Denial is a defense mechanism that involves disregarding the truth of a situation to avoid anxiety. Defense mechanisms are coping methods used by people to deal with unpleasant emotions.
Denial can involve either refusing to acknowledge reality or refuting the consequences of that truth.
When patients are in denial, they try to accept something that appears to be overpowering or upsetting. However, in the short term, this defense mechanism can be beneficial. It gives patients time to adapt to an abrupt change in their reality. They may be able to embrace, adjust, and eventually move on if they give themselves time.
Denial can also cause difficulties in life, especially when it prevents patients from confronting a problem or making necessary changes. It can sometimes prevent people from receiving support or necessary therapy.
Signs and Symptoms of Denial
There are several indicators that someone is using denial as a defense mechanism. The following are the common indicators that patients in the denial stage experience:
- refusing to discuss the issue
- seeking justifications for their actions
- blaming other individuals or other sources for the issue
- continuing to engage in a behavior despite unfavorable outcomes
- promises to deal with the issue in the future
- trying to avoid worrying about the situation
Types of Denial
The famous psychoanalyst Sigmund Freud first proposed the concept of denial as a defense mechanism. Denial is the rejection of an unpleasant fact that a person cannot accept. Moreover, Sigmund Freud’s paradigm was elaborated by the psychiatrist Elisabeth Kubler-Ross, who suggested that denial is the first stage toward accepting one’s difficult situation. Denial is now widely regarded as a normal part of the grieving process.
Denial in the Model of Sigmund Freud
According to Freud, there are three types of denial:
1. Simple Denial. When someone rejects that something terrible is happening, this is referred to as simple denial.
An individual with an incurable illness, for example, may dispute the fact that he or she will die.
2. Minimization. This type of denial happens when a person acknowledges an unpleasant reality while rejecting its severity. A person who is about to divorce, for example, may disregard the divorce as unimportant.
3. Projection. This type of denial happens when a person acknowledges the severity and realism of an unpleasant fact while blaming someone else. For example, a cancer patient may argue that his or her doctor is not giving proper care and that a different doctor could result in a better outcome.
Other Types of Denial
Several mental health professionals have expanded on Freud’s model to include different types of denial, such as:
1. Denial of denial. The refusal to acknowledge an undesirable fact while insisting that one is not suffering denial.
2. Cycle denial. The incapacity to recognize what is happening. A victim of domestic violence, for example, may deny that his or her partner previously behaved in an abusive manner.
3. Denial of Responsibility. Refusal to acknowledge a person’s accountability in an unpleasant incident produced by that person is referred to as denial of responsibility. A driver who hits and injures another person, for example, may reject the impact of the incident, deny accountability, or even rationalize his or her behavior.
Impact of Denial
Denial is often not harmful. When confronted with anything shocking or painful, being in denial can provide a patient with little time and space to progressively, and sometimes unconsciously, come to terms with the change.
For instance, patients may remain in denial about a health risk because they do not want to confront the likelihood of being extremely ill. Rather than panicking unnecessarily, being in denial can offer them some time to deal with the situation and be calm while seeking medical counsel.
Denial can be difficult and even dangerous in some circumstances. For example, if a patient remains in denial about a medical condition and never sees a doctor, the situation may develop.
Similarly, suppose a patient is in denial about signs of mental diseases, such as depression or anxiety. In that case, they may put off obtaining help from a doctor or psychological health expert.
Denial of Diagnosis, Therapy, and Mental Health
Patients frequently undergo denial of diagnosis and treatment or therapy quickly after getting the news. Whether the ailment is mental or physical, the mind may require adjustment.
Patients may experience some shock, including denial, before considering what it all entails. However, denial can quickly escalate into a significant issue.
Patients who keep denying their condition are at risk of receiving insufficient therapy and developing various symptoms. Unfortunately, denial can be a chronic difficulty for some persons suffering from mental illnesses. Thus, their caretakers may grow frustrated and stressed as a result. Understanding what is causing the denial is a significant first step toward understanding how to deal with it.
Here are some possible reasons for Denial of Diagnosis, Therapy, or Mental Health:
- Anosognosia. Anosognosia is a medical term that describes an individual who lacks insight or understanding of their situation. They are in denial about their sickness because their brain is not completely capable of comprehending it. In many circumstances, the individual will see the reality of their condition at times while experiencing denial.
- Fears of Stigma or Treatment. Some patients are concerned about their treatment. Their concerns may be founded on misunderstandings and preconceptions, and personal experiences. Regardless, the anxieties are real and justified. As a result, a similar issue arises when someone takes therapy for their diagnosis, and it fails. They believe that the diagnosis was erroneous.
Examples of Denial
People frequently use denial to avoid dealing with troublesome feelings. Here are several examples:
- A person denies having an alcohol or substance use disorder since they can function and go to work every day.
- Following the untimely death of a loved one, a person may refuse to acknowledge the death and pretend that nothing occurred. This type of denial is a normal aspect of the grieving process.
- After offending other people, the patient may refuse to think about it or attempt to blame others for their actions.
- Someone having signs of a mental health disorder may avoid talking about it and not seek help since they do not want to confront the difficulties; if they do not receive the necessary encouragement and guidance, their condition may deteriorate.
- When a chronic sickness or terminal illness is identified, a person may refuse to realize that the situation is already terrible. Instead, they may believe that they will overcome it. Unfortunately, this denial can impede treatment.
Treating and Overcoming Denial
Overcoming denial is frequently determined by the nature of the situation. Given enough time and assistance, people may typically come to terms with the truth of a circumstance independently. Psychotherapy and support groups may also be beneficial.
Learning to acknowledge and identify defense mechanisms such as denial in psychodynamic therapy increases an individual’s self-awareness and understanding of their conduct.
Here are some successful methods for dealing with denial:
- The patient must consider why he is afraid to confront the situation.
- Consider the repercussions of failing to address the issue.
- Talk to a close friend or relative who may be able to provide an accurate, more objective viewpoint.
- Work on detecting any erroneous thoughts that may exist.
Ineffective Denial
The North American Nursing Diagnosis Association (NANDA) defines ineffective denial as a person’s conscious or unconscious attempt to ignore the information or significance of an incident to minimize their emotional distress to the cost of their wellbeing.
Defining Characteristics of ineffective denial include:
- Delay in obtaining professional assistance or denial of health care to the cost of one’s health.
- Misinterpretation of the significance of symptoms or risky situations.
- Patients tend to self-medicate to relieve symptoms instead of seeking medical help.
- Ignorance about death or disability.
- Reduction of symptoms.
- Relocation of the source of the symptoms to other organs.
- Refusal to acknowledge the influence of disease on one’s lifestyle.
- Disinterest in or dismissal of traumatic events when discussing them.
- Exhibition of inappropriate emotions.
Nursing Outcome Classification (NOC):
- anxiety management
- fear management
- symptom management
- health beliefs, such as a perceived threat
Nursing Intervention Classification (NIC):
- emotional assistance
- guidance
- improved coping abilities
- lessened anxiousness
- increased security
- techniques for relaxation
- assist in self-improvement
- encourage self-sufficiency
- health literacy
- disease progression education
- increased self-awareness
- pay attention
- make communication easier
Denial Nursing Diagnosis
Denial Nursing Care Plan 1
Substance Abuse Disorder
Nursing Diagnosis: Denial related to personal vulnerability, difficulty dealing with unfamiliar circumstances, past ineffective or insufficient coping skills with drug substitution, learned responses such as cultural aspects, personal and family belief systems secondary to substance abuse disorder as evidenced by a deferment in pursuing or complete unwillingness of healthcare attention to the detriment of health and life, failure to recognize personal relevance of symptoms or threat, or failure to acknowledge the influence of condition on current lifestyle, projection of blame or responsibility for problems, and use of manipulation to avoid taking responsibility for self.
Desired Outcomes:
- The patient will express knowledge of the connection between substance abuse and the present situation.
- The patient will participate in a therapeutic program.
- The patient will express verbal acknowledgment of obligation for his or her actions.
| Nursing Interventions for Denial | Rationale |
| Determine how the patient wants to be addressed. | This intervention demonstrates respect and courtesy, providing the patient with a sense of orientation and control. |
| Encourage family members to seek help regardless of whether the abuser does. | This intervention aims to help the patient cope with the situation appropriately. Being in the denial stage is the patient’s coping with his current situation, so the patient’s family should seek assistance when required. |
| Convey an accepting attitude while separating the individual from inappropriate behavior. | Despite being in the denial stage, this intervention promotes feelings of dignity and self-worth. |
| Help and enable patients to accept accountability for their recoveries, such as developing alternatives to drug longing and use. | When the patient chooses to accept the reality of his or her own responsibility, denial can be overtaken with decisive change. |
| In a social circle, confront and investigate denial and rationalization. Use confrontation with compassion. | Since denial is the primary defensive measure in habit-forming disease, confrontation with peers can assist patients in accepting the fact of negative consequences of behavior patterns and the fact that drug use is a significant problem. A caring attitude maintains self-concept and aids in the reduction of defensive reactions. |
| Maintain a strong assumption that the patient regularly attends recovery support and therapy groups. | Participation is related to acknowledging the need for assistance, dealing with denial, and maintaining a long-term drug-free existence. |
| Provide information on how addiction affects mood and personal qualities. | Individuals frequently misinterpret the impacts of addictive behavior and use this to excuse or justify their drug consumption. |
| Show appreciation to those who express denial awareness in themselves and everyone else. | This intervention is required to boost self-esteem and reinforce behavioral understanding. |
| Nurses and health care providers should strive to maintain neutrality. Nurses should be watchful for behavioral changes such as anxiousness and heightened tensions. | Confrontation can cause increased agitation, putting both the patient and the health care staff at risk. That is why it is critical to approach patients with compassion and understanding. |
Denial Nursing Care Plan 2
Nursing Diagnosis: Denial related to unfulfilled expectations, erroneous preconceptions, and inappropriate coping mechanisms secondary to hypertension as evidenced by excessive worry and anxiousness, and noncompliance to the treatment regimen.
Desired Outcomes:
- The patient will be able to recognize ineffective coping behaviors such as denial and its consequences.
- The patient will express awareness of his or her coping abilities and strong points.
- The patient will recognize potential challenging circumstances and take steps to prevent or modify them.
- The patient will demonstrate efficient coping mechanisms or techniques.
| Nursing Interventions for Denial | Rationale |
| Assist the patient in identifying the specific stress factors and potential coping mechanisms. | Recognizing sources of stress is the first step toward changing one’s response to stressful situations. Knowing what causes denial can help the patient to overcome it. |
| Include the patient in care planning and ask them to participate as much as possible in the care plan. | Participation gives the patient a sense of continuing control, reduces denial tendencies, and can improve cooperation with the medication regimen. |
| Take note of reports of sleep disruptions, tiredness, poor concentration, mood swings, reduced headache tolerance, and inability to cope or problem-solve. | Dysfunctional adaptation strategies can be indicators of denial of one’s health condition. |
| Assist the patient in replacing self-destructive thoughts with positive ones. | Denial is the patient’s way of coping with his condition to avoid anxiety. As a result, the goal of this intervention is to address the patient’s psychological needs. |
| Assist the patient in recognizing and preparing for required lifestyle changes against hypertension. Instead of abandonment and denial of his health condition, assist him/her in adjusting to the lifestyle changes that he/she will appy. | Required changes should be realistically prioritized so that patients are not carried away and experience denial. |
Denial Nursing Care Plan 3
Prenatal Substance Abuse
Nursing Diagnosis: Denial related to anxiety or fear, sense of powerlessness, trouble managing unfamiliar challenges, previous inefficient coping mechanisms with drug replacement, and a lack of support networks secondary to prenatal substance abuse as evidenced by reduced ability to cope with the stress of ailment or hospitalization, deficient adaptive behavior and problem-solving abilities, and refusal to accept that drug use is to blame for the current situation
Desired Outcomes:
- The patient will express awareness of the connection between substance misuse and the present situation.
- The patient will be able to recognize ineffective coping behaviors and their consequences.
- The patient will employ appropriate coping strategies and problem-solving techniques.
- The patient will make the necessary lifestyle adjustments.
- The patient will participate in a support group.
| Nursing Interventions for Denial | Rationale |
| Examine the patient’s comprehension of pregnancy, present situation, and preceding techniques of dealing with life’s difficulties. | This intervention reveals coping mechanisms that can be used in the current care plan and provides information about the extent of denial. |
| When a patient conveys consciousness of denial in themselves and acknowledges it in others, give them valuable responses. | Denial is a primary coping strategy in habit-forming disorders and may impede therapy improvements until the client accepts the truth of the problem. Positive responses are essential for increasing self-esteem and reinforcing behavioral insight. |
| Encourage the patient to attend recovery support or therapy groups on a regular basis. | Participating in therapy groups is associated with acknowledging the need for assistance, dealing with denial, achieving the best possible pregnancy outcome, and maintaining a long-term drug-free way of life. |
| Encourage and support the patient’s decision to take accountability for his or her recovery. | Denial can be replaced with an appropriate approach once the patient accepts the reality of his or her accountability. |
| Be fully conscious of enabling feelings and behaviors in family and personnel. | Inadequate therapeutic options for substance abusers may result from a lack of knowledge of enabling and controlling behavior. |
| Help the patient learn relaxation exercises, mental imagery, or visualization techniques and encourage her to use them. | This intervention assists the patient in relaxing and developing new ways to cope with stress and problem-solving. |
Denial Nursing Care Plan 4
Nursing Diagnosis: Denial related to fear of death, feelings of helplessness and doubt about acceptance by others, and anxiety as evidenced by fear of rejection or reaction from others, inability to deal with change or loss, failure to take personal accountability for self-care, and a complete absence of follow-through.
Desired Outcomes:
- The patient will explain how his body changes and how he accepts himself in this situation.
- The patient will begin developing stress management to deal with the issues effectively.
- The patient will be able to illustrate adaptation to adjustments by setting realistic goals and actively participating in work or personal relationships as suitable.
| Nursing Interventions for Denial | Rationale |
| Discuss how the treatment options affect their daily lives, family, and job activities with the patient and significant others. | This intervention assists in defining issues in order to start the problem-solving procedures. This approach may also help to reduce the patient’s denial tendencies. |
| Encourage patients to express their concerns about the impact of cancer and treatment options on their roles as homemakers, wage earners, or parents. | This intervention may aid in reducing issues that impede treatment acceptance or promote the progression of the disease. |
| Recognize any difficulties the patient may be having. Inform them that counseling is frequently required and significant in the adjustment process. | This approach validates the reality of the patient’s sentiments and gives consent to take whatever steps are required to deal with what is occurring. |
| During the diagnostic and treatment phases, provide emotional support to the patient and significant others. | Although some patients adapt to cancer consequences or adverse effects of therapeutic interventions, many require additional assistance during this time. Emotional support may assist the patient in accepting his current health situation. |
| Allow for non-confrontational outbursts of anger, fear, and hopelessness. Provide information that feelings are reasonable and should be expressed appropriately. | Acceptance of feelings enables the patient to begin dealing with the situation. |
Denial Nursing Care Plan 5
Perinatal Loss
Nursing Diagnosis: Denial related to anxiety, emotional conflict, stress, painful thoughts, and frightening information secondary to perinatal loss as evidenced by verbalization of negative sentiments such as helplessness or worthlessness, difficulty making judgments, and accepting life’s circumstances.
Desired Outcomes:
- The patient will show adaptation to newborn death and integration of bereavement into daily life by making plans for the future.
- The patient will discover his or her capabilities and accessible resources.
- The patient will verbalize effective coping.
| Nursing Interventions for Denial | Rationale |
| Examine the patient’s or couple’s knowledge and comprehension of the events regarding the death of the fetus or infant. Based on the couple’s willingness and capacity to listen effectively, provide more reliable information, and clarify misconceptions. | Emotional responses may make it difficult for the couple to accept and evaluate the importance of occurrences. At this point, concrete thinking processes such as literal interpretation may be the only viable methods of coping with information. |
| Recognize the stage of sorrow shown, for example, denial, anger, bargaining, sadness, and acceptance. Use therapeutic communication techniques like active listening or acknowledgment and understand the patient’s choice or request not to speak. | If the mourning process is not finished, sorrow can become dysfunctional, leading to behaviors that endanger personal security and the future of family life. |
| Examine the patient’s activity level, sleeping habits, appetite, and personal hygiene. | These aspects may be overlooked due to the denial stage and related despair. Sleeping habits may be interrupted, resulting in exhaustion and an inability to deal with stress. The patient may require assistance in satisfying physical demands and reassurance that it is safe to resume normal activities. |
| Positive encouragement should be given for expressing needs and recognizing concerns. | This intervention assists parents in coping with the sadness of the circumstance and accepting what happened, no matter how difficult it is. |
| Determine valuable relationships and resources to call on during difficult times, such as parents and siblings, friendships, or religious affiliations. | Using a support system might help the patients cope with denial and keep their perspective. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
