A validation of the Defence Mechanism Inventory

Psychopathological outcomes and defence mechanisms in clinically healed adults with a paediatric cancer history: an exploratory study

Background

The incidence of paediatric cancers has increased in recent years; however, with advances in the treatment of paediatric cancer, almost 80% of children and adolescents who receive a diagnosis of cancer become long-term survivors. Given the high stress levels associated with cancer, it becomes important to ascertain the risk and likelihood of psychiatric disorders in adult paediatric cancer survivors.

Aims

This study aims to investigate the relationship between defence styles and predisposition to psychiatric diseases in adults with a history of paediatric cancer.

Methods

We performed an explorative study on a sample of 66 clinically healed adults with a history of paediatric cancer (survivors) during follow-up visits at the University Hospital ‘Policlinico G Rodolico’ of Catania (Italy) and 98 healthy controls among medicine students. We administered the Defence Mechanism Inventory (DMI) to assess defence styles. The Symptom Checklist-90-Revised (SCL-90-R) and the Davidson Trauma Scale (DTS) were administered to assess psychopathological indices. We conducted comprehensive statistical analysis based on correlation analysis and mediation analysis to investigate the relationship between defence styles and psychopathological outcomes in survivors compared with controls.

Results

The survivors obtained statistically significant lower values in TAO, PRO and TAS defence styles and a higher value in REV. Both groups showed non-pathlogical mean scores in DTS and SCL-90-R (with an exception of the obsessive-compulsive subscale), with lower mean values among survivors. The results of mediation analysis showed that TAS had mediation effects on interpersonal sensitivity, anxiety, PSDI, GSI and avoidance, while TAO had mediation effects on DTS total score and intrusivity. Thus, for these psychopathological indices, the effect of the oncological pathology was indirect and mediated by TAO or TAS. Our analysis exlcluded mediation effects between the remaining variables and defence styles.

Conclusion

Integrating data from mediation and correlation analysis, we found how the decreasing of TAS utilization in survivors as the consequence of cancer history, has decreased interpersonal sensitivity, anxiety and GSI score in these subjects compared with controls. Similary, the decrease of TAO utilization played a role in lower values of DTS total score and intrusivity subscale. Unexpectedly, our analysis excluded relationships between cancer history, other defence styles and psycopathological scores as we initially assumed.

Pathways of ego development: Contributions to maladaptation and adjustment

This article investigates the impact of ego development on the course of psychiatric illness in a group of 37 psychiatrically hospitalized adolescents ages 12 to 16. The subjects, 21 males and 16 females, were evaluated at time of admission and again after 9 months of hospitalization. Using the Loevinger Sentence Completion Test (Loevinger, Wessler, & Redmore, 1970), two ego pathway groups were defined: progressors, those subjects who had advanced at least one-half stage in ego development, and nonprogressors, those who did not progress at least one-half state in ego development. Significant differences in clinical course were found between the two groups. Progressors demonstrated more significant decreases in psychiatric symptoms as measured by the Achenbach and Edelbrock (1987) Youth Self Report and had a significant change in their use of coping and defense processes compared with the nonprogressors. The findings are discussed in the context of a constructivist approach to developmental psychopathology.

An empirical look at the Defense Mechanism Test (DMT): reliability and construct validity

Although the Defense Mechanism Test (DMT) has been in use for almost half a century, there are still quite contradictory views about whether it is a reliable instrument, and if so, what it really measures. Thus, based on data from 39 female students, we first examined DMT inter-coder reliability by analyzing the agreement among trained judges in their coding of the same DMT protocols. Second, we constructed a "parallel" photographic picture that retained all structural characteristic of the original and analyzed DMT parallel-test reliability. Third, we examined the construct validity of the DMT by (a) employing three self-report defense-mechanism inventories and analyzing the intercorrelations between DMT defense scores and corresponding defenses in these instruments, (b) studying the relationships between DMT responses and scores on trait and state anxiety, and (c) relating DMT-defense scores to measures of self-esteem. The main results showed that the DMT can be coded with high reliability by trained coders, that the parallel-test reliability is unsatisfactory compared to traditional psychometric standards, that there is a certain generalizability in the number of perceptual distortions that people display from one picture to another, and that the construct validation provided meager empirical evidence for the conclusion that the DMT measures what it purports to measure, that is, psychological defense mechanisms.

Development of a short form of the adolescent version of the Defense Mechanisms Inventory

This article describes the construction of a short form of the adolescent version of the Defense Mechanisms Inventory (DMI; Gleser & Ihilevich, 1969; Ihilevich & Gleser, 1986). The DMI is a paper-and-pencil test for which subjects are asked to describe their reactions to 10 hypothetical dilemmas. The responses involve a forced choice method in which each of the alternative responses represent one of five defense clusters entitled Turning Against the Object, Principalization, Turning Against the Self, Reversal, and Projection. Two hundred ninety-five adolescent psychiatric patients (122 boys and 173 girls) ages 12-16 were administered the adolescent form of the DMI. Based on an analysis of each of the 10 dilemma stories, a 6-story short form was devised. Correlations between this short form and the long form of the DMI ranged from .90 to .95 on the five defense scales, with no significant effect of gender. Internal reliability estimates of the short form scales were also favorable. These results indicate that the short form of the adolescent DMI is an acceptable substitute for the lengthier inventory from which it was derived and is more utilizable in clinical and research settings.

Validity of Self-Report Measures of Defense Mechanisms

The Life Style Index (LSI), the Defense Style Questionnaire (DSQ), the Defense Mechanisms Inventory (DMI), and the FIRO Coping Operations Preferences Enquiry (FIRO) were administered to 187 undergraduates in order to determine convergent and discriminant validity of self-report measures of defense mechanisms. A correlational analysis of the four scales resulted in low correlations among subscales measuring similar defense mechanisms. A factor analysis produced factors based on particular scales rather than identical or similar constructs. Results suggest that self-report measures may not be an effective method for assessing various ego defense strategies.

Factor Analysis of Ipsative Measures

lpsative measures are multiple measures, where the data are collected, or are modified, in such a way that all subject totals across the measures are equal. Much has been written about factor analysis with such data, however, no clear consensus has been reached regarding the suitability of ipsative measures for factor analysis. The purpose of the present article is to show analytically the fundamental problems that ipsative measures impose for factor analysis. The expected value of the correlation between ipsative measures is shown to equal - 1/ ( k - I), where k is the number of measures. The rank of the resulting correlation matrix is reduced by one to k - 1, and ipsativity alone produces k - 1 artifactual bipolar factors, which will obscure any actual interrelations among the measures. If the data are known to be ipsative or if the tell-tale signs of ipsativity are seen, factor analysis should not be done.

A direct comparison of the defense mechanisms of nondepressed people and depressed psychiatric inpatients

This report presents a direct comparison of defensive styles (as measured by the Defense Mechanisms Inventory [DMI]) in a sample of depressed psychiatric inpatients and samples of nondepressed male and female normative groups. Consistent with the "depressive realism" literature, nondepressed men and women were more likely than their depressed counterparts to bias their perceptions in an overly cheerful, optimistic direction. Counternormative sex differences were also found. Depressed men were more likely to use internalizing defenses and depressed women were more likely to use externalizing defenses than their respective nondepressed comparison groups. Overall, as has been speculated, there was a relationship within depressed subjects between depression severity and the amount of negatively biased self-perception.

Defense mechanism correlates of orality

Although there has been a great deal of research assessing behavioral correlates of oral dependency, the defensive style of the oral dependent person remains unexplored. This paper describes two studies investigating the orality--defense mechanism relationship. In the first study, 154 undergraduate subjects (74 males and 80 females) completed the Defense Mechanisms Inventory (DMI; Gleser and Ihilevich, 1969), and were administered the Group Rorschach test which was scored for oral dependent content in the standard manner (Masling, 1986). In the second study, 64 undergraduate subjects (30 males and 34 females) completed the DMI and the Lazare-Klerman Trait Scale (Lazare, Klerman & Armor, 1966, 1970). Results of both studies indicated that orality is positively related to the use of turning-against-self (TAS) defenses, and negatively related to the use of turning-against-object (TAO) defenses in male subjects. In both studies, orality scores were negatively related to scores on a DMI-derived index of outward-directed aggression (AGG) in males. In Study 2, neither obsessiveness nor hysteria scores were related to TAS, TAO or AGG scores in subjects of either sex. Findings are discussed in the context of previous research on oral dependence.

A systematic inquiry into recollections of childhood experience and their relationship to adult defence mechanisms

The relationships between childhood experience, measured by the PBI, and adult defence mechanisms, evaluated through the DMI, were examined in 114 subjects. There were modest but significant correlations between the primitive defences of 'turning against others' and 'projection' on the one hand, and a lack of parental care, as experienced by the subjects, on the other. 'Principalisation' (e.g. intellectualisation, isolation and rationalisation) and 'reversal' (e.g. negation, reaction formation, denial and repression) were positively associated with parental care. These findings account for only a small portion of the variance but show that, as with certain personality traits, actual or perceived childhood experience contributes in a recognisable fashion to the patterns of adult defences and behaviour.