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Projection

Psychiatry and Psychology · NLM MeSH · updated 2026-11-04 · version 1

Citations verified against PubMedNot yet clinician-reviewed10 referencesApproximately 5 min read

A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others.

Table of Contents

1. Definition2. Research landscape3. Reading the evidence4. Open-access studies5. Key reviews6. References7. About this article

Definition and research guide

This page combines a MeSH definition, publication statistics and selected research abstracts. It is a starting point for reading the literature, not a medical textbook or a systematic evidence review.

Content available: 4 complete abstracts (953 words), 10 references. Full article text is not stored or reproduced here; follow the PMID, DOI or PMC links to read the original sources and their access terms.

Definition

A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others.

Definition: NLM Medical Subject Headings (MeSH) scope note (Public domain (U.S. National Library of Medicine); attribution requested). View the MeSH record.

Where it fits in the MeSH classification

Broader topics
Defense Mechanisms
Narrower topics
Scapegoating

Research landscape

PubMed indexes 1,489 records tagged with the MeSH heading “Projection” (counts retrieved 2026-10-31). 53 of them (3.6%) were published from 2020 onward, and the busiest period so far is through 1999 with 1,023 records.

Reviews account for 74 records (5.0%) and meta-analyses for 2. Randomized controlled trials number 11 (0.7%) as a share of all records on the topic. Randomized trials make up only a small share of this literature, so much of what is known comes from laboratory, observational or descriptive work.

PubMed records by publication periodthrough 1999: 1,023 records; 2000-2009: 238 records; 2010-2019: 175 records; 2020 onward: 53 records1,023through 19992382000-20091752010-2019532020 onward
Records in PubMed indexed with this heading, by publication period. Real counts from NCBI E-utilities; the final period covers only part of the current year. Volume reflects how much has been published, not how strong the evidence is.
Show the data
PeriodRecords
through 19991,023
2000-2009238
2010-2019175
2020 onward53
Share of records by publication typeReviews: 5.0 percent; Meta-analyses: 0.1 percent; Randomized controlled trials: 0.7 percentReviews5.0% (74)Meta-analyses0.1% (2)Randomized controlled trials0.7% (11)
Share of all PubMed records on this heading that carry each publication type. Types overlap with other records, so the shares do not sum to 100%.
Publication-type chart data
Publication types among 1,489 PubMed records
TypeRecordsShare
Reviews745.0%
Meta-analyses20.1%
Randomized controlled trials110.7%

Method: PubMed query "Projection"[MeSH Terms] with publication-type and date filters, retrieved 2026-10-31.

Reading the evidence in psychiatry and psychology

Research on mental health and behaviour relies on questionnaires, interviews and rating scales rather than physical measurements, so how a condition was defined and measured shapes every result. Many studies are observational or small, placebo responses can be large, and findings in one group or culture may not carry over to another. Nothing on this page is advice about diagnosis or treatment; anyone worried about their mental health should talk to a qualified clinician. Check how outcomes were measured, who took part and how long they were followed.

Evidence from open-access studies

These open-access studies come from PubMed’s best-match results for this heading (papers whose main topic it is), ranked here by citation count, with one recent addition. Each abstract is reproduced in full under its recorded open licence so that you can read the authors’ own words. They illustrate the literature; they are not a systematic summary of it. Citation counts measure attention, not reliability or clinical benefit.

Study comparison — selected abstracts, not a systematic review
Study / authorsYearSource label / designEurope PMC citationsLicence / source
Doctors are to blame for perceived medical adverse events. A cross sectional population study. The Tromsø Study
Hotvedt R, Førde OH
2013Research article
Design not recorded in structured metadata
14cc by
PMID 23384420 · DOI · PMC3623705
Conduct symptoms and emotion recognition in adolescent boys with externalization problems
Aspan N, Vida P, Gadoros J, Halasz J
2013Research article
Design not recorded in structured metadata
10cc by
PMID 24302873 · DOI · PMC3835356
Clouding the Judgment of Domestic Violence Law: Victim Blaming by Institutional Stakeholders in Cambodia
Brickell K
2017Research article
Design not recorded in structured metadata
4cc by
PMID 26076978 · DOI · PMC5390939
Scapegoating in Healthcare: A Primitive Response to Tragedy
Gibbons R
2026Research article
Design not recorded in structured metadata
0cc by
PMID 41454473 · DOI · PMC13478434

Doctors are to blame for perceived medical adverse events. A cross sectional population study. The Tromsø Study [1]

Research article Hotvedt R, Førde OH · · 2013 · cited 14 times (Europe PMC)

Abstract reading summary — source excerpts
Opening excerpt
BackgroundMost current knowledge of the incidence of medical adverse events (AEs) comes from studies carried out in hospital settings.
Closing excerpt
Therefore, such complaints are of limited value as a basis for patient safety work.
Interpretation limits
Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (331 words)

BackgroundMost current knowledge of the incidence of medical adverse events (AEs) comes from studies carried out in hospital settings. Little is known about AEs occurring outside hospitals, in spite the fact that most of contacts between patients and health care take place in primary care. Small sample population studies report that 4-49% of the general public have experienced AEs related to their own or family members´ care.The purpose with the present study was to investigate the occurrence of experienced medical adverse events in a large general population.MethodsWe invited 19763 inhabitants of a municipality in northern Norway, age 30 years and older, to fill in a questionnaire. Main outcome measures were life time prevalence of AEs experienced by respondents or their first degree relatives, perceived responsibility for and predictors of such events, as well as formal complaints as a reaction to the events.ResultsThe response rate was 66%. Nine and 10% of the respondents reported self-experienced adverse events, and 15 and 19% (men and women, respectively) that their relatives had experienced AEs. Logistic regression models showed that the strongest predictors of reporting self-experienced adverse events were: Having been persuaded to accept an unwanted examination or treatment, difficulties in getting a referral from primary to specialist health care, and inadequate communication with the doctor. Of the respondents who had experienced adverse events personally, 62% placed the responsibility for the event on the general practitioner, 39% on the hospital doctor, and 19% on failing routines or cooperation. Only 7% of men and 14% of women who reported self-experienced events handed in a formal complaint.ConclusionsThe public predominantly place the responsibility for medical adverse events on doctors, in particular general practitioners, and to a lesser degree on the system. This should be emphasised by doctors and managers who communicate with patients who have experienced AEs, and in patient safety work. Only a small fraction of adverse events results in a formal written complaint. Therefore, such complaints are of limited value as a basis for patient safety work.

Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 23384420 · DOI · PMC3623705

Conduct symptoms and emotion recognition in adolescent boys with externalization problems [2]

Research article Aspan N, Vida P, Gadoros J, Halasz J · · 2013 · cited 10 times (Europe PMC)

Abstract reading summary — source excerpts
Opening excerpt
BackgroundIn adults with antisocial personality disorder, marked alterations in the recognition of facial affect were described.
Closing excerpt
ConclusionsOur results suggest that impaired emotion recognition is dimensionally related to conduct problems and might have importance in the development of antisocial behavior.
Interpretation limits
Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (186 words)

BackgroundIn adults with antisocial personality disorder, marked alterations in the recognition of facial affect were described. Less consistent data are available on the emotion recognition in adolescents with externalization problems. The aim of the present study was to assess the relation between the recognition of emotions and conduct symptoms in adolescent boys with externalization problems.MethodsAdolescent boys with externalization problems referred to Vadaskert Child Psychiatry Hospital participated in the study after informed consent (N = 114, 11-17 years, mean = 13.4). The conduct problems scale of the strengths and difficulties questionnaire (parent and self-report) was used. The performance in a facial emotion recognition test was assessed.ResultsConduct problems score (parent and self-report) was inversely correlated with the overall emotion recognition. In the self-report, conduct problems score was inversely correlated with the recognition of anger, fear, and sadness. Adolescents with high conduct problems scores were significantly worse in the recognition of fear, sadness, and overall recognition than adolescents with low conduct scores, irrespective of age and IQ.ConclusionsOur results suggest that impaired emotion recognition is dimensionally related to conduct problems and might have importance in the development of antisocial behavior.

Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 24302873 · DOI · PMC3835356

Clouding the Judgment of Domestic Violence Law: Victim Blaming by Institutional Stakeholders in Cambodia [3]

Research article Brickell K · · 2017 · cited 4 times (Europe PMC)

Abstract reading summary — source excerpts
Opening excerpt
This article examines victims' purported complicity in the judicial failures of domestic violence law to protect them in Cambodia.
Closing excerpt
In turn, the article signals the importance of research on, and better professional support of, intermediaries who (discursively) administrate the relationship between DV Law and the victims/citizens it seeks to protect.
Interpretation limits
Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (216 words)

This article examines victims' purported complicity in the judicial failures of domestic violence law to protect them in Cambodia. It is based on 3 years (2012-2014) of research in Siem Reap and Pursat Provinces on the everyday politics of the 2005 "Law on the Prevention of Domestic Violence and the Protection of the Victims" (DV Law). The project questioned why investments in DV Law are faltering and took a multi-stakeholder approach to do so. In addition to 40 interviews with female domestic violence victims, the research included 50 interviews with legal and health professionals, NGO workers, low- and high-ranking police officers, religious figures, and local government authority leaders who each have an occupational investment in the implementation and enforcement of DV Law. Forming the backbone of the article, the findings from this latter sample reveal how women are construed not only as barriers "clouding the judgment of law" but also as actors denying the agency of institutional stakeholders (and law itself) to bring perpetrators to account. The findings suggest that DV Law has the potential to entrench, rather than diminish, an environment of victim blaming. In turn, the article signals the importance of research on, and better professional support of, intermediaries who (discursively) administrate the relationship between DV Law and the victims/citizens it seeks to protect.

Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 26076978 · DOI · PMC5390939

Scapegoating in Healthcare: A Primitive Response to Tragedy [4]

Research article Gibbons R · · 2026

Abstract reading summary — source excerpts
Opening excerpt
BackgroundIn recent years, a pattern has emerged in healthcare systems where clinicians and organisations are publicly blamed and punished following tragic events such as suicides or homicides.
Closing excerpt
The paper argues that only by recognising and resisting these unconscious group dynamics can healthcare systems foster genuine accountability, psychological safety, and real learning.
Interpretation limits
Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (220 words)

BackgroundIn recent years, a pattern has emerged in healthcare systems where clinicians and organisations are publicly blamed and punished following tragic events such as suicides or homicides. These responses often reflect more than institutional accountability, they reveal unconscious cultural mechanisms of scapegoating rooted in collective anxiety, grief, and the intolerability of uncertainty.AimsThis paper explores scapegoating in healthcare not merely as an ethical or organisational failure, but as a deep-seated psychological and sociocultural process. It aims to illuminate how blame is mobilised as a primitive defence against psychic pain and systemic dysfunction, and to consider the implications for clinical practice, regulation, and public trust.Methodological approachThis article employs an interpretive narrative approach, synthesising psychoanalytic and sociological theory to illuminate scapegoating in healthcare. It draws on the work of Freud, Bion, Menzies-Lyth, Douglas, and Girard, and integrates contemporary case material from international healthcare refined through peer discussion to illustrate and develop the theoretical analysis.Key Arguments:Scapegoating functions as a symbolic ritual of emotional discharge that obstructs learning and distorts justice. Organisational investigations and media narratives often collapse systemic complexity into linear blame, serving retributive rather than restorative purposes. Those targeted are frequently among the most vulnerable, socially, professionally, or structurally. The paper argues that only by recognising and resisting these unconscious group dynamics can healthcare systems foster genuine accountability, psychological safety, and real learning.

Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 41454473 · DOI · PMC13478434

Key reviews and meta-analyses

The most cited review-type papers among PubMed’s best-match results for this heading, listed with bibliographic details only. Follow the links for the full text and access terms.

  • Research article Culpable control and the psychology of blame [5]
    Alicke MD · Psychol Bull · 2000 · cited 223 times (Europe PMC)
  • Research article Stigmatization, scapegoating and discrimination in sexually transmitted diseases: overcoming 'them' and 'us' [6]
    Gilmore N, Somerville MA · Soc Sci Med · 1994 · cited 117 times (Europe PMC)
  • Research article Social projection to ingroups and outgroups: a review and meta-analysis [7]
    Robbins JM, Krueger JI · Pers Soc Psychol Rev · 2005 · cited 111 times (Europe PMC)
  • Research article Collective futures: how projections about the future of society are related to actions and attitudes supporting social change [8]
    Bain PG, Hornsey MJ, Bongiorno R, Kashima Y, Crimston D · Pers Soc Psychol Bull · 2013 · cited 27 times (Europe PMC)
  • Research article On scapegoating in therapy groups: a social constructivist and intersubjective outlook [9]
    Cohen BD, Schermer VL · Int J Group Psychother · 2002 · cited 11 times (Europe PMC)
  • Research article Clarification of projective identification [10]
    Goldstein WN · Am J Psychiatry · 1991 · cited 11 times (Europe PMC)

References

  1. Hotvedt R, Førde OH. Doctors are to blame for perceived medical adverse events. A cross sectional population study. The Tromsø Study. . 2013. PMID 23384420 · DOI · PMC3623705
  2. Aspan N, Vida P, Gadoros J, Halasz J. Conduct symptoms and emotion recognition in adolescent boys with externalization problems. . 2013. PMID 24302873 · DOI · PMC3835356
  3. Brickell K. Clouding the Judgment of Domestic Violence Law: Victim Blaming by Institutional Stakeholders in Cambodia. . 2017. PMID 26076978 · DOI · PMC5390939
  4. Gibbons R. Scapegoating in Healthcare: A Primitive Response to Tragedy. . 2026. PMID 41454473 · DOI · PMC13478434
  5. Alicke MD. Culpable control and the psychology of blame. Psychol Bull. 2000. PMID 10900996 · DOI
  6. Gilmore N, Somerville MA. Stigmatization, scapegoating and discrimination in sexually transmitted diseases: overcoming 'them' and 'us'. Soc Sci Med. 1994. PMID 7801170 · DOI
  7. Robbins JM, Krueger JI. Social projection to ingroups and outgroups: a review and meta-analysis. Pers Soc Psychol Rev. 2005. PMID 15745863 · DOI
  8. Bain PG, Hornsey MJ, Bongiorno R, Kashima Y, Crimston D. Collective futures: how projections about the future of society are related to actions and attitudes supporting social change. Pers Soc Psychol Bull. 2013. PMID 23456559 · DOI
  9. Cohen BD, Schermer VL. On scapegoating in therapy groups: a social constructivist and intersubjective outlook. Int J Group Psychother. 2002. PMID 11797247 · DOI
  10. Goldstein WN. Clarification of projective identification. Am J Psychiatry. 1991. PMID 1987813 · DOI

About this article

Sources
NLM Medical Subject Headings (definition, synonyms); NCBI PubMed (counts, identifiers); Europe PMC (open-access abstracts and citation counts).
Verification
Every reference was resolved against PubMed on 2026-11-04; title, year and DOI matched.
Review state
automated source verified; no human expert review has been recorded yet.
Version
1, last updated 2026-11-04.

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At a glance

1,489
PubMed records on this heading
4%
published since 2020
74
review articles
11
randomized trials
10
verified references below

Counts come from PubMed on 2026-10-31; they show how much has been written, not how strong the evidence is.

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