Role of Parenting and Maltreatment Histories in Unipolar and Bipolar Mood Disorders: Mediation by Cognitive Vulnerability to Depression

In this article, we review empirical research on the role of individuals' parenting and maltreatment histories as developmental antecedents for symptoms and diagnosable episodes of unipolar and bipolar spectrum disorders. Our review is focused on the following three overarching questions: (1) Do negative parenting and a history of maltreatment contribute risk to symptoms or diagnosable episodes of unipolar and bipolar disorders? (2) Are the associations of negative parenting and maltreatment histories with bipolar disorders similar to those for unipolar depression? and (3) Are the associations between negative parenting and maltreatment histories and unipolar and bipolar symptoms or disorders mediated by cognitive vulnerability to depression? We begin by discussing the methodological requirements for demonstrating a psychosocial risk factor and the methodological issues that plague the parenting and maltreatment literatures. Next, we review the extant studies on the role of parenting histories in unipolar and bipolar disorders. We consider the specificity and possible moderators of the parenting-mood disorder relationship, as well as cognitive vulnerability to depression as a mediator of this relationship. Then, we review studies on the association of maltreatment histories with unipolar and bipolar disorders and the role of cognitive vulnerability to depression as a mediator of this association. We conclude with an assessment of the state of the parenting and maltreatment literatures in unipolar and bipolar disorder with regard to our guiding questions.     

Spatial and Selective Attention in the Cerebral Hemispheres in Depression, Mania, and Schizophrenia

Two tachistoscopic tests examining distinct aspects of attention were administered to normal subjects and patients with depression, mania, and schizophrenia. The first examined spatial attentional bias using happy-sad chimeric faces, known to elicit a perceptual bias to the left side of space in normal right-handers provided the right cerebral hemisphere is intact. The second used a lateralized version of the Stroop task, a traditional test of selective attention. Normals showed the expected leftward perceptual bias but showed equivalent susceptibility to the Stroop effect in both visual fields. As previously demonstrated with chimeric faces viewed in free vision, depression and mania were associated with weak and strong biases respectively with schizophrenics showing no bias to either side of space. The relationship between perceptual bias, as assessed by reaction time and absolute performance and the Stroop effect, showed differences according to diagnosis. This may be interpreted as evidence for the dissociability of attentional processes as well as lateralized differences in the pattern of cerebral activation in affective disorders and schizophrenia. The independence of performance variables on these tests in the schizophrenic group points to severe neuropsychological dysfunction.     

Attributional Style and Psychodynamic Defense Mechanisms: Toward an Integrative Model of Depression

The present study examined the influences of cognitive style and psychodynamic defense mechanisms in accounting for levels of dysphoria. Measures of dysphoria, defense mechanisms, and attributional style were completed by 147 undergraduate students. Consistent with the hypothesis, both attributional style and principalization were independently associated with dysphoria. Moreover, principalization moderated the influence of attributional style on levels of dysphoria. In addition, attributional style and turning against self were independently associated with dysphoria. Turning against other, projection, and reversal were not associated with dysphoria. The results provide partial support for the notion that the applicability and validity of the hopelessness theory of depression are bolstered by a consideration of psychodynamic phenomena. Potential implications of this line of research for the movement toward psychotherapy integration are discussed.     

Personality, Personality Disorders, and Defense Mechanisms

The prototype approach was used to assess the presence of personality features associated with borderline, narcissistic, histrionic, and psychopathic personality syndromes in a sample of 91 young adults from the Block and Block (1980) longitudinal study. These personality prototypes were found to be related to the use of denial and projection, and especially to the immature manifestations of those defenses, in ways consistent with theory.     

The Use of the Rorschach to Differentiate Unipolar and Bipolar Disorders

We compared the Rorschach performance (using the Comprehensive System; Exner, 1986) of 29 unipolar depressed, 15 bipolar depressed, and 18 bipolar manic inpatient subjects (N = 62) classified on the basis of the Research Diagnostic Criteria (RDC; Spitzer, Endicott, & Robbins, 1985). The three main groups differed from one another on a variety of variables, especially those related to ideation and information processing. One finding of particular importance was that bipolar depressed subjects, like bipolar manic and unlike unipolar depressed subjects, showed a high level of cognitive slippage. These results suggest that the Rorschach possesses utility in the differential diagnosis of affective disorders.     

Defensiveness and Defense Mechanisms

This introduction to the Journal of Personality's special issue on the topic of defense mechanisms raises the question of why defenses have been largely overlooked in personality research. Although defenses were originally discussed in the context of psychopathology, for the past 60 years psychodynamically oriented psychologists have understood that defenses play an important part in normal psychological development. Recently, psychologists outside the field of personality have incorporated the ideas of unconscious mental processes and of defenses into their research programs. In this issue, personality researchers discuss their ideas about defense mechanisms, organized around three topical areas: current conceptualizations of defense, the measurement of defense mechanisms, and the integration of defense mechanisms into personality research. The issue concludes with a commentary on these articles and provides suggestions for future work.     

Linguistic Styles of Eminent Writers Suffering From Unipolar and Bipolar Mood Disorder

Past research has shown that the styles of drawings by patients with unipolar and bipolar mood disorder differ, the latter expressing more positive and fewer negative emotions (Wadeson, 1980 Wadeson , H. ( 1980 ). Art psychotherapy . New York : Wiley . [Google Scholar]). In the first study presented here, it was expected that prose texts by eminent writers who suffered from unipolar versus bipolar mood disorder would show this same effect. One novel per writer was analyzed, using Pennebaker, Francis, and Booth's (2001 Pennebaker , J. W. , Francis , M. E. , & Booth , R. J. ( 2001 ). Linguistic inquiry and word count . Mahwah , NJ : Lawrence Erlbaum Associates, Inc . [Google Scholar]) Linguistic Inquiry and Word Count. Results disconfirmed the hypothesis, but indicated 3 other differences that were then replicated in Study 2, using a second set of novels by the same authors. Results indicated that: (a) Bipolar writers referred to death more than did unipolar writers; (b) unipolar writers referred to people other than themselves more than did control writers; (c) unipolar writers used more words describing cognitive mechanisms (e.g., understand, know) than did both other groups. The fact that the unipolar and bipolar groups did not differ from controls on measures related to emotions and feelings can be partially explained in terms of the therapeutic effect of writing (Pennebaker, 1997 Pennebaker , J. W. ( 1997 ). Writing about emotional experiences as a therapeutic process . Psychological Science , 8 , 162 – 166 .[Crossref], [Web of Science ®] , [Google Scholar]). The interest displayed by unipolar writers in cognitive mechanisms is consistent with Verhaeghen, Joorman, and Khan's (2005 Verhaeghen , P. , Joorman J. , Khan , R. ( 2005 ). Why we sing the blues: The relation between self-reflective rumination, mood and creativity . Emotion , 5 , 226 – 232 .[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) finding that rumination mediates the link between creativity and unipolar depression.     

Defense Mechanisms Development in Children,Adolescents, and Late Adolescents

To replicate and extend Cramer's (1987) original cross-sectional study concerning the development of defense mechanisms, the Thematic Apperception Test responses of 148 students in Grades 2, 5, 8, 11, and college freshmen were collected and scored for denial, projection, and identification using Cramer's Defense Mechanisms Manual (1991). Our results supported the notion that the relative use of denial and projection decreases and identification increases as a function of grade level. The findings provide additional support for the psychoanalytic view (Freud, 1966) of an ontogenetic developmental line of defense.     

A Family Therapist's Guide to Bipolar III: Antidepressant-Induced Mania or Hypomania

This article explores the phenomenon of hypomania and mania induced by the treatment with antidepressants, sometimes called bipolar III. Family therapists need to be aware of this phenomenon because estimates are that between 3–10% of depressed individuals may be at risk for developing hypomania or mania when treated with antidepressants. The article discusses implications for family therapists, including their role in the prevention and early detection of antidepressant-induced mania or hypomania.     

Immunizing Strategies and Epistemic Defense Mechanisms

An immunizing strategy is an argument brought forward in support of a belief system, though independent from that belief system, which makes it more or less invulnerable to rational argumentation and/or empirical evidence. By contrast, an epistemic defense mechanism is defined as a structural feature of a belief system which has the same effect of deflecting arguments and evidence. We discuss the remarkable recurrence of certain patterns of immunizing strategies and defense mechanisms in pseudoscience and other belief systems. Five different types will be distinguished and analyzed, with examples drawn from widely different domains. The difference between immunizing strategies and defense mechanisms is analyzed, and their epistemological status is discussed. Our classification sheds new light on the various ways in which belief systems may achieve invulnerability against empirical evidence and rational criticism, and we propose our analysis as part of an explanation of these belief systems’ enduring appeal and tenacity.     

The Development of Defense Mechanisms

ABSTRACT It is proposed that defense mechanisms may be characterized as forming a hierarchy, from least to most complex, and that the lowest level defenses emerge early in life, while the more complex defenses emerge later in development Three defenses–Denial, Projection and Identification–were chosen to test this assumption A method for assessing the use of these defenses in Thematic Apperception Test (TAT) stories was developed and validated in a study of four age groups preschool, elementary school, early adolescent, and late adolescent The results of the study were consistent with the prediction Denial was used most frequently by preschool children, and decreased in use thereafter Identification was used minimally by preschool children but increased steadily through adolescence The use of Projection was most frequent in the two middle age groups Some evidence for sex differences, based on the internal/external orientation of the defense, also was found     

Observer-Rated Measures of Defense Mechanisms

Observer-rated measures of defense mechanisms are the direct lineal descendants of Freud's clinical proposition that an observer can reasonably infer defensive operations in an individual of which the individual himself or herself is unaware. Assessment methods of defenses have used both projective testing and clinical interview data. Recent Rorschach test methods have focused on borderline and neurotic-level defenses used to discriminate diagnostic groups and predict other aspects of functioning. A TAT method has demonstrated some evidence for age progression in the development of defensive functioning and for regression in defensive functioning following psychological stress. While interrater reliability is generally good, the methods are limited by the availability of the testing situation and the need to demonstrate generalization to external situations.
Following the early introduction of systematic methods by Haan and Vaillant, a number of methods use clinical interview data to assess specific defenses and overall defensive functioning. These methods identify defenses either as qualitative categories, rank-ordered scores by Q-sort, or actual counts of each instance a defense is used. Summary scores are generally of good reliability, with wider variation for individual defenses. There is wide variation on training required, ease of use, and levels of validation.
A review of some correlates of each method suggests that the instruments have a robust potential for use in fundamental and applied clinical research. While each method has some clear applications, the quantitative clinical interview methods appear best adapted to microanalytic process research on issues of defensive change in treatment.     

The Identification and Modification of Defense Mechanisms in Counseling

This article suggests considerations and strategies for identifying and modifying a client's defense mechanisms in counseling. A systematic approach to a client's mechanisms of defense contributes to therapeutic gain. Inappropriate counselor responses intensify an individual's defenses and undermine the counseling relationship. Definitions of individual defenses and indicators for identifying the mechanisms are provided. A literature review focuses on the counseling implications of the defenses. The process of defense mechanism modification is illustrated through a case example.     

Narcissism,Mania and Analysts' Envy

Character traits like narcissism, mania and grandiosity are routinely discussed in the psychoanalytic literature as aspects of psychopathology only. However, many individuals who have both achieved and contributed to society in the most profound ways often have such characteristics. Psychoanalysts, sometimes envious of patients who possess considerable wealth and/or power, may be inclined to overly pathologize such qualities, denying their own desires for the perks of power and material success. Mad Men is discussed largely in this context.     

The Clinical Utility of the MMPI-2 in Diagnosing Unipolar Depression Among Male Alcoholics

The correspondence between Scale 2 elevations on the MMPI-2 and SCID-diagnosed unipolar depression (major depression and dysthymia) and alcohol-induced depression was evaluated among 106 consecutive male admissions to an inpatient alcohol treatment unit. Valid profiles were obtained from 87 subjects, 15% of whom were diagnosed with unipolar depression and another 4.5% with presumed alcohol-induced depression. The sensitivity of Scale 2 (the probability that a depressed subject would obtain an elevated score) ranged from .19 to .42. Positive predictive power (the probability that a subject who obtained an elevated score had a depressive disorder) ranged from .23 to .38. Neither Scale 2 alone nor Scale 2 paired in 2-point code types predicted the presence or absence of comorbid depressive disorders among male alcoholics.