Immature Defense Research Articles

Investigating Correlations Between Defence Mechanisms and Pathological Personality Characteristics

IntroductionThe purpose of this study was to investigate the relationship between defence mechanisms and pathological personality traits. Material and methodsWe 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. ResultsThe 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%). DiscussionThe results indicate that those who tend to use immature defence mechanisms are also those most likely to present pathological personality traits. ConclusionsThe findings indicate the importance of investigating these correlations as a possible improvement to clinical assessment and intervention.

Comparing the Effectiveness of Mentalization-Based Therapy and Cognitive-Analytic Therapy on Ego Strength and Defense Mechanisms in People With Borderline Personality Disorder

Aims Mentalization-Based Therapy (MBT) and Cognitive Analytic Therapy (CAT) are psychotherapy approaches offering specific methods for the treatment of Borderline Personality Disorder (BPD). Therefore, this study compared the effectiveness of MBT and CAT on improving the ego strength and defense mechanisms in people with BPD. Methods & Materials This was a quasi-experimental study with a pretest-posttest and a control group design and follow-up stage. In total, 40 men with BPD were selected by purposive sampling technique. The samples were selected from males admitted to Isar psychiatric Hospital and the psychiatric department of Fatemi Hospital in Ardabil City, Iran, in 2018. The samples were randomly assigned into two experimental groups and one control group. The first experimental group received 20 sessions of MBT, and the second experimental group received 16 sessions of CAT. To collect data, we used psychological inventory ego strength and defense styles questionnaire. The obtained data were analyzed using mixed model Analysis of Variance (ANOVA) and Scheffe posthoc test. Findings The collected results suggested that both interventions were effective in improving the ego strength and defense mechanisms of people with BPD (P<0.001). However, the effect of MBT on the overall score of the ego strength and the immature defenses was higher than that of the other intervention (P<0.05). Moreover, there was no significant difference in neurotic defense between the two interventions (P>0.05). Conclusion The present research results can support the use of these therapies as part of a non-pharmaceutical treatment program in different treatment centers or psychiatric hospitals.

A hypothetical model of pain perception in patients with chronic pain: The predictive role of unconscious, emotional, behavioral and meta-cognitive factors

ObjectiveChronic pain has a great prevalence in the society of adults, which causes important problems for health and quality of life. The present study aims to investigate a hypothetical model of pain perception in patients with chronic pain, considering the role of unconscious, emotional, behavioral and meta-cognitive factors. MethodsA total of 391 patients (155 males, 236 females) who referred to the pain centers in Tehran suffering from chronic musculoskeletal pain, participated in the study. Participants were asked to complete the Defense Style Questionnaire (DSQ-40), Toronto Alexithymia Scale (TAS-20), The Inhibition/Activation System Scale (BIS/BAS), Meta-Cognitions Questionnaire (MCQ-30), and Numeric Rating Scale (NRS). ResultsThe results revealed that the model could anticipate the intensity of pain in patients with chronic pain. Immature defence style, behavioral inhibition system, alexithymia, and meta-cognitive beliefs predicted the intensity of pain in patients with chronic pain. ConclusionEvaluation of results indicated that the perception of the intensity of pain in patients with chronic pain is affected by unconscious, emotional, behavioral and meta-cognitive factors.

Insight Into Illness and Defense Styles in Schizophrenia.

Although the psychological denial model argues that poor insight is a result of defense mechanisms, the direct relationship between the two remains unclear. This study aimed to examine the relationship between insight into illness and defense mechanisms while considering cognitive dysfunction in schizophrenia. A total of 38 patients with schizophrenia were evaluated for level of insight (Schedule for the Assessment of Insight), defense mechanisms (Defense Style Questionnaire), neurocognitive function (Brief Assessment of Cognition in Schizophrenia), and psychotic symptoms (Brief Psychiatric Rating Scale). Regarding level of insight, partial correlation analysis controlling neurocognitive and psychotic variables showed that "recognition of illness" was positively correlated with immature defense styles and negatively correlated with mature defense styles. Stepwise regression analyses revealed that "recognition of illness" was significantly predicted by immature defense styles. Our findings suggest that patients who tend to use immature defense styles are more likely to accept their own mental illness.

How do schema modes and mode factors align with defense styles and personality disorder symptoms?

Maladaptive schema modes (or modes) are a key concept in schema therapy; they reflect sets of currently activated maladaptive schemas, schema-evoked emotional distress, and coping attempts. Drawing on a set of 20 modes, this study aimed to replicate personality disorder (PD)-specific mode models, to investigate relationships among modes, higher order mode factors (i.e., Internalization, Externalization, and Compulsivity), and defense styles and to test the contributions of higher order mode factors and defense styles to variance in PD symptoms. The sample consisted of N = 533 German-speaking psychiatric inpatients. A total of 67 practically significant correlations between 20 modes and 10 PD scores were found (range: |.44| to |.76|), and 36 out of 47 hypothesized PD-mode associations were confirmed. In a series of 23 regression analyses, the immature, neurotic, and mature defense styles showed 23, 10, and 12 significant effects on mode variables, respectively. Defense styles jointly accounted for 9.0% to 42.4% of variance in mode variables after controlling for the effects of age and sex, implying that modes and defense styles are related yet distinguishable constructs. Finally, mode factors and defense styles independently accounted for unique variance in all 10 PD scores, with mode factors contributing significantly more to variance in antisocial, obsessive-compulsive, and avoidant PD symptoms. Implications of the results for theory and practice are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychiatric Assessment of Deliberate Self-Poisoning

Psychological differences between those who attempt suicide and those who do not are not agreed upon by all specialists. The current study was carried out to compare psychological factors between patients with deliberate and nondeliberate self-poisoning in Kermanshah, Iran. It is a frequency matched case-control study. For the purpose of this study, among people who deliberately attempted suicide who were taken to Imam Khomeini Hospital of Kermanshah, 200 were selected as a sample. The controls were frequency matched with nondeliberate self-poisoning patients. For both deliberate and nondeliberate cases of self-poisoning, drug use was the most significant cause of poisoning. In comparison with nondeliberate self-poisoning, people with deliberate self-poisoning used more neurotic and immature defense mechanisms, and people with nondeliberate self-poisoning used more mature defense mechanisms. In general, both groups showed significant use of defense mechanisms; however, with regard to self-concept and general health, they showed no significant difference in any subcategories. When a person does not have the ability to adapt to stressful and difficult situations, he or she may turn to defense mechanisms that make the situation worse rather than better. Thus, enhancing defense and psychological mechanisms among vulnerable people should be considered. [ Psychiatr Ann. 2019;49(8):362–367.]

The Mediating Role of Implicit and Explicit Emotion Regulation in the Relationship Between Academic Emotions and Approaches to Learning: Do Defense Styles Matter?

The present study belongs to a new strand of research in learning in higher education focusing on emotions and emotion regulation, including defense mechanisms. The purpose of the study was to investigate the mediating role of implicit and explicit emotion regulation in the relationship between academic emotions and approaches to learning. Participants were composed of 226 undergraduates (40 males and 186 females studying in a social science department). They completed the following questionnaires: Emotion Regulation Questionnaire, Student Experience of Emotions Inventory, Defense Style Questionnaire, and Approaches to Learning and Studying Inventory. Both the moderating (interaction) and the mediational (indirect) effects were examined using the PROCESS program. Results failed to indicate the moderating role of emotion regulation in the association between academic emotions and approaches to learning. Instead, results revealed the dominant mediating role of emotion regulation and particularly the role of immature defense style in the relationship between negative emotions and approaches to learning. Moreover, reappraisal and suppression seemed to act as mediators in the relationship between positive and negative emotions with deep and surface approaches, respectively. The results of the study are discussed in the context of the recent literature. Implications for higher-education institutions regarding the role of unconscious cognitive processes are also discussed.

Mature Defense Mechanisms Affect Successful Adjustment in Young Adulthood-Adjustment to Military Service in South Korea.

ObjectiveA defense mechanism is an automatic psychological process necessary for successful adaptation. It reflects adaptive capacity. The purpose of this study is to explore the relationship between the adaptation ability of individuals who face mandatory military service and the pattern of defense mechanisms. MethodsThe subjects were 69 men (21.4±2.2 years) who expressed psychological difficulties in three military service situations. Control group was 36 men (24.0±1.4 years) who had successfully completed military service. We examined psychiatric history, the pattern of defense mechanisms, and depression and anxiety levels. Defense mechanisms were compared between two groups. ResultsThe maladjusted group used immature defenses more frequently than the control group did. There were no differences in the defense patterns according to diagnosis. The control group used more identification and rationalization, classified as immature defenses. The temporarily maladjusted group used more somatization, regression, and avoidance. ConclusionUsing mature defense mechanisms helped young adults to adapt to a particular situation. The maturity of the defense is more valuable than the psychiatric diagnosis. Some immature defenses are also helpful to adapt. We cautiously assume that some defenses can be protective or risk factors in adapting to stressful situations by young adults.

Mindfulness dispositions and defense style as positive responses to psychological distress in oncology professionals.

Working in oncology departments is a stressful and emotionally consuming experience and oncology professionals are particularly at risk for developing stress-related syndromes. Defense mechanisms (high-adaptive) and mindfulness dispositions are known as facilitators of well-being and adaptation. In this study we analysed the role of these unconscious and conscious strategies in protecting the oncology clinicians from stress-related symptoms. A convenience sample of 63 oncology professionals was assessed on defense style, mindfulness disposition, depression and anxiety symptoms using self-reported questionnaires. Demographic and professional information was included in data collection. Results did not show significance differences in demographic and professional characteristics among all studied variables. Mature defense style and mindfulness were highly and negatively correlated with depression and anxiety, while a positive association was found between immature defense style and both depression and anxiety symptoms. Hierarchical multiple regression analyses found defense styles and mindfulness as predictors of depression, whereas only immature defense style predicted anxiety. The present study provides the first empirical evidence of the influence of unconscious defense mechanisms and conscious mindfulness dispositions in protecting oncology professionals from depression and anxiety symptoms. Defense mechanisms and mindfulness share several common-points and should be seen as complementary in enhancing physical and psychological well-being. Further studies are required for a deeper understanding of the impact of mindfulness and defenses in improving adaptation.

The Role of Defense Mechanisms in Emerging Personality Disorders in Clinical Adolescents

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.

The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders.

Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

Victimization in childhood as a suicide risk factor in adults

Background/Aim. There is a burgeoning literature on the association between childhood victimization and the risk of suicidal behavior in early adolescence, while there is significantly less research showing this association in adults. The aim of our study was to examine whether victimization in childhood increased the likelihood of suicide attempt in adults. Methods. The sample consisted of 90 patients, 71 females and 19 males, aged 37.92 ? 11.04 years on average, hospitalized in the Day Hospital of the Clinic of Psychiatry Military Medical Academy, Belgrade, Serbia. The Juvenile Victimization Questionnaire (JVQ), Defense Style Questionnaire (DSQ-40) and Beck Depression Inventory were used for 50 patients following suicide attempt and in 40 patients who were on psychotherapeutic treatment due to various life crises not resulting in suicide attempt. According to the indications, we excluded the patients with psychosis (F20-F29, F30-31 and F 32.3), substances abuse (F10-F19) and dementia (F00-F09), satisfying International Classification of Diseases-10 version (ICD-10) (the World Health Organization criteria). The examinees of both groups were matched by age, education and marital status. Comparison of the patient groups was done by the Students? t-test for the parametric features and Mann-Whitney U test for nonparametric data. Results. The suicide attempters had moderate depression (19.76 ? 10.52) and used immature defense mechanisms (p < 0.001). The JVQ established statistical differences in the Total score (p < 0.005) and in two modules: Peer and Sibling Victimization (p < 0.005) and Sexual victimization (p < 0.005). Conclusion. The adults who were more likely to attempt suicide during their lifetime were more often victims of peer and sexual abuse in their childhood. Data on victimization in early childhood provide opportunities for early detection of persons with suicide risk that could help in the psychotherapeutic work with these patients, but also in the suicide prevention in a wider population.

Defense style and dissociative phenomena in patients with borderline personality disorder

Introduction Patients with borderline personality disorder (BPD) are unique and diverse in their pathology, defense style, and clinical presentations. Many of these patients have other personality disorders as well. They tend to display a wide range of other psychiatric disorders, including dissociative phenomena and experiences. Patients and methods A total of 60 female patients were diagnosed with BPD using the Diagnostic and Statistical Manual of Mental Disorders, IV ed. Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Severity of illness and emotional and behavioral aspects of patients were assessed using Borderline Evaluation of Severity over Time. Defense style of patients was assessed using the Defense Style Questionnaire. Dissociative phenomena were studied using the Dissociative Experience Scale (DES). Results The most commonly used defenses by the study patients were undoing, idealization, somatization, and splitting. Patients with absent criteria 4 (impulsivity) and 7 (feeling of emptiness) of BPD significantly displayed more mature defenses, whereas patients having criterion 9 (paranoid ideation and severe dissociation) of BPD significantly displayed neurotic type of defenses. Mature defenses were significantly negatively correlated with the absorption and depersonalization factors of DES. Neurotic defenses were significantly correlated with the total score of DES, absorption, and depersonalization factors. Immature defenses were significantly correlated only with the depersonalization factor of DES. Conclusion Patients with BPD have a specific pattern of defense style that might be linked to their specific illness criteria. Displaying certain phenomena of dissociation might be related to the particular pattern of the dominant defense mechanisms in these patients.

Relationships of attention-deficit hyperactivity disorder with defense styles and harm avoidance among male inpatients with alcohol use disorder.

Introduction:Patients with alcohol use disorder (AUD) use immature defense styles, and AUD is related with adult attention-deficit hyperactivity disorder (ADHD). Harm avoidance (HA) is related with both AUD and particularly inattentiveness (IN) dimension of ADHD.Aim:The aim of the present study was to evaluate the relationship of defense styles with probable ADHD and severity of ADHD symptoms while controlling the effect of HA among male inpatients with AUD.Settings and Design:The present study with cross-sectional design was conducted at the Alcohol and Drug Research, Treatment and Training Center (AMATEM) of Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery in Istanbul.Statistical Analysis:Chi-square test, independent samples t-test, multiple logistic and linear regression analyses, and multivariate analysis of covariance (MANCOVA) were used.Materials and Methods:Participants (n = 151) were evaluated with the Adult ADHD Self-Report Scale, the Defense Style Questionnaire, and the HA Dimension of the Temperament and Character Inventory.Results:HA (particularly HA-1 [anticipatory worry and pessimism]) and immature defense style (particularly acting out) predicted the presence of probable ADHD. In linear regression analysis, HA (particularly HA-1 and HA-4 [fatigability and asthenia]), high immature (particularly acting out), and low mature defense styles predicted the severity of ADHD symptoms. In MANCOVA, immature defense style predicted both the IN and the hyperactivity/impulsivity (HI) dimensions of ADHD, whereas HA and IN dimension and low mature defense style predicted HI dimension.Conclusions:These findings suggest that immature defense style (i.e., acting out) is related with both the presence of probable ADHD and severity of ADHD symptoms, together with HA, which must be taken into account while treating patients with ADHD among male populations with AUD.

The Investigation of the Mediator Effect of Sexism and Defense Style in the Relationship Between Homophobia and Aggression.

Homophobia is seen all over the world and it may lead to aggressive behavior towards individuals with different sexual orientations. In this study, it is aimed to examine the mediator effect of sexism and defense style in the relationship between homophobia and aggression. 281 students from Tekirdağ Namık Kemal and İstanbul Aydın University are included in the study. The participants filled out the Demographic Information Form, Hudson-Ricketts Homophobia Scale, Defense Style Questionnaire, Ambivalent Sexism Inventory and Aggression Questionnaire. It was found that as homophobia level increased, sexism, neurotic and immature defense style increased. In addition, the relationship between homophobia and aggression was mediated by neurotic defenses and hostile sexism. Moreover, it was found that immature defense styles have a significant positive relationship with aggression. The findings of the study suggest that homophobia is related to aggression and this relationship coincides with other findings in the literature. However, it is seen that there are findings that coincide with the literature on the mediator effect of sexism and defense styles in the relationship between homophobia and aggression.

Comparison of Mature, Immature, and Neurotic Defense Mechanisms in Veterans and Normal People

Comparison of Mature, Immature, and Neurotic Defense Mechanisms in Veterans and Normal People

Associations Between Defense Styles, Approaches to Learning, and Achievement Among University Students

The present study explores associations between defense styles, approaches to learning, students’ preferences for different types of courses/teaching and achievement. The psychometric properties of the Defense Style Questionnaire (DSQ-40), used for assessing students’ defense styles, are also explored. Participants in this study were undergraduates (N=425) studying in a social science department.The Approaches and Study Skills Inventory for Students (ASSIST) is used for exploring students’ approaches to learning, while Grade Point Average (GPA) measured students’ academic achievement. The study suggests the contribution of defense styles to the Student Learning Research; it reports a mature and an immature learning pattern. Deep and strategic approaches to learning, preferences for classes that support understanding and GPA are associated with a mature defense style, whereas surface approach and preferences for classes that transmit information are associated with immature, image-distorting and neurotic defense styles. Defense styles as well as preferences for different courses appear to act as antecedents of approaches to learning; approaches mediate the effect of defenses and preferences on achievement although defenses have only a small impact. The study also suggests a four factor structure of the DSQ-40 in undergraduates. The findings are discussed in the context of the recent literature.

Change in Children's Self Confidence and the Use of Defense Mechanisms

Change in the personality trait of self-confidence was studied in a group of children from the Berkeley Guidance Longitudinal study. Self-confidence was assessed at age 6 (n = 99) and again at age 10 (n = 97). Results indicated that a change in level of self-confidence was related to the use of defense mechanisms, as assessed from Thematic Apperception Test stories. A decrease in self-confidence was positively related to the use of the immature defense of denial and negatively related to the use of the relatively mature defense of identification. In contrast, an increase in self-confidence was unrelated to the use of defense mechanisms.

Dialectical behavior therapy skills training affects defense mechanisms in borderline personality disorder: An integrative approach of mechanisms in psychotherapy

Objective: Borderline personality disorder (BPD) is characterized by immature defense mechanisms. Dialectical behavior therapy (DBT) is an effective treatment for BPD. However, understanding the underlying mechanisms of change is still limited. Using a transtheoretical framework, we investigated the effect of DBT skills training on defense mechanisms. Method: In this randomized controlled trial, 16 of 31 BPD outpatients received DBT skills training adjunctive to individual treatment as usual (TAU), while the remaining 15 received only individual TAU. Pre–post changes of defense mechanisms, assessed with the Defense Mechanism Rating Scale, were compared between treatment conditions using ANCOVAs. Partial correlations and linear regressions were conducted to explore associations between defenses and symptom outcome. Results: Overall defense function improved significantly more in the skills training condition (F(1, 28) = 4.57, p = .041). Borderline defenses decreased throughout skills training, but not throughout TAU only (F(1, 28) = 5.09, p = .032). In the skills training condition, an increase in narcissistic defenses was associated with higher symptom scores at discharge (β = 0.58, p = .02). Conclusions: Although DBT does not explicitly target defense mechanisms, skills training may have favorable effects on defense function in BPD. Our findings contribute to an integrative understanding of mechanisms of change in BPD psychotherapy.

Defense Styles Mediate the Association Between Empathy and Burnout Among Nurses.

Research has extensively identified empathic skills as essential in health trainings, policies, and recommendations. However, there have been conflicting views of the impact of empathy on burnout. Some studies contend that empathy serves a protective role, whereas other studies have shown that burnout leads to a diminished capacity to empathize. To date, studies have not yet explored whether defense styles mediate associations between empathy and burnout. A total of 442 nurses completed questionnaire measures of empathy, burnout, and defense mechanisms as part of a large-scale research study on nurse burnout. Findings reflected very high levels of emotional exhaustion and depersonalization among the nursing staff. The nurses in this study endorsed a predominantly immature defense style. In addition, immature defense styles mediated the association between empathy and emotional exhaustion and between empathy and depersonalization. The study provides further knowledge about the role of defense styles in nurse burnout and empathy.