Italian version of the defense style questionnaire

Defensive functioning in individuals with depressive disorders: A systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis aimed to address the limited generalizability of studies on defense mechanisms in depression by comparing depressive individuals with non-clinical controls (aim a) and examining changes throughout psychological interventions (aim b) (PROSPERO CRD42023442620).

METHODS

We followed PRISMA 2020 guidelines, searching PubMed/Web of Science/(EBSCO)PsycINFO until 13/04/2023 for studies evaluating defense mechanisms with measures based on the hierarchical model in depressive patients versus non-clinical controls or throughout psychological intervention. We conducted random-effect meta-analyses for mature defenses/non-mature (neurotic/immature) defenses/overall defensive functioning (ODF), with standardized mean difference (SMD) as outcome measure metric. Meta-regression/sub-group/sensitivity analyses were conducted. Study quality was appraised using the Newcastle-Ottawa Scale (NOS), and certainty of evidence for aim b outcomes was evaluated using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).

RESULTS

18 studies were included (mean NOS score = 5.56). Depressive patients used significantly more non-mature defenses than non-clinical controls (SMD = 0.74; k = 13). Non-clinical controls did not significantly differ in use of mature defenses compared to depressive patients (SMD = 0.33; k = 14). Significant moderators were publication year/NOS score/geographical distribution/mean age for non-mature defenses and NOS score/geographical distribution for mature defenses. Throughout psychological interventions, only ODF significantly increased (SMD = 0.55; k = 2) (GRADE = very low).

LIMITATIONS

Quality of many studies was medium/sub-optimal, and longitudinal studies were scarce.

CONCLUSION

Individuals with depressive disorders show a high use of non-mature defenses that could be assessed and targeted in psychological interventions, especially in younger patients.

Initial validation of the Turkish version of the defense mechanisms rating scales-self-report-30

The Defense Mechanisms Rating Scales-Self Report-30 (DMRS-SR-30) was recently developed to add a self-report alternative to the assessment of defenses, reflecting their generally accepted hierarchical organization. In this study, we aimed to examine psychometric properties and factor structure of the Turkish language version of the DMRS-SR-30. The sample consisted of 1.002 participants who filled out a survey comprising the DMRS-SR-30, the Brief Symptom Inventory, and the Inventory of Personality Organization through Qualtrics. Confirmatory Factor Analysis indicated a three-factor structure (CFI = 0.89, RMSEA = 0.05) that confirms the DMRS theoretical frame with a relatively acceptable fit. Defensive categories and total scale scores showed good to excellent reliability (α values ranging from 0.64 to 0.89). Correlations between defenses, symptoms, and personality functioning demonstrated good convergent and discriminant validity. The individuals with clinically significant BSI scores (T-score ≥ 63) differed on the DMRS-SR-30 scores from the individuals in the non-clinical range. The Turkish version of the DMRS-SR-30 is a reliable and valid instrument to self-assess the hierarchy of defense mechanisms and overall defensive functioning. Moreover, the current study supports the validity of the tripartite model of defenses in a language and culture different from the origins of the DMRS and DMRS-SR-30.

Defense Mechanisms and Parenting Styles in Patients With Anorexia and Bulimia

ABSTRACT

Dysfunctional parenting styles are risk factors for eating disorders (EDs). In this observational study, we examined 57 women with ED, a psychiatric control group (n = 26), and healthy participants (n = 60). Several instruments were administered: Defense Style Questionnaire (DSQ-40) to examine the type of defense mechanism used, Parental Bonding Instrument (PBI) to investigate the perception of the relationship with parents, Eating Disorder Examination Questionnaire and Eating Disorder Inventory-3 to assess the severity of the ED, and Body Shape Questionnaire to investigate the perception of their body shape. In patients with anorexia and bulimia, neurotic factor (p = 0.007) and immature factor (p = 0.002) are associated with perception of relationship with their own parents. In the PBI, maternal care was associated with higher scores in the DSQ-40 in the immature factor (p = 0.012), whereas paternal overprotection was associated with lower scores in the DSQ-40 in the mature factor (p = 0.016). Patients with anorexia and bulimia overutilize more neurotic and primitive defense mechanisms compared with nonclinical subjects, and this use is associated with greater severity of eating symptomatology. This can be related to diversified ego forces, can inform about the nature and severity of disease, and can characterize prognostic and psychotherapeutic value.

Mindfulness and Defense Mechanisms as Explicit and Implicit Emotion Regulation Strategies against Psychological Distress during Massive Catastrophic Events

Emotion regulation is an important aspect of psychological functioning that influences subjective experience and moderates emotional responses throughout the lifetime. Adaptive responses to stressful life events depend on the positive interaction between explicit and implicit emotion regulation strategies, such as mindfulness and defense mechanisms. This study demonstrates how these emotion regulation strategies predict psychological health during the early phase of the COVID-19 pandemic. A convenience sample of 6385 subjects, recruited via snowball sampling on various social media platforms, responded to an online survey assessing psychological reaction to social restrictions imposed to limit the spread of COVID-19 in Italy. Psychological distress, post-traumatic stress symptoms, mindfulness, and defense mechanisms were assessed using SCL-90, IES-R, MAAS, and DMRS-30-SR, respectively. Higher mindfulness was significantly associated with higher overall defensive maturity and a greater use of high-adaptive defenses (p < 0.0001). Both mindfulness and defense mechanisms acted as good predictors of psychological health (R² = 0.541) and posttraumatic symptoms (R² = 0.332), confirming the role of emotion regulation in protecting against maladaptive responses to stressful situations.

Heavy Study Investment: An Analysis of the Defense Mechanisms Characterizing Studyholism and Study Engagement

Defense mechanisms are unconscious processes that protect a person from excessive anxiety. They are part of everyday functioning, and mature defenses are associated with positive outcomes. However, the excessive use of defenses or the use of immature defenses is associated with psychopathology. The present study aims to analyze the defense mechanisms that characterize two types of heavy study investment: Studyholism and Study Engagement. We performed a path analysis, MANOVAs, and binary logistic regressions on 422 Italian college students (Mage = 22.56 ± 2.87; 63.5% females). Among the main findings, the strongest (and positive) predictor of Studyholism is regression (maladaptive defense), while for Study Engagement, it is task-orientation (adaptive defense). Hence, Studyholism might be defined as a new potential clinical condition. Additionally, a critical analysis of all the defense mechanisms predicting Studyholism supports the appropriateness of the OCD-related framework for conceptualizing Studyholism. Regarding Study Engagement, even if generally associated with a positive defense style, the finding that it is positively predicted by projection confirms previous studies suggesting that, for some students, it might constitute a coping strategy with paranoid symptoms (and social anxiety and anxiety). Hence, we recommend screening engaged students for social impairment and clinically relevant symptoms that might be hidden by hard studying.

Psychotic Experiences and Sleep Quality in the Emerging Adulthood: The Interplay Between Emotional Neglect, Bodily Threat, and Defense Mechanisms

ABSTRACT

The present study investigated the integrated role of emotional neglect, bodily threat, and defense mechanisms in understanding sleep quality and psychosis experiences in a sample of emerging adults. A sample of 898 emerging adults (295 males) with an age range between 19 and 30 years participated in this study. The emotional neglect and bodily threat factors of the Traumatic Experiences Checklist, the Defense Style Questionnaire-40, the Pittsburgh Sleep Quality Index, and the psychosis factor of the Inventory of Personality Organization were administered. Results of path analyses showed that the emotional neglect and bodily threat factors predicted lower sleep quality. A path from emotional neglect and bodily threat to sleep quality via defense styles was also found. The defense styles mediated the relationships between emotional neglect and bodily threat factor with psychosis experiences. These findings provide new insight into the psychological mechanisms underlying the onset of poor sleep quality and psychotic experiences during emerging adulthood.

The Interplay of Attachment Styles and Defense Mechanisms on Eating Disorders Risk: Cross-Sectional Observation in the Community Population

OBJECTIVE

Eating Disorders (Eds) are considered a broad group of pathological conditions characterized by dysregulated eating-related behaviors and habits. Attachment styles and defense mechanisms appear to be linked to the development of EDs-related unhealthy behaviors; however, these factors have been seldom investigated jointly. This study aimed at exploring the shared association between attachment styles, defense mechanisms, and EDs-related behaviors; additionally, we aimed at investigating whether defense mechanisms might be potential mediators of the association between attachment and Eds behaviors.

METHOD

A community-based sample was recruited (88% females, mean age= 22.33 ± 4.81 years) and underwent a comprehensive evaluation protocol assessing attachment styles, defense mechanisms, and risk of eating disorders.

RESULTS

Several shared associations between attachment styles, defense mechanisms, and eating disorders scores were found. Additionally, a maladaptive defense style appeared to be a significant mediator of the association between attachment styles and EDs-related symptoms.

CONCLUSIONS

The integrated evaluation of attachment and defense mechanisms could generate a more comprehensive framework of the psychological antecedents related to Eating Disorders, and it could be a beneficial factor involved in therapies.

Personality, Defense Mechanisms and Psychological Distress in Women with Fibromyalgia

Background: Previous studies have shown that many personality traits are associated with fibromyalgia (FM), worsening both the quality of life and psychological distress of patients. Despite the high comorbidity of psychopathological disorders in this syndrome and their association with immature defense styles, few studies have examined the defense mechanisms used by FM patients. The main aim of our study was to investigate personality traits and defense mechanisms in FM patients compared to in a healthy control group (HC). Moreover, we investigated the effect of personality traits and defense mechanisms on psychological distress in both FM and HC groups. Methods: A total of 54 women with FM and 54 healthy women completed the (1) Temperament and Character Inventory—Revised; (2) the Toronto Alexithymia Scale; (3) the Defense Style Questionnaire; and (4) the Hospital Anxiety and Depression Scale. Results: The results indicated that FM patients display higher alexithymia, higher harm avoidance, lower self-directedness, lower persistence, and the higher use of a maladaptive defense style compared to HC. We found that alexithymia, harm avoidance, and maladaptive defense style are significant predictors of patients’ psychological distress. Moreover, harm avoidance and adaptive defense style significantly predicted psychological distress in the HC group. Conclusion: The present study is the first to explore the contribution of both defense mechanisms and personality characteristics on the psychological distress of FM patients. Our findings have important clinical implications and may help diagnose and treat FM patients more in depth.

Defense Mechanisms Reloaded in the Light of Impaired Personality Functioning: An Attempt of Clarification and Simplification Resulting in the DSQ-22-A for Adolescents

With the upcoming ICD-11, the diagnostic guidelines for personality disorders will change fundamentally to a dimensional severity concept, including the evaluation of several domains of personality functioning. Moreover, the lifetime perspective will allow this diagnosis even in early adolescence, providing the opportunity for early detection and intervention. In psychodynamic understanding, defense mechanisms are considered to be a part of the "personality structure", which is one axis in the related diagnostic system (OPD) and showed great similarities to the concept of personality functioning. The most common inventory to assess defense mechanisms is the Defense Style Questionnaire, especially the DSQ-40, which has unfortunately not been specifically adapted to younger ages yet. Using an age-adapted version of the DSQ-40 with simplified formulations, a thorough empirical item analyses and selection was performed, including a face-validity check of the items by experienced therapists and assessments for item correlations, factor structure, reliability, construct and clinical validity in a german clinical and school sample containing 396 adolescents. Though several improvements, similar problems as reported for the adult DSQ versions concerning face-validity and coherence of the item pairs (2-item-method) to represent the single defense mechanisms were obtained. Thus, not all item pairs could be kept and a shortened version DSQ-22-A for adolescents with good psychometric properties was build. The three resulting defense categories adaptive, neurotic and maladaptive showed acceptable scale reliabilities (0.63, 0.56, 0.68), sound factor structure and convincing convergent and clinical validity in terms of highly significant correlations with impaired personality structure according to the OPD-CA2-SQ as well as with PHQ-D depression and somatic symptoms, especially for the maladaptive defense category (0.75, 0.44, 0.34). Likewise, the maladaptive defense category differed highly significant (p = 0.000) and with a large effect size of d = 0.9 standard deviations between adolescents from the school and the clinical sample. The DSQ-22-A can be recommended for use in adolescents for research, diagnostics and therapy planning, especially with regard to personality functioning and structure. Possible fundamental changes concerning some basic operationalization's of the defense mechanisms and the 2-item-method were suggested for international discussion.

Personality and Lockdown: A Study on Italian Undergraduates During the COVID-19 Pandemic

The current study aimed at increasing our understanding of the psychological impact of the COVID-19 lockdown on undergraduate students, particularly with respect to the association between personality traits; defense mechanisms (DMs); depression, anxiety, and stress symptoms (DASSs); and compliance with the government recommended health measures. A sample of 1,427 Italian undergraduate students were administered the Personality Inventory for the DSM-5-Brief Form; the Defense Style Questionnaire-40; and the Depression, Anxiety and Stress Scale-21. Compliance with the COVID-19 behavioral recommendations was measured through a 10-item survey measure. Results showed that immature DMs and internalizing personality traits (i.e., detachment, negative affect, psychoticism) were risk factors of DASSs. Furthermore, subjects with higher levels of DASSs appeared less compliant with the health measures recommended by the Italian government. Experts may use these results to identify and subsequently support (via the Internet) young subjects at greater risk of mental health problems as a result of the COVID-19 pandemic.

Trauma and defense style as response predictors of pharmacological treatment in panic patients

Background

As panic disorder (PD) has a chronic course, it is important to identify predictors that might be related to non-remission. The aim of this study is to verify whether history of trauma and defense style are predictors to pharmacological treatment response in PD patients.

Method

The sample was composed by 47 PD patients according to DSM-IV who were treated with sertraline for 16 weeks. Evaluations were assessed by the C.G.I. (Clinical Global Impression), the Hamilton-Anxiety Scale, the Hamilton-Depression Scale, the Panic Inventory and the DSQ-40 (Defense Style Questionnaire) at baseline and after treatment.

Results

Full remission was observed in 61.7% of the sample. The predictors significantly associated with non-remission were: severity of PD (p = 0.012), age of onset (p = 0.02) and immature defenses (p = 0.032). In addition, the history of trauma was associated with early onset of PD (p = 0.043).

Conclusion

Panic patients had as predictors of worse response to pharmacological treatment the early onset and the severity of PD symptoms as well as the use of immature defenses at baseline. This finding corroborates the relevance of the evaluation of factors that might affect the response so as to enable the development of appropriate treatment for each patient.

Relationships of attention-deficit hyperactivity disorder with defense styles and harm avoidance among male inpatients with alcohol use disorder

INTRODUCTION

Patients with alcohol use disorder (AUD) use immature defense styles, and AUD is related with adult attention-deficit hyperactivity disorder (ADHD). Harm avoidance (HA) is related with both AUD and particularly inattentiveness (IN) dimension of ADHD.

AIM

The aim of the present study was to evaluate the relationship of defense styles with probable ADHD and severity of ADHD symptoms while controlling the effect of HA among male inpatients with AUD.

SETTINGS AND DESIGN

The present study with cross-sectional design was conducted at the Alcohol and Drug Research, Treatment and Training Center (AMATEM) of Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery in Istanbul.

STATISTICAL ANALYSIS

Chi-square test, independent samples t-test, multiple logistic and linear regression analyses, and multivariate analysis of covariance (MANCOVA) were used.

MATERIALS AND METHODS

Participants (n = 151) were evaluated with the Adult ADHD Self-Report Scale, the Defense Style Questionnaire, and the HA Dimension of the Temperament and Character Inventory.

RESULTS

HA (particularly HA-1 [anticipatory worry and pessimism]) and immature defense style (particularly acting out) predicted the presence of probable ADHD. In linear regression analysis, HA (particularly HA-1 and HA-4 [fatigability and asthenia]), high immature (particularly acting out), and low mature defense styles predicted the severity of ADHD symptoms. In MANCOVA, immature defense style predicted both the IN and the hyperactivity/impulsivity (HI) dimensions of ADHD, whereas HA and IN dimension and low mature defense style predicted HI dimension.

CONCLUSIONS

These findings suggest that immature defense style (i.e., acting out) is related with both the presence of probable ADHD and severity of ADHD symptoms, together with HA, which must be taken into account while treating patients with ADHD among male populations with AUD.

Psychological defense mechanisms among individuals with SCI with adjustment disorder

OBJECTIVES

The used psychological defense styles among individuals with spinal cord injury (SCI) with adjustment disorders (AJD) have not yet been described. In the present investigation, the prevalence of AJD among people with SCI has been estimated and the pattern of used defense styles has been identified.

DESIGN

Cross-sectional investigation.

SETTING

A tertiary rehabilitation center in Iran.

PARTICIPANTS

Individuals referred to Brain and Spinal Cord Injury Research Center were invited to participate in a screening interview. AJD was diagnosed based on DSM-V criteria. Those with AJD diagnosis were scheduled for another interview to assess defense mechanisms.

OUTCOME MEASURES

Demographic and injury-related variables were recorded. Defense mechanisms were assessed by the 40-item version of the Defense-Style Questionnaire (DSQ-40).

RESULTS

Among 114 participants, 32 (28%) were diagnosed with AJD among whom 23 subjects attended the second interview. Mean age and time since injury were 29.57 ± 9.29 years and 11.70 ± 6.34 months, respectively. The majority of patients were using idealization defense mechanism (91.3%). In the second and third place, passive aggression (87.0%) and somatization (82.6%) defense mechanisms were observed, respectively. Neurotic style was dominantly used (11.52 ± 2.26). Sex, marital status, educational level, cause of the injury and injury level were not related to defense style (P: 0.38, 0.69, 0.88, 0.73, and P: 0.32, respectively).

CONCLUSION

Prevalence of AJD is estimated to be 28% among individuals with SCI. The most prevalent defense style was neurotic and the dominant used defense mechanism was "idealization." The role of demographic and injury-related variables in determining the used defense mechanisms was insignificant.

MELDNa score is associated with psychopathology and reduced quality of life in cirrhotic patients with a liver transplant perspective

Psychopathological symptoms and reduced health related quality of life (HRQoL) are frequent in cirrhotics, but no data on their association with cirrhosis prognosis assessed by the MELDNa score are available. Prospective data on the long-term effect of deceased donor liver transplantation (LT) on psychopathological symptoms are needed. Before entering the LT waiting list, 44 consecutive LT cirrhotic candidates without a major psychiatric disorder underwent a psychopathological assessment, including Symptom Checklist-90-revised (SCL-90-R) and Defense Style Questionnaire (DSQ). HRQoL was measured by Short Form 36 Health Survey (SF-36). Abnormal performance at each questionnaire was defined by using 44 age, gender, BMI and education-matched healthy subjects. Separate binary logistic regression models were used to test the association of the Child-Pugh, MELD and MELDNa scores with abnormal performance at each questionnaire. Fourteen patients repeated the battery tests 3 years after LT. Before LT, increasing MELDNa was the only prognostic score independently associated with an abnormal SCL-90-R global psychopathological score index (OR: 1.207; 95% CI: 1.026-1.420; P = 0.02) and the best independent predictor of reduced HRQoL. After LT, compared to status prior to LT, performance at SF-36 general health perception scale ameliorated (P = 0.02), performance at SCL-90-R somatization scale (P = 0.001) and global psychopathological score index (P < 0.001) worsened and the negative correlation between the psychopathological global score index and HRQoL disappeared. The severity of cirrhosis in LT candidates should be monitored by the MELDNa score to better establish the right psychological counselling. Psychopathology, and in particular somatization, worsens after LT and should be carefully investigated.

Do spinal cord-injured individuals with stronger sense of coherence use different psychological defense styles?

OBJECTIVES

Although the importance of sense of coherence (SOC) and psychological defense mechanisms (PDMs) in the process of coping has been demonstrated, it has not yet been clarified whether individuals with stronger SOC use specific PDMs.

STUDY DESIGN

Cross-sectional.

SETTING

Iran.

METHODS

Demographic and injury-related variables including injury level, time since injury, American Spinal Cord Association (ASIA) Scale and Spinal cord independence measure-III were collected among individuals with spinal cord injury (SCI). SOC was assessed by the Short-form Sense of Coherence Scale. PDMs were identified using 40-version of the Defense Style Questionnaire.

RESULTS

Neurotic defense style was the most commonly used style especially. The overall most commonly used PDM was 'rationalization', which was used by 95%. Individuals with stronger SOC used more mature style (P=0.001, r=0.52), particularly 'humor' and 'suppression' mechanisms (P<0.0001 and 0.024, respectively). There was a negative correlation between stronger SOC and the use of immature defenses including passive aggression (P=0.001, r=-0.51), acting out (P=0.001, r=-0.48), isolation (P=0.009, r=-0.50), autistic fantasy (P=0.010, r=-0.30) and somatization (P<0.0001, r=-0.62). Married individuals had significantly stronger SOC (P=0.01). Age, gender, age at the time of injury incidence, time since injury, ASIA score and cause of injury were not determinants of SOC.

CONCLUSION

In this study, PDMs, which are more probable to be used by individuals with stronger SOC, have been identified. Mature defenses including 'humor' and 'suppression' are used by stronger SOC more often, whereas immature mechanisms are less likely to be used.

Hypnosis-based psychodynamic treatment in ALS: a longitudinal study on patients and their caregivers

Background: Evidence of psychological treatment efficacy is strongly needed in ALS, particularly regarding long-term effects.

Methods: Fifteen patients participated in a hypnosis treatment and self-hypnosis training protocol after an in-depth psychological and neurological evaluation. Patients' primary caregivers and 15 one-by-one matched control patients were considered in the study. Measurements of anxiety, depression and quality of life (QoL) were collected at the baseline, post-treatment, and after 3 and 6 months from the intervention. Bayesian linear mixed-models were used to evaluate the impact of treatment and defense style on patients' anxiety, depression, QoL, and functional impairment (ALSFRS-r), as well as on caregivers' anxiety and depression.

Results: The statistical analyses revealed an improvement in psychological variables' scores immediately after the treatment. Amelioration in patients' and caregivers' anxiety as well as caregivers' depression, were found to persist at 3 and 6 months follow-ups. The observed massive use of primitive defense mechanisms was found to have a reliable and constant buffer effect on psychopathological symptoms in both patients and caregivers. Notably, treated patients decline in ALSFRS-r score was observed to be slower than that of control group's patients.

Discussion: Our brief psychodynamic hypnosis-based treatment showed efficacy both at psychological and physical levels in patients with ALS, and was indirectly associated to long-lasting benefits in caregivers. The implications of peculiar psychodynamic factors and mind-body techniques are discussed. Future directions should be oriented toward a convergence of our results and further psychological interventions, in order to delineate clinical best practices for ALS.

Emotion Regulation and Defense Mechanisms

This study examined the relations between emotion regulation and defense mechanisms as assessed through self-report questionnaires. Participants were 314 undergraduate students at the University of Turin (Faculty of Agricultural Studies, School of Sport and Exercise Sciences and Faculty of Psychology). Correlational analysis identified several associations between emotion regulation strategies and defense mechanisms. A second-order factor model was tested in which each of the dimensions assessed by the defense mechanisms and emotion regulation instruments was assigned to either an adaptive or maladaptive latent dimension. The results suggested that the dimensions of adaptiveness and maladaptiveness may represent a key link between emotion regulation and defense mechanisms.

Study of defensive methods and mechanisms in developmental, emotional (internalization), and disruptive behavior (externalization) disorders

We need to find a way for adaptation with inherent unpleasantness of being human condition and conflicts that it caused, as we did not fail. Methods that we used for adaptation are named defense. This research have performed with the aim of study and compare defensive mechanisms and methods of Developmental, Emotional (Internalization), and Disruptive behavior (Externalization) disorders. Method, sample of this research included 390 family that are by available sampling method are selected. Tools of research were structured clinical interview of forth cognitive and statistical guide of psychopathic disorders for axis I and the way used for assess defensive mechanisms is defensive method 40 question's questionnaires of Andrews (1993). The data are compared by statistical methods comparison of averages and one way variance analysis and HSD tests and results show that undeveloped defensive mechanisms in by developmental disorder family (25.2 ± 3.7) mean and standard deviation, it is most used mechanism and in disruptive behavior disorder family by (11.2 ± 1.9) mean and standard deviation is used least mechanism and in developed mechanism of emotional disorder family by (7.8 ± 3.1) mean and standard deviation is most used mechanism and in developmental disorder family by (4.3 ± 1.5) mean and standard deviation is least mechanism in neuroticism patient, social phobia affected emotional disorder family (15.6 ± 2.6) and disruptive behavior disorder family have least mean and standard deviation (9.2 ± 1.7) (p< 0.005). Recent research shows significant of study defensive mechanism in psychopathic family of disorder children that affecting on the way of life of persons and interpersonal and intrapersonal relations and method of solving problem in family of them in life, so defensive mechanisms require more attention.

Relationship of defense styles with history of childhood trauma and personality in heroin dependent inpatients

In the present study the defense styles were assessed in heroin dependent inpatients to verify whether they used less adaptive defense mechanisms compared to healthy controls and to evaluate if immature defense styles are related with childhood traumas, while controlling the effect of age, temperament and character on this relationship in male heroin dependent inpatients. Participants were consecutively admitted 109 male heroin dependent inpatients and 60 healthy controls. Patients were investigated with the Defense Style Questionnaire, the Childhood Trauma Questionnaire, and Temperament and Character Inventory. Heroin dependent patients were using immature defense style more, particularly acting-out and splitting, than the control group. Together with lower age, immature defense style discriminated heroin dependents from control group (lower age, and higher devaluation and splitting in second regression model). Lower physical neglect score was related with a mature defense style, whereas higher cooperativeness (C) and self-transcendence (ST) were related with a neurotic defense style and lower reward dependence (RD), self-directedness (SD) and higher ST and emotional abuse were related with immature defense style. These suggest that heroin dependents are using maladaptive immature defense styles more, which can be taken into account in the development of therapeutic programs for these patients. Also, immature defense style may mediate the relationship between childhood emotional abuse and some personality dimensions (lower RD, SD and higher ST) in heroin dependent inpatients.

Relationship between defense styles, alexithymia, and personality in alcohol-dependent inpatients

In the present study, the defense styles were assessed in alcohol-dependent patients to verify whether they used less adaptive defense mechanisms compared with healthy controls and to evaluate if immature defense styles (IDSs) are related with alexithymia, while controlling the effect of age, temperament, and character on this relationship in male alcohol-dependent inpatients. Participants were consecutively admitted 118 male alcohol-dependent inpatients and 60 healthy controls. Patients were investigated with the Defense Style Questionnaire, the Toronto Alexithymia Scale, and the Temperament and Character Inventory. The alcohol-dependent patients were using neurotic defense style, some IDSs (projection, acting out, splitting, and somatization) more, and the mature defense style humor less than the control group. Together with higher age, IDS discriminated alcohol dependents from the control group (higher age, acting out, and splitting and lower humor in the second regression model). Immature defense style was positively correlated with novelty seeking, harm avoidance, self-transcendence, difficulty in identifying feelings (DIF), difficulty in describing feelings, external oriented thinking, and total alexithymia score in the present study, whereas it was negatively correlated with self-directedness and cooperativeness. Mean scores of neurotic and IDS were higher in the alexithymic group than the nonalexithymic group, and alexithymia was correlated with some IDSs. Higher difficulty in describing feelings predicted mature defense style, higher harm avoidance and DIF predicted neurotic defense style, and lower cooperativeness and self-transcendence and higher DIF predicted IDS. These suggest that alcohol dependents are using maladaptive IDS more, which can be taken into account in the development of therapeutic programs for these patients. In addition, IDS seems to be related with alexithymia, particularly DIF factor, whereas low cooperativeness and high self-transcendence are significant covariants. Thus, these results could indicate the use of specific strategies in the clinical and psychotherapeutic management of patients with alexithymic feature and IDS.

The Greek version of the Defense Style Questionnaire: psychometric properties in three different samples

BACKGROUND

The Defense Style Questionnaire (DSQ) was designed to assess behavior indicative of conscious derivatives of defensive styles. This study aimed to assess the factor structure and the main psychometric properties of its Greek version in 3 different samples.

METHODS

The DSQ-88 was translated into Greek using back-translation, and it was administered to 2308 participants (984 healthy subjects, 1084 medical patients, and 240 psychiatric patients). Exploratory factor analyses were performed; Symptom Distress Checklist-90-R and Minnesota Multiphasic Personality Inventory (MMPI) ego strength scales were administered for testing criterion and concurrent validity, followed by hierarchical multiple regression analysis.

RESULTS

Four factors were identified, largely corresponding to the original version's maladaptive, image-distorting, self-sacrificing, and adaptive styles, showing a remarkable stability in all 3 samples. Adaptive style was positively correlated to ego strength, whereas maladaptive, image-distorting, and self-sacrificing styles were negatively correlated, in descending order. This, along with the intercorrelations observed between the 4 styles, provides evidence that this version supports the hierarchical organization of defensive functioning. Test-retest reliabilities were adequate for all styles (r(1i)'s = 0.88, 0.81, 0.77, and 0.81, respectively). Internal consistencies were satisfactory for maladaptive style (0.82), sufficient for self-sacrificing (0.76), and rather low for image-distorting (0.68) and adaptive (0.66) styles. Maladaptive, image-distorting, and self-sacrificing-but not adaptive-styles could differentiate nonpatients from psychiatric patients. Maladaptive style was positively and adaptive style was negatively independently associated with psychological distress.

CONCLUSIONS

The present findings support the applicability of the Greek version of DSQ-88 within the Greek population. Future studies could improve its psychometric properties by finding new items for image-distorting and, especially, adaptive styles.

The use of the defence style questionnaire in major depressive and panic disorders: a comprehensive meta-analysis

PURPOSE

The issue of defence mechanisms is of great importance in clinical practice. The aim of this meta-analysis is to compare different defence styles (Mature, Neurotic, and Immature), assessed using the three-factor defence style questionnaire (DSQ), in major depressive disorder (MDD), and panic disorder (PD) in order to evaluate potential differences in defence profiles among these disorders.

METHODS

We assessed all publications listed in PubMed, PsycINFO, ISI, and Lilacs databases focusing on DSQ defence styles in MDD and PD. To be included studies had to be published in English, to include psychiatric patients, to provide defence style mean scores, and to employ the three-factor DSQ versions. Data were entered into the Cochrane Collaboration Review Manager Software and analysed by RevMan version 4.2.

RESULTS

MDD patients reported significantly lower scores in Mature style and both MDD and PD patients reported significantly higher scores in Neurotic and Immature styles.

CONCLUSIONS

A dissimilarity between depressive and anxious profiles emerged, since the former profile was characterized by low Mature and high Neurotic and Immature scores while the latter by high Neurotic and Immature scores only. These results could indicate the use of specific strategies in clinical and psychotherapeutic management of patients with these diagnoses. Nevertheless, present results should be considered with caution because of the high heterogeneity of the studies and some weaknesses in the psychometric properties of the DSQ.

The Italian version of the Response Evaluation Measure-71

OBJECTIVE

The aim of the present study was to analyze the psychometric properties of the Italian version of the Response Evaluation Measure (REM-71), a 71-item self-report measure previously developed for the assessment of defenses in adults and adolescents. The authors also examined the differences in the use of defenses based on sex and age (early adolescence, late adolescence, and early adulthood), and the association between defenses, psychosocial health, and psychologic distress in a large community sample.

METHOD

The Italian version of REM-71 was obtained through back-translation and administered to 1648 (1020 female subjects, mean age = 19.5 years, SD = +/-5.77) community subjects, aged between 13 and 68 years, voluntarily recruited among high school and university students in Milan, Italy, and the surrounding area. All subjects completed a self-report measure to assess demographic variables and satisfaction with life. A subsample (n = 1197) completed the Italian version of the Symptom Checklist-90-Revised to assess symptoms of psychologic distress.

RESULTS

Results were highly consistent with those obtained in the original English version of the REM-71 and included satisfactory internal consistency of the measure. Factor analyses yielded 2 principal factors that showed overall stability across age and sex subgroups. Factor 1 and factor 2 defenses were significantly correlated, in line with theoretical expectations, with positive and negative aspects of various domains of life.

CONCLUSIONS

Results provide further support for the structure and validity of the REM-71 as a useful instrument for the assessment of defenses in adolescents and adults and suggest no major cross-cultural differences in the organization of these defenses.

Dissecting the determinants of depressive disorders outcome: an in depth analysis of two clinical cases

Clinicians face everyday the complexity of depression. Available pharmacotherapies and psychotherapies improve patients suffering in a large part of subjects, however up to half of patients do not respond to treatment. Clinicians may forecast to a good extent if a given patient will respond or not, based on a number of data and sensations that emerge from face to face assessment. Conversely, clinical predictors of non response emerging from literature are largely unsatisfactory. Here we try to fill this gap, suggesting a comprehensive assessment of patients that may overcome the limitation of standardized assessments and detecting the factors that plausibly contribute to so marked differences in depressive disorders outcome. For this aim we present and discuss two clinical cases. Mr. A was an industrial manager who came to psychiatric evaluation with a severe depressive episode. His employment was demanding and the depressive episode undermined his capacity to manage it. Based on standardized assessment, Mr. A condition appeared severe and potentially dramatic. Mrs. B was a housewife who came to psychiatric evaluation with a moderate depressive episode. Literature predictors would suggest Mrs. B state as associated with a more favourable outcome. However the clinician impression was not converging with the standardized assessment and in fact the outcome will reverse the prediction based on the initial formal standard evaluation. Although the present report is based on two clinical cases and no generalizability is possible, a more detailed analysis of personality, temperament, defense mechanisms, self esteem, intelligence and social adjustment may allow to formalize the clinical impressions used by clinicians for biologic and pharmacologic studies.