Kaplan USMLE Step 3: Which defense mechanism led to man’s career?

If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 3 exam, you might want to know which questions are most often missed by test-prep takers. Check out this example from Kaplan Medical, and read an expert explanation of the answer. Also check out all posts in this series.  

This month’s stumper

A 32-year-old man presents to the office for an initial visit. He states that as a child he used to love playing with fire. He would constantly light matches and watch them burn. He liked to set fires in garbage cans and attend bonfires on the beach. Now, as an adult, he has applied this fascination into a career of pyrotechnics for films and concerts.

Which of the following defense mechanisms best explains this patient's response?

A. Acting out.

B. Rationalization.

C. Reaction formation.

D. Sublimation.

E. Undoing.










The correct answer is D.

Kaplan Medical explains why

Sublimation is one of the mature defense mechanisms. It occurs when an unacceptable impulse has been transformed into an acceptable form. In this case, the patient's impulse to play with fire has been turned into an acceptable format: a professional pyrotechnic working on film sets and concerts. He transformed his impulse to an acceptable form.

Why the other answers are wrong

Choice A: Acting out occurs when a person does not get what he wants, and he has an emotional outburst (i.e., a temper tantrum).

Choice B: Rationalization occurs when a person tries to make an excuse for an unacceptable action (i.e., when a child blames the teacher for her bad grade).

Choice C: Reaction formation is an unacceptable impulse changed to the opposite (i.e., an alcoholic extolling the virtues of abstinence).

Choice E: Undoing is often exhibited in patients with obsessive compulsive disorder, performing an act to “undo” a previous unacceptable act or thought.

Tips to remember

Sublimation is a mature defense mechanism in which the unacceptable impulse is changed into an acceptable impulse.

For more prep questions on USMLE Steps 1, 2 and 3, view other posts in this series.

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