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CHARACTERISTICS OF PSYCHOLOGICAL DEFENSE MECHANISMS IN HEALTHY TESTEES
AND IN PATIENTS WITH SOMATIC DISORDERS

VADIM S ROTENBERG vadir@post.tau.ac.il
Abarabanel Mental Health Center Tel Aviv, Israel

A. N. Michailov
Moscow Medical Academy, Russia

Homeostasis, 1993, 34:54-58

ABSTRACT

Correlations between data of psychological defense mechanisms (according to the Plutchik questionnaire) and MMPI as well as 16 PF data were analyzed in 56 healthy subjects and 70 patients with different somatic diseases. It was found that these correlations depend on gender, on the level of psychic adaptation and on the presence or absence of somatic disorders. Healthy subjects as a group, compared to somatic patients, have significantly more correlations between defense mechanism and MMPI scales as well as 16 PF factors. It reflects a rich repertoire of defense behavior in healthy subjects. In the patient group the most prominent and stable is the positive correlation between repression and D scale. The strain of defense mechanisms in the patient group is higher than in the group of healthy men. Healthy women according to their defense mechanisms are more similar to the patient group than to the group of healthy men. The cause-and-effect relationships between defense mechanisms and psychological scales are discussed.

In spite of numerous investigations of psychological defense mechanism, many important aspects of this problem are not clear and there is controversy regarding the appropriate theoretical approach.

Cause and effect relationships between defense mechanisms and clinical syndromes, for example between repression and anxiety, are ambiguous. According to A Freud (1966) repression referred only to inner mental contents such as wishes and ideas. The theory suggests that unconscious wishes and ideas are a threat to the ego, leading to anxiety. A prominent psychodynamic theoretician Mitcherlich (1956), considers repression to be a defense mechanism against anxiety, while anxiety in ego-psychology is considered to be a reaction to ego-threatening information. Repression is discussed as the pathogenic mechanism of conversion hysteria, which is usually characterized clinically by the absence of anxiety. The distinction between repression and denial in such clinical investigations is not clear. A Freud (1966) discussed 8 defense mechanisms and proposed that for each individual there was a given repertoire of all these mechanisms, this point of view contradicts the suggestion (Plutchik et al, 1979) of stable and specific relationships between particular defense mechanisms and emotional state.

The aim of this study is to clarify these and other unresolved questions by means of polydimensional investigations and to correlate psychological defense mechanisms with data of clinical psychological investigations in healthy subjects and in patients with mental and somatic disorders. Subjects and Methods.

SUBJECTS.

We have investigated 56 healthy subjects (34 men and 22 women, age 20 - 48) and 70 general practice patients with different somatic disorders (34 men and 36 women, age 30 - 50). The somatic patients were hospitalized in the inpatient clinic of the Moscow Medical Academy. The group of somatic patients consisted of a) 15 patients with essential hypertension b) 15 patients with organic heart disorders c) 9 patients with functional neuro-circulatory disorders, d) 10 patients with asthma bronchiale, e) 9 patients with ischemic heart disease, f) 12 patients with pneumonia. Methods. Psychological investigations included:
a) the Plutchik questionnaire (in Russian translation),
b) MMPI (validated Russian version, see Berezin et al, 1975),
c) 16 PF questionnaire in Russian translation, validated.

Plutchik's questionnaire (Plutchik et al, 1979) consists of 97 statements which describe types of ordinary human behavior in different situations. Subject has to choose a definite type of behavior in every situation. According to the subject s choice of behavior, every type of defense acquires its own " weight" reflecting the strain of individual defense mechanisms. Plutchik described 8 defense mechanisms, i. e. Denial, Repression, Projection, Compensation, Reaction Formation, Intellectualization, Regression, Displacement.

According to MMPI data we have divided all somatic patients into 3 groups. Group A - all MMPI scales are less than 70 T (low level group). Group B - at least 2 of the MMPI scales are between 70 T and 80 T (moderate level group). Group C - at least 2 of the MMPI scales exceed 80 T (high level group).

Statistical analysis and analysis of correlations have been performed on computer SM-1880. Only significant results are discussed in this paper.

RESULTS.

1. There are no stable correlations between data of psychological defense mechanisms and either the MMPI or 16PF. These correlations are determined by gender, level of psychic adaptation, and the presence or absence of somatic disorders. For example, in healthy women general emotional tension (anxiety, factor FI of 16PF) correlates positively with displacement and repression (0.45 and 0.50) while in healthy men the same factor correlates with regression, compensation and projection (0.45, 0.43 and 0.39, correspondingly). In somatic patients of group A (low level of MMPI) denial correlates positively with Ma scale (0.44) and negatively - with the scale Introversion-Extraversion (-0.41) of MMPI. In those somatic patients who displayed a moderate MMPI level, denial correlated negatively with the scale of asocial behavior (-0.41), and when MMPI score was high, there were no significant correlations between denial and clinical MMPI scales. In subjects with the leading D scale of MMPI, denial correlated negatively with the scale of asocial behavior (- 0.50), while in subjects with leading Hs and Hy scales it was a negative correlation with Hy scale (-0.56).

2. Healthy subjects as a group, compared to somatic patients, have significantly more correlations between defense mechanisms and MMPI scales as well as 16 PF factors. In healthy subjects one clinical scale of MMPI or one factor of 16 PF test correlates, in average, with 3 defense mechanisms, while in somatic patients only with one mechanism (p<0.01). The total number of correlations between clinical MMPI scales and psychological defense mechanisms in healthy subjects exceeds the total number of such correlations even in patients who belong to group A according to MMPI .

3. In the patient group, there is a positive correlation between repression and D scale (0.48). This correlation characterizes not only subjects with leading D scale (depression), but also subjects with leading Pa scale, and is common both for and MMPI groups. Thus, it is the most stable correlation in the group of patients. The data support the conclusion that D score is significantly higher in patients with a high level of repression compared to patients with a low level of repression (p<0.01). It also suggests that repression prevails in patients with passive behavior (Plutchik et al., 1979). 4. In the patient group defense mechanisms are much more "strained" than in healthy subjects, especially denial, regression, projection, displacement and reaction formation. However, this difference is gender dependent and is visible only in men. Sick women differ from their control group only in regression. At the same time sick men differ from healthy women only in the level of denial (p<0.01). On the other hand, sick women differ from healthy men according to the defense mechanisms as much as healthy women differ from healthy men: in both women's groups the strain of regression, projection, displacement and reaction formation is higher than in healthy men, while in healthy men the strain of intellectualization is higher. It is necessary to take into consideration that intellectualization is the most adaptive and highly-developed defense mechanism. In women factor C - ego strength - correlates negatively with repression and displacement. In healthy women a general emotional tension - anxiety (factor F, of 16 PF) has a positive correlation with repression (0.45), while in healthy men F correlates positively with displacement, regression, projection and compensation. Denial correlates positively with factors E (0.42), A (0.47) and Q3 (0.35) and negatively - with factor Q4 (-0.33).

DISCUSSION.

We shall discuss our data in the same sequence as it was presented.

1. There are no stable correlations between defense mechanisms and psychic state estimated by MMPI and 16 PF test. This suggests that psychological defense mechanisms are flexible and the organization of the psychological defense as well as its correlation with clinical state and behavior depends on many different factors. It appears that the same defense mechanisms may play different roles in different conditions and in different psychic states, according to their hierarchy (A. Freud) and to global context of situation. This data does not confirm the proposition (Plutchik et al., 1979) of the definite and specific relationships between defense mechanisms and emotional state. It also does not confirm the hypothesis that every type of personality is characterized by only one structure of psychological defense mechanisms.

2. According to our data, it is possible to speculate that healthy subjects, in comparison to somatic patients, have a rich repertoire of defense behavior. The restriction of defense mechanisms can be an important part of the pathogenesis of psychosomatic disorders. Even when healthy subjects have the same traits of personality as patients have (according to MMPI and 16 PF), they are able to use a broader spectrum of defense mechanisms which increases their adaptability.

It is necessary to stress that in healthy subjects defense mechanisms correlate predominantly with those clinical scales of MMPI that represent the most stable personal attitudes, while there are only few correlations with so called neurotic scales.

3. According to the stable and strong correlation between D scale and repression it is possible to suggest that repression of unacceptable motives as well as behavioral attitudes causes depression and anxiety. Cause-and-effect relationships between defense mechanisms and clinical disorders are variable. When repression correlates positively with depression/anxiety, it is possible to suggest that the strong repression determines the increase of depression/anxiety. The opposite suggestion seems to be less reasonable: if repression defends subjects against negative emotional state, it would be natural to predict positive correlations between repression and D scale exactly in group A which contains subjects with the lowest level of MMPI clinical scales, because this group represents the most successful psychological adaptation. However, the data contradicts this prediction: the correlation between repression and D scale is found only in psychologically maladapted subjects. The same is true for the correlation between repression and F1 factor. Our explanation corresponds to findings that the high strain of repression distinguishes essential hypertension from all other somatic disorders: the role of the chronic emotional tension in the elevation of blood pressure is well known.

According to A. Freud (1966) anxiety reflects the ego-threat. However, repression of unacceptable wishes, ideas and images does not guarantee ego protection from anxiety because repression does not eliminate repressed wishes and ideas. Repression only protects subject from the conscious awareness of such ideas and as a result protects ego as well as behavior from disintegration. Repression, as every other defense mechanism, leads to a distorted perception of reality and to the exclusion of conflicting self-aspects in a goal to prevent self from fragmentation (Aeschelmann et al, 1992). The realized behavior is not determined directly by inappropriate wishes and attitudes, however to repress attitude does not mean to abolish it or to resolve the motivational conflict. Repressed information being in unconsciousness does not lose its threatening power. Thus, repression protects self from disintegration but not from the anxiety about the possibility of such disintegration. Defense operations may only conserve the functioning of ego in a situation of overwhelming anxiety (Steffens & Kachele, 1988). As a result repression is only the first line of defense and requires the activity of other defense mechanisms to achieve the psychological adaptation. For example, repression requires the activity of dreams (Grieser et al, 1972) and if this activity is decreased due to the natural or artificial reasons the anxiety has a tendency to increase (Greenberg et al ,1972).

On the other hand, when FI factor correlates positively with defenses of displacement, projection or compensation in healthy subjects, cause-and-effect relations seems to be opposite.

Activation of these defense mechanisms is not likely to cause emotional tension. It is more reasonable to think that the increase of emotional tension due to various factors leads to the compensatory activation of these defense mechanisms in order to protect healthy subjects from further increase of emotional tension. This corresponds with the suggestion that the strain of defense mechanisms reflects the aspiration to emotional stability. A negative correlation between denial and Q4 (16 PF) means, most probably, that the ability to ignore some aspects of reality protects against frustration. It is less reasonable to suggest that the frustration of the actual motives (Q4) determines the decrease of denial. This assumption is indirectly supported by the fact that denial is more active in MMPI group A, in comparison to groups B and C, while repression, as we have already stressed, is more active in MMPI group B. In the study of Aeschelmann et al (1992), denial was activated by such frustration like bone marrow transplantation.

Thus, our data provide the opportunity to confirm the different position of different defense mechanisms in the whole defensive system. Denial prevents the realization of stressful events and presumably even the entrance of this information in the subconsciousness. That is why, the more active the defense, the lower the state of tension. Most other defense mechanisms change behavior according to the already perceived stressful information which can be conscious or unconscious. This information increases emotional tension, and can determine the appearance of pathological syndromes. In this situation defense mechanisms are stimulated secondarily, to protect the subject against information which is already perceived, and the more disturbing the information, the higher the strain of defense mechanisms. It was shown, that insofar the defense does not interfere with an active life, even serious illness has a better prognosis (Battegay, 1989) If patients after a bone marrow transplantation rated their coping strategies, active problem oriented coping was regarded as the most helpful behavior (Neuser, 1989). It is in a good agreement with the Search Activity Concept (Rotenberg & Arshavsky, 1979, Rotenberg, 1984). Repression is passive in its nature, it protects consciousness but does not allow the subject to discharge emotional tension - as a result high repression leads to anxiety and depression.

4. Regarding differences between sexes, it is possible to conclude that in Moscow even healthy women (without obvious somatic and mental disorders) are in a state of the permanent strain of psychological defense mechanisms, which means - a high risk state.

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