Defense mechanisms in alexithymia

Time in the Mental Health Context: Neurotic Symptomatology, Defense Mechanisms and the Perception of Time Perspective Among Patients Diagnosed With Neurotic and Personality Disorders - A Clinical Study

AIM

The main objective of the study is to explore relations between the time perspective, neurotic symptoms, anxiety, and defense mechanisms in the group of patients diagnosed with neurotic and personality disorders (ICD-10 groups: F4x, F60.x and F61) treated with group psychotherapy. The research is conducted on the theoretical basis of the Zimbardo and Boyd's Time Perspective Theory.

METHODS

The study included 49 patients treated in the day ward for the Treatment of Neurotic Disorders and Behavioral Syndromes at the University Hospital. The measurement of the TP was performed with the Zimbardo Time Perspective Inventory. Patients also completed the State-Trait Anxiety Inventory and the Defense Style Questionnaire 40. The diagnosis was done by licensed psychiatrists and supported with the measures: Symptom Checklist KO"O", Neurotic Personality Questionnaire KON-2006.

RESULTS

Multiple regression analysis models showed that the four time perspectives (past negative, present fatalistic, present hedonistic, and future) are predicted in different variations by the level of anxiety state or trait and repertoire of used defense mechanisms (immature or mature).

CONCLUSIONS

Considering the established bilateral correlations, change in the time perspective may constitute an important factor in the reduction of neurotic symptoms, possibly through changes in the repertoire of utilized defense mechanisms. However, there is also possible that altering neurotic symptomatology would alter time perspective. The assessment of the time perspective in patients with neurotic and personality disorders may provide useful data for the diagnosis and the monitoring of psychotherapy effectiveness. Based on the results of this study conducting further research on the role of the changes in the time perspective in the course of psychotherapy is recommended and necessary to expand the understanding of the relations observed in this study.

The Impact of Past Trauma on Psychological Distress: The Roles of Defense Mechanisms and Alexithymia

Objectives

Posttraumatic stress disorder (PTSD) symptoms following past trauma could lead to psychological distress. Little is known, however, about the roles of defense mechanisms and alexithymia may play in the process. The current study aimed to examine the potential impact of alexithymia and defense mechanisms on the relationship between past trauma and distress among Chinese university students.

Method

455 university students completed a set of questionnaires: PTSD Checklists for DSM-5, Toronto Alexithymia Scale (TAS-20), Defense Style Questionnaire, and General Health Questionnaire-28.

Results

PTSD following past trauma was associated with increased psychological distress. Alexithymia and defenses (especially immature defense) mediated the path between PTSD and psychological co-morbidities.

Conclusion

Following past trauma, people developed PTSD and other psychological symptoms. The severity of these distress symptoms was influenced by the way they defended themselves psychologically, and their ability to identify, express, and process distressing emotions.

Posttraumatic Stress and Interpersonal Sensitivity: Alexithymia as Mediator and Emotional Expressivity as Moderator

This study examined 1) the link between PTSD from past trauma, interpersonal sensitivity and psychiatric co-morbidity, 2) mediational effects of alexithymia on 1), and 3) moderated mediational effects with emotional expressivity as the moderator. Five hundred and fifteen Kazakh students completed the Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28, Toronto Alexithymia Scale-20, Berkeley Expressivity Questionnaire and Interpersonal Sensitivity Measure. The results showed that 28% met the criteria for full-PTSD. Controlling for academic year, age and university major, PTSD from past trauma was significantly correlated with interpersonal sensitivity and psychiatric co-morbidity. Alexithymia mediated the impact of PTSD on interpersonal sensitivity and psychiatric co-morbidity. Alexithymia, however, did not interact with type of emotional expressivity to influence outcomes. Moderated mediational effects were not found. To conclude, following trauma, Kazakh students can experience heightened levels of interpersonal sensitivity and psychological symptoms. These problems are particularly severe for those who have difficulty getting in touch with their emotions.

Alexithymia, Defenses, and Ego Strength: Cross-sectional and Longitudinal Relationships with Psychological Well-Being and Depression

Affect regulation is important to mental health. A deficit in one's ability to identify and express emotions (alexithymia), cognitive styles of regulating emotional conflict (defenses), and the capacity for integrative and complex self-other understanding (ego strength or maturity) need to be studied to understand how they relate to each other as well as to mental health and well-being. A sample of 415 community-dwelling adults from a major metropolitan area in the Midwest U.S., stratified for gender, age, and ethnicity, completed three methodologically different measures of affect regulation along with measures of well-being and depression. Six years later, 49% of the sample again reported their well-being and depression. At baseline, ego strength and the defenses of principalization and reversal correlated negatively with alexithymia and the other defenses (turning against self, turning against object and projection), even after controlling for negative affect. Cross-sectionally, relationships were largely as hypothesized, with low alexithymia, use of mature defenses, and greater ego strength correlating with less depression and greater well-being, although some of these relationships were attenuated after controlling for negative affect. Prospectively, each of the affect regulation measures predicted hypothesized changes in well-being after 6 years, after controlling for baseline well-being, but affect regulation did not predict changes in depression. These findings illuminate similarities and differences among these affect regulation constructs, suggest the importance of differentiating well-being from depression, and reveal that affect regulation uniquely predicts changes in long-term well-being.

Psychopathological symptoms, defense mechanisms and time perspectives among subjects with alcohol dependence (AD) presenting different patterns of coping with stress

Background

The problem of coping with stress is an important one in the context of development and persistence of alcohol dependence. In the literature to date very little attention has been paid to coping patterns construed as a configuration of specific coping styles, particularly as regards the functioning of addicted individuals. The aim of the study was to verify whether individuals with alcohol dependence characterized by different coping patterns differ with respect to the severity of psychopathological symptoms, defense mechanisms and time perspectives.

Methods

Participants were given a battery of psychological tests—Coping Inventory for Stresfull Situations (CISS), Defense Style Questionnaire (DSQ 40), Syndrom Checklist (SCL-90) and Short Zimbardo Time Perspective Inventory (SZPTI-PL). The sample comprised 112 individuals with alcohol dependence, aged 20 to 63 years old, the average age was 37.86; 78 percent were men. There were identified three sub-groups of individuals characterized by a distinctive patterns of coping with stress —“emotional-avoidant”, “task oriented” and a “mixed one”.

Results

Individuals with the predominant emotional-avoidant coping pattern are characterized by significantly higher severity of psychopathological symptoms, less mature defense mechanisms and past time perspectives. Subjects reliant on task-oriented coping pattern were characterized by the highest level of adaptation and the most constructive way of functioning in the face of difficulties.

Conclusion

It is worth regarding the examination of patterns of coping as an indispensable element of collecting medical history from alcohol dependent individuals.

Exploring the interrelationship between alexithymia, defense style, emotional suppression, homicide-related posttraumatic stress disorder and psychiatric co-morbidity

This study investigated the interrelationship between alexithymia, defense style, emotional suppression, posttraumatic stress disorder (PTSD) following homicide and psychiatric co-morbidity. One hundred and fifty male homicide perpetrators and 156 male perpetrators of non-violent crime completed the Posttraumatic Stress Diagnostic Scale (except for non-violent perpetrators), the General Health Questionnaire-28, the Defense Styles Questionnaire, the Courtauld Emotional Control Scale and the Toronto Alexithymia Scale-20. The results showed that 44% of homicide perpetrators met the criteria for PTSD. No significant differences were found between groups in alexithymia, defense style and psychiatric co-morbidity. Homicide perpetrators suppressed depression significantly more than the non-violent group. PLS analyses showed that alexithymia was significantly correlated with defense style. Defense styles were significantly correlated with emotional suppression which, in turn, was associated with homicide-related PTSD and psychiatric co-morbidity. To conclude, perpetrators can experience PTSD reactions following the act of homicide. The severity of these reactions and other psychological problems were related to difficulty getting in touch with distressing emotions, the defenses they used to protect themselves psychologically and the way they suppressed their emotion.

Short-term intensive psychodynamic group therapy versus cognitive-behavioral group therapy in day treatment of anxiety disorders and comorbid depressive or personality disorders: study protocol for a randomized controlled trial

BACKGROUND

Psychodynamic and cognitive-behavioral group therapies are frequently applied in day hospitals for the treatment of anxiety disorders and comorbid depressive or personality disorders in Poland and other Eastern European countries. Yet there is not enough evidence as to their effectiveness in this environment; this study addresses this gap. The aim of the study is to determine the effectiveness of these two kinds of day treatment care consisting of intensive, short-term group psychodynamic and cognitive-behavioral therapy, for patients with anxiety disorders and/or comorbid depressive or personality disorders. Our objectives are to: 1) show the effectiveness of each treatment in a day-care setting relative to the wait-list control group; 2) demonstrate the relative short- and long-term effectiveness of the two active treatments; 3) carry out a preliminary examination of the predictors and moderators of treatment response; 4) carry out a preliminary examination of the mediators of therapeutic change; and 5) compare the impact of both methods of treatment on the outcome of the measures used in this study.

METHODS/DESIGN

In this randomized controlled trial, a total of 199 patients with anxiety disorders and comorbid depressive and/or personality disorders will be assigned to one of three conditions: 1) psychodynamic group therapy; 2) cognitive-behavioral group therapy; or 3) wait-list control group. The therapy will last 12 weeks. Both treatments will be manualized (the manuals will address comorbidity). Primary outcome measures will include self-reported symptoms of anxiety, observer-rated symptoms of anxiety, global improvement, and recovery rate. Secondary outcome measures will include the number of pathological personality traits, depression, self-esteem, defense mechanisms, beliefs about self and others, interpersonal problems, object relations, parental bonding, meta-cognition, and quality of life. Measures will be taken at baseline, post-treatment, and at six months following the end of therapy.

DISCUSSION

The rationale is to investigate how effectively anxiety disorders and/or comorbid depressive or personality disorders can be treated in a day hospital setting, typical of the Polish health care system, during a three-month treatment period.

TRIAL REGISTRATION

Clinicaltrials.gov identifier NCT02126787 , registered on 28 April 2014.

Clinical approaches to somatization

Somatization is the experience and expression of psychological distress through bodily symptoms. Somatization can be conceptualized as an emotional state that has not been represented symbolically or as a defense against intolerable emotions and fantasies. Bodily concerns can also function as a means of seeking responsiveness from others. Alexithymia refers to a difficulty identifying and symbolizing emotional states that has been found to be associated with somatization. When functioning as a defense, a focus on the body can be used to avoid frightening or intolerable feelings and fantasies, or to ward off aggressive fantasies by viewing oneself as physically damaged. Systematic studies have demonstrated the presence of the defense of somatization in mood disorders, particularly anxiety and panic disorders. In treating anxiety disorders, the therapist helps the patient to determine the nature of emotions and fantasies that the patient is defending against, particularly fears and conflicts surrounding anger and separation.

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.

Attribution of cause by patients with depression, anxiety, and alexithymia

This study evaluated the relationship between the personality construct of alexithymia and the attribution of depression to biological, psychological, sociocultural, and external stress. When alexithymia was considered as a continuous variable, there was a significant correlation between a higher score on the Toronto Alexithymia Scale and a greater belief in psychological causes for their psychiatric disorder. The other factors also had positive but nonsignificant correlations with alexithymia. When alexithymia was categorically partitioned and controlled for depressed mood, alexithymic subjects more frequently endorsed all four factors to be causal for their psychiatric illness. This appears to contradict earlier assumptions that alexithymic patients tend to be less psychologically minded than those without this psychological trait.

[Somatization and alexithymia in male infertility. A replication study]

BACKGROUND AND OBJECTIVE

In a previous study, we found a higher degree of alexithymia and somatization in infertile men (Hum Reprod 2001 Vol.16(3),587-592). This study was designed to confirm the findings of the former study

PATIENTS/METHODS

88 infertile men (48 idiopathic infertility, 40 somatic infertility) were consecutively enrolled in the study. The control group consisted of 44 healthy men. Alexithymia was measured by the 20-item-Toronto-Alexithymia-Scale;somatization was measured by the Symptom Checklist-90-R.

RESULTS

There were no differences between the subgroups of infertile men. The study group showed a significantly higher sum score in the TAS-20 (p<0.01) and a higher score on the scale somatization in the Symptom Checklist-90-R (p<0.05) compared to the control group.

CONCLUSIONS

Our study replicated the findings of the previous investigation. Alexithymia and somatization are discussed as consequences of coping with male infertility.

Alexithymie: Kompetenzdefizit oder (motivierte) Hemmung?

Zusammenfassung. Theoretischer Hintergrund: Alexithymie bezeichnet eine eingeschränkte Fähigkeit, Affekte zu identifizieren und zu beschreiben. Auf konstruktheoretischer Ebene ist ungeklärt, ob alexithyme Phänomene auf einer defizitären oder auf einer gehemmten Affektregulation beruhen. Fragestellung: Um eine Entscheidung zu ermöglichen, wurden aus jeder der beiden theoretischen Perspektiven Hypothesen formuliert und überprüft. (1) Alexithyme Patienten verfügen über einen weniger differenzierten semantischen Raum für die Unterscheidung von Emotionen. (2) Alexithyme Patienten akzeptieren ihre eigene Emotionalität in geringerem Maße als nichtalexithyme Patienten und/oder erwarten in stärkerem Ausmaß, daß ihre Emotionalität von anderen abgelehnt wird. Methode: Bei 39 Patienten mit DSM-III-R Angststörungen wurde der Differenzierungsgrad der Emotionswahrnehmung individuell für jeden Patienten mit einer Variante der Repertory-Grid-Technik, dem “Emotions-Grid“, bestimmt. Die Emotionsakzeptanz wurde mittels Ratings für diverse Grundemotionen bestimmt. Mit der Toronto Alexithymia Scale (TAS-20) wurden alexithyme Merkmale psychometrisch erfasst. Ergebnisse: Eine emotionale Differenzierungsschwäche alexithymer Patienten kann belegt werden. Schlussfolgerungen: Die Befunde stützen ein “Defizitkonzept“ der Alexithymie.