Defensive Functioning Scale Research Articles

Comparing Psychoanalytic Process in Consulting Room and Teleconference: A Naturally Occurring Controlled Experiment.

In response to COVID-19, clinicians migrated psychoanalyses to videoconference platforms, creating an opportunity for a controlled empirical study in which only the site varied. There will be no differences in the quality of the psychoanalytic process (QAP) in the consulting room (CR) and in videoconference (VC). Individuals' defensive functioning (adaptive style) will be associated with their capacity to maintain the analytic process when treatment moves from CR to VC. Underlying was the concept that empirical research of clinical psychoanalysis is possible. Forty psychoanalysts of all ranks in the Accreditation Council for Psychoanalytic Education, Inc., accredited programs contributed 50 cases. Participants scored QAP at each site on a 0-to-100 scale. They reported patients' characteristic defense mechanisms using the Defensive Functioning Scale (DFS). To minimize bias, investigators calculated median DFS scores from data provided by clinicians. They compared QAP scores in CR and VC for the entire group without and with DFS scores, and for each DFS level (when feasible) using the related-samples Wilcoxon signed-rank test. There was no difference in QAP between CR and VC for the group as a whole; but QAP of the Minor Image Distorting group degraded significantly from CR to VC. This was the only group showing a significant difference. While statistical significance may not reflect clinical significance, individual differences in adaptation to telepsychoanalysis warrant further study. Empirical research of phenomena occurring naturally in clinical psychoanalysis appears feasible.

Breast cancer prognostication with neutrophil–lymphocyte ratio and platelet–lymphocyte ratio

Introduction Peripheral blood-derived inflammation-based markers such as neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) have been recently evaluated as prognostic markers in solid tumors. Although evidence to support these markers as prognostic factors is documented in gastrointestinal cancers, little is known of their impact on breast cancer (BC). Patients and methods A total of 100 patients presented with resectable early-stage BC treated with neoadjuvant chemotherapy. Tumor characteristics included tumor size, number of positive lymph nodes, estrogen and progesterone receptors, tumor grade, lympho-vascular invasion, and human epidermal growth factor receptor 2 (HER2) status. Sample of peripheral blood was analyzed and NLR and PLR were calculated. Results Forty-two (42%) patients were judged as having low NLR and 58 (58%) as high NLR. Low NLR was significantly correlated with younger age (P=0.028), premenopausal status (P=0.032), pathological complete response result (P Conclusion Both NLR and PLR are independently associated with an increased risk of Defensive Functioning Scale in BC.

Features of Developmental Level of Defense Mechanisms and Adjustment Status of University Students in Japan

A person with high-level mental defensive functioning exhibits optimal, effective adaptive states when encountering stressors. This may be an important factor in maintaining a sound campus life. Participants were 47 physically and mentally healthy students (average age 19.0 ± 0.6). We first investigated the developmental level of mental defensive functioning as an indicator of participants’ adaptive state at the time of the study. We used the Defensive Functioning Scale proposed in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). We attempted to quantify this scale by summing scores of seven Defense Levels based on individual defense mechanisms. We then measured physical and mental symptoms using the Cornell Medical Index (CMI), and compared the relationships between symptoms and defensive functioning (defensive functioning scale and physical symptoms, defensive functioning scale and mental symptoms, and physical symptoms and mental symptoms). Finally, we compared male and female results. Although there was no statistical difference, males showed higher average scores than females on the Defensive Functioning Scale vs physical/mental symptoms, which may indicate the relative suppression of women that characterizes the social and cultural background in Japan. In addition, there was a relatively high unisex positive correlation between physical symptoms and mental symptoms, which suggests that university health administrative staff need to provide mental as well as physical care to help students manage stress effectively. However, larger, more comparative studies on the social and cultural background are needed to further explore these issues.

Características Resilientes do Empreendedor Associadas ao Insucesso Empresarial

Este estudo tem como objetivo analisar as características resilientes do empreendedor no intuito de compreender se e como o seu comportamento pode ser associado à descontinuidade do negócio. Caracteriza-se como um estudo qualitativo, exploratório e utilizou a técnica de análise de conteúdo, associada à aplicação da Escala de Funcionamento Defensivo, para analisar o comportamento de empreendedores antes do insucesso empresarial. Foram entrevistados 13 empreendedores paulistas que vivenciaram o insucesso empresarial. Como principais resultados, evidencia-se a onipotência como estilo apresentado por 12 dos 13 entrevistados; a afiliação, constatada em nove dos 13 entrevistados; e a atuação, em sete dos 13 entrevistados antes do insucesso empresarial. Considerando que a onipotência foi a característica comportamental mais evidenciada, pode-se entender que esse comportamento pode demonstrar a arrogância do indivíduo diante de outras pessoas, o que pode influenciar nas decisões do empreendedor, desmotivação de funcionários e insatisfação de clientes, acarretando assim, o insucesso empresarial.

Convergent Validity of the Defense Mechanisms Manual and the Defensive Functioning Scale

We examined the convergent validity of Cramer’s Defense Mechanisms Manual (DMM; Cramer, 1991b) by comparing it to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Defensive Functioning Scale (DFS). A total of 60 low income urban women from a primary care medical facility responded to four Thematic Apperception Test (TAT; Murray, 1943) cards and an interview of early memories and descriptions of significant others. We scored the TAT narratives with the DMM, and we coded the interview narratives with the DFS. DMM Denial and Projection scales were negatively correlated with the DFS Overall Defensive Functioning scale (r= –.28, p< .01 and r= –.22, p< .10, respectively) and were positively correlated with a DFS pathological composite score (r= .36, p< .01 and r= .32, p< .05, respectively). These findings support the convergent validity of the DMM Denial and Projection scales.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Defensive Functioning Scale: a validity study

Objective We assess the convergent and predictive validity of the Defensive Functioning Scale (DFS) with measures of life events, including childhood abuse and adult partner victimization; dimensions of psychopathology, including axis I (depressive) and axis II (borderline personality disorder) symptoms; and quality of object relations. Method One hundred and ten women from a university-based urban primary care clinic completed a research interview from which defense mechanisms were assessed. The quality of object relations was also assessed from interview data. The women completed self-report measures assessing depression, borderline personality disorder symptoms, childhood physical and sexual abuse, and adult partner physical and sexual victimization. Results Inter-rater reliability of the scoring of the DFS levels was good. High adaptive defenses were positively correlated with the quality of object relations and pathological defenses were positively correlated with childhood and adult victimization and symptom measures. Although major image distorting defenses were infrequently used, they were robustly correlated with all study variables. In a stepwise multiple regression analysis, major image distorting defenses, depressive symptoms, and minor image distorting defenses significantly predict childhood victimization, accounting for 37% of the variance. In a second stepwise multiple regression analysis, borderline personality disorder symptoms and disavowal defenses combined to significantly predict adult victimization, accounting for 16% of the variance. Conclusions The DFS demonstrates good convergent validity with axis I and axis II symptoms, as well as with measures of childhood and adult victimization and object relations. The DFS levels add nonredundant information to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition beyond axis I and axis II.

Defense Mechanisms and Major Depressive Disorder in African American Women

This study explored differences in defense use between a group of predominantly African American women diagnosed with Major Depressive Disorder (MDD; n = 20) and a healthy control sample (n = 20), both from a primary care medical clinic. Patients completed the Patient Health Questionnaire to assess DSM-IV diagnoses and underwent video-recorded interviews, which were assessed for defenses using the Defensive Functioning Scale from the DSM-IV. Groups were compared for differences in overall defensive functioning, defense levels, and individual defenses using independent samples t tests. Results showed that the MDD group scored higher on mental inhibition, minor image distorting, and major image distorting defense levels as well as the individual defenses devaluation, dissociation, and isolation. The control group scored higher on the overall defensive functioning and the individual defense anticipation. The results also showed a trend toward the MDD group scoring higher on the disavowal defense level and the individual defense splitting.

A relação entre os mecanismos de defesa e a qualidade da aliança terapêutica em psicoterapia de orientação analítica

INTRODUÇÃO: O estabelecimento de uma aliança terapêutica de boa qualidade em uma psicoterapia psicanalítica é fundamental para o processo terapêutico. Este estudo avaliou a influência do nível de funcionamento defensivo do paciente na qualidade da aliança terapêutica estabelecida durante a psicoterapia. MÉTODO: Para avaliação da qualidade da aliança estabelecida, pacientes em psicoterapia psicanalítica e seus respectivos terapeutas responderam ao Helping Alliance Questionnaire (versão paciente e versão terapeuta, respectivamente). O nível defensivo foi inferido através da Escala de Funcionamento Defensivo proposta no Manual de Diagnóstico e Estatística das Perturbações Mentais, quarta edição, texto revisado. RESULTADOS: Não houve associação entre o estabelecimento de uma aliança terapêutica de boa qualidade e o nível defensivo do paciente. No entanto, houve diferença significativa quando a versão do terapeuta foi comparada com a respondida pelo paciente: os pacientes estabeleceram uma aliança terapêutica de melhor qualidade em relação a seus terapeutas do que o inverso. CONCLUSÕES: O fato de a aliança terapêutica de boa qualidade ter se estabelecido independentemente do nível defensivo do paciente sugere que o treinamento e as características pessoais do terapeuta podem levar a uma capacidade de conectar-se com o paciente, apesar do grau de comprometimento do seu funcionamento psíquico.

Brazilian–Portuguese version of defensive style questionnaire-40 for the assessment of defense mechanisms: construct validity study

The aim of this study is to analyze the reliability and validity of the Brazilian–Portuguese version of the Defensive Style Questionnaire (DSQ). Participants were evaluated by clinical interview and the Mini-International Neuropsychiatric Interview. Reliability was assessed by factor analysis and Cronbach's alpha. The 3-factor model's replication was tested using confirmatory factor analysis (CFA). Controls were reevaluated after 4 months to assess test–retest reliability. Subsamples were also evaluated using the Minnesota Multiphasic Personality Inventory and Defensive Functioning Scale (DFS). Factor analysis of the various defense mechanisms produced a distribution of mechanisms among the factors that was largely similar to previous analyses based on the original instrument. The 3-factor model was supported by CFA. The test–retest evaluation showed sufficient intraclass correlation for all factors. Patients used more immature and neurotic defenses than controls. There was a correlation between DFS and immature defenses. Individuals with pathological personality traits scored higher on the immature and neurotic factors than those without. The Brazilian–Portuguese version of the DSQ-40 has psychometric features that allow the use of this instrument in our culture.

Psychiatric Assessment of Living Organ Donors for Renal Transplantation: Utility of the Defensive Functioning Scale

The author addresses the need for clinical guidelines to assess subtle psychological characteristics of living organ donors in view of the continuing concern with issues of motivation, manipulation, and uncertain outcome. Since the traditional DSM diagnostic approach has failed to clarify these issues, the identification of the ego-defense mechanisms of six prospective donors and their utility in guiding the decision to accept or reject them is described.

The relationship of patient defensive functioning and alliance with therapist technique during short-term psychodynamic psychotherapy

This study investigates the relationship of patient defensive functioning, therapeutic alliance and therapists' use of technical interventions in Short-Term Psychodynamic Psychotherapy (STPP; Book, 1998; Luborsky, 1984; Strupp & Binder, 1984; Wachtel, 1993). Participants in this study were 44 patients admitted for individual psychotherapy at a university based outpatient community clinic. Patient defensive functioning was assessed with the Defensive Functioning Scale (DFS) of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994). Therapeutic alliance was assessed using patient ratings from the Combined Alliance Short Form (CASF; Hatcher & Barends, 1996). External raters coded videotaped sessions using the Comparative Psychotherapy Process Scale (CPPS; Hilsenroth, Blagys, Ackerman Bonge & Blais, in press) to assess the use of Psychodynamic–Interpersonal (PI) and Cognitive–Behavioral (CB) techniques early (third or fourth session) in psychotherapy. Patient Overall Defensive Functioning (ODF) was found to predict therapists' overall use of PI interventions, as well as specific PI and CB interventions. Additionally, patients who utilized fewer adaptive defenses were found to receive more PI interventions in general. The implications of these findings for treatment planning and intervention are discussed. Copyright © 2006 John Wiley & Sons, Ltd.

A Study of the Face Validity of the 40 Item Version of the Defense Style Questionnaire (DSQ-40)

There are few studies examining the face validity of the 40-item version of the Defense Style Questionnaire (DSQ-40). Moreover, the existing studies have provided conflicting results. The present study provides an in-depth examination of the face validity of the DSQ-40. Eight clinicians independently attributed each item of the DSQ-40 to a defense mechanism. The defense mechanisms listed in the DSM-IV Defensive Functioning Scale and their definitions were provided as a guide, along with the definition of those defense mechanisms investigated by the DSQ that are not included. It was further specified that the raters could attribute the items to defense mechanisms other than those listed or coping mechanisms. Twelve items out of 40 (30%) were attributed to the defense mechanisms they were supposed to investigate by fewer than four out of the eight raters. This result suggests that a substantial part of the DSQ-40 is lacking in face validity.

Childhood Sexual Abuse and Adult Defensive Functioning

Differences in defensive functioning between those who reported a history of childhood sexual abuse (CSA) and those who did not was examined in a naturalistic treatment-seeking sample of adult outpatients (N = 67). Defensive functioning and childhood sexual abuse history were rated by clinicians and external raters utilizing the DSM-IV Defensive Functioning Scale and the Abuse Dimensions Inventory, respectively, based on information gathered as part of a larger therapeutic assessment. Individuals reporting a history of CSA were found to use more major image-distorting level defenses than the non-CSA group, and abuse severity was also related to greater use of major image-distorting level defenses. Those reporting a history of CSA relied more on defenses indicative of impairment in realistic perception of self and others. This defensive style likely contributes to the greater difficulties in interpersonal functioning and psychological problems in adulthood.

Clinical Utility of the Defensive Functioning Scale in the Assessment of Depression

The Defensive Functioning Scale (DFS) and Overall Defensive Functioning score (ODF) have been used as reliable and valid measures of defense structure when applied to clinical narratives. This study aims to replicate and extend positive clinical validity data for the ODF in the assessment of depression and examine the relationship between specific defense levels of the DFS and depressive symptoms. Sixty-nine outpatients who completed the Symptom Checklist 90-Revised and Personality Assessment Inventory were rated on the DFS by trained clinicians. Lower (more maladaptive) scores on the ODF were significantly related to the presence and severity of patient-reported depression symptoms. Furthermore, depression symptoms were significantly related to both the presence of low-level action defenses and an absence of higher-range defenses in the mental inhibitions-obsessional level. Findings from this study provide further support for the clinical application and relevance of the DFS system; support the theory of defensive processes falling into a hierarchy of adaptive functioning; and, because of a naturalistic setting, are highly generalizable to real-world practice.

Further reliability, convergent and discriminant validity of overall defensive functioning.

The reliability, convergent and discriminant validity of the Defensive Functioning Scale (DFS) and the overall defensive functioning score (ODF) has been previously examined. This study aims to address gaps in the literature as well as to replicate and extend the initial positive clinical validity data emerging on the DFS ( Blais et al., 1996; Hoglend and Perry, 1998; Lingiardi et al., 1999; Perry 2001; Perry and Hoglend, 1998; Perry et al., 1998). Fifty-three outpatient clients were rated by clinicians trained on the DFS. The relationship between the ODF with both clinician-rated and self-report measures of psychopathology was examined. The mean interrater reliability for the DFS levels rated in this study was found to be moderate to high, and reliability for the ODF score was found to be excellent. Coefficient alpha of individual defense levels as well as across the entire DFS indicated high levels of internal consistency. Factor analysis revealed that the ODF represents a construct different from various aspects of patient self-report and clinician ratings of psychopathology. These results provide further support for the clinical application and relevance of the DFS system.

The French Version of the Defense Style Questionnaire

Background: Bond et al. developed the Defense Style Questionnaire (DSQ), a self-questionnaire that aims at empirically measuring conscious derivatives of defense mechanisms. The original analysis yielded 4 factors called Defense Styles (DS). DSQ discriminates between mature and immature defense styles. Objectives: Determine if the French version of DSQ has (a) face validity, (b) a similar structure to the original version, (c) internal consistency, (d) grouping of defense mechanisms into clinically pertinent defense styles, (e) evidence of nonpatients using more mature defense styles, (f) correlation with Defensive Functioning Scale (DFS) (DSM-IV) [<citeref rid="ref002">2</citeref>]. Methods: Reliability and validity study on 82 control subjects and 140 patients, 59 among them evaluated for defensive level. Results: Factor analysis of controls sample yielded 4 factors ranging from immature to mature defense styles. DSQ scores on factor I (maladaptive style) are significantly higher in outpatients than in controls. Maladaptive style score correlates with clinical evaluation of defensive level of functioning (DFS). Conclusion: Psychometric features of the French version are similar to the original scale, although minor differences in individual defense mechanisms are present. Factor I (maladaptive defense style) remains more stable than other factors, accounts for most of variance contribution, has high internal consistency and applies to behaviors, i.e. conscious derivatives of defense mechanisms that can be easily identified. The French version of DSQ is (a) an easy and economical way to rate immature defense style in populations of ‘neurotic’ and borderline patients and (b) further provides a hierarchical grouping of defense mechanisms in defense styles.

An empirical study of the DSM-IV defensive functioning scale in personality disordered patients

The inclusion of the Defensive Functioning Scale (DFS) in the DSM-IV provides clinicians with the opportunity to incorporate psychodynamic information into their descriptive diagnoses. The DFS contains 27 specific defenses covering six levels of defensive functioning ranging from psychotic to normal. This study undertook an initial empirical evaluation of the DFS. A sample of 100 clinicians completed a questionnaire containing both the personality disorder (PD) symptoms and the DFS defenses of PD patients known to them. DFS ratings were not related to clinician orientation. Patient gender was related to only one defense level, with women being assigned significantly more action level defenses than men. Multiple regression analyses revealed unique and meaningful patterns of association between the defense levels and PD symptoms. Additionally, the DFS ratings provided unique information regarding level of impairment and treatment success. These results provide initial empirical support for the clinical application and relevance of the proposed DFS system.