A patient diagnosed with paranoid schizophrenia angrily tells a nurse, "You act like a homosexual. No one trusts you or wants to be around you." Select the most likely analysis. The patient:
a. is showing reaction formation in response to feelings of abandonment.
b. is unleashing unconscious, hostile feelings toward the nurse.
c. is dwelling on others' shortcomings, thus placing them on the defensive.
d. may be projecting homosexual urges.
ANS: D
Patients with paranoid ideation unconsciously use the defense mechanism projection to deal with unacceptable, anxiety-producing ideas and impulses, in this case homosexual urges. Although the behavior seems hostile, the projection is homosexual urges rather than hostility. Patients who exhibit paranoid ideation usually fear abandonment, but this situation does not represent reaction formation to abandonment feelings. Although it is true that dwelling on others' shortcomings places them on the defensive, it is not the correct analysis of the behavior described in the scenario.
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