The determination of defense style by questionnaire

The Defense Style Questionnaire was relabeled in terms of DSM-III-R defenses and administered to three groups: a normal population, family practice patients, and patients with anxiety disorders. The preferred factor structure identified mature defenses (sublimation, humor, anticipation, and suppression), neurotic defenses (undoing, altruism, idealization, and reaction formation), and immature defenses (projection, passive aggression, acting out, etc). Factor scores varied systematically with group membership and with measures of total symptoms. In this cross-sectional study, the vulnerability factors of neuroticism, locus of control, and defense style were all correlated with neurotic symptoms, but defense style added little to the variance explained by the other two. Within the patient group, however, neuroticism and locus of control did not distinguish among panic disorder, agoraphobia, social phobia, and obsessive-compulsive disorder, while defense style showed patterns characteristic of each disorder.     

Defensive styles and psychological symptoms among Chinese adolescents in Hong Kong

Specific defenses were assessed in a cohort of 490 Chinese adolescent boys and girls in Hong Kong using the Chinese version of the short form of the Defense Style Questionnaire (DSQ). Commonly employed defenses included anticipation, sublimation, and reaction formation, indicating that adolescents tended to deal with stressors and emotional conflicts with relatively mature or adaptive defenses. Factor analysis revealed that a mature or adaptive defensive style could generally be distinguished from an immature or maladaptive defensive style, but a neurotic defensive style was not differentiable for this group of adolescents. Results also indicated that general and specific psychological symptoms were associated with the use of immature defenses characterized by somatization and externalizing emotional conflicts through acting out and misattribution. The use of the DSQ for assessing defenses among Chinese adolescents and crosscultural comparisons are discussed.     

Psychometric properties of the defense style questionnaire (DSQ-40) in adolescents

This study examined the psychometric properties of the Defense Style Questionnaire (DSQ-40) in adolescents. Internal consistency, factor structure, and discriminant and concurrent validity of the DSQ-40 were studied in 211 adolescent psychiatric outpatients aged 13 to 19 years and 199 age-matched and sex-matched controls. Principal components analysis yielded four internally consistent components: mature, neurotic, image-distorting, and immature defense styles. The outpatients reported more immature, image-distorting, and neurotic styles and less mature style than did the controls, suggesting adequate discriminant validity. As a demonstration of convergent and concurrent validity, the severity of psychiatric symptoms assessed by the General Health Questionnaire and psychosocial adjustment assessed by the Global Assessment of Functioning Scale correlated theoretically meaningfully with the different defense styles. The DSQ-40 appears to be a reliable and valid instrument for adolescents.     

Changes in ego defenses with recovery from depression.

This study aimed to determine whether patterns of ego defense change with short-term treatment of psychiatric illness. The subjects were 37 inpatients and outpatients with a DSM-III-R diagnosis of major depressive disorder being treated using standard clinical methods. Ego defenses before and 7 to 9 weeks after commencement of treatment were measured using a shortened version of the Defense Style Questionnaire. There was a significant decline in the use of immature defenses with symptomatic recovery, but no change in the neurotic or mature defenses. Patients with additional axis I diagnoses and/or abnormal personality traits (N = 15) used more neurotic defenses than their counterparts with major depression alone (N = 22), but this pattern did not change with time. The study demonstrates the short-term mutability of immature defenses in relation to an episode of psychiatric illness and provides empirical support for the concept of temporary regression in the context of psychiatric illness episodes.     

Defense mechanisms in a community-based sample of female adolescents with partial eating disorders

OBJECTIVES: The purpose of this study is to assess whether female adolescents diagnosed with partial eating disorders (EDs) will show less adaptive defense mechanisms compared to female controls with no-ED. METHODS: The following questionnaires were administered to 423 female high-school students: The Eating Attitudes Test (EAT-26), the Defense Style Questionnaire (DSQ), and Life Style Index (LSI) (both tapping defense mechanisms), and a structured questionnaire assessing eating-related issues. Weight and height were also recorded. Partial anorexia nervosa (AN) and bulimia nervosa (BN) were defined with the combination of a maladaptive EAT score and fulfillment of adapted DSM-IV criteria. RESULTS: Compared to non-ED controls, participants with partial AN and partial BN used more immature defenses, including the DSQ-immature defense style (only those with partial BN) and LSI-regression, as well as more neurotic defenses, namely the DSQ-neurotic defense style, and LSI-compensation and displacement. CONCLUSIONS: The combined use of immature and neurotic defenses may be associated with a greater risk to develop a partial ED in adolescent females.     

Defense styles explain psychiatric symptoms: an empirical study

To examine the relation between psychiatric symptoms and defense mechanisms, we administered two questionnaires, the Symptom Check-list 90 (SCL-90) and the Defense Style Questionnaire (DSQ) to 122 psychiatric out-patients and to a community sample of 337 subjects. Using regression analysis, we found that 51.8% of the variation in subject's Global Severity Index value could be explained by his defense style. Of the three defense styles, the immature style explained most of the variation in the symptoms. We found little overall evidence for specific connections between particular defenses and symptoms. Projection and dissociation were central in most of the symptom dimensions. We compared patients and controls with the same level of general symptom severity and found that patients used significantly more devaluation and splitting, and controls used significantly more altruism and idealization. Whether defenses predispose to certain symptomatology or are one of its aspects is discussed.     

Measuring overall defensive functioning with the Defense Style Questionnaire: a comparison of different scoring methods

The evidence for the division of defenses measured with the Defense Style Questionnaire (DSQ) into immature, neurotic, and mature types appears to be lacking. We hypothesized that defenses can be represented unidimensionally. Classical multidimensional scaling was applied to the maturity ratings of items given by 279 experts. It appeared that the items of the DSQ can be represented unidimensionally. In a second study, two three-factor models of the DSQ were tested with confirmatory factor analysis, using scores of 543 psychiatric outpatients. Both three-factor models were implausible. A third study showed that the overall defensive functioning scores derived from the first study discriminated well between samples of 543 psychiatric outpatients, 69 medical students, and 68 graduate students attending a student counselor. We also found that the overall defensive functioning scores correlated positively with the current Global Assessment of Functioning in the psychiatric sample. We concluded that the DSQ is a useful instrument for measuring overall defensive functioning.     

Defense styles, impulsivity and suicide attempts in major depression

BACKGROUND: The aim of our study was to identify if defense mechanisms are associated with impulsivity and lifetime suicide attempts in depressed patients. SAMPLING AND METHODS: The Defense Style Questionnaire, the Impulsivity Rating Scale and the Impulse Control Scale were used in 77 depressed inpatients. RESULTS: Impulsivity was correlated positively with immature and neurotic styles and negatively with mature style. Some but not all defense mechanisms were relevant in this respect. The number of lifetime suicide attempts was positively correlated not only with impulsivity, but also with immature style and to a lesser extent with neurotic style. Several defense mechanisms were involved in these correlations: undoing, projection, passive aggression, acting out, splitting and somatization. CONCLUSIONS: Like impulsivity, defense styles may be relevant to discriminate recurrent suicide attempters in depression. Prospective assessment of defense styles and suicide attempts in depression is needed.     

有无广场恐怖的惊恐障碍患者防御方式研究

目的:探讨伴与不伴广场恐怖的惊恐障碍患者的防御方式。方法:采用防御方式问卷(DSQ)对21例不伴广场恐怖的惊恐障碍患者、26例伴广场恐怖的惊恐障碍患者和37名健康对照者评估其防御方式。结果:与对照组比较,伴或不伴广场恐怖患者退缩和躯体化及伴无能之全能和交往倾向得分均显著增高,而幽默得分显著降低;伴广场恐怖的惊恐患者投射、分裂得分和不成熟防御方式总分,以及反作用形成、理想化、假性利他等得分及中间型防御方式总分也显著高于对照组,而成熟防御方式总分显著低于对照组。结论:伴与不伴广场恐怖的患者使用不成熟和中间防御方式增多,而使用成熟防御方式减少;伴广场恐怖患者尤其使用防御方式不当,且与其对场所恐怖的严重程度及病程无关。     

Defense mechanisms, negative emotions, and psychopathology in adolescent inpatients

Ego defense mechanisms were compared in adolescent psychiatric inpatients and healthy adolescents to determine their relationship to specific diagnoses and to negative emotions. Seventy-one patients with schizophrenia, 28 with major depressive disorder, and 24 with obsessive-compulsive disorder (OCD) and 87 normal adolescents were assessed for defense mechanisms by the Life Style Index (LSI) and Ego Defense Scale (EDS). The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Multidimensional Anger Inventory (MAI) were used to assess depression, anxiety, and anger. Several defenses distinguished all psychiatric patients from controls, and a few defenses characterized different patient groups, especially those with OCD. Projection (on the LSI), displacement, and regression correlated significantly with anger; displacement, reaction formation, and undoing on the EDS correlated with anxiety, and denial was negatively correlated with depression. These findings have some relevance for the evaluation of Plutchik's psychoevolutionary theory of emotions and for the further empirical study of defenses in psychopathology.     

Psychological defenses of Danish medical students

Patterns in the psychological defenses of medical students may have implications for the way they handle and respond to the pressures and developmental issues they encounter in medical school and beyond. Using the Defense Style Questionnaire (DSQ40) to assess psychological defenses, a sample of first-year Danish medical students was compared with a sample of students at a short-term boarding school for general education. The medical students scored significantly higher on items connected with pseudo-altruism, denial, and undoing. Trends in the data furthermore suggest a greater use of sublimation, rationalization, and dissociation among medical students. When defense mechanisms were labeled into mature, neurotic, and immature categories, there were no differences between the groups or in the total defense scores.     

女性抑郁症心理应激和防御方式特征研究

目的研究女性抑郁症心理应激和防御特征。方法人组87例女性抑郁症患者，进行一般资料调查、生活事件量表（LES）、防御方式问卷（DSQ）、汉密尔顿抑郁量表（HAMD-24）、和汉密尔顿焦虑量表（HAMA）评定。结果74例（87．12％）患者报告过去一年中发生过明确的生活事件。女性抑郁患者较多采用幻想、退缩等防御方式，防御方式和临床抑郁症状的严重程度之间存在关联（P〈0．05）。结论不良防御方式是女性对抑郁症的易感因素之一。     

Defense style in panic disorder before and after pharmacological treatment

Whether or not the use of maladaptive defense style is a trait, as opposed to a state dependent phenomenon, in panic disorder (PD) is a topic still very much up for debate. The aim of the study was to verify whether PD patients, both before and after treatment, used different defense style than the control group. Sixty-one PD patients (recruited from an original sample of 90 patients) and 64 healthy controls were evaluated against the Structured Clinical Interview for DSM-IV disorders, the Symptoms Check List-90, the Hamilton Rating Scales for Anxiety and for Depression and finally the Defense Style Questionnaire-40 (DSQ). The patients were treated with paroxetine or citalopram and were evaluated monthly for one year to assess the remission. The DSQ was re-administered to the patients at the end of the study. Before treatment, PD patients used more neurotic and immature forms of defense than controls. After treatment, those in remission used the same defense styles as the control group, whereas non-remitters still used more immature defenses. However, all the aforementioned difference disappeared, after excluding the effect of symptom severity. Our data supports the hypothesis that the use of maladaptive defenses might be the consequence of PD: when subjects fall ill, their capacity to use mature adaptive defenses may diminish, but when they recover their defensive style returns to a greater maturity. The present results are however limited by the dropout rate (one third of patients did not complete the study) and the use of just one questionnaire to evaluate the complexity of defense styles.     

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

Abstract

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.     

Impact of defense style on brief psychotherapy of postpartum depression

In this study, we evaluated the impact of defense style (DS) on outcome and its relation to the therapeutic alliance. Women with postpartum depression were allocated to a brief psychotherapeutic intervention. To evaluate DS and the therapeutic alliance, the Defense Style Questionnaire and the Working Alliance Inventory were employed. The main outcome was the Edinburgh Postnatal Depression Scale score at end point; anxiety and retention in treatment were also evaluated. Fifty-nine patients were included; 46 completed the therapy and 65.4% responded (Edinburgh Postnatal Depression Scale score <10). Intense use of immature defenses was related to persistence of depression and anxiety symptoms at end point, even when controlled for potential confounders. Results tended to confirm a hierarchy of DSs independently of the alliance. Clinicians should be aware of possible differential responses to brief psychotherapies related to DS.     

老年抑郁症患者防御方式和人格特征研究

目的探讨老年抑郁症患者的防御方式和人格特征及两者间的关系。方法采用防御方式问卷（DSQ）及明尼苏达多项个性调查表（MMPI）分别对60例老年抑郁症患者（研究组）及60名老年健康者（对照组）测评。结果 DSQ评分研究组不成熟防御方式评分显著高于对照组（P〈0.01）,MMPI各临床量表中疑病、抑郁、癔症、精神病态、偏执、精神衰弱评分均高于对照组（P〈0.01）,男性-女性化评分低于对照组（P〈0.01）;DSQ总分与抑郁、精神病态、偏执、精神衰弱呈负相关（P〈0.05）,不成熟防御机制与偏执呈正相关（P〈0.05）,成熟防御机制与疑病、抑郁、癔症呈负相关（P〈0.05）,与男性-女性化呈正相关（P〈0.05）。结论老年抑郁症患者有一定的人格基础,多采用不成熟的防御方式,并且这两者密切相关。     

强迫性障碍患者防御方式与人格特征的关系

目的:探索强迫症患者防御方式、人格特征及相互关系。方法:应用防御方式问卷(DSQ)和明尼苏达多相人格调查表(MMPI)对住院治疗的77例强迫性障碍患者施测,将防御方式与人格特征进行典型相关分析。结果:本组DSQ不成熟防御机制(4.29±0.96)分,成熟防御机制(4.99±1.10)分,中间型防御机制(4.49±0.67)分;MMPI中癔症、抑郁症、病态人格、神经衰弱4个临床量表标准分(T)均高于中国划界值60分。第一对典型变量相关系数(r1)=0.712,其反映不成熟和中间型防御机制与精神分裂、神经衰弱、轻躁狂、病态人格和疑病的人格特征正相关;第二对典型变量相关系数(r2)=0.490,其反映成熟防御机制与病态人格、抑郁、偏执、癔症的人格特征负相关。结论:强迫性障碍患者使用不成熟和中间型防御方式与精神病性倾向和部分神经症倾向的人格特征相关;不成熟防御方式与精神病倾向人格相关性最强。     

Long-term changes in defense style among patients recovering from major depression

The long-term stability of ego defenses was examined in a group of 68 patients with major depression being treated in a rural private psychiatric practice. Current symptomatology and dispositional characteristics, including defense style (40-item Defense Style Questionnaire), were assessed pretreatment and at approximately 6 months and 2 years after treatment commenced. Age- and gender-matched comparison groups were also selected from two community-based studies that utilized similar instruments and time periods. The major depression group reported significantly lower usage of mature defenses initially, but with recovery they moved progressively toward the range of mature defenses displayed by the nonpatient comparison group. Neurotic defenses were relatively stable throughout the study, as were immature defenses during the first 6 months. Comparisons between patients who discontinued treatment (N = 24) and those who remained in treatment (N = 33) revealed similar rates of symptom reduction; however, the latter group reported continuing reductions in their use of immature defenses, to a level below that of the nonpatient comparison group.     

Does defense style vary with severity of mental disorder?

Bond's Defense Style Questionnaire was administered to control subjects from the general population (n= 50) and to psychiatric outpatients with neurosis (n= 42), high-level personality disorder (n= 37) and low-level personality disorder (n= 22). Factor analysis yielded 4 defense styles ranging on a continuum from immature to mature; the reliabilities of the subscales as measured with Cronbach's alpha were adequate. Three of the styles – the mature, neurotic and immature – were similar to the styles in Bond's original study, but the fourth style consisted of items reflecting inhibition instead of omnipotence as in the original study. The level of defense maturity varied with severity of disorder. The construct and criterion validity of the measure are discussed.     

Investigating the Impact of Past Trauma and Defense Styles on Posttraumatic Stress Following Homicide and Psychiatric Co-morbidity

To examine the prevalence of PTSD following homicide and investigate the relationship between PTSD from past traumas, defense styles and PTSD following homicide and psychiatric co-morbidity. 167 male homicide perpetrators participated in the study and completed the Posttraumatic Stress Diagnostic Scale, the General Health Questionnaire-28 and the Defense Styles Questionnaire. 45% met the criteria for PTSD following homicide and 55% for no-PTSD. With the number of times for imprisonment adjusted, regression analyses showed that immature defense style was associated with PTSD following homicide with the severity of PTSD from past traumas as a moderator. Neurotic and immature defense styles and PTSD from past trauma were significantly and independently associated with psychiatric co-morbidity. Homicide perpetrators could develop PTSD following homicide. The severity of PTSD from past traumas could affect PTSD following homicide and other psychological problems, and influence the effect of using immature defense against PTSD from homicide. Past trauma, immature and neurotic defense styles had a unique and specific pattern of influence on psychological symptoms, other than trauma symptoms.