This article was downloaded by: [University of Victoria] On: 19 November 2014, At: 04:15 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
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The Relationship Between Defenses and Symptoms in Adolescent Psychopathology Gil G. Noam & Christopher J. Recklitis Published online: 22 Jun 2011.
To cite this article: Gil G. Noam & Christopher J. Recklitis (1990) The Relationship Between Defenses and Symptoms in Adolescent Psychopathology, Journal of Personality Assessment, 54:1-2, 311-327 To link to this article: http://dx.doi.org/10.1080/00223891.1990.9673996
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The Relationship Between Defenses and Symptoms in Adolescent Psychopathology Gia G. Noam and Christopher J. Recklitis ffarvarif .?.fedicd School and Mcbxan Hospital
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I 3e reiacionship between defense mechanisms and symptoms was assessecj in a group oi 196 psychia:r:cziiv hospitalized adoiescects. Defense mechanisms were z~easuredthrough rhe use of the Defense Mechanisms inventorr :Dh\.'II!:svrr,ptorns and prohlerr: behaviors mere measured wi:h :he Y o x h SelfiRepmt. Lniiar:a:e and mt;itivaria:e anaiyses indicarecl that externalizing symptoms are assocmed wirh defenses tinat locate :he confiic: olitside of' the self, whereas :nternzliilng svmptoxs are associated with defenses that locate the conflic: within :he self !r, cc)n:rast tc. previous reports, no gender differences were f ~ u n dI: defense ?reference, t h o ~ g kgende: differences were found in :'he reiatier. of deimses :o svmp
toms. The 5ndings are consistent with clinical theory
ni defense prscesses and
support the cilstinctmn Serween interna!i~:ng~'exteri~aiizing behaviors and pe~sonaiity disensions for both sy:xp:omr and defenses. The studv suppx:s :he 1-z!id:ru of rbe adoIescent form of the DhU.
Ir is a wideiy held i r k s : in clinical cirfies that defense mechanism. and srmpcoms are ciosely relared. Macv ciinical reports actest tc chis perspecrive :ha: originared wirh FreuiZts early concep:ital:za:ions. In the psi-c'hoanz1;:ic traditior, since :henT defenses have been an important too1 In understanding the development o i psycRopatholog7;. In particular: Anna Freud's ( 1 ? 5';; 1966)derailed cat~ioging . of defenses has inspired a variety of m o d e n attempts co s:lidy the role of defenses ir: psrchopathcriogy !e.g., BeIlack, PIurvicIrl Sr Gediman. 199.3: Prelinger & Zimec, 1064). h a p k c ' s (1965) now-classic n o n o g a p h relanng ' L ~ ~ e i i styIesn r ~ t i ~ to the:? characterisric defense mechanisms 2nd Kern'berg's (i975! e s a m i ~ a t i o no i t h e roie of defenses in characten pathoiogy are exampies of rhe cxnrinue? reiiance on h e concept. of defense in ?he underscanding of symptoms. As interest in th:s area Bas grown, the krLpiickdevebpment-a1 idezs of d e h s e s : in ~sychoana!ysis have been made expilcit in a variety of theories and
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studies. Most important, Vaillant (1977) defined a developmentai hierarchy of defenses that are related to levels of psychopathology (from psychotic defenses through character-disordered and neurotic defenses to mature defenses). Furthermore, researchers have introdaced other developmental principies, such as cognitive, moral, and ego development, as relevant to both defenses and psyzhopathoiogy (e.g., Haan, 1917; Noam, 1984). Although chere have Seen conceptuai, ciinical, and empirical advances in uncovering the role of defenses in pathology, few stuciies have empirically demonstrated this relationship. A recent research monograph, devoted to measurement issues of defense mechar&ms (Vai?,larrt,2985), emphasized the difficult technical problems, such as precision of definitions and reliabiliries! that continue to chalienge researchers. Despite these difficulties, there is an increasing awareness in psychology and psychiatry of the need to incorporate defenses more fornaiIy into personality and diagnostic assessments. Millon (l984j, for example, argued that a systematic assessment of defense mechanisms 'Ps central to a comprehensive personaiity assessment" {p. 460). VaiIlant (1984) argued for the necessity of evaluating defense mechanisms in forrnulati~gre&:ab'aepsychiatric diagnoses. The recognitior, of this need has led tu the indusion of a lexicon of defense mechanisms in ehe recent revision of the Diagnostic ard Statistical Manual of Mental Disorclen (3rd ed., rev. [DSM-ZII-Rl, American Psychiarric Association, 1983. However, krther systematic research is essential if defenses are so be rneaniragfulfy integrated. into personality and diagnostic applications and investigation.
ASSESSING DEFENSE PROCESSES The increased interest in the empiricai study of defenses has led to only a few empirical reports s n the relationship between defenses and symptoms. Of the studies conducted, some have no: found an empirrcal relationship between psychopathology and defenses. For example, on the basis of studies with a newly developed measure, Bond and Vaillant (1986) argued that deienses are not reiated to psychoparhology. However, their conclusion is c h w n from their study examining differences between chartderived diagnostic groups. Recent advances in empirically deriving diagnostic categories by way of structured interviews (e.g., Costello, Edelbrock, Dulcan, Kaias, G,Klaric, 1984)provide the opportunity to investigate the relationship between defenses and psychopathology more reliably. However, the diagnostic paradigm, which identifies categories of psychopz
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Given the progress in the deieiciprner;: of empkicai methods of stud?-ing . , . , defenses and rise m a w sradies conducted usmg the ZMI, it 1s sur7r:si:ip :hat iew
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NOAM AND RECKLITIS 7.4BLE 5 Canonrcal Correlation of the Defense and Broad-Band Sympt~nrScriies Cun~mralCo-;e:acm~
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Defenses
TAC PRO PRK TAS Syrnpto~.~
Inrernalizing
Exrernalizing
empirical reports Lave demonstrated t i e relaticnship hetween defense mechanisms and ciinical symptoms (Ihilevich & Gieser , 1986).This Iack of evidence is especialEy apparent in research concerning adolesce~ts.Crzmer's (1088) extensive review of :be DMI cted no studies using the adolescent form. Our st&? ~ 0 n t r i ' ~ uco t e the ~ research iiterature nn defense mechanisms both bjl assessing the new For= oi rhe DMH and bv demonstraring rciatiomsizip patterns betweerr defenses arid symptoms. Our findings s ~ p p c r ithe distinction herween internaiizing/externaiizing processes cha: has become increasingly important ra aaoiescent research , The ccrrelations s u ~ p o r the t hypothesis that (.4cheni?ach. i382; C ~ w a n 1975). persons using defenses that locate ccnflict outside :he seli (TAO and PRO) dispiay mere externalizing, aggressive symptom behaviors, The resdts aisc reveal that individ~aiswho use defense mechanisms that locate cnzflict within the seli {TAS),report more internalizing (depressed in giris, anC seii-destructive i~ 'boy) symptoms.. Both these findings gain fi~rihcrsupport from the mere srringent: xulrivariate analyses which demonstrated that when :he shared variance of each set of measures is accmnted for, there are stJE sever2 significant relationships between the defenses acd syrraprorn measures and cha: these relacionships are ir; iiae with o w hypotheses. Airhough many resuirs biiowed theorericai prcciictjcns: some did not. ?!e ,. . predicted tha: PRW and -PAS wonld br associated with internairzng syxproms, because both these defenses deal with conflict: internally. Unlike the TXS scslr, howevert the PRW scale was not significa~ti.; associated u-irh internaiizing C . behaviors. Like the KEV scale, it was associate2 with a general lack or ali . ,, symptoms. Although :his finding is coztrarr to o.ur hyporhesis. ii is s~miz:.to a finciing repcrted by Frank: M~Eaughiin,arid C r s c o (1984).In their study of colkge srudents, :hey reported that bn:h PXN and REV were negatively correlzted with iwel of symptom dlstress. These findings suggest thar the
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reversal and principalizi~g defenses c d d be related mere :o ae;;.!si of .. . spmporns rvpicai s y m ~ t ~ m a i o i o gthan ) : to the internalized and intel~ectzailze~ . . n i cie~ressionor obsessive-comp~Is:vebehavior, Alternamreii, It c o d mean ,. that these deienses rr.ay be particslsrlv suited t e rprever.ting suqects frcm e x ~ e p i e r k n gpsvchoiog:caI discomfort or syrnpr-ms, as Crerrier (1962) szggested. A n interesting and unanricipaced finding suggests 2 dist:nxioc bet wee^ aggressive and deiinrjuent si7mptorns.According ro our original hyp~thesis? we wauid hzve expecred both aggressive en2 delinquent s m - i p x n s :o be assocrated with "0 and TAO. Overa!l. the resdts szpporred this k v ~ o t h e s i sbut ~ servai 5ndings suggest a difference in the defenses in\~oive,?in Jeiinquent and aggressive symptoms. The ccrreiations wggest chat delinquent s;mpzcms w r e mcre ccmsistently associated with TAC?,a re1a:innship &so ii7~nciin a stucic of nor& ado'lescenrs (Portncv, 19861. Aggresslii syrzptoms. by coxrast, were mc:e cansisrentli7 associated with FRC. This findi:rg is 6.1rther stlpportej 6;the canonical :orre!a:ions. in which the second c e : ~ c ~ i c acerreiarion I In the girls grottc supported the reiation of FRO u k h aggressive svxptoms. i hese 5r2ings snggest rbar deiinquency may be asso~iatedwith t.he dispiacexenr of cor:C.ic: nrxo neutral ob~ects,resdting in Kchavicrs such as d e x r l y i q properti. and disobeying parents and teachers i~temso n the Delinquerrcv s:aie!. .ttggressi\.e svxptoms, on the ather hand, x a y be related to a prqecthr, of c c n i l z onco others, wh:ch increases :he !ikelihood of aggressii7e hehat.iors s u i t 2 5 a::asking a d rhreateninp others (both items cr! the Aggressive scaie' !fsxih a reiati~n. .. 5 x 2 beccxnes a consisten: i:niiing, ir cooid be important [or h ~ the ~ p rh~ & i t i o z
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a d :he :rearmen: oi aggressh-e and de',inq:,lent svrnpmns. The Lack of gender d:$erence5 ir; the resu!:~. is another noca'rie findine. Significant differences Serweer: mais and femaie sobjects on the DhG ha.\.e been ronsiscent1)- repclrred. Across sanpies. men score highe: on h e deier,se ciT.kO , , .. and PRG, wherea~woner: score higher o n PRN (Zramer, i5.iiei.lcj & . ,' Gieser, 14861. In e study dsing the aduit form oi the DL4 w:h adclescents (Cramer, 13791, sirniiar gender difference. were repor:ed. Spe~ifiiali~., .;he Faies in h e sampie scored sgnificantly higher on T h o , PRC. a: FKX, and the iemaies scored signiiicantIy higher on IAS. B!: contrast, nc: s~gnlficantdifferences were fcriind between t5e maies and fenales :no x s x q k on 2s)' ofrhe five . , defense scales. This finding suppixs the nvpcrthesir that rhe iexaies 2nd naies ir: cwr sampie are more similar by 1;irtse oi their patient s:a:as than &pi- ?re differen: by virt;~eof gender differences. . Althoqi?, there was no first-order effect oigender oz the irkem detense score:., :here were g2ndsr Ji8eie:encec:in the relation between svmp:c?ms and :kkises. A i t h a g h there was consirierabie smilarity 'Seen-ees the pattern of coreiations ir: * . . .-. :be male an,! fernale groups, manv more s~gnrirczctEndings ;vex kx:nJ In the , . :eveale? +e.T :, d..e group. The finding nf the cznocicai correlation,, ir! par:~cu;zr. I-j--:, sigdjcant association between the s v x ~ t o r ; and ! defense 3 e a s x e s kt the -F
?
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female sample, as a whoie, than in the =ale sample. The findings of severai other sruciies (Frank et a!., 1984; Gieser & Sacks, 19'7.3) also suggest that the relation of the DMI to orher variabies is significantlv affected by gender. Nonetheless, the focus in the DX4I literature on gender has remained on the differences bemeen group means. Our findings arid those of the cited studies suggest a more complex picture, in which gender exerts its iniluence primarily through the relationship between defenses and other behavioral and personality variabies. It might appear reasonable to question whether the findings of chi!: srrldy refiect a tautoiogy, :r, u+kh the same cjuestions or xems char lead to assigning a defense also lead to a synpcom score. Th:s is, in fact, not the case. Although the defenses are cier~vedfrom hypothetical siemmas arid tap the fi-ame of reference that an aiiolescenr app&esto a hypothetical interpersonal conflict, the symptom scores are derived from. descriptions o i ciiscrete and actually occurring behavmrs in the adoHescent's life. The relationships bemeen symptoms and defenses, thus, argue for a link herween a broader srrbjective framing of reality and maiadaptive behaviors. Should this link become a consistent hd:ng, it would no: only proiride the necessarr empiricai evidenc.~f a some of the chicai-theoreticai ideas regarding defenses but would also proGde an avenlae for studying specific and discrete symptoms and behaviors ir. relationship to broader persor,al~ty variabies. This c o d 6 heip overcome some or' the typical ciichotomies berween the study of behavioral and ~~ersonality dimensions that are so prevalent :r: psychology an2 psychiatry. 7 r o investigate this link, establishing the vaiidiry of the measures used is of central importance. O c r findings refiect positiveiy OR the validicy of the ymth version of the Dh?I. The adolescent form is closelir based on the originai adult form, but it has not been as thoroughly invest~.gated.Earlier studies of adoiescenrs using :he DM1 h v e rypicaliy used :he adzit forzns (Cramer, 1999; Gieser, Winget, C4, Seiigman, 19?9;Horr., 1973). Aithosgh che mama! presenrs normative data from these and other studies s i n g high school and cciiege samples, it presents as.vaiidatisr: srrlciies specific to the adolesce~tform. Because of this void, 1hiiev;ch an8 GIeser (1986) stressed the need to restrict the use ofthe youth w-sian to research psrposes. The preponderance of evidence $om our study supports :he vaIiciit\- of the DMk. F ~ r t h e rinvestigations with new samples will be required to examine the relationship of iietenses an2 symptoms using parent and c i ~ n r c ~ areports. c an psvchopzthsiag) as iveli as w r h n a n p a t h o i o g d saxpies. Perhaps most important, :he roie of defense processes and svmpcomatrc behmmrs TXG need ro he placed m the con:ext of lcngltudinal srud~esto observe the associamn between changes of symptoms and defenses as weEi as d:nicai outcome. Invest~gat~ons usrng the DMk, behavmr checkiists, and developme~tai measures, such as cognitive and ego deveiopmcnt measures, may he'i~to ~Ilurninstefarther rhe reistionshp berween s\7mptoms and defenses because larger developmental processes mav snderlie both the defense and symptom FatTerns: ear!ier s ~ d i e suCport s szch a hvpothes~s..For exam&, our invesqa-
:ions have demonstrated that many symptom groupings are sign~ficaxiyrelated t 3 ego development: (Noam er a!.. 1984) and t c cognitive and rnorai development (Nozm. Didisheim, & Recklitis, i985!. Studies h a w aisc shown that defenses are significantly associated wth both ego and moral developclear iNoarn, 19S41. hlapping rhe three-wav relacionship between deveiopmentsi le~,eI,svmproms. and defenses from a 1ocgit:~dina;perspective is ar: importan: step irLo:.:r present research efforts buiiding o c the fndings presented in this arcrcie.
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We thank Sara M:sch and GopeIanci Young for helping with earlier drafis of :his arricie. Drs. John Mouiihan and Robert tiarrisor. gave exceilent methn3ological advice. S o p h e Bars:, D a d Evans, and other members of the taborarorv of Deveiopnen:al Psychoiogc and Developmental Psychopathoing:. at !&Lean Hospital a d H a r v a d htedicsl Schod przvicied us with ~nsigh-4 L L 1 ~ co~nmcnts. .
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Cramer. F. (1988).The Eefense Mechanism Inventory: A review of research and discussion oi:he scales. Joumai 0.f Fe~sonal~ty Assessment, 52, 142- 164. Donovanl D. W., E?ohsenow, D. J., Schan, E. J., & O'Leary, M. R. [197:!. Detensive styles in aicoholics and nonaicoholics. Journal oj Studies on Aicohd, 38, 465-4?0. Frank, S. I.? McLaughkn, A. M., &a Crusco. A. (i984). Sex role attrihtes, symptom distress, and defensive sqie among college mer. a& women. joum! of Persodit> and Social Psyc:wlo~,47, 182-192. Freud, A. (19661. The ego and the meckn~smsof &fme New York: Internatmnal Universities Press. (Driginal work puhiished 19373 Gleser, G. C., &a ihiievich, 9. (1969). An objective instrsment for measuring defense mechanisms. Journal of Consuldng and Cliniml Psychology, 33. 51-60, Gleser, 6 . C.: &. Sacks. M. (1973:. Ego defenses and reaction tc stress: A validation study of the Defense Mechanisms Inventory. Joumai of Consuiting and Clinicai Psychdoe, 40, 181-187. Glese:, C-. C., Winget, C., 6r Seligman, R. (1979). Content scaling of affect is adolescent speech sampies. ioumz! (;!' \.'outir Adolescence, 8. 283-297. Gordon, N. 6.. & Erackney, E. E. (1979). Defense mechanism preference and dimensions of psychopa:hoiogy. .Fsychciogzca! Reprts: 44, i88-19C. Haan. hi. ( l S T ) . Coping and defending New York: Academic. Horn: C. M. (1973). The relationship betweer. cognitive con:rois and defenses. Disserrat~or.Abstxzts ir.tema:lotwi, 34. 4 l3b. (University Microfiims No. 73--170:2) Ihiievich, 3.: & Gieser, G C. (197i). Relationship of defense mechan~sms tc fieid dependence-independence. jounur! of Abnowd Rycbiog?., 77,296-362. Ihiievich, D., & Gieser, G.C. (1933. Defense mechanisms Owosso, Mi: DM1 Associates. Jacobson, A., Beardsiee. V., Mauser, S., Noam, G., Sr Powers, S. (1986).An approach toevaluating arioiescenr ego defense mechan:sms using clmicai inre:views. In G. Vaiiiant (Ed.), Empirical studies of egG mechrrzism .Jli tefense (pp 48-59]. Washingron. DC: American Psvchiatrk Press. Juni, S. (i882i. The composite measilre of the Defense hlechanisins Inventory. Journa! of Research in Personaliry. 16; 193-200. k n i , S., k Masling. 3. (1980h Reaction to aggressioo and rhe Defense Mechanisms Iwentory. h m d of Fersoilali~,4ssessment, 44, 484-480. Kelier, M. (1980). Soziaie Kognicion, Moralisches Urteii und ich-Prozesse [Sociai cognition, morai judgment. and ego processes]. ir. L. I-!. Eckensberger 5r R. K. Silbereisen (Eds.), Entwiciclur~g sorialer Kognit~onen:.~odelk, Tneon'er:, Metbiien, .4nuiedung (pp. 163-183). Stuttgart, West Germanv: Kietc-Cottz. Kernberg, 9. (1975;. Eorderiine coditions and pathological narcissism. New York: Aronson. Levine, M. S. (IE77i. CanonlcaL analysis and jhctor comparison. Beverly E-iills: Sage. Massong. S. R., D~ckson,A. i.: Ritzier, E.-4.: Sr Laynt. C. C . (1982). A correiationai comparison of defense mechznisrn measures: The Defense h'lechanism !nren:orv and the Blackv Sfense Preference inventory. .lournu! of Peersom!rt? Assessment: 46, 477-4%. htilion. T. (1984). Or. rhe renaissance of personakp assessment an3 personality theory. . l o u d of Personality Assessment, 48:45-3-455. Woam, G. 119841. Seif, momlity cad biog~aphy:Studies in clinical-dec!eio.~menrat psychology. i!npblished doctoral dissertation: Harvard University, Noam, G., Didlsheim, D,, & Reck!itis, C. (1955,,idy). Cogntcior and morai deveiopmenr in reiationship to synptoms ir. G group of adoiescent patients. Paper presented at the meeting of the International Society for the Study of Behavioral Development, Tours, France. Noam, 6.. Hauser, S.. Santostefano. S.: Garrison, W", jacobsoz, A.: Powers, S.? 6r Mead, 94. (1986;) Ego development and psgchopathoiogv: .A st& oi hospitalized adoiescents. Chiid Development, 55. 18"-194. Perry, j. C., &a Cooper, S. H.(1986). What do cross-sectional rneasires oi defense mechanisms predict? in 6. Vaillant (Ed.!, Empirical studies oj ego me&anisn:s oj'defeme (pp 31.-46). Washington, DC: Amerrcar. Psvchw.tric Press.
DEFENSES LI: ADOLESCEh" PSYCh-IOPATPfOt@GY
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?ortnoy, ii. X. (1986.Ego defenses as a predictor oideterrencc Disserra:io.i ibs:rc:! i n c m t ~ o d . 47, 2183b. {U~.!versityMicrofiims No. 86-14412 Prelinger. F.. & Zimet. C. ii9M). Ar. ego p.r;cioIogiid appo6lci; t c c b i w ~ ~~sessmrn:. ~7 Giencix. iL. Free Press. Qllav. H.C., 6: C&mv,L.C . ~1W.53Shavior probiems in ear!!. adoiezienze. Ciri;di3rc.eio.pme.it. 36:
2 15-23. Rohsenoa:, I).j., Erickson. k.C.. 5i P ~ e a r vEvi. . r\. i 2978. The Defense klechan~srr,i n v e n r x ~en2 alcohoiics, Inretmtiond jmnd of the Ajiicrmr~~, 2.423-41". Ross, j.M.! &Johnson. R. W. (:Q"i. Social-evaiuation zroxeiy and deiensn.e s~yie.P::.;LiOiog~iil; 2 e . w ~38, . 1575-1278 Scholz, j. A. i!'T?l. Defense stvles :n su~cidea:ter.pters j o u d o,?Concui::ng awi . d n i c d ?5:.ibh9?. 41, 73-73. Schuefer, D. E. (I98Li. Defensive ?reference. p:emo:Srd adjusxnent 222 the schizophrenic s i r r r : p toms. Drcsmarror, Absrmts ! n r m t ~ m d :42, II?JB. (,Ln~versi:ykticrofrinr No. 5,1-;4f.::! Schueier. 3. E., tierroz, W. G., & Poland, H V. (L962: Defense mcchan:sms in reacrive an5 process schizophrenics. lac& !,1: Clinrzd Fs:;cbio~.3E. 486-4F. Shapra, 3. ;I965). Natrodc s ~ i e sNen . York: Basic. , . Siei, bl. N.,5r Atitins, .4. L. i1979:. Some defensive and cognitive aspem of ?hobias. .imnnr q . & n o d ?.ycho!op, %. '72-5; .. :'zlllant. S.E. :1877!. Adcpa:lor. to Iife.Baston: L!tcie, Yxwn. V eiliant . G. E.\!3Sdi. T'he disadvaxaget of 39.4-!:A wiirweigt; s:: aSvantages. Amrncnr, journat 0:' ?:+at?, i4il 4 2 - 5 4 . .bsilianr, , G.E. ( M i . (iQ86:.Enp.p:nzds d i e r n j ego ~ e c h i s m3: &iEje~ue. '&ash:ngton. DC Anericac Psvchiacric Press. \"&xi,]. F. ;l?S::. Recovery from surgery an2 scores or. t . 5 Defense ~ hkiS.an:srr; hsentar!. . i o ~ ~ : w : of F s s o d : > Anessmmc, 46,ji'i-3;9.
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.(s.
Cil G. Xoarn l-iaIi,hiercer Lzboratoru of Developmental 17svchoiogYand Deveiopmental Psvchopathoiogy f-l~rvardM e d d School-McLean 1 15 lvfiil Scree: Belmanr , h4A 1331 2
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The Relationship Between Defenses and Symptoms in Adolescent Psychopathology Gil G. Noam & Christopher J. Recklitis Published online: 22 Jun 2011.
To cite this article: Gil G. Noam & Christopher J. Recklitis (1990) The Relationship Between Defenses and Symptoms in Adolescent Psychopathology, Journal of Personality Assessment, 54:1-2, 311-327 To link to this article: http://dx.doi.org/10.1080/00223891.1990.9673996
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The Relationship Between Defenses and Symptoms in Adolescent Psychopathology Gia G. Noam and Christopher J. Recklitis ffarvarif .?.fedicd School and Mcbxan Hospital
7.
I 3e reiacionship between defense mechanisms and symptoms was assessecj in a group oi 196 psychia:r:cziiv hospitalized adoiescects. Defense mechanisms were z~easuredthrough rhe use of the Defense Mechanisms inventorr :Dh\.'II!:svrr,ptorns and prohlerr: behaviors mere measured wi:h :he Y o x h SelfiRepmt. Lniiar:a:e and mt;itivaria:e anaiyses indicarecl that externalizing symptoms are assocmed wirh defenses tinat locate :he confiic: olitside of' the self, whereas :nternzliilng svmptoxs are associated with defenses that locate the conflic: within :he self !r, cc)n:rast tc. previous reports, no gender differences were f ~ u n dI: defense ?reference, t h o ~ g kgende: differences were found in :'he reiatier. of deimses :o svmp
toms. The 5ndings are consistent with clinical theory
ni defense prscesses and
support the cilstinctmn Serween interna!i~:ng~'exteri~aiizing behaviors and pe~sonaiity disensions for both sy:xp:omr and defenses. The studv suppx:s :he 1-z!id:ru of rbe adoIescent form of the DhU.
Ir is a wideiy held i r k s : in clinical cirfies that defense mechanism. and srmpcoms are ciosely relared. Macv ciinical reports actest tc chis perspecrive :ha: originared wirh FreuiZts early concep:ital:za:ions. In the psi-c'hoanz1;:ic traditior, since :henT defenses have been an important too1 In understanding the development o i psycRopatholog7;. In particular: Anna Freud's ( 1 ? 5';; 1966)derailed cat~ioging . of defenses has inspired a variety of m o d e n attempts co s:lidy the role of defenses ir: psrchopathcriogy !e.g., BeIlack, PIurvicIrl Sr Gediman. 199.3: Prelinger & Zimec, 1064). h a p k c ' s (1965) now-classic n o n o g a p h relanng ' L ~ ~ e i i styIesn r ~ t i ~ to the:? characterisric defense mechanisms 2nd Kern'berg's (i975! e s a m i ~ a t i o no i t h e roie of defenses in characten pathoiogy are exampies of rhe cxnrinue? reiiance on h e concept. of defense in ?he underscanding of symptoms. As interest in th:s area Bas grown, the krLpiickdevebpment-a1 idezs of d e h s e s : in ~sychoana!ysis have been made expilcit in a variety of theories and
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studies. Most important, Vaillant (1977) defined a developmentai hierarchy of defenses that are related to levels of psychopathology (from psychotic defenses through character-disordered and neurotic defenses to mature defenses). Furthermore, researchers have introdaced other developmental principies, such as cognitive, moral, and ego development, as relevant to both defenses and psyzhopathoiogy (e.g., Haan, 1917; Noam, 1984). Although chere have Seen conceptuai, ciinical, and empirical advances in uncovering the role of defenses in pathology, few stuciies have empirically demonstrated this relationship. A recent research monograph, devoted to measurement issues of defense mechar&ms (Vai?,larrt,2985), emphasized the difficult technical problems, such as precision of definitions and reliabiliries! that continue to chalienge researchers. Despite these difficulties, there is an increasing awareness in psychology and psychiatry of the need to incorporate defenses more fornaiIy into personality and diagnostic assessments. Millon (l984j, for example, argued that a systematic assessment of defense mechanisms 'Ps central to a comprehensive personaiity assessment" {p. 460). VaiIlant (1984) argued for the necessity of evaluating defense mechanisms in forrnulati~gre&:ab'aepsychiatric diagnoses. The recognitior, of this need has led tu the indusion of a lexicon of defense mechanisms in ehe recent revision of the Diagnostic ard Statistical Manual of Mental Disorclen (3rd ed., rev. [DSM-ZII-Rl, American Psychiarric Association, 1983. However, krther systematic research is essential if defenses are so be rneaniragfulfy integrated. into personality and diagnostic applications and investigation.
ASSESSING DEFENSE PROCESSES The increased interest in the empiricai study of defenses has led to only a few empirical reports s n the relationship between defenses and symptoms. Of the studies conducted, some have no: found an empirrcal relationship between psychopathology and defenses. For example, on the basis of studies with a newly developed measure, Bond and Vaillant (1986) argued that deienses are not reiated to psychoparhology. However, their conclusion is c h w n from their study examining differences between chartderived diagnostic groups. Recent advances in empirically deriving diagnostic categories by way of structured interviews (e.g., Costello, Edelbrock, Dulcan, Kaias, G,Klaric, 1984)provide the opportunity to investigate the relationship between defenses and psychopathology more reliably. However, the diagnostic paradigm, which identifies categories of psychopz
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Given the progress in the deieiciprner;: of empkicai methods of stud?-ing . , . , defenses and rise m a w sradies conducted usmg the ZMI, it 1s sur7r:si:ip :hat iew
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NOAM AND RECKLITIS 7.4BLE 5 Canonrcal Correlation of the Defense and Broad-Band Sympt~nrScriies Cun~mralCo-;e:acm~
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Defenses
TAC PRO PRK TAS Syrnpto~.~
Inrernalizing
Exrernalizing
empirical reports Lave demonstrated t i e relaticnship hetween defense mechanisms and ciinical symptoms (Ihilevich & Gieser , 1986).This Iack of evidence is especialEy apparent in research concerning adolesce~ts.Crzmer's (1088) extensive review of :be DMI cted no studies using the adolescent form. Our st&? ~ 0 n t r i ' ~ uco t e the ~ research iiterature nn defense mechanisms both bjl assessing the new For= oi rhe DMH and bv demonstraring rciatiomsizip patterns betweerr defenses arid symptoms. Our findings s ~ p p c r ithe distinction herween internaiizing/externaiizing processes cha: has become increasingly important ra aaoiescent research , The ccrrelations s u ~ p o r the t hypothesis that (.4cheni?ach. i382; C ~ w a n 1975). persons using defenses that locate ccnflict outside :he seli (TAO and PRO) dispiay mere externalizing, aggressive symptom behaviors, The resdts aisc reveal that individ~aiswho use defense mechanisms that locate cnzflict within the seli {TAS),report more internalizing (depressed in giris, anC seii-destructive i~ 'boy) symptoms.. Both these findings gain fi~rihcrsupport from the mere srringent: xulrivariate analyses which demonstrated that when :he shared variance of each set of measures is accmnted for, there are stJE sever2 significant relationships between the defenses acd syrraprorn measures and cha: these relacionships are ir; iiae with o w hypotheses. Airhough many resuirs biiowed theorericai prcciictjcns: some did not. ?!e ,. . predicted tha: PRW and -PAS wonld br associated with internairzng syxproms, because both these defenses deal with conflict: internally. Unlike the TXS scslr, howevert the PRW scale was not significa~ti.; associated u-irh internaiizing C . behaviors. Like the KEV scale, it was associate2 with a general lack or ali . ,, symptoms. Although :his finding is coztrarr to o.ur hyporhesis. ii is s~miz:.to a finciing repcrted by Frank: M~Eaughiin,arid C r s c o (1984).In their study of colkge srudents, :hey reported that bn:h PXN and REV were negatively correlzted with iwel of symptom dlstress. These findings suggest thar the
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..
reversal and principalizi~g defenses c d d be related mere :o ae;;.!si of .. . spmporns rvpicai s y m ~ t ~ m a i o i o gthan ) : to the internalized and intel~ectzailze~ . . n i cie~ressionor obsessive-comp~Is:vebehavior, Alternamreii, It c o d mean ,. that these deienses rr.ay be particslsrlv suited t e rprever.ting suqects frcm e x ~ e p i e r k n gpsvchoiog:caI discomfort or syrnpr-ms, as Crerrier (1962) szggested. A n interesting and unanricipaced finding suggests 2 dist:nxioc bet wee^ aggressive and deiinrjuent si7mptorns.According ro our original hyp~thesis? we wauid hzve expecred both aggressive en2 delinquent s m - i p x n s :o be assocrated with "0 and TAO. Overa!l. the resdts szpporred this k v ~ o t h e s i sbut ~ servai 5ndings suggest a difference in the defenses in\~oive,?in Jeiinquent and aggressive symptoms. The ccrreiations wggest chat delinquent s;mpzcms w r e mcre ccmsistently associated with TAC?,a re1a:innship &so ii7~nciin a stucic of nor& ado'lescenrs (Portncv, 19861. Aggresslii syrzptoms. by coxrast, were mc:e cansisrentli7 associated with FRC. This findi:rg is 6.1rther stlpportej 6;the canonical :orre!a:ions. in which the second c e : ~ c ~ i c acerreiarion I In the girls grottc supported the reiation of FRO u k h aggressive svxptoms. i hese 5r2ings snggest rbar deiinquency may be asso~iatedwith t.he dispiacexenr of cor:C.ic: nrxo neutral ob~ects,resdting in Kchavicrs such as d e x r l y i q properti. and disobeying parents and teachers i~temso n the Delinquerrcv s:aie!. .ttggressi\.e svxptoms, on the ather hand, x a y be related to a prqecthr, of c c n i l z onco others, wh:ch increases :he !ikelihood of aggressii7e hehat.iors s u i t 2 5 a::asking a d rhreateninp others (both items cr! the Aggressive scaie' !fsxih a reiati~n. .. 5 x 2 beccxnes a consisten: i:niiing, ir cooid be important [or h ~ the ~ p rh~ & i t i o z
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a d :he :rearmen: oi aggressh-e and de',inq:,lent svrnpmns. The Lack of gender d:$erence5 ir; the resu!:~. is another noca'rie findine. Significant differences Serweer: mais and femaie sobjects on the DhG ha.\.e been ronsiscent1)- repclrred. Across sanpies. men score highe: on h e deier,se ciT.kO , , .. and PRG, wherea~woner: score higher o n PRN (Zramer, i5.iiei.lcj & . ,' Gieser, 14861. In e study dsing the aduit form oi the DL4 w:h adclescents (Cramer, 13791, sirniiar gender difference. were repor:ed. Spe~ifiiali~., .;he Faies in h e sampie scored sgnificantly higher on T h o , PRC. a: FKX, and the iemaies scored signiiicantIy higher on IAS. B!: contrast, nc: s~gnlficantdifferences were fcriind between t5e maies and fenales :no x s x q k on 2s)' ofrhe five . , defense scales. This finding suppixs the nvpcrthesir that rhe iexaies 2nd naies ir: cwr sampie are more similar by 1;irtse oi their patient s:a:as than &pi- ?re differen: by virt;~eof gender differences. . Althoqi?, there was no first-order effect oigender oz the irkem detense score:., :here were g2ndsr Ji8eie:encec:in the relation between svmp:c?ms and :kkises. A i t h a g h there was consirierabie smilarity 'Seen-ees the pattern of coreiations ir: * . . .-. :be male an,! fernale groups, manv more s~gnrirczctEndings ;vex kx:nJ In the , . :eveale? +e.T :, d..e group. The finding nf the cznocicai correlation,, ir! par:~cu;zr. I-j--:, sigdjcant association between the s v x ~ t o r ; and ! defense 3 e a s x e s kt the -F
?
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female sample, as a whoie, than in the =ale sample. The findings of severai other sruciies (Frank et a!., 1984; Gieser & Sacks, 19'7.3) also suggest that the relation of the DMI to orher variabies is significantlv affected by gender. Nonetheless, the focus in the DX4I literature on gender has remained on the differences bemeen group means. Our findings arid those of the cited studies suggest a more complex picture, in which gender exerts its iniluence primarily through the relationship between defenses and other behavioral and personality variabies. It might appear reasonable to question whether the findings of chi!: srrldy refiect a tautoiogy, :r, u+kh the same cjuestions or xems char lead to assigning a defense also lead to a synpcom score. Th:s is, in fact, not the case. Although the defenses are cier~vedfrom hypothetical siemmas arid tap the fi-ame of reference that an aiiolescenr app&esto a hypothetical interpersonal conflict, the symptom scores are derived from. descriptions o i ciiscrete and actually occurring behavmrs in the adoHescent's life. The relationships bemeen symptoms and defenses, thus, argue for a link herween a broader srrbjective framing of reality and maiadaptive behaviors. Should this link become a consistent hd:ng, it would no: only proiride the necessarr empiricai evidenc.~f a some of the chicai-theoreticai ideas regarding defenses but would also proGde an avenlae for studying specific and discrete symptoms and behaviors ir. relationship to broader persor,al~ty variabies. This c o d 6 heip overcome some or' the typical ciichotomies berween the study of behavioral and ~~ersonality dimensions that are so prevalent :r: psychology an2 psychiatry. 7 r o investigate this link, establishing the vaiidiry of the measures used is of central importance. O c r findings refiect positiveiy OR the validicy of the ymth version of the Dh?I. The adolescent form is closelir based on the originai adult form, but it has not been as thoroughly invest~.gated.Earlier studies of adoiescenrs using :he DM1 h v e rypicaliy used :he adzit forzns (Cramer, 1999; Gieser, Winget, C4, Seiigman, 19?9;Horr., 1973). Aithosgh che mama! presenrs normative data from these and other studies s i n g high school and cciiege samples, it presents as.vaiidatisr: srrlciies specific to the adolesce~tform. Because of this void, 1hiiev;ch an8 GIeser (1986) stressed the need to restrict the use ofthe youth w-sian to research psrposes. The preponderance of evidence $om our study supports :he vaIiciit\- of the DMk. F ~ r t h e rinvestigations with new samples will be required to examine the relationship of iietenses an2 symptoms using parent and c i ~ n r c ~ areports. c an psvchopzthsiag) as iveli as w r h n a n p a t h o i o g d saxpies. Perhaps most important, :he roie of defense processes and svmpcomatrc behmmrs TXG need ro he placed m the con:ext of lcngltudinal srud~esto observe the associamn between changes of symptoms and defenses as weEi as d:nicai outcome. Invest~gat~ons usrng the DMk, behavmr checkiists, and developme~tai measures, such as cognitive and ego deveiopmcnt measures, may he'i~to ~Ilurninstefarther rhe reistionshp berween s\7mptoms and defenses because larger developmental processes mav snderlie both the defense and symptom FatTerns: ear!ier s ~ d i e suCport s szch a hvpothes~s..For exam&, our invesqa-
:ions have demonstrated that many symptom groupings are sign~ficaxiyrelated t 3 ego development: (Noam er a!.. 1984) and t c cognitive and rnorai development (Nozm. Didisheim, & Recklitis, i985!. Studies h a w aisc shown that defenses are significantly associated wth both ego and moral developclear iNoarn, 19S41. hlapping rhe three-wav relacionship between deveiopmentsi le~,eI,svmproms. and defenses from a 1ocgit:~dina;perspective is ar: importan: step irLo:.:r present research efforts buiiding o c the fndings presented in this arcrcie.
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3
We thank Sara M:sch and GopeIanci Young for helping with earlier drafis of :his arricie. Drs. John Mouiihan and Robert tiarrisor. gave exceilent methn3ological advice. S o p h e Bars:, D a d Evans, and other members of the taborarorv of Deveiopnen:al Psychoiogc and Developmental Psychopathoing:. at !&Lean Hospital a d H a r v a d htedicsl Schod przvicied us with ~nsigh-4 L L 1 ~ co~nmcnts. .
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Cramer. F. (1988).The Eefense Mechanism Inventory: A review of research and discussion oi:he scales. Joumai 0.f Fe~sonal~ty Assessment, 52, 142- 164. Donovanl D. W., E?ohsenow, D. J., Schan, E. J., & O'Leary, M. R. [197:!. Detensive styles in aicoholics and nonaicoholics. Journal oj Studies on Aicohd, 38, 465-4?0. Frank, S. I.? McLaughkn, A. M., &a Crusco. A. (i984). Sex role attrihtes, symptom distress, and defensive sqie among college mer. a& women. joum! of Persodit> and Social Psyc:wlo~,47, 182-192. Freud, A. (19661. The ego and the meckn~smsof &fme New York: Internatmnal Universities Press. (Driginal work puhiished 19373 Gleser, G. C., &a ihiievich, 9. (1969). An objective instrsment for measuring defense mechanisms. Journal of Consuldng and Cliniml Psychology, 33. 51-60, Gleser, 6 . C.: &. Sacks. M. (1973:. Ego defenses and reaction tc stress: A validation study of the Defense Mechanisms Inventory. Joumai of Consuiting and Clinicai Psychdoe, 40, 181-187. Glese:, C-. C., Winget, C., 6r Seligman, R. (1979). Content scaling of affect is adolescent speech sampies. ioumz! (;!' \.'outir Adolescence, 8. 283-297. Gordon, N. 6.. & Erackney, E. E. (1979). Defense mechanism preference and dimensions of psychopa:hoiogy. .Fsychciogzca! Reprts: 44, i88-19C. Haan. hi. ( l S T ) . Coping and defending New York: Academic. Horn: C. M. (1973). The relationship betweer. cognitive con:rois and defenses. Disserrat~or.Abstxzts ir.tema:lotwi, 34. 4 l3b. (University Microfiims No. 73--170:2) Ihiievich, 3.: & Gieser, G C. (197i). Relationship of defense mechan~sms tc fieid dependence-independence. jounur! of Abnowd Rycbiog?., 77,296-362. Ihiievich, D., & Gieser, G.C. (1933. Defense mechanisms Owosso, Mi: DM1 Associates. Jacobson, A., Beardsiee. V., Mauser, S., Noam, G., Sr Powers, S. (1986).An approach toevaluating arioiescenr ego defense mechan:sms using clmicai inre:views. In G. Vaiiiant (Ed.), Empirical studies of egG mechrrzism .Jli tefense (pp 48-59]. Washingron. DC: American Psvchiatrk Press. Juni, S. (i882i. The composite measilre of the Defense hlechanisins Inventory. Journa! of Research in Personaliry. 16; 193-200. k n i , S., k Masling. 3. (1980h Reaction to aggressioo and rhe Defense Mechanisms Iwentory. h m d of Fersoilali~,4ssessment, 44, 484-480. Kelier, M. (1980). Soziaie Kognicion, Moralisches Urteii und ich-Prozesse [Sociai cognition, morai judgment. and ego processes]. ir. L. I-!. Eckensberger 5r R. K. Silbereisen (Eds.), Entwiciclur~g sorialer Kognit~onen:.~odelk, Tneon'er:, Metbiien, .4nuiedung (pp. 163-183). Stuttgart, West Germanv: Kietc-Cottz. Kernberg, 9. (1975;. Eorderiine coditions and pathological narcissism. New York: Aronson. Levine, M. S. (IE77i. CanonlcaL analysis and jhctor comparison. Beverly E-iills: Sage. Massong. S. R., D~ckson,A. i.: Ritzier, E.-4.: Sr Laynt. C. C . (1982). A correiationai comparison of defense mechznisrn measures: The Defense h'lechanism !nren:orv and the Blackv Sfense Preference inventory. .lournu! of Peersom!rt? Assessment: 46, 477-4%. htilion. T. (1984). Or. rhe renaissance of personakp assessment an3 personality theory. . l o u d of Personality Assessment, 48:45-3-455. Woam, G. 119841. Seif, momlity cad biog~aphy:Studies in clinical-dec!eio.~menrat psychology. i!npblished doctoral dissertation: Harvard University, Noam, G., Didlsheim, D,, & Reck!itis, C. (1955,,idy). Cogntcior and morai deveiopmenr in reiationship to synptoms ir. G group of adoiescent patients. Paper presented at the meeting of the International Society for the Study of Behavioral Development, Tours, France. Noam, 6.. Hauser, S.. Santostefano. S.: Garrison, W", jacobsoz, A.: Powers, S.? 6r Mead, 94. (1986;) Ego development and psgchopathoiogv: .A st& oi hospitalized adoiescents. Chiid Development, 55. 18"-194. Perry, j. C., &a Cooper, S. H.(1986). What do cross-sectional rneasires oi defense mechanisms predict? in 6. Vaillant (Ed.!, Empirical studies oj ego me&anisn:s oj'defeme (pp 31.-46). Washington, DC: Amerrcar. Psvchw.tric Press.
DEFENSES LI: ADOLESCEh" PSYCh-IOPATPfOt@GY
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?ortnoy, ii. X. (1986.Ego defenses as a predictor oideterrencc Disserra:io.i ibs:rc:! i n c m t ~ o d . 47, 2183b. {U~.!versityMicrofiims No. 86-14412 Prelinger. F.. & Zimet. C. ii9M). Ar. ego p.r;cioIogiid appo6lci; t c c b i w ~ ~~sessmrn:. ~7 Giencix. iL. Free Press. Qllav. H.C., 6: C&mv,L.C . ~1W.53Shavior probiems in ear!!. adoiezienze. Ciri;di3rc.eio.pme.it. 36:
2 15-23. Rohsenoa:, I).j., Erickson. k.C.. 5i P ~ e a r vEvi. . r\. i 2978. The Defense klechan~srr,i n v e n r x ~en2 alcohoiics, Inretmtiond jmnd of the Ajiicrmr~~, 2.423-41". Ross, j.M.! &Johnson. R. W. (:Q"i. Social-evaiuation zroxeiy and deiensn.e s~yie.P::.;LiOiog~iil; 2 e . w ~38, . 1575-1278 Scholz, j. A. i!'T?l. Defense stvles :n su~cidea:ter.pters j o u d o,?Concui::ng awi . d n i c d ?5:.ibh9?. 41, 73-73. Schuefer, D. E. (I98Li. Defensive ?reference. p:emo:Srd adjusxnent 222 the schizophrenic s i r r r : p toms. Drcsmarror, Absrmts ! n r m t ~ m d :42, II?JB. (,Ln~versi:ykticrofrinr No. 5,1-;4f.::! Schueier. 3. E., tierroz, W. G., & Poland, H V. (L962: Defense mcchan:sms in reacrive an5 process schizophrenics. lac& !,1: Clinrzd Fs:;cbio~.3E. 486-4F. Shapra, 3. ;I965). Natrodc s ~ i e sNen . York: Basic. , . Siei, bl. N.,5r Atitins, .4. L. i1979:. Some defensive and cognitive aspem of ?hobias. .imnnr q . & n o d ?.ycho!op, %. '72-5; .. :'zlllant. S.E. :1877!. Adcpa:lor. to Iife.Baston: L!tcie, Yxwn. V eiliant . G. E.\!3Sdi. T'he disadvaxaget of 39.4-!:A wiirweigt; s:: aSvantages. Amrncnr, journat 0:' ?:+at?, i4il 4 2 - 5 4 . .bsilianr, , G.E. ( M i . (iQ86:.Enp.p:nzds d i e r n j ego ~ e c h i s m3: &iEje~ue. '&ash:ngton. DC Anericac Psvchiacric Press. \"&xi,]. F. ;l?S::. Recovery from surgery an2 scores or. t . 5 Defense ~ hkiS.an:srr; hsentar!. . i o ~ ~ : w : of F s s o d : > Anessmmc, 46,ji'i-3;9.
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.(s.
Cil G. Xoarn l-iaIi,hiercer Lzboratoru of Developmental 17svchoiogYand Deveiopmental Psvchopathoiogy f-l~rvardM e d d School-McLean 1 15 lvfiil Scree: Belmanr , h4A 1331 2
