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Euler S, Babl A, Dommann E, Stalujanis E, Labrish C, Kramer U, McMain S. Maladaptive defense mechanisms moderate treatment outcome in 6 months versus 12 months dialectical-behavior therapy for borderline personality disorder. Psychother Res 2024:1-17. [PMID: 38648578 DOI: 10.1080/10503307.2024.2334053] [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] [Received: 08/14/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE We investigated whether defense mechanisms in patients with borderline personality disorder (BPD) predict treatment response of dialectical behavior therapy (DBT) and whether they moderate outcome in different treatment lengths. METHOD We analyzed a subsample of 60 outpatients with BPD, randomized into either 6 (n = 30) or 12 (n = 30) months of DBT. The average level of defensive adaptiveness, assessed with observer-rated overall defensive functioning (ODF) and "immature" (i.e., maladaptive) defenses were used as predictors and moderators of self-reported frequency of self-harm. We conducted a Generalized Linear Mixed Model (GLMM). RESULTS A lower ODF at treatment onset predicted smaller reductions in self-harm, irrespective of treatment length (IRR = 0.92, 95% CI = [0.86, 0.99], p = .020). Lower order "immature" ("major image distorting") defenses showed significantly smaller (IRR = 1.13, 95% CI = [1.06, 1.21], p < .001) and higher order "immature" ("minor image distorting") defenses showed significantly larger (IRR = .91, 95% CI = [.85, .97], p = .006) reductions in self harm in the 6-month but not in the 12-month treatment. CONCLUSION Even though the results have to be regarded as preliminary due to the small sample size, findings might indicate that patients with BPD and lower average defensive adaptiveness may benefit from individualized treatment plans including specific interventions targeting defense function.
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Affiliation(s)
- Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital of Zürich, Zürich, Switzerland
| | - Anna Babl
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Eliane Dommann
- Clinical Psychology and Psychotherapy Department, University of Bern, Bern, Switzerland
| | - Esther Stalujanis
- Department of Consultation Psychiatry and Psychosomatics, University Hospital of Zürich, Zürich, Switzerland
| | - Cathy Labrish
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Ueli Kramer
- Department of Psychiatry, Institute of Psychotherapy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Shelley McMain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Furnham A, Cuppello S. Maladaptive (dark-side) and adaptive (bright-side) personality traits and defense styles. Acta Psychol (Amst) 2023; 239:104002. [PMID: 37573741 DOI: 10.1016/j.actpsy.2023.104002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023] Open
Abstract
This study explores the relationship between bright- and dark-side personality traits and four major styles of defense mechanisms (DMs) as this relationship remains unexplored and important in understanding the DMs. In all, 435 adult working participants (241 men; 194 women; Mean age 46.06 yrs) mainly in middle management jobs, completed a 78-item, six-trait measure of bright-side personality (HPTI: High Potential Type Indicator), a 25-item five-trait measure of the dark-side personality (PID-5;BF: DSM-5-Brief Form) and 88-item, four-styles measure of defense mechanisms (Defense Style Questionnaire). The aim was to examine demographic (sex, age, education), ideological and personality trait correlates of the DMs. It was hypothesized that the dark-side traits, particularly Detachment would be most strongly related to the DMs. Thereafter, a hierarchical linear regression was performed with each DM factor as criterion and predictors being demography, ideology, self-esteem as well as bright- and dark-side personality traits. Detachment was associated with all DMs, particularly Maladaptive (r = 0.68) and Image Distorting Style (r = 0.38) while Conscientiousness was associated with none. One implication concerns the assessment of DMs by standard tests. Limitations are acknowledged and include method invariance and sample homogeneity.
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Affiliation(s)
- Adrian Furnham
- Department of Leadership and Organisational Behaviour, Norwegian Business School (BI), Nydalveien, Olso, Norway.
| | - Stephen Cuppello
- Department of Psychology, City University London, London, United Kingdom of Great Britain and Northern Ireland
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Robin M, Surjous L, Belbèze J, Bonnardel L, Lamas C, Silva J, Peres V, Corcos M. Four attachment-based categories of emotion regulation in adolescent psychic troubles. Front Psychol 2023; 14:1133980. [PMID: 37275718 PMCID: PMC10237043 DOI: 10.3389/fpsyg.2023.1133980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/06/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Emotion regulation is altered in many psychiatric disorders in adolescence, but the understanding of mechanisms that underlie this alteration is still poor. Methods The PERCEPT study explores alexithymia, empathy, facial emotion recognition (FER) and defence mechanisms in a sample of adolescents in psychiatric care (n = 61, 74% of girls, mean age = 15.03 y.o.), in relation with participants' attachment styles. Results Results revealed correlations between attachment dimensions and all of the emotion regulation variables, suggesting that attachment modalities have functional links with emotional regulation at its different levels: FER accuracy was inversely correlated with avoidant attachment, while affective empathy, difficulty in identifying feelings (alexithymia) and immature as well as neurotic defence mechanisms were positively correlated with anxious attachment. Moreover, attachment categories delineated distinct emotional perception profiles. In particular, preoccupied attachment included adolescents with the highest levels of facial emotion perception (sensitivity and accuracy) and of affective empathy, whereas detached attachment included adolescents with the lowest levels of these variables. Neurotic defence mechanisms and difficulty to identify feelings were correlated with preoccupied attachment; immature defence mechanisms and difficulty to describe feelings to others characterized fearful attachment. Discussion These results suggest that attachment categories underlie emotion regulation processes in psychiatric disorders in adolescence. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- CESP, INSERM U1178, Paris-Saclay University, Villejuif, France
| | - Luc Surjous
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Jean Belbèze
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Lucile Bonnardel
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Claire Lamas
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Jérôme Silva
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Victoire Peres
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
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Tanzilli A, Cibelli A, Liotti M, Fiorentino F, Williams R, Lingiardi V. Personality, Defenses, Mentalization, and Epistemic Trust Related to Pandemic Containment Strategies and the COVID-19 Vaccine: A Sequential Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114290. [PMID: 36361183 PMCID: PMC9656964 DOI: 10.3390/ijerph192114290] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic has considerably influenced all domains of people's lives worldwide, determining a high increase in overall psychological distress and several clinical conditions. The study attempted to shed light on the relationship between the strategies adopted to manage the pandemic, vaccine hesitancy, and distinct features of personality and mental functioning. METHODS The sample consisted of 367 Italian individuals (68.1% women, 31.9% men; M age = 37, SD = 12.79) who completed an online survey, including an instrument assessing four response styles to the pandemic and lockdown(s), the Personality Inventory for DSM-5-Brief Form, the Defense Mechanisms Rating Scales-Self-Report-30, the Reflective Functioning Questionnaire, and the Epistemic Trust, Mistrust, Credulity Questionnaire. RESULTS Maladaptive response patterns to pandemic restrictions were related to dysfunctional personality traits, immature defense mechanisms, poor mentalization, and epistemic mistrust or credulity. Moreover, more severe levels of personality pathology were predictive of an extraverted-maladaptive response style to health emergency through the full mediation of low overall defensive functioning, poor certainty of others' mental states, and high epistemic credulity. CONCLUSIONS Recognizing and understanding dysfunctional psychological pathways associated with individuals' difficulties in dealing with the pandemic are crucial for developing tailored mental-health interventions and promoting best practices in healthcare services.
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Di Giuseppe M, Perry JC, Prout TA, Conversano C. Editorial: Recent Empirical Research and Methodologies in Defense Mechanisms: Defenses as Fundamental Contributors to Adaptation. Front Psychol 2021; 12:802602. [PMID: 34925197 PMCID: PMC8678405 DOI: 10.3389/fpsyg.2021.802602] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - John Christopher Perry
- McGill University and the Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, QC, Canada
| | - Tracy A Prout
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
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Di Giuseppe M, Perry JC. The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning With the Defense Mechanisms Rating Scales Q-Sort. Front Psychol 2021; 12:718440. [PMID: 34721167 PMCID: PMC8555762 DOI: 10.3389/fpsyg.2021.718440] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
The psychodynamic concept of defense mechanisms is nowadays considered by professionals with various theoretical orientations of great importance in the understanding of human development and psychological functioning. More than half century of empirical research has demonstrated the impact of defensive functioning in psychological well-being, personality organization and treatment process-outcome. Despite the availability of a large number of measures for their evaluation, only a few instruments assess the whole hierarchy of defenses, based on the Defense Mechanisms Rating Scales (DMRS), which arguably offers an observer-rated gold standard of assessment. The present article illustrates the theoretical and methodological background of the DMRS-Q, the Q-sort version of the DMRS for clinical use. Starting from the definition and function of the 30 defense mechanisms included in the hierarchy, we extracted 150 items that captured a full range of defensive manifestations according to the DMRS theory. The DMRS-Q set is described in this paper with reference to the DMRS manual. Directions are also provided for using the DMRS-Q online software for the free and unlimited coding of defense mechanisms. After each coding, the DMRS-Q software provides a report including qualitative and quantitative scores reflecting the individual’s defensive functioning. Qualitative scores are displayed as the Defensive Profile Narratives (DPN), while quantitative scores are reported as Overall Defensive Functioning (ODF), defensive categories, defense levels, and individual defense mechanisms. Syntax for the scoring is displayed in the results and a clinical vignette of a psychotherapy session coded with the DMRS-Q is provided. The DMRS-Q is an easy-to-use, free, computerized measure that can help clinicians in monitoring changes in defense mechanisms, addressing therapeutic intervention, fostering symptoms decreasing and therapeutic alliance. Moreover, the DMRS-Q might be a valid tool for teaching the hierarchy of defense mechanisms and increase the observer-rated assessment of this construct in several research fields.
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Affiliation(s)
- Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - J Christopher Perry
- McGill University Department of Psychiatry at the Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, QC, Canada
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Taurino A, Antonucci LA, Taurisano P, Laera D. Investigating defensive functioning and alexithymia in substance use disorder patients. BMC Psychiatry 2021; 21:337. [PMID: 34229633 PMCID: PMC8259003 DOI: 10.1186/s12888-021-03340-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance Use Disorder (SUD) causes a great deal of personal suffering for patients. Recent evidence highlights how defenses and emotion regulation may play a crucial part in the onset and development of this disorder. The aim of this study was to investigate potential differences in the defensive functioning between SUD patients and non-clinical controls. Secondly, we aimed at investigating the relationships between alexithymia and maladaptive/assimilation defenses. METHODS The authors assessed defensive functioning (Response Evaluation Measure-71, REM-71), personality (MMPI-II), and alexithymia (TAS-20) of 171 SUD patients (17% female; mean age = 36.5), compared to 155 controls. Authors performed a series of ANOVAs to investigate the defensive array in SUD patients compared to that of non-clinical controls. Student t test for indipendent samples was used to compare clinical characteristics between the SUD group and the controls. To investigate the role of single defenses in explaining alexithimia's subscores, stepwise multiple regression analysis were carried out on socio-demographic characteristics of participants (gender, age, and years of education), with REM-71 defenses as predictors. RESULTS SUD patients presented a more maladaptive/assimilation (Factor 1) defensive array (p < .001). Among SUD sub-groups, Alcohol Use Disorder patients showed more disfuncional defenses. Factor 1 defenses were related to a worse psychological functioning. In addition, alexyhimia (particularly DIF) was strongly related to Factor 1 defenses, expecially Projection (38% of variance explained, β = .270, p < .001). CONCLUSION The REM-71 and the TAS-20 might be useful screening instruments among SUD patients.
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Affiliation(s)
- Alessandro Taurino
- Department of Education, Psychology, Communication, University of Bari, Palazzo Chiaia-Napolitano, Via Scipione Crisanzio 42, 70122, Bari, Italy
| | - Linda A Antonucci
- Department of Education, Psychology, Communication, University of Bari, Palazzo Chiaia-Napolitano, Via Scipione Crisanzio 42, 70122, Bari, Italy
| | - Paolo Taurisano
- Section of Clinical Psychology and Neuropsychology, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Domenico Laera
- Department of Education, Psychology, Communication, University of Bari, Palazzo Chiaia-Napolitano, Via Scipione Crisanzio 42, 70122, Bari, Italy.
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Kampe L, Bohn J, Remmers C, Hörz-Sagstetter S. It's Not That Great Anymore: The Central Role of Defense Mechanisms in Grandiose and Vulnerable Narcissism. Front Psychiatry 2021; 12:661948. [PMID: 34177651 PMCID: PMC8226035 DOI: 10.3389/fpsyt.2021.661948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives: The concept of narcissism contains a yet unresolved paradox: Its grandiose facet depicts the psychopathological core but is often associated with life-satisfaction and overall functioning, whereas its vulnerable facet is associated with psychological distress, but still not included in the international classification systems. Our goal was to investigate the relationship between the two facets of narcissism expecting underlying defense mechanisms to be core elements. First, we aimed to identify defense mechanisms specific to grandiose and vulnerable narcissism. Second, we explored how both facets are differentially associated with psychological distress, assuming that grandiose narcissism would be associated with less psychological distress than vulnerable narcissism. Third, we investigated the mediating role of defense mechanisms between narcissism and psychological distress. Methods: In a non-clinical sample of N = 254 individuals, the Pathological Narcissism Inventory was used for the assessment of grandiose and vulnerable facets of narcissism, the Defense Style Questionnaire for defense mechanisms, and the Brief Symptom Inventory for psychological distress. Structural equation modeling was employed to identify distinct factors of grandiose and vulnerable narcissism. Associations between specific defense mechanisms and both facets were calculated. Furthermore, the direct association between both facets and psychological distress was examined. We finally explored whether defense mechanisms mediate the association between distress and both grandiose and vulnerable narcissism. Results: A distinct pattern of defense mechanisms for each facet of narcissism could be extracted: Both facets showed significant positive correlations with specific intermediate and all maladaptive defense mechanisms. Only grandiose narcissism showed significant positive correlations with adaptive defenses. Vulnerable narcissism showed negative correlations with all adaptive defenses. Specifically, grandiose narcissism was significantly related to anticipation, pseudo-altruism, rationalization, and dissociation, whereas vulnerable narcissism was negatively related to all these defense mechanisms. While grandiose narcissism was not related to psychological distress, vulnerable narcissism showed high correlations with psychological distress. Intriguingly, mediator analysis found that grandiose narcissism was related to psychological distress when mediated by maladaptive defense mechanisms. Discussion: The role of defense mechanisms is central for a differentiated understanding of the two different faces of narcissism. The relevance of assessing defense mechanisms in clinical settings, and related empirical findings are discussed.
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Affiliation(s)
- Leonie Kampe
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Psychosoziales Zentrum Itzehoe, Itzehoe, Germany
| | - Johannes Bohn
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Carina Remmers
- Faculty of Health/School of Psychology and Psychiatry, Witten/Herdecke University, Witten, Germany
| | - Susanne Hörz-Sagstetter
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
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Boldrini T, Lo Buglio G, Giovanardi G, Lingiardi V, Salcuni S. Defense mechanisms in adolescents at high risk of developing psychosis: an empirical investigation. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:456. [PMID: 32913831 PMCID: PMC7451313 DOI: 10.4081/ripppo.2020.456] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/02/2020] [Indexed: 12/23/2022]
Abstract
Research within psychotherapy and psychopathology frameworks has been inspired by the central concept of defense mechanisms, which play a pivotal role in psychoanalysis. Defense specificities have only recently been studied systematically in the context of several clinical diagnoses. The present study aimed to explore the specificities of defense mechanisms in adolescents at ultra-high risk of developing psychosis and test the relationship between defensive functioning and attenuated psychotic symptoms. Twenty-six adolescent inpatients at ultra-high risk of developing psychosis and a matched clinical control group of inpatients not at risk of psychosis were interviewed. Two observer-rater methods, the Defense Mechanism Rating Scales and the Psychotic-Defense Mechanism Rating Scales were applied to interview transcripts to assess the individual use of defenses. Ultra-high-risk patients demonstrated lower defense mechanisms (i.e., total instances of defense mechanisms observed) and lower overall adaptiveness of the defenses presented. When specific differences between groups were observed, psychotic defenses were the sole defenses that could partially discriminate between ultra-high-risk and not at-risk patients. Regarding the relationship between defense mechanisms and subthreshold psychotic symptoms, psychotic defenses were associated with negative and disorganization symptoms, rather than with positive symptoms. The psychological vulnerability of ultra-high-risk patients is discussed and treatment implications for psychotherapy with such challenging patients are addressed.
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Affiliation(s)
- Tommaso Boldrini
- Department of Developmental and Socialization Psychology, University of Padova, Padova
| | - Gabriele Lo Buglio
- Department of Developmental and Socialization Psychology, University of Padova, Padova
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome
- Department of Psychology, University of Campania “Luigi Vanvitelli,”Caserta, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome
| | - Silvia Salcuni
- Department of Developmental and Socialization Psychology, University of Padova, Padova
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Bedel A. The Role of Interpersonal Problem Solving in Using the Immature Defense Mechanisms in Adolescents. UNIVERSITAS PSYCHOLOGICA 2019. [DOI: 10.11144/javeriana.upsy18-5.rips] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to examine associations between interpersonal problem solving and immature defense mechanisms in addition to whether interpersonal problem solving are predictors of immature defense mechanisms. The participants of the study consists of 428 high schools students (184 of the students were females). Interpersonal Problem Solving Inventory and Defense Style Questionnaire were applied. Results of multiple regression analyses indicated that all variables of interpersonal problem solving skills together accounted for 32% of the variance in defense mechanisms. Specifically, significant predictors of immature defense mechanisms levels were lack of self-confidence, negative approach to the problems, constructive problem solving respectively. Generally, the levels of adolescents resort to immature defense mechanisms, lack of self-confidence and negative approach to the problem of the increase, a decrease in constructive problem-solving skills are seen to be effective. The results of the study was discussd within the results of the previous studies.
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Carvalho LDF, Reis AM, Pianowski G. Investigating Correlations Between Defence Mechanisms and Pathological Personality Characteristics. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2019; 48:232-243. [PMID: 31779874 DOI: 10.1016/j.rcp.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/10/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the relationship between defence mechanisms and pathological personality traits. MATERIAL AND METHODS We analysed 320 participants aged from 18 to 64 years (70.6% women, 87.5% university students) who completed the Dimensional Clinical Personality Inventory (IDCP) and the Defence Style Questionnaire (DSQ-40). We conducted comparisons and correlations and a regression analysis. RESULTS The results showed expressive differences (d>1.0) between mature, neurotic and immature defence mechanism groups, and it was observed that pathological personality traits are more typical in people who use less mature defence mechanisms (i.e., neurotic and immature), which comprises marked personality profiles for each group, according to the IDCP. We also found correlations between some of the 40 specific mechanisms of the DSQ-40 and the 12 dimensions of pathological personality traits from the IDCP (r ≥ 0.30 to r ≤ 0.43), partially supported by the literature. In addition, we used regression analysis to verify the potential of the IDCP dimension clusters (related to personality disorders) to predict defence mechanisms, revealing some minimally expressive predictive values (between 20% and 35%). DISCUSSION The results indicate that those who tend to use immature defence mechanisms are also those most likely to present pathological personality traits. CONCLUSIONS The findings indicate the importance of investigating these correlations as a possible improvement to clinical assessment and intervention.
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Affiliation(s)
| | - Ana Maria Reis
- Department of Psicology, Universidade São Francisco, Campinas, São Paulo, Brazil
| | - Giselle Pianowski
- Department of Psicology, Universidade São Francisco, Campinas, São Paulo, Brazil
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12
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Di Giuseppe M, Gennaro A, Lingiardi V, Perry JC. The Role of Defense Mechanisms in Emerging Personality Disorders in Clinical Adolescents. Psychiatry 2019; 82:128-142. [PMID: 30925112 DOI: 10.1080/00332747.2019.1579595] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Defensive functioning is related to overall mental functioning and personality traits in adults but only few studies investigated the role of defenses in adolescence. The present study analyzed the use of defense mechanisms in clinical adolescents to test how defensive functioning is related to age, gender, and personality traits.Design: 102 self-referred outpatients were interviewed using the Clinical Diagnostic Interview (CDI). Defense mechanisms and personality profile were assessed using the Defense Mechanisms Rating Scale (DMRS) and the Shedler-Westen Assessment Procedure-200 for Adolescence (SWAP-200-A) respectively.Findings: Multivariate analysis of variance showed significant age and gender differences in clinical adolescents; while younger teenagers used more immature defenses, older adolescents scored significantly higher in high-neurotic and mature defenses. Girls showed higher use of minor image distortion and neurotic defenses, whereas boys recurred more frequently to obsessional level defenses. Neither age nor gender differences were found for narcissistic defense level. Significant correlations between personality disorders and specific defenses were found for all personalities with sufficient base rate, with the exception of paranoid, schizotypal, and schizoid personalities.Conclusions: In line with previous studies we confirmed the hypothesis of an ontogenetic line of development of defense mechanisms. In addition, the present study found that age and gender differences in adolescence are related to the use of specific defenses that contribute to the development of the personality and various psychological capacities. Several clinical implications are linked to the systematic investigation of defense mechanisms in youth, although further studies are required to confirm these findings.
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Punzi E, Lindgren K. Relationships, Emotions, and Defenses Among Patients with Substance Use Disorders, Assessed with Karolinska Psychodynamic Profile: Possibilities to use Intensive Short-Term Dynamic Psychotherapy in Substance Abuse Treatment. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1544059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Elisabeth Punzi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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van Beek J, Vuijk PJ, Harte JM, Scherder EJA. Symptom Profile of Psychiatric Patients With Psychosis or Psychotic Mood Disorder in Prison. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2018; 62:4158-4173. [PMID: 29426253 DOI: 10.1177/0306624x18757116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is evidence that psychiatric patients with psychotic or manic disorders who are incarcerated suffer from the same symptoms as psychiatric patients who are treated in the community. There are also indications that their symptoms might be more severe. The aim of this study was to examine the severity of psychotic and manic symptoms, as well as to collect information about the emotional functioning of patients admitted to a prison psychiatric ward. Incarcerated patients with a diagnosis of psychotic or a manic disorder were examined with the Brief Psychiatric Rating Scale-Expanded (BPRS-E). With the scores of 140 assessments, a symptom profile was created using the domains of the BPRS-E. This profile was compared with the clinical profile of three nonincarcerated patient groups described in literature with a diagnosis in the same spectrum. We found high scores on positive and manic psychotic symptoms and hostility, and low scores on guilt, depression, and negative symptoms. High scores on manic and psychotic symptoms are often accompanied by violent behavior. Low scores on guilt, depression, and negative symptoms could be indicative of externalizing coping skills. These characteristics could complicate treatment in the community and warrant further research along with clinical consideration.
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Affiliation(s)
- J van Beek
- 1 Vrije Universiteit Amsterdam, The Netherlands
| | - P J Vuijk
- 2 Massachusetts General Hospital, Boston, USA
| | - J M Harte
- 1 Vrije Universiteit Amsterdam, The Netherlands
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Tassi F, Ciucci E, Baroncelli A, Batani A. Callous-unemotional traits, borderline personality, and self-injury in gothic subculture. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2017. [DOI: 10.1080/17405629.2017.1320279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fulvio Tassi
- Department of Education and Psychology, University of Florence, Florence, Italy
| | - Enrica Ciucci
- Department of Education and Psychology, University of Florence, Florence, Italy
| | - Andrea Baroncelli
- Department of Education and Psychology, University of Florence, Florence, Italy
| | - Azzurra Batani
- Department of Education and Psychology, University of Florence, Florence, Italy
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Abstract
Understanding defense mechanisms is an important part of psychotherapy. In this article, we trace the history of the concept of defense, from its origin with Freud to current views. The issue of defense as an unconscious mechanism is examined. The question of whether defenses are pathological, as well as their relation to pathology, is discussed. The effect of psychotherapy on the use of defenses, and their relation to a therapeutic alliance is explored. A series of empirical research studies that demonstrate the functioning of defense mechanisms and that support the theory is presented. Research also shows that as part of normal development, different defenses emerge at different developmental periods, and that gender differences in defense use occur.
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Ferrero A, Simonelli B, Fassina S, Cairo E, Abbate-Daga G, Marzola E, Fassino S. Psychopathological Functioning Levels (PFLs) and their possible relevance in psychiatric treatments: a qualitative research project. BMC Psychiatry 2016; 16:253. [PMID: 27439471 PMCID: PMC4955138 DOI: 10.1186/s12888-016-0940-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/20/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Symptoms description is often not enough to provide clinicians with guidelines for treatments and patients' clinical history does not represent an exhaustive source of data. Psychopathological dysfunctions are known to relate to the core disturbances that underlie different forms of psychopathology so the identification of such dysfunctions could be helpful for treatments. Some tools are available although highly complex and lengthy. This study aimed to provide clinicians with an easy-to-administer instrument able to capture different levels of impairment in psychopathological functioning, namely the Psychopathological Functioning Levels - Rating Scale (PFL-RS). METHODS The Psychopathological Functioning Level - Research and Training Committee (PFL-RTC) has been established in Turin since 2002 including psychiatrists and clinical psychologists with extensive clinical and research experience. Our research was grounded on the Qualitative Research Criteria (QRC) 1-7 and conducted with subsequent steps in order to identify those core psychopathological dysfunctions to be rated by this tool. RESULTS From 2002 until 2014, 316 outpatients were administered the clinical interview on at least two different occasions. Diagnoses were mixed and included: Schizophrenic and Psychotic Disorders, Depressive Disorders, Anxiety Disorders, Obsessive-Compulsive Disorder, Post- Traumatic Stress Disorder, Somatic Symptoms Disorders, Eating Disorders and Personality Disorders. Focus groups were conducted to identify those psychopathological dysfunctions which needed to be rated, according to two Phenomenological Selection Criteria (PhSC) and four Etiopathogenetic Selection Criteria (EtSC). As a result, five dysfunctional areas emerged: Identity (ID); Comprehension (CO); Negative Emotions (NE); Action-Regulation (AR); Social Skills (SS). After checking such dimensions for consistency with the existing instruments, 7 levels of severity were identified for each area. Finally, a provisional Italian schedule of Psychopathological Functioning Levels - Rating Scale (PFL-RS) was obtained and checked for semantic comprehension and then administered gathering preliminary data. CONCLUSIONS Psychopathological dysfunctions underlying mental disorders have been recognized in the present study with the PFL-RS. This instrument seems promising to inform in a specific way treatments strategies and goals, specifically concerning psychotherapy. Notwithstanding, further research is needed in order to confirm validity, sensitivity and reliability of this instrument.
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Affiliation(s)
- Andrea Ferrero
- Psychotherapy Unit, Mental Health Department, Health District TO-4, Settimo Torinese Turin, Italy ,SAIGA Institute for Research, Turin, Italy
| | - Barbara Simonelli
- Psychotherapy Unit, Mental Health Department, Health District TO-4, Settimo Torinese Turin, Italy ,SAIGA Institute for Research, Turin, Italy
| | - Simona Fassina
- Psychotherapy Unit, Mental Health Department, Health District TO-4, Settimo Torinese Turin, Italy ,SAIGA Institute for Research, Turin, Italy
| | | | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
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Meaney R, Hasking P, Reupert A. Borderline Personality Disorder Symptoms in College Students: The Complex Interplay between Alexithymia, Emotional Dysregulation and Rumination. PLoS One 2016; 11:e0157294. [PMID: 27348858 PMCID: PMC4922551 DOI: 10.1371/journal.pone.0157294] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/26/2016] [Indexed: 11/17/2022] Open
Abstract
Both Emotional Cascade Theory and Linehan’s Biosocial Theory suggest dysregulated behaviors associated with Borderline Personality Disorder (BPD) emerge, in part, because of cycles of rumination, poor emotional recognition and poor emotion regulation. In this study we examined relationships between rumination, alexithymia, and emotion regulation in predicting dysregulated behaviors associated with BPD (e.g. self-harm, substance use, aggression), and explored both indirect and moderating effects among these variables. The sample comprised 2261 college students who completed self-report measures of the aforementioned constructs. BPD symptoms, stress, family psychological illness, and alexithymia exerted direct effects on behaviors. Symptoms had an indirect effect on behaviors through rumination, alexithymia and emotional dysregulation. In addition, the relationship between symptoms and dysregulated behaviors was conditional on level of rumination and alexithymia. Implications for early identification and treatment of BPD and related behaviors in college settings are discussed.
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Affiliation(s)
- Rebecca Meaney
- Faculty of Education, Monash University, Melbourne, Victoria, Australia
| | - Penelope Hasking
- School of Psychology & Speech Pathology, Curtin University, Perth, Western Australia, Australia.,Department of Psychiatry, Monash University, Clayton, Victoria, Australia
| | - Andrea Reupert
- Faculty of Education, Monash University, Melbourne, Victoria, Australia
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Halim MA, Sabri F. Relationship Between Defense Mechanisms and Coping Styles Among Relapsing Addicts. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.sbspro.2013.07.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perry JC, Presniak MD, Olson TR. Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. Psychiatry 2013; 76:32-52. [PMID: 23458114 DOI: 10.1521/psyc.2013.76.1.32] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Numerous authors have theorized that defense mechanisms play a role in personality disorders. We reviewed theoretical writings and empirical studies about defenses in schizotypal, borderline, antisocial, and narcissistic personality disorders, developing hypotheses about these differential relationships. We then examined these hypotheses using dynamic interview data rated for defenses in a study of participants (n = 107) diagnosed with these four personality disorder types. Overall, the prevalence of immature defenses was substantial, and all four disorders fit within the broad borderline personality organization construct. Defenses predicted the most variance in borderline and the least variance in schizotypal personality disorder, suggesting that dynamic factors played the largest role in borderline and the least in schizotypal personality. Central to borderline personality were strong associations with major image-distorting defenses, primarily splitting of self and other's images, and the hysterical level defenses, dissociation and repression. Narcissistic and antisocial personality disorders shared minor image-distorting defenses, such as omnipotence or devaluation, while narcissistic also used splitting of self-images and antisocial used disavowal defenses like denial. Overall, differential relationships between specific defenses and personality disorder types were largely consistent with the literature, and consistent with the importance that the treatment literature ascribes to working with defenses.
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Chabrol H, Valls M, Leeuwen NV, Bui E. Callous-unemotional and borderline traits in nonclinical adolescents: Personality profiles and relations to antisocial behaviors. PERSONALITY AND INDIVIDUAL DIFFERENCES 2012. [DOI: 10.1016/j.paid.2012.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Research has shown that a disturbed capacity to relate to others is a key feature of borderline personality disorder (BPD; e.g., Bender & Skodol, 2007; Gunderson, 2007). However, few attempts have been made to determine if and how this disturbance translates into identifiable core interpersonal patterns. This study investigated the relationship patterns of 68 patients presenting with BPD. Vignettes of interpersonal interactions spontaneously reported by participants were rated using the Core Conflictual Relationship Theme (CCRT; Luborsky & Crits-Christoph, 1990) method. Results of a factor analysis revealed six patterns of interactions: (1) interactions involving the ego ideal; (2) dependent-depressive interactions; (3) receptive interactions; (4) passive-submissive interactions; (5) successful interactions; and (6) sadomasochistic interactions. The clinical implications of these findings are discussed.
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Affiliation(s)
- Martin Drapeau
- McGill Psychotherapy Process Research Group, McGill University, 3700 McTavish, Montreal, Quebec, H3A 1Y2, Canada.
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Liu N, Zhang Y, Brady HJ, Cao Y, He Y, Zhang Y. Relation between childhood maltreatment and severe intrafamilial male-perpetrated physical violence in Chinese community: the mediating role of borderline and antisocial personality disorder features. Aggress Behav 2012; 38:64-76. [PMID: 22028215 DOI: 10.1002/ab.20417] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 07/26/2011] [Accepted: 07/29/2011] [Indexed: 11/07/2022]
Abstract
This study investigates the role of borderline personality disorder (BPD) and antisocial personality disorder (ASPD) features as mediators of the effects of childhood maltreatment on severe intrafamilial physical violence amongst Chinese male perpetrators. A cross-sectional survey and face-to-face interview were conducted to examine childhood maltreatment, personality disorder features, impulsivity, aggression, and severe intrafamilial physical violence in a community sample of 206 abusive men in China. The results suggest that ASPD or BPD features mediate between childhood maltreatment and intimate partner violence perpetration in Chinese abusive men. These findings may yield clinical and forensic implications for assessing the psychopathology of abusive men, and may steer the intervention of intimate partner violence.
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Affiliation(s)
- Na Liu
- Mental Health Institute; Second Xiangya Hospital; Central South University; Changsha Hunan People's Republic of China
- Department of Clinical Psychology; Nanjing Brain Hospital; Nanjing Medical Hospital; Nanjing Jiangsu People's Republic of China
| | - Yalin Zhang
- Mental Health Institute; Second Xiangya Hospital; Central South University; Changsha Hunan People's Republic of China
| | | | - Yuping Cao
- Mental Health Institute; Second Xiangya Hospital; Central South University; Changsha Hunan People's Republic of China
| | - Ying He
- Mental Health Institute; Second Xiangya Hospital; Central South University; Changsha Hunan People's Republic of China
| | - Yingli Zhang
- Mental Health Institute; Second Xiangya Hospital; Central South University; Changsha Hunan People's Republic of China
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