothing, I'm fine."  Which of the following best describes this patient's behavior?

Quizplus · Accepted Answer

11ec160b_3612_b62b_9249_c557f7ebe0a0_MD0001_00 This patient's indirect expression of anger about having to wait for the physician is an example of passive aggression. Rather than directly expressing his feelings, he agrees to fill out the forms and then resists performing the expected task. Other examples of behaviors used to indirectly defuse hostile feelings include procrastination, forgetfulness, and purposeful inefficiency. Backhanded compliments, sarcasm, and denial of being angry are also characteristic of passive-aggressive behavior. (Choice A) Acting out is an immature defense mechanism that involves expressing unconscious wishes or impulses through overtly aggressive actions (eg, the patient tore up the forms in anger). (Choice B) In displacement, negative feelings associated with a person or situation are transferred to another person or object that appears less threatening (eg, the patient did not express his anger to the physician but yelled at his wife instead). (Choice D) In reaction formation, unacceptable feelings are transformed into their opposites (eg, the patient's irritation was redirected into being overly complimentary to the physician). (Choice E) Splitting involves experiencing the self or others in extremes, either all positive or all negative (eg, the patient was told of the delay in his appointment time and then perceived the physician as horrible with no redeeming qualities). (Choice F) Suppression involves consciously putting aside unwanted feelings (eg, the patient made a conscious decision to temporarily put aside his anger, completed the paperwork as directed, and was cordial to the physician during the appointment). (Choice G) Undoing involves symbolically nullifying a guilt-provoking thought or feeling by confession or atonement (eg, this patient brought the physician a gift at his next appointment to negate his angry feelings). Undoing is commonly seen in obsessive-compulsive disorder. Educational objective: Passive aggression is the expression of angry feelings in a nonconfrontational manner. __________ References: Understanding defense mechanisms. (http://www.ncbi.nlm.nih.gov/pubmed/26583439)

A 54-Year-Old Man Arrives for an Appointment with a New