The Development of the Attachment Defenses Questionnaire (ADQ-50): A Preliminary Examination of Reliability, Validity, and Factor Structure

This paper marks the initial phase in the development of the Attachment Defenses Questionnaire (ADQ-50), a self-report tool crafted to assess defense mechanisms associated with attachment processes, catering to both clinical and research contexts. Anchored in the theoretical framework of attachment theory, the ADQ posits that an individual's internalized attachment style plays a influential role in predicting their defense mechanisms. The paper outlines the comprehensive development and refinement process of the ADQ-50. In Study 1 a preliminary 176-item version of the ADQ was examined. Data was collected online drawing from participants sourced from Prolific and undergraduate students (N = 1994). Study 2 further refined the ADQ, evaluating its initial convergent validity with a diverse participant pool (N = 726), including undergraduates, Prolific contributors, general practice medical patients, and individuals from social media. Exploratory factor analysis revealed a robust ten-factor structure, resulting in a 50-item scale aligning with theoretical expectations and demonstrating good psychometric properties. Findings, limitations, strengths and future research directions are discussed. We posit that the ADQ holds great potential to deepen our comprehension of defense mechanisms linked to attachment, with wide-ranging implications for clinical practices.

Identification of Psychological Profiles of Cancer Patients Undergoing Fertility Preservation Counseling

Gonadotoxicity is one of the most distressing side effects of cancer treatment. Fertility preservation strategies should be included during the treatment pathway to prevent the risk of infertility, but the decision to preserve fertility often represents a challenging process that carries an emotional decision-making burden. The aim of this study is to characterize the psychological profiles of women undergoing fertility preservation counseling and to better understand their features. Eighty-two female cancer patients were included in the study. They were asked to complete a battery of self-administered tests which evaluated socio-demographic characteristics, defense mechanisms, depression, anxiety, and representations regarding the importance of parenthood. Based on the psychometric variables, cluster analysis identified four groups which showed significantly different combinations of these psychological characteristics. An additional analysis was performed to evaluate if sociodemographic variables were associated with the four groups, but the results did not show significant differences. These results suggest that very diverse psychological profiles may lead cancer patients to attend oncofertility counseling and choose fertility preservation. For this reason, all patients in childbearing age should have the opportunity to receive appropriate fertility preservation counseling in order to make an informed decision that could have an important impact on their long-term quality of life.

Parental bonding in retrospect and adult attachment style: A comparative study between Spanish, Italian and Japanese cultures

Attachment is an innate human relational mechanism that develops progressively from early childhood, influences individuals' representations and behaviors, shapes relationships, and affects the social and cultural environment. Parental bonding refers to the ability of parents to be emotionally and behaviorally available to the child during infancy. Attachment style refers to the individual's relational attitude in close relationships that influences adult love, bonding, handling relationships, and social exploration. The role of intergenerational, cultural and developmental factors influencing the relationship between the attachment style in adulthood and the parental bonding style recalled during childhood has been debated. This study explores the relationships between recalled parental bonding, adult attachment style, and cultural background in a sample of Spanish, Italian, and Japanese adults using a cross-sectional and cross-cultural design. For this purpose, the validated versions of the Experience in Close Relationship Scale and the Parental Bonding Instrument were administered to a non-clinical population of three hundred and five participants in the three countries. Results show that the most frequent adult attachment style is the secure style, followed by the dismissing-avoidant, the preoccupied, and the fearful-avoidant style. The dismissing-avoidant style was the most frequent insecure attachment style in the Japanese sample whereas the preoccupied style was the most frequent insecure attachment style in the Italians and Spaniards. Japanese are more anchored to the memory of maternal and paternal overprotection, which is related to more avoidance in actual close relationships. Spaniard's current relationships are mildly independent of recalled parental bonding, showing an association between lower current avoidance to primary parental care. In the Italian sample, there is no significant relationship between current adult close relationships and recalled parental bonding. These results suggest that different cultural models influence adult attachment representations differently, in terms of the weight placed on attachment-related avoidance, attachment-related anxiety, care, and overprotection in infant and adult relationships.

Default defenses: the character defenses of attachment-anxiety and attachment-avoidance

Contemporary attachment researchers claim that attachment-anxiety is associated with a hyperactivating defense strategy while attachment-avoidance is associated with a deactivating defense strategy. However, to date, no study has comprehensively examined the basic patterns of specific defense expression in the two dimensions of attachment insecurity (anxiety/avoidance). To address this research gap, the current study aimed to assess the character defenses associated with attachment-avoidance and attachment-anxiety, incorporating a broad spectrum of psychological defenses. The main objective was to understand what differentiates attachment-avoidance and attachment-anxiety in defensive functioning. In this study of online questionnaire design (N = 250), university undergraduates aged between 17 to 65 completed the Experiences in Close Relationship Scale (ECR) and the Defense Style Questionnaire (DSQ-60). The results show that the two dimensions of insecure attachment exhibit different defensive patterns. Regarding the main findings, attachment-avoidance uniquely predicted defensive isolation, and attachment-anxiety uniquely predicted the defenses splitting, projective identification, anticipation, acting out, passive-aggression, reaction formation, and undoing. Overall, the results indicate that attachment-anxiety is a significant predictor of global defensive functioning, over and above that of attachment-avoidance. One implication of this study is that the two-dimensional model of adult attachment may offer a promising framework for organizing psychological defenses. We discuss the significance of this concerning the future of the empirical study of psychological defenses. The discussion also considers the clinical application and relevance to attachment-based psychotherapy.

Do Immature Defense Mechanisms Mediate the Relationship Between Shame, Guilt, and Psychopathological Symptoms?

When shame and guilt emotional experiences related to stressful events remain unresolved, they can be related to psychological impairment and recursive thoughts. The present study aims to explore the association between state shame and state guilt related to past stressful experiences and psychopathological symptoms and evaluating a mediation role by immature defenses. A total of 90 participants (48.9% female; mean age 23.66) were considered in the present study to (a) investigate correlations between state guilt and shame scores related to personal stressful events and psychopathological symptoms related to global severity index; (b) assess whether state guilt and shame scores related to personal stressful events are positively correlated with immature defenses; (c) test whether immature defenses mediates the relationship between, respectively, state shame and state guilt with psychopathological symptoms. Significant correlations between state shame, state guilt, psychopathological symptoms, and immature defenses were found. Higher activations on immature defenses partially mediated the relationship between psychopathological symptoms and state shame and state guilt, respectively. Past experiences related to shame and guilt should be targeted by specific treatments that could help stop recursive maladaptive thoughts and empower more adaptive defensive strategies.

The Relationship Between Defense Mechanisms and Attachment as Measured by Observer-Rated Methods in a Sample of Depressed Patients: A Pilot Study

Despite many theoretical and clinical writings, the theorized connection between defense mechanisms and adult attachment in depressed patients has received little empirical attention. This is the first study to examine patients’ defense mechanisms in relation to their attachment in a clinical sample of depressed patients and also the first to use observer-rated measures for assessing both defense mechanisms and attachment. In this pilot study, we aimed to investigate the relationship between patients’ attachment and their use of defense mechanisms in psychotherapy sessions, as well as patterns of change over treatment. We conducted a secondary analysis of data from a randomized controlled trial of 30 patients receiving psychotherapy for major depression. Session transcripts were previously coded for defense mechanisms using the Defense Mechanisms Rating Scales, and depression severity data were collected by the clinician-rated HRSD-17 and the self-report BDI-II. Patients’ attachment was assessed in two transcripts, one in an early session and a second in a late session, using the novel observer-rated Patient Attachment Coding System. In contrast with expectations, in the early phase of therapy, preoccupied attachment-related characteristics were significantly positively related to overall defensive functioning and negatively related to Depressive immature defenses. In the late phase of treatment, preoccupied attachment-related characteristics were negatively correlated with Non-depressive immature defenses. Moreover, as expected, early-phase defense use was related to late phase attachment; specifically, early neurotic and immature Depressive and Non-depressive defenses predicted an increase in avoidant, whereas immature Non-depressive defenses predicted a decrease in preoccupied attachment-related characteristics over the course of treatment, after controlling for early attachment effects. The results imply a longitudinal relationship between defenses and change in attachment-related characteristics over the course of treatment in a depressed sample and warrant further research about the relationship between defenses and attachment during psychotherapy.

Associations between early maladaptive schema domains of parents and their adult children: The role of defence styles

Although existing research recognized the associations between early maladaptive schemas (EMSs) of parents and their adult children, the mechanisms that underpin these associations were not fully understood. Therefore, the purpose of the current study was to explore the role of defence styles (DSs) on the associations between two EMS domains (Disconnection/Rejection and Impaired Autonomy) of parents and their adult children. Two hundred and fifteen families (i.e., mother, father, and their adult children) participated in the study. Both parents and their adult children were asked to complete Young Schema Questionnaire-Short Form (YSQ-SF) and Defence Style Questionnaire (DSQ) to assess their EMS domains and DSs. According to the results of the current study, there were significant associations between Disconnection/Rejection and Impaired Autonomy EMS domains of parents and their adult children, and these associations were mediated by only immature DS of parents and their adult children in a serial mediation model. These results contributed to our understanding of the associations between EMS domains of parents and their adult children through immature DSs. Moreover, our findings highlighted the importance of synthesizing the concepts of different theories to enhance our understanding of mental representations in families.

Investigating defensive functioning and alexithymia in substance use disorder patients

BACKGROUND

Substance Use Disorder (SUD) causes a great deal of personal suffering for patients. Recent evidence highlights how defenses and emotion regulation may play a crucial part in the onset and development of this disorder. The aim of this study was to investigate potential differences in the defensive functioning between SUD patients and non-clinical controls. Secondly, we aimed at investigating the relationships between alexithymia and maladaptive/assimilation defenses.

METHODS

The authors assessed defensive functioning (Response Evaluation Measure-71, REM-71), personality (MMPI-II), and alexithymia (TAS-20) of 171 SUD patients (17% female; mean age = 36.5), compared to 155 controls. Authors performed a series of ANOVAs to investigate the defensive array in SUD patients compared to that of non-clinical controls. Student t test for indipendent samples was used to compare clinical characteristics between the SUD group and the controls. To investigate the role of single defenses in explaining alexithimia's subscores, stepwise multiple regression analysis were carried out on socio-demographic characteristics of participants (gender, age, and years of education), with REM-71 defenses as predictors.

RESULTS

SUD patients presented a more maladaptive/assimilation (Factor 1) defensive array (p < .001). Among SUD sub-groups, Alcohol Use Disorder patients showed more disfuncional defenses. Factor 1 defenses were related to a worse psychological functioning. In addition, alexyhimia (particularly DIF) was strongly related to Factor 1 defenses, expecially Projection (38% of variance explained, β = .270, p < .001).

CONCLUSION

The REM-71 and the TAS-20 might be useful screening instruments among SUD patients.

It's Not That Great Anymore: The Central Role of Defense Mechanisms in Grandiose and Vulnerable Narcissism

Objectives: The concept of narcissism contains a yet unresolved paradox: Its grandiose facet depicts the psychopathological core but is often associated with life-satisfaction and overall functioning, whereas its vulnerable facet is associated with psychological distress, but still not included in the international classification systems. Our goal was to investigate the relationship between the two facets of narcissism expecting underlying defense mechanisms to be core elements. First, we aimed to identify defense mechanisms specific to grandiose and vulnerable narcissism. Second, we explored how both facets are differentially associated with psychological distress, assuming that grandiose narcissism would be associated with less psychological distress than vulnerable narcissism. Third, we investigated the mediating role of defense mechanisms between narcissism and psychological distress. Methods: In a non-clinical sample of N = 254 individuals, the Pathological Narcissism Inventory was used for the assessment of grandiose and vulnerable facets of narcissism, the Defense Style Questionnaire for defense mechanisms, and the Brief Symptom Inventory for psychological distress. Structural equation modeling was employed to identify distinct factors of grandiose and vulnerable narcissism. Associations between specific defense mechanisms and both facets were calculated. Furthermore, the direct association between both facets and psychological distress was examined. We finally explored whether defense mechanisms mediate the association between distress and both grandiose and vulnerable narcissism. Results: A distinct pattern of defense mechanisms for each facet of narcissism could be extracted: Both facets showed significant positive correlations with specific intermediate and all maladaptive defense mechanisms. Only grandiose narcissism showed significant positive correlations with adaptive defenses. Vulnerable narcissism showed negative correlations with all adaptive defenses. Specifically, grandiose narcissism was significantly related to anticipation, pseudo-altruism, rationalization, and dissociation, whereas vulnerable narcissism was negatively related to all these defense mechanisms. While grandiose narcissism was not related to psychological distress, vulnerable narcissism showed high correlations with psychological distress. Intriguingly, mediator analysis found that grandiose narcissism was related to psychological distress when mediated by maladaptive defense mechanisms. Discussion: The role of defense mechanisms is central for a differentiated understanding of the two different faces of narcissism. The relevance of assessing defense mechanisms in clinical settings, and related empirical findings are discussed.

Mentalization, attachment, and defense mechanisms: a Psychodynamic Diagnostic Manual-2-oriented empirical investigation

Mentalizing capacities depends on the quality of primary attachment interactions with caregivers who thinks of the child as a subject with mental states. Operationalized as reflective functioning, mentalization is crucial for regulating emotions and developing of a coherent sense of identity, for interacting with individuals making sense to own and others mental states, and for distinguishing internal and external realities without distortions. Although the clinical literature on interplay between mentalization, attachment, and emotional regulation is rich, the empirical research is limited. This study sought to explore connections between reflective functioning, attachment styles, and implicit emotion regulation, operationalized as defense mechanisms, in a group of depressive patients. Twenty-eight patients were interviewed using the adult attachment interview (AAI) and diagnosed using the Psychodynamic Chart-2 of the Psychodynamic Diagnostic Manual, Second Edition. The reflective functioning scale and the defense mechanisms rating scale Qsort were applied to AAI transcriptions to assess reflective functioning and defensive profile. Patients with secure attachment showed significantly higher levels in reflective functioning and overall defensive functioning as compared to those with insecure attachment. Good reflective functioning and secure attachment correlated with mature defenses and specific defensive mechanisms that serve in better regulating affective states. Overall, the relationship between mentalization, attachment and emotion regulation lay the foundations for the delineation of defensive profiles associated with attachment patterns and reflective functioning in depressive patients. The systematic assessment of these psychological dimensions with gold-standard tools may help in tailoring personalized therapeutic interventions and promoting more effective treatments.

Psychological Aspects Associated With Fertility Preservation in Oncology: An Exploratory Study

Objective

Gonadotoxicity is considered one of the most distressing side effects of cancer treatment. Although fertility preservation can be a valid solution, it also involves a challenging process. A clear understanding of the features of women who decide to pursue fertility preservation after cancer diagnosis is missing. The purpose of the present study was therefore to analyze the personality profile of female patients referred to oncofertility prior to gonadotoxic treatment.

Methods

Fifty-two female cancer patients took part in the study. The Temperament and Character Inventory-Revised (TCI-R), the Response Evaluation Measure-71 (REM-71), the Beck Depression Inventory (BDI-II), and the State-Trait Anxiety Inventory-Y Form (STAI-Y) were administered to examine personality characteristics, defense mechanisms, depression and anxiety symptoms.

Results

Compared with reference data of the Italian population, our sample reported significantly lower scores in Harm Avoidance and trait anxiety, and significantly higher levels of mature defense mechanisms. Most of the patients reported low scores in immature defense mechanisms, depression, and trait anxiety, and medium scores in state anxiety.

Conclusions

Our findings suggest that these women display functional personality traits and defensive style, in association with low levels of depression and trait anxiety. These features may enable a proactive attitude to cancer and the ability to make long-term plans. This may favor psychological adjustment to cancer and a projection toward the future.

The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis

INTRODUCTION

Insecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation.

METHODS

One-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome.

RESULTS

Fearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress.

CONCLUSIONS

The results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.