Defense Mechanisms in Mania,Bipolar Depression and Unipolar Depression

The present study compared the use of defense mechanisms in ten bipolar manic, ten bipolar depressed and ten unipolar depressed patients. The defense mechanisms were assessed by two methods: TAT stories scored by Defense Mechanism Manual and Defense Mechanism Rating Scale ratings of psychodynamic interviews. The severity of symptoms was assessed by Beck Depression Inventory for depressed patients and Young’s Manic Rating Scale for manic patients. Both bipolar manic and depressed groups used the defense mechanism of denial, borderline level defenses and immature defenses significantly more than the unipolar depression group. The manic group showed greater dependence on narcissistic level defenses as compared to the other two groups. Positive relationships were found between severity of manic symptoms and the defense mechanisms of denial as well as the narcissistic level defenses. The bipolar depression group also used more action level defenses as compared to the unipolar depression group. The unipolar depression group scored higher on the defense mechanism of identification and adaptive level defenses as compared to the manic group. A negative correlation was found between the severity of depressive symptoms for unipolar depression group and the defense mechanism of identification. The neurotic level defenses were used most frequently by unipolar depression group, followed by the bipolar depression group and manic group. Some of these findings are in consonance with the psychoanalytic understanding of mania and depression.     

A study of schizophrenic outpatients with the Defense Mechanism Test.

Intrapsychic defensive strategies are allegedly expressed on the Defense Mechanism Test through the presentation, at increasing tachistoscopic exposure times, of a picture in which a central figure is threatened by a peripheral person. Several types of perceptual alterations of the stimulus configuration are coded as defenses in the subjective reports. A number of test variables have already been shown to differentiate significantly between nonclinical controls and nonpsychotic psychiatric patients. In the present study, after a review of the pertinent percept-genetic literature, nonpsychotic patients (n = 57) were compared with a group of schizophrenic outpatients in the active phase (n = 21). As predicted, significantly more schizophrenics than controls were coded for projection and regression and for certain variants of these signs. Four subcodings of repression, three of isolation, the sign of reaction formation, and several variants of identification differentiated in the same direction. Reports in which the central figure was too old and changed from a correct to an incorrect sex attribution were highly characteristic of the schizophrenic sample. No defensive variable was significantly linked with nonpsychotic pathology. Two variants, one of regression and one of identification, allowed a correct diagnostic placement for all schizophrenics and for 82.4% of the nonpsychotic patients. The findings, besides being a further clinical validation of the Defense Mechanism Test, provide a preliminary distinction between high- and low-level defenses. It is suggested that they are congruent with an hierarchical model which implies inclusive nonreflexive relationships between classes of mental disorders.     

Further Validation for the Cramer Defense Mechanism Manual

This article presents psychometric properties of the Cramer Defense Mechanism Manual (Cramer, 1991b) for the Thematic Apperception Test (Murray, 1943). The developmental hierarchy of defenses originally postulated by Cramer was supported in this cross-sectional sample. Gender differences and the validity of distinguishing between mature and immature levels of defense were also investigated. Findings for gender differences largely replicate those previously reported by Cramer (1987, 1991a). Results also support the view of a developmental hierarchy of defenses and the validity of distinguishing between mature and immature levels of two of the three types of defenses.     

An empirical approach to the study of defense mechanisms: I. Reliability and preliminary validity of the Rorschach Defense scales

Despite widespread use of the Rorschach for the study of defense mechanisms, few recent Rorschach scales have been developed for the study of defensive functioning. We critically review previous empirical research and describe the Rorschach Defense scales. These scales provide criteria for rating both lower level defense mechanisms, such as splitting and primitive idealization, as well as higher level defenses, such as intellectualization and isolation. The scales utilize a broad range of content including all Rorschach responses, associative content, and verbalization of the tester-patient relationship. Data on interrater reliability and preliminary validity are presented.     

The composite measure of the defense mechanism inventory

A reanalysis of previously published data suggests that the Defense Mechanism Inventory can be utilized to yield a composite measure of reaction to frustration by contrasting linearly the defenses of Turning-against-object and Projection against those of Principalization and Reversal-of-affect. Factor-analytic and correlational data support the exclusion of Turning-against-self from the composite measure. Studies of content validity are presented for the combination of the four defenses into one dimension. Patterns of interitem reliability are charted for the five defenses and the composite measure for both men and women. Internal consistency data are also presented for the standard scoring as well as for a modified method to explore the feasibility of simplifying and shortening the test-taking procedure.     

Gender differences in ego defenses in adolescence: sex roles as one way to understand the differences.

Gender differences in ego defenses were hypothesized in adolescence, with greater internalization by girls and greater externalization by boys. Through the inclusion of sex role constructs (masculinity and feminity, agency and communion, and passivity-dependency), relational models as well as psychoanalytic theory were investigated as bases for sex differences. The Berm Sex Role Inventory and the Defense Mechanism Inventory were administered to 66 high school students (31 boys and 25 girls), ages 14-19. As expected, boys scored higher on projection and aggression-outward defenses and girls scored higher on turning against the self, but girls failed to exceed boys on reversal. Multiple regression supported sex roles as moderating variables in gender differences in defenses. Alternative reconceptualizations of sex roles supported aspects of both psychoanalytic and relational models as explanation of gender differences in defenses.     

Different defense mechanisms among men with different sex role orientations

Thirty male college students completed the Bem Sex Role Inventory and the Defense Mechanism Inventory. Results demonstrated that sex role orientation moderates the use of defense mechanisms in men, so that men with different orientations differed in the defenses they used. Masculine men used externalizing defenses such as turning against object and rationalizing defenses such as principalization more often than feminine men. Feminine men used an internalizing mode of defense, such as turning against self, more often than masculine and androgynous men. Results were compared with similar studies and the implications were discussed.The order of the authors was alphabetically determined. The authors wish to thank Michal T. Lewy and Jacqueline Franko for their help in conducting the study.     

The Defense Mechanism Test in clinical and personality research.

Different research strategies are used for the application of the Defense Mechanism Test in clinical and personality research. It is argued that the harvest of useful information would be greater if the effort of different research groups could be coordinated.     

Relationships among defensive styles, cognitive styles, processing styles, and attentional styles of normal adolescents

Cognitive and psychodynamic theorists agree that an individual's personality and behavior are determined by both cognitive and dynamic processes. This study examined the relationship among three cognitive approaches--cognitive style, attentional style, and processing style--and examined their relations to defensive style. Adolescents from Grades 11 and 12 (146 boys, 164 girls) were examined in groups for cognitive style (Group Embedded Figures Test), attentional style (Test of Attentional and Interpersonal Style), processing style (a sequential/simultaneous processing test battery), and defensive style (Defense Mechanism Inventory). Least squares completely randomized two-way analyses of variance (or analyses of covariance where applicable) were employed to assess the relations among the three cognitive measures and/or between the cognitive measures and defensive style. While most comparisons were nonsignificant, a significant relationship was observed between sequential processing and field-dependence and between simultaneous processing and field-independence. Also, a trend was noted between field-independence and ideational defenses and between field-dependence and repression-based defenses.     

The relationship between defenses and symptoms in adolescent psychopathology

The relationship between defense mechanisms and symptoms was assessed in a group of 196 psychiatrically hospitalized adolescents. Defense mechanisms were measured through the use of the Defense Mechanisms Inventory (DMI); symptoms and problem behaviors were measured with the Youth Self-Report. Univariate and multivariate analyses indicated that externalizing symptoms are associated with defenses that locate the conflict outside of the self, whereas internalizing symptoms are associated with defenses that locate the conflict within the self. In contrast to previous reports, no gender differences were found in defense preference, though gender differences were found in the relation of defenses to symptoms. The findings are consistent with clinical theory of defense processes and support the distinction between internalizing/externalizing behaviors and personality dimensions for both symptoms and defenses. The study supports the validity of the adolescent form of the DMI.     

Seven Pillars of Defense Mechanism Theory

Defense mechanisms are cognitive processes that function to protect the individual from excessive anxiety or other negative emotions. They also protect the person from loss of self‐esteem and, in the extreme, the loss of self‐integration. Although past critics questioned the existence of defense mechanisms, recent research has supported seven basic tenets regarding defenses. These include: (1) defenses function outside of awareness; (2) there is a chronology of defense development; (3) defenses are present in the normal personality; (4) defense use increases under conditions of stress; (5) defense use reduces the conscious experience of negative emotions; (6) defense function is connected to the autonomic nervous system; (7) excessive use of defenses is associated with psychopathology. Research supporting the seven pillars of defense mechanism theory is described in this essay.     

The Relationship Between Defenses and Symptoms in Adolescent Psychopathology

The relationship between defense mechanisms and symptoms was assessed in a group of 196 psychiatrically hospitalized adolescents. Defense mechanisms were measured through the use of the Defense Mechanisms inventory (DMI); symptoms and problem behaviors were measured with the Youth Self-Report. Univariate and multivariate analyses indicated that externalizing symptoms are associated with defenses that locate the conflict outside of the self, whereas internalizing symptoms are associated with defenses that locate the conflict within the self. In contrast to previous reports, no gender differences, were found in defense preference, though gender differences were found in the relation of defenses to symptoms. The findings are consistent with clinical theory of defense processes and support the distinction between internalizing/externalizing behaviors and personality dimensions for both symptoms and defenses. The study supports the validity of the adolescent form of the DML.     

Learning Related and Interpersonal Social Skills Constructs in Two Existing Social Skills Assessments

In the social skills literature it has been identified that both learning related social skills and interpersonal social skills may exist. This study ascertained the views of 16 experts regarding the existence of the two proposed constructs, learning related social skills and interpersonal social skills, within two pre-existing assessments: Preschool and Kindergarten Behavior Scales–2nd edition and Child Behavior Rating Scale. Sixteen experts from Australia (n = 11) and Singapore (n = 5) with pediatric backgrounds in occupational therapy, speech pathology, psychology and early childhood education took part in the study. Experts were asked to sort cards with each of the items from the Child Behavior Rating Scale and Preschool and Kindergarten Behavior Scales–2nd edition (66 items in total) into one of two piles (one for learning related social skills and one for interpersonal social skills) and then answered several open ended questions about the clinical utility of these constructs. Preliminary evidence demonstrated the existence of the learning related social skills and interpersonal social skills constructs within the items of the two assessments (Child Behavior Rating Scale and Preschool and Kindergarten Behavior Scales–2nd edition). The experts' opinion also suggested the potential clinical benefits of assessing both learning related social skills and interpersonal social skills in preschool-age children. The study results and implications for further research and clinical practice are discussed.     

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.     

The Defense Mechanism Inventory: A Review of Research and Discussion of the Scales

The current status of the Defense Mechanism Inventory (DMI) is assessed through a review of the published research. Despite some psychometric problems and questions of scale interpretation, the defense scales are found to be meaningfully related to cognitive, personality, pathological, and demographic variables. An argument is presented for the continued use of the individual scales.     

Prediction of outcome in transsexualism by means of the Defense Mechanism Test and multivariate modeling: a pilot study

To elaborate the predictive value of the projective method using the Defense Mechanism Test in a 5-yr. follow-up study of 16 transsexuals, all subjects were approved for sex reassignment surgery and had completed the baseline assessments and the 5-yr. follow-up evaluation. Furthermore, we intended to create an outcome model based on the test data for prior patients wherein new consecutive applicants for sex change could be tested to predict the outcome in individual cases. Outcomes after five years showed that 62% of the transsexuals were judged as improved in a variety of areas of psychosocial functioning, 19% were unchanged, and 19% were worsened. Firstly, the analysis of the test data confirmed differences between the improved transsexuals and those who were not. Secondly, sex differences were found, with female-to-male transsexuals having a better outcome and being more homogeneous than their male counterparts. Thirdly, there was good correspondence in prediction of outcome between the model based on the Defense Mechanism Test and a clinical judgment made by a psychiatrist for two new applicants for sex reassignment surgery. It appears the Defense Mechanism Test has a predictive ability for patients with gender-identity disorder.     

Multivariate modelling and personality organization: A comparative study of the Defense Mechanism Test and linguistic expressions

The main aim of the study is to establish an empirical connection between perceptual defences as measured by the Defense Mechanism Test (DMT)–a projective percept-genetic method–and manifest linguistic expressions based on word pattern analyses. The subjects were 25 psychiatric patients with the diagnoses neurotic personality organization (NPO), borderline personality organization (BPO) and psychotic personality organization (PPO) in accordance with Kernberg's theory. A set of 130 DMT variables and 40 linguistic variables were analyzed by means of partial least squares (PLS) discriminant analysis separately and then pooled together. The overall hypothesis was that it would be possible to define the personality organization of the patients in terms of an amalgam of perceptual defences and word patterns, and that these two kinds of data would confirm each other. The result of the combined PLS analysis revealed a very good separation between the diagnostic groups as measured by the pooled variable sets. Among other things, it was shown that NPO patients are principally characterized by linguistic variables, whereas BPO and PPO patients are better defined by perceptual defences as measured by the DMT method.     

Defense mechanisms in psychology today. Further processes for adaptation

Although the concept of the defense mechanism was rejected from academic psychology for a number of years, recent empirical studies show renewed interest in defenses. Cognitive psychologists have confirmed the existence of unconscious psychological processes, a requisite for defenses. Developmental, personality, and social psychologists have all found evidence for defense mechanisms that explicate psychological functioning. The relevance of this new information for clinical practice is discussed.     

Appraisal of behavioral measurement techniques for assessing dental anxiety and fear in children: A review

The aim of this article is to review and evaluate behavioral and physiological measurement techniques frequently used to assess dental anxiety and fear in children. Attention is given to the data collected, the empirical findings obtained, and the availability of normative data. The main focus, however, is on the reliability and validity. Results show that all questionnaires are open to criticism. Of the behavioral measures, Melamed's Behavior Profile Rating Scale is to be preferred to Frankl's Rating Scale, Venham Rating Scales, and Visual Analogue Scales. The main reasons are that Melamed's BPRS measures the behavior of the child more precisely and that it has superior psychometric properties. Furthermore, because of their practical, conceptual, and psychometric problems, physiological measures at this stage are found to be less appropriate for assessing dental fear in children. It is concluded that a behavioral measure is not always the ideal, but often the only available technique for assessing dental fear in children.     

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.