Evaluating ego defense mechanisms using clinical interviews: an empirical study of adolescent diabetic and psychiatric patients

Toward developing a scale to empirically measure psychotic defense mechanisms

In recent years, research on psychological processes has greatly advanced our understanding of various psychopathologies. Defense mechanisms, for example, have been described as observable phenomena, and studies have shown meaningful relationships among these processes and other measurable dimensions of health and illness. Despite some notable exceptions, one area that has been overlooked is the empirical study of defenses in psychotic disorders. This is in part due to the lack of valid instruments measuring psychotic-level defenses. Propadeutic to creating an empirical scale for measuring psychotic defenses, the psychoanalytic and empirical literature on psychotic defenses is reviewed, after which the concept of psychotic defenses as measured by the P-DMRS (Psychotic-Defense Mechanism Rating Scales)--which can be used independently or in combination with the current DMRS (Defense Mechanism Rating Scales)--is operationalized. Finally, current research directions applying the P-DMRS to the clinical setting are presented, as well as its implications for guiding current clinical practice.

Ego defense mechanisms in Pakistani medical students: a cross sectional analysis

BACKGROUND

Ego defense mechanisms (or factors), defined by Freud as unconscious resources used by the ego to reduce conflict between the id and superego, are a reflection of how an individual deals with conflict and stress. This study assesses the prevalence of various ego defense mechanisms employed by medical students of Karachi, which is a group with higher stress levels than the general population.

METHODS

A questionnaire based cross-sectional study was conducted on 682 students from five major medical colleges of Karachi over 4 weeks in November 2006. Ego defense mechanisms were assessed using the Defense Style Questionnaire (DSQ-40) individually and as grouped under Mature, Immature, and Neurotic factors.

RESULTS

Lower mean scores of Immature defense mechanisms (4.78) were identified than those for Neurotic (5.62) and Mature (5.60) mechanisms among medical students of Karachi. Immature mechanisms were more commonly employed by males whereas females employed more Neurotic mechanisms than males. Neurotic and Immature defenses were significantly more prevalent in first and second year students. Mature mechanisms were significantly higher in students enrolled in Government colleges than Private institutions (p < 0.05).

CONCLUSIONS

Immature defense mechanisms were less commonly employed than Neurotic and Mature mechanisms among medical students of Karachi. The greater employment of Neurotic defenses may reflect greater stress levels than the general population. Employment of these mechanisms was associated with female gender, enrollment in a private medical college, and students enrolled in the first 2 years of medical school.

Specificities of defense mechanisms in bipolar affective disorder: relations with symptoms and therapeutic alliance

Defense mechanisms as a central notion of psychoanalysis have inspired various levels of interest in research in psychotherapy and psychopathology. Defense specificities have only recently been investigated systematically with regard to several clinical diagnoses, such as affective and personality disorders. For the present study, 30 inpatients diagnosed with Bipolar Affective Disorder I (BD) were interviewed. An observer-rater method, the Defense Mechanisms Rating Scales (DMRS), applied to session-transcripts, of assessment of defenses was used. A matched, nonclinical control group was introduced. Defense specificities in BD encompass a set of 5 immature defenses, of which omnipotence is linked with symptom level. The level of the therapeutic alliance is predicted by mature defenses. These results are discussed with regard to the psychological vulnerability of BD, and treatment implications for psychodynamic psychotherapy with such challenging patients are evoked.

Configuração adaptativa e o nível de maturidade dos mecanismos de defesa

Dentre os recursos que o Ego possui para garantir a estabilidade adaptativa, destacam-se os mecanismos de defesa. Este conceito teórico inspirou a presente pesquisa, que procurou determinar as relações entre uma medida da configuração adaptativa de sujeitos que buscavam psicoterapia psicanalítica e os níveis de maturidade dos mecanismos de defesa. Duas escala, desenvolvidas a partir da experiência clínica, foram utilizadas: Escala Diagnóstica Adaptativa Operacionalizada - EDAO e Defense Mechanisms Rating Scales - DMRS. De um total de 36 sujeitos, previamente avaliados com a EDAO, selecionou-se 20 apresentando adaptação estável. 10 eram adaptados não eficaz moderados e 10 não eficaz severos. Quando se considerou as defesas em função do nível de maturidade, verificou-se que os dois grupos se diferenciavam em função do emprego das defesas dos níveis extremos de maturidade.Os níveis intermediários não se mostraram discriminativos. Correlações significantes foram observadas entre os escores globais das duas escalas.

Avaliação de mudança em processos terapêuticos

O estudo das psicoterapias tem sido marcado pelo uso de métodos de investigação intensiva do processo terapêutico voltados para a compreensão dos fatores que facilitam a mudança. Baseiam-se, usualmente, na análise intensiva de caso único, identificando regularidades características dos estados mentais, padrões de conduta, assim como interacionais, que são associadas com mudança. Contam com instrumentos de avaliação desenvolvidos segundo referencial teórico específico em que conceitos metapsicológicos são definidos operacionalmente. Dependem, em geral, da avaliação de juizes independentes, experientes na técnica avaliada, que se baseiam em vídeos e / ou áudios das sessões de terapia, além de considerarem o contexto. Têm permitido o estudo exaustivo de processos terapêuticos e a obtenção de julgamentos baseados em construtos que evidenciam validade preditiva, além de gozarem de precisão entre avaliadores. A título de ilustração apresentam-se pesquisas envolvendo as seguintes escalas: "Defense Mechanisms Rating Scales", "Rutgers Psychotherapy Progress Scale" e "Escala Diagnóstica Adaptativa Operacionalizada - Redefinida".

Psychosocial predictors of acute complications of diabetes in youth

In this paper we determine whether individual and family psychosocial functioning predicts the risk for recurrent acute diabetic complications. An onset-cohort of 61 children and adolescents with Type 1 diabetes received conventional diabetes care. Episodes of ketoacidosis and of severe hypoglycemia were recorded for 8 years, and glycaemic control was measured by glycohaemoglobin. Measures of psychosocial functioning of the patient and parents were obtained during the first year. Over 8 years, 28% of subjects had at least one episode of ketoacidosis, and 21% had at least one episode of hypoglycaemia. The odds of observing recurrent hypoglycaemia versus recurrent ketoacidosis was 14 times greater in boys than in girls (Fisher's exact test p < 0.05). Girls with recurrent ketoacidosis had more behaviour problems and lower social competence, they reported higher levels of family conflict, and their parents reported lower levels of family cohesion, expressiveness and organization in year one. These relationships were independent of any association with poor glycaemic control. Recurrent hypoglycaemia in boys was generally unrelated to individual and family functioning or glycohaemoglobin. Despite our small sample size, our findings are suggestive of relationships that may lead to early identification of patients who are prone to recurrent ketoacidosis, and to the development of early intervention strategies.

Should an axis for defense mechanisms be included in DSM-IV?

The purpose of this review is to address empirical evidence bearing on the desirability of including a Defense Mechanisms Axis in DSM-IV. The authors reviewed studies based on standardized clinical or self-report methods for assessing defense mechanisms. Information was sought pertinent to methods for assessment, relevance to clinicians with diverse theoretical perspectives, definitions, suitability for an axial format, complexity, reliability, clinical utility, and relationship to existing axes. Methods for reliably rating defense mechanisms have been developed, and data on the clinical utility of ratings have begun to accumulate. A consensus on definitions is emerging, and evidence supports a hierarchy of defenses based on their adaptiveness. Since training in psychodynamic theory and treatment approaches is required of residencies performed in the United States, all psychiatrists should be able to evaluate patient defenses. However, new methodologies have not been tested under usual clinical conditions with limited, "live" clinical data. A viable option for DSM-IV is the inclusion of a defense mechanisms axis in an appendix of optional axes for use in special clinical and research settings. In addition to providing dynamically meaningful diagnostic data, this axis would facilitate expansion of the empirical data base on a standardized measure of defenses under conditions of routine clinical practice.

Self-rated defense style, life stress, and health status: an empirical assessment

The authors compared the 14-defense and 20-defense versions of the self-report Bond Defense Style Questionnaire in a nonclinical sample of adults. Factor analyses of both versions yielded a stable factor representing immature defenses, while factors representing image-distorting, neurotic, and mature defenses were less stable. In correlational analyses, immature defenses were highly associated with higher reported levels of life stress, physical illness, and affective symptoms. Methodological issues and the possible implications of these findings are presented. The Bond questionnaire appears to be an additional helpful tool in consultation-liaison psychiatry for identifying poor copers at high risk for distress.