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Rajewska-Rager A, Dmitrzak-Weglarz M, Lepczynska N, Kapelski P, Pawlak J, Skibinska M. Clinical assessment of impulsiveness and defence mechanisms in young patients with mood disorders in a two-year prospective study. Early Interv Psychiatry 2023; 17:1001-1011. [PMID: 36683289 DOI: 10.1111/eip.13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/23/2022] [Accepted: 01/01/2023] [Indexed: 01/24/2023]
Abstract
AIM There have been limited prospective investigations of early clinical markers involved in mood regulation and diagnosis change in young patients. This study aimed to evaluate the changes in impulsivity and defence mechanisms in patients with major depressive disorder (MDD) and bipolar disorder (BD) with acute symptoms and remission compared to healthy controls (HC), and possible psychological predictors of diagnosis conversion. METHODS Seventy-nine young MDD or BD patients and 40 HC were enrolled in a two-year prospective study. A comprehensive clinical interview focused on clinical and psychological evaluation during follow-up visits. The severity of depressive symptoms was evaluated using the Hamilton Depression Rating Scale (HDRS-17), whilst the Young Mania Rating Scale (YMRS) was used for hypo/manic symptoms during each control visit. All patients completed the Defence Style Questionnaire (DSQ-40) and Barratt Impulsiveness Scale (BIS-11). RESULTS Patients used more immature defences, and had significantly higher total impulsivity scores than controls. BD patients had elevated motor and non-planning impulsivity compared with HC and MDD subjects. Total and non-planning impulsiveness remained elevated in euthymia in BD and MDD compared to HC. There were no statistically significant differences in total defence styles and impulsiveness scores at baseline vs. euthymia in MDD or BD patients groups. Significantly higher dissociation scores at baseline discriminated depressive patients who convert to BD in their diagnosis. CONCLUSIONS Patients with acute mood symptoms used more frequent immature defences and had significantly higher total impulsivity scores than healthy persons. A lack of differences in total defence styles and impulsiveness between patients with acute symptoms and after reaching euthymia in both MDD and BD groups indicates that they are independent of disease status. Dissociation defence mechanisms may be an early diagnostic indicator of BD.
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Affiliation(s)
- Aleksandra Rajewska-Rager
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Dmitrzak-Weglarz
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Natalia Lepczynska
- Department of Child and Adolescent Psychiatry, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences, Poznań, Poland
| | - Pawel Kapelski
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Pawlak
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Maria Skibinska
- Department of Psychiatric Genetics, Chair of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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Cavalera C, Andreani P, Baumgartner O, Oasi O. Do Immature Defense Mechanisms Mediate the Relationship Between Shame, Guilt, and Psychopathological Symptoms? Front Psychol 2022; 13:832237. [PMID: 35592158 PMCID: PMC9113260 DOI: 10.3389/fpsyg.2022.832237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/28/2022] [Indexed: 01/09/2023] Open
Abstract
When shame and guilt emotional experiences related to stressful events remain unresolved, they can be related to psychological impairment and recursive thoughts. The present study aims to explore the association between state shame and state guilt related to past stressful experiences and psychopathological symptoms and evaluating a mediation role by immature defenses. A total of 90 participants (48.9% female; mean age 23.66) were considered in the present study to (a) investigate correlations between state guilt and shame scores related to personal stressful events and psychopathological symptoms related to global severity index; (b) assess whether state guilt and shame scores related to personal stressful events are positively correlated with immature defenses; (c) test whether immature defenses mediates the relationship between, respectively, state shame and state guilt with psychopathological symptoms. Significant correlations between state shame, state guilt, psychopathological symptoms, and immature defenses were found. Higher activations on immature defenses partially mediated the relationship between psychopathological symptoms and state shame and state guilt, respectively. Past experiences related to shame and guilt should be targeted by specific treatments that could help stop recursive maladaptive thoughts and empower more adaptive defensive strategies.
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Affiliation(s)
- Cesare Cavalera
- Deparment of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Paolo Andreani
- Deparment of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Oliver Baumgartner
- Deparment of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Osmano Oasi
- Deparment of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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Evren C, Cicikci E, Umut G, Evren B, Durmus K. Relationships of attention-deficit hyperactivity disorder with defense styles and harm avoidance among male inpatients with alcohol use disorder. Indian J Psychiatry 2019; 61:584-591. [PMID: 31896864 PMCID: PMC6863000 DOI: 10.4103/psychiatry.indianjpsychiatry_318_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Cuneyt Evren
- Alcohol and Drug Research, Treatment and Training Center (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Elvan Cicikci
- Alcohol and Drug Research, Treatment and Training Center (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Gokhan Umut
- Alcohol and Drug Research, Treatment and Training Center (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Bilge Evren
- Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey
| | - Kubra Durmus
- Governorship of Istanbul, Provincial Directorate of Social Studies and Projects, Istanbul, Turkey
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Prunas A, Preti E, Huemer J, Shaw RJ, Steiner H. Defensive functioning and psychopathology: a study with the REM-71. Compr Psychiatry 2014; 55:1696-702. [PMID: 25070477 DOI: 10.1016/j.comppsych.2014.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The aim of the present study is to explore the association between defensive functioning (as assessed through the REM-71) and psychiatric symptoms in a large sample from the community, and the moderating role of age and gender on that association. Furthermore, we explored the concurrent validity of REM-71 as compared with "caseness" (SCL-90-R). METHODS The REM-71 was administered together with SCL-90-R to a community sample of 1,060 Italian high-school and university students (mean age=19.01±3.85 years; 66.7% females). RESULTS Factor 1 defenses were by far the primary contributors to the predictor synthetic variable (i.e. association between defenses and psychopathology). Gender proved to moderate the association between immature defenses and symptoms. Using ROC analysis, we derived a cut-off score for Factor 1 defenses. CONCLUSIONS Our results support the adoption of the REM-71 as a useful instrument for the assessment of defensive array and psychopathological liability in adolescents and adults.
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Affiliation(s)
- Antonio Prunas
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy.
| | - Emanuele Preti
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Julia Huemer
- Medical University of Vienna, Department of Child and Adolescent Psychiatry, Vienna, Austria
| | - Richard J Shaw
- Division of Child Psychiatry and Child Development, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA94305-5719
| | - Hans Steiner
- Division of Child Psychiatry and Child Development, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA94305-5719
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Costa RM, Brody S. Immature psychological defense mechanisms are associated with greater personal importance of junk food, alcohol, and television. Psychiatry Res 2013; 209:535-9. [PMID: 23866675 DOI: 10.1016/j.psychres.2013.06.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/07/2013] [Accepted: 06/22/2013] [Indexed: 11/27/2022]
Abstract
Immature psychological defense mechanisms are psychological processes that play an important role in suppressing emotional awareness and contribute to psychopathology. In addition, unhealthy food, television viewing, and alcohol consumption can be among the means to escape self-awareness. In contrast, engaging in, and responding fully to specifically penile-vaginal intercourse (PVI) is associated with indices of better emotional regulation, including less use of immature defense mechanisms. There was a lack of research on the association of immature defense mechanisms with personal importance of junk food, alcohol, television, PVI, and noncoital sex. In an online survey, 334 primarily Scottish women completed the Defense Style Questionnaire (DSQ-40), and rated the personal importance of junk food, alcohol, television, PVI, and noncoital sex. Immature defense mechanisms correlated with importance of junk food, alcohol, and television. Importance of PVI correlated with mature defenses, and less use of some component immature defenses. Importance of alcohol correlated with importance of junk food, television, and noncoital sex. Importance of junk food was correlated with importance of television and noncoital sex. The findings are discussed in terms of persons with poorer self-regulatory abilities having more interest in junk food, television, and alcohol, and less interest in PVI.
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Affiliation(s)
- Rui Miguel Costa
- School of Social Sciences, University of the West of Scotland, Paisley PA1 2BE, United Kingdom
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Evren C, Ozcetinkaya S, Ulku M, Cagil D, Gokalp P, Cetin T, Yigiter S. Relationship of defense styles with history of childhood trauma and personality in heroin dependent inpatients. Psychiatry Res 2012; 200:728-33. [PMID: 22917960 DOI: 10.1016/j.psychres.2012.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 05/26/2012] [Accepted: 07/18/2012] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Cuneyt Evren
- Bakırköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Alcohol and Drug Research, Treatment and Training Center (AMATEM), Istanbul, Turkey.
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Association between PPP1R1B polymorphisms and defense mechanisms in healthy Chinese-Han subjects. J Mol Neurosci 2012; 49:618-24. [PMID: 23080070 DOI: 10.1007/s12031-012-9907-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
Abstract
Defense mechanisms resulting from the interaction between biological factors and the environment have been established. In genetic studies, dopamine genes have been recognized to play an important role in the determination of defense mechanisms. DARPP-32 (dopamine- and cAMP-regulated phosphoprotein) plays a central role in the biology of dopamine-receptive neurons; its coding gene (PPP1R1B) has been linked to psychological and psychopathological traits. Here, we aimed to explore the association between PPP1R1B polymorphisms and defense mechanisms measured using the 88-item Defense Style Questionnaire in 400 healthy Chinese-Han subjects. Of the three polymorphisms examined, rs12601930 was associated with projection (P = 0.028) and splitting (P = 0.032), while rs3764352 was associated with splitting (P = 0.042). No significant association was found between rs879606 and defenses. When analyzed separately by gender, no significant association between defense mechanisms and PPP1R1B polymorphisms in males was observed. In females, however, rs12601930 was significantly associated with splitting (P = 0.018), and rs879606, with projection (P = 0.015), help-rejecting complaining (P = 0.030), and immature defense style (P = 0.031), while rs3764352 was not associated with any defense. The distribution of genotypes between the low- and high-scoring subgroups for each defense style showed no significant differences. Our results suggest that PPP1R1B polymorphisms are, at least partially, responsible for immature defenses.
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Relationship between defense styles, alexithymia, and personality in alcohol-dependent inpatients. Compr Psychiatry 2012; 53:860-7. [PMID: 22341212 DOI: 10.1016/j.comppsych.2012.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 12/30/2011] [Accepted: 01/11/2012] [Indexed: 11/21/2022] Open
Abstract
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.
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