A medical student who fails an exam becomes very angry at his roommate for minor reasons later that evening. According to Vaillant's hierarchy, which defence mechanism is he using, and which level does it belong to?

• A Displacement; immature (neurotic) level ✓
• B Projection; psychotic level
• C Sublimation; mature level
• D Reaction formation; mature level

Explanation

Displacement involves redirecting an impulse (anger at failing) from its original target (himself/examiners) to a substitute target (roommate) who is less threatening or less directly relevant. In Vaillant's hierarchy, displacement is classified at the neurotic (intermediate) level. Mature defences (sublimation, altruism, humour, suppression) channel impulses constructively. Immature defences (acting out, projective identification, passive-aggression) cause interpersonal difficulties. Psychotic defences (denial of external reality, delusional projection) involve major reality distortion. Sublimation would be if he channelled the frustration into productive study.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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