MANUAL FOR THE DEFENSE STYLE QUESTIONNAIRE (DSQ)
MICHAEL BOND, M.D. STEVEN WESLEY, M.D.
©Copyright 1996
DEVELOPMENT OF THE DEFENSE STYLE QUESTIONNAIRE
The development of the DSQ has been based on the premise that people are sufficiently aware of the way they respond to situations of conflict and stress to provide information that can 1
be classified as evidence of types of defensive functioning. Bond et al. developed the original version of the DSQ with the objective of assessing conscious derivatives of defensive functioning, the intention being "to elicit manifestations of a subject's characteristic style of dealing with conflict, either conscious or unconscious, based on the assumption that persons can accurately comment on their behavior from a distance". Initially, a pool of statements was designed to reflect behaviors suggestive of the following defense or coping mechanisms: mecha nisms: acting out, pseudoaltruism, as-if-behavior, clinging, humor, passive-aggressive behavior, regression, somatization, suppression, withdrawal, dissociation, denial, displacement, omnipotence-devaluation, inhibition, intellectualization, identification, primitive idealization, projection, reaction formation, repression, splitting, sublimation, and turning against the self. These statements were subjected to an initial initial test of face validity by having two psychologists and one psychiatrist (of whom two of the three are psychoanalysts) to independently match up each statement with its relevant defense mechanism. Only statements on which they all could agree formed the 97-statement 97-statement questionnaire. A sample of 98 patients and 111 nonpatient control subjects were asked to indicate their degree of agreement or disagreement with each statement on a nine-point scale: 1 indicated strong 1
DEVELOPMENT OF THE DEFENSE STYLE QUESTIONNAIRE
The development of the DSQ has been based on the premise that people are sufficiently aware of the way they respond to situations of conflict and stress to provide information that can 1
be classified as evidence of types of defensive functioning. Bond et al. developed the original version of the DSQ with the objective of assessing conscious derivatives of defensive functioning, the intention being "to elicit manifestations of a subject's characteristic style of dealing with conflict, either conscious or unconscious, based on the assumption that persons can accurately comment on their behavior from a distance". Initially, a pool of statements was designed to reflect behaviors suggestive of the following defense or coping mechanisms: mecha nisms: acting out, pseudoaltruism, as-if-behavior, clinging, humor, passive-aggressive behavior, regression, somatization, suppression, withdrawal, dissociation, denial, displacement, omnipotence-devaluation, inhibition, intellectualization, identification, primitive idealization, projection, reaction formation, repression, splitting, sublimation, and turning against the self. These statements were subjected to an initial initial test of face validity by having two psychologists and one psychiatrist (of whom two of the three are psychoanalysts) to independently match up each statement with its relevant defense mechanism. Only statements on which they all could agree formed the 97-statement 97-statement questionnaire. A sample of 98 patients and 111 nonpatient control subjects were asked to indicate their degree of agreement or disagreement with each statement on a nine-point scale: 1 indicated strong 1
disagreement and 9 indicated strong agreement. All scales were constructed such that a high score on any one defense measure/variable indicated the subject to be using that defense (to a significant degree). In a pilot project, 30 patients were tested on this first version of this questionnaire. Internal consistency among statements designed to measure the same defense was assessed through item-to-total correlations. Only statements correlating with their parent group at a significance level of greater than .001 were retained. On this basis, 81 of the the initial 97 questionnaire statements were retained. The hypotheses tested were (1) factor analysis would demonstrate separate clusters of defense mechanisms, i.e., defensive styles, and (2) defenses thought to be immature (such as acting out, projection, withdrawal, and passive-aggressive behavior) would cluster at one end of a continuum, whereas defenses thought to be mature (such as humor, suppression, and sublimation) and would cluster at the opposite end. Results
As in the pilot project, item-to-total correlations were carried out for each question and for the total score of the questions attributed to each defense mechanism in relation to the factor to which it belonged to ensure that reliability had been retained and that the statements still correlated with the other statements in the the relevant defense category. All correlations remained remained at a level greater than .001. 2
Principal component factor analyses (type PA1, quatrimax rotation) were carried out on the 24 sets of defense statements for the entire sample and for the patient and nonpatient samples taken separately. The size of the eigenvalues indicated a four factor solution provided an 2
adequate representation of the data for both the combined group and for the patient and nonpatient samples taken separately. (See Table 1; other data available on request.) Whether the factor analysis was carried out on the combined group or on the patient and nonpatient samples taken separately, the same defenses clustered together.
3
Table 1 Factor Loadings on Defenses (Combined Sample)* ___________________________________________________________________________ Defense Factor Factor Factor Factor 1 2 3 4 _ __________________________________________________________________________ Acting out .76 .11 -.10 -.23 Regression .67 -.01 -.09 -.29 Passive-aggressive behavior .74 .10 -.02 -.09 Withdrawal .75 -.17 -.11 -.05 Projection .69 .31 .02 -.41 Inhibition .69 -.20 .17 -.01 Omnipotence-devaluation .17 .70 -.10 .21 Splitting .38 .60 -.05 -.20 Primitive idealization .36 .54 .36 .15 Pseudoaltruism .33 -.08 .62 .06 Reaction formation .36 -.07 .56 .06 Sublimation -.09 .12 .17 .64 Humor -.14 .02 -.27 .63 Suppression -.10 .02 .00 .62 As-if behavior .62 .05 .07 .32 Clinging .64 .34 .04 .02 Denial .33 .04 .52 -.05 Displacement .49 .15 -.19 .05 Dissociation .63 .22 .15 -.17 Identification .45 .32 .19 .29 Intellectualization .49 -.12 -.11 .33 Repression .53 -.08 .05 -.17 Somatization .56 .19 .11 .10 Turning against self .61 -.26 .02 -.03 ___________________________________________________________________________ * Type PA1, Quartimax rotation.
Defensive style 1 (factor 1) consisted of apparent derivatives of defense mechanisms usually viewed as immature, namely, withdrawal, acting out, regression, inhibition, passive aggression, and projection. All of the above produced factor loadings greater than .65.
4
Defensive style 2 (factor 2) consisted of apparent derivatives of omnipotence, splitting, and primitive idealization. All three loaded greater than .50. Defensive style 3 (factor 3) consisted of apparent derivatives of only two defense mechanisms: reaction formation and pseudoaltruism. These loaded .56 and .62 respectively. Defensive style 4 (factor 4) consisted of apparent derivatives of suppression, sublimation, and humor, all of which loaded at a greater than .50 level. From the original 24 defense mechanisms, the 14 mentioned above were again factor analyzed, resulting in the factor structure and loadings shown in Table 2. The total number of items remaining was 67. Table 2 Factor Loadings of Selected Self-reported Defense Derivatives* ___________________________________________________________________________ Defense
Factor Factor Factor Factor 1 2 3 4 _ ___________________________________________________________________________
Acting out .78 .21 -.02 -.14 Passive-aggression .76 .18 .06 .00 Regression .76 -.05 .10 -.19 Withdrawal .75 -.03 .22 .10 Inhibition .68 -.15 .23 -.01 Projection .69 .39 .06 -.32 Omnipotence-devaluation .06 .75 -.08 .26 Primitive idealization .25 .54 .34 .10 Splitting .29 .70 .06 -.17 Pseudoaltruism .22 -.04 .70 .03 Reaction formation .27 -.01 .60 .08 Humor -.10 -.04 -.27 .70 Suppression -.17 .09 .09 .61 Sublimation -.06 .05 .11 .73 ____________________________________________________________________________ * Quartimax rotation with Kaiser normalization. The developmental level which these defense styles reflected was assessed in a number 5
of ways. Table 3 shows that defense style 1 has a significant negative correlation with style 4, which may indicate that these two styles represent two extreme poles of a continuum of defense adaptiveness. The patient sample had significantly higher mean scores than the nonpatient sample on style 1 through 3 defenses, thought to represent the immmature end of the defense spectrum. The nonpatient sample had a significantly higher mean score on style 4, representing mature defenses. Table 3 Intercorrelations of Defense Styles _____________________________________________________________ Style 2 Style 3 Style 4 _ ____________________________________________________________
Style 1
.39*
.37*
-.28*
Style 2
....
.18†
.07
Style 3 .... .... -.02 _____________________________________________________________ *p‹.001.
Table 4 shows the correlations of the four defense styles with two measures indicative of ego maturity, the Ego Function Questionnaire (EFQ) and the Sentence Completion Test of Leovinger. The relative relationships of these indicates that defense styles 1 through 4 can be ranked in that order; that is, the ego strength score derived from the EFQ has high negative correlation with style 1, a lower negative correlation with styles 2 and 3, and a significantly positive correlation with style 4. The same pattern holds for the ego development score (the 6
Loevinger test). When the ego strength and ego development scores were factor analyzed (type PA1, quartimax rotation) along with the separate defenses that constitute the four defense styles, a four-factor solution resulted with the ego strength and ego development scores loading negatively with style 1 defenses and positively with style 4 defenses. Table 4 Correlations of Defense Styles With Loevinger's Ego Development and Ego Strength Measures of Brown and Gardner* ________________________________________________________________ Defense Defense Defense Defense Style 1 Style 2 Style 3 Style 4 ________________________________________________________________
Ego strength
-.91†
-.37†
-.38†
.32†
Loevinger's ego development -.42† -.22† -.29‡ .19‡ _______________________________________________________________ *R.D. Brown, MD, and S.T.G., written communication, Jan. 15, 1980. †p‹.001, ‡p‹.01. In 1986, eleven items were added to the original 67-item version of the DSQ, representing 6 defense or coping mechanisms of undoing, help-rejecting complaining, consummatory behavior, isolation, task orientation, affiliation. This revised 78-item questionnaire was not at that time shown to possess the same psychometric properties of its predecessor. However, in a study of 131 men involved in a longitudinal research project of 3
defenses and psychological health, Vaillant et al. found that the 78-item version of the DSQ identified the same defense styles that were identified 7 years earlier by clinical assessment. In addition, scores from the immature and intermediate grouping of defense styles (1 through 3) on 7
the 78-item version were found to significantly correlate with an observer-rated measure o f the 4
same level of defenses in a study of 156 outpatient psychiatry patients . In 39 patients from this study the DSQ was repeated 6 months later. The test-retest reliability for the four defense styles was highly significant ( p = 0.001); for style 1, r = .73; for style 2, r = .71; for style 3, r = .68; and for style 4, r = .69. The Relationship of the DSQ to other Measures of Mental Health
The above discussion has demonstrated the considerable validity of the DSQ as a measure of several dimensions of defensive maturity. In addition to having cross-validated with other measures of defensive and ego functioning, the DSQ has been correlated to a variety of mental health measures in a manner which reveals both its unique properties and its consistency with defense theory. The DSQ has correlated in a theoretically expected direction with several different 4,5,6
measures of each of the following; general psychopathologic symptomatology 4,5
5,7,8
medical symptomatology , anxiety 14,15
eating disorders
7,9
10,11,12
, depression , personality disorder
10,16
, neuroticism
, general
, life stress
4,13,5
,
17,18
, and coping
. It has been demonstrated to successfully 14,15,19
differentiate between clinical and nonclinical samples in the following disorders: anorexia 14,15,19
bulimia
5,8,20
, anxiety
17
9,20
, depression
21
,
17
, impotence , delinquency , psychosomatic
22
10,13,20
disorders , child abusers , and personality disorders 10
. The DSQ has also been correlated
23
with inpatient status and severity of mental illness . Translated versions of the measure have been used in psychopathology studies in the native languag es of the following countries; 20
23
8
24
21
25
26
27
Norway , Finland , Holland , Germany , Italy , Switzerland (French) , China , and Egypt . This body of research offers encouraging support for the validity of the DSQ, but it also 8
raises the question of whether the DSQ is more than just a measure of general psychopathology. Defense theory generally conceives of defensive functioning as a relatively stable aspect of personality organization but does allow for some correlation with affective state. In general, 28
measures of personality traits are known to be influenced by affective state . Research from social psychology has made it clear that affects and emotions can profoundly influence coping 29
behavior . The conventional view of defense theory is that patients tend to "regress" when they 30
become ill and are said to adopt a more mature defense pattern as they recover . Several DSQ studies have shown that patients who recover from affective/symptom disorders demonstrate 6,9,31
decreased reliance on immature defense functioning
. The DSQ has also been demonstrated
to significantly correlate in a theoretically expected direction with two different measures of life 4,5
stress . That is, life stress correlates positively with the immature-range defenses and negatively with the mature-range defenses. The impact of life stress on defensive functioning may be modulated by its influence on the state variables of affect and cognition. Such variables may in turn impact on defensive functioning by influencing the selection and interpretation of the contextual cues which activate the specific defense processes. However, it has been suggested that defensive functioning should not be synonymous with affective symptomatology since it would therefore add little information beyond the present DSM-IV, Axis I-based 31
diagnostic criteria . The result of several DSQ studies indicate that, although elements of defensive functioning are influenced by affective symptomatology, it is an aspect of mental functioning which is to some degree independent of, and more stable than such symptomatology. In one 9,
study of patients treated for depression , recovered patients showed the theoretically expected 9
improvements in immature and mature defense factors, but c ontinued to use less mature and more intermediate defensive functioning than nonclinical controls, despite having normalized their affective symptomatology. In addition, patients with secondary diagnoses used more intermediate-range defenses and showed less improvement in affective symptomatology. 6
A study of bulimic patients demonstrated that personality disorder classification accounted for more variance in DSQ socres than any other measures of psychopathology, which included measures of depression, general psychopathological symptomatology, and three measures of eating disorder symptomatology. Patients who relied more heavily on immature defense functioning demonstrated less improvement in eating disorder symptomatology. These studies indicate tht DSQ findings are consistent with the theoretical notion that defensive functioning does vary with symptomtology but is also in some measure independent of it. They also suggest that defensive functioning (and the DSQ) may have prognostic significance beyond symptomatology. DSQ and Personality
More evidence for the trait-like aspect of DSQ scores comes from studies of personality disorder. Several studies have demonstrated a consistently robust relationship between personality disorder symptomatology and the DSQ. In a study of 150 personality disorder patients the DSQ revealed borderline personality disorder patients to use significantly more immature and significantly less mature range defenses than nonborderline personality disorder 11
patients . This finding is consistent with theoretical views of borderline personality disorder 35
20
presented by Kernberg . A Norwegian study demonstrated personality disorder patients to use more immature-range and less mature-range defensive functioning than a group of patients 10
comprising panic disorder and depressed patients. This study also demonstrated greater use of immature defensive functioning amongst cluster A and B personality disorders than cluster C personality disorders. The DSQ has also been showns to correlate significantly with personality disorder symptomatology in nonclinical populations. In a study of 106 undergraduate students the DSQ immature and mature-range defenses correlated in a theoretically expected direction 12
with the Personality Disorder Questionnaire (PDQ-R) composite index . In addition, each PDQ-R subscale showed a unique pattern of association with the different defense factors. Perhaps the most compelling demonstration of the DSQs' power to tap trait-like aspects of psychopathology comes from a study comparing its ability to account for the variance in personality disorder symptomatology with that of a self-report measure of the widely supported, 10
dimensionally-based, Five Factor Model (FFM) of personality . This model of personality is based on the results of extensive factor-analytic studies of a large number of existing personality 32
measures and of lexical analysis of adjectival descriptors of personality . Proponents of this model contend that the basic dimensions of personality description can be represented by five factors which "are both necessary and reasonably sufficient for describing at a global level the 33
major features of personality" . The nature of these five factors can be summarized by the broad concepts of: Surgency/Extroversion, Agreeableness, Conscientiousness, Emotional 34
Stability versus Neuroticism, and Openness to Experience . It has also been stated/proposed 35
that the FFM "is fully adequate to account for the dimensions of abnormal personality" . The comparison study of a measure of this FFM and the DSQ involved 257 psychiatric outpatients and included 109 personality disorder patients who had no Axis-I pathology which required focused treatment (e.g.-depression, substance abuse, neurological impairment). It demonstrated 11
the DSQ to have greater power in accounting for the variance in an interview-based measure of personality disorder symptomatology than did the FFM measure. The DSQ was also shown to contribute substantial additional variance in explaining the degree of personality pathology beyond that of the FFM measure. These findings are particularly significant in that the FFM and related models of personality have in recent years garnered considerable support as dimensionally-based alternatives to the current categorically-based diagnosis and classification 36
of personality disorders . They suggest that models of personality organization which more specifically account for the dynamics of affect regulation may have greater validity in the explanation of psychopathology. Prognostic and Therapeutic Value
The data thus far presented on the DSQ suggests that it may tap aspects of psychological functioning which have significant and unique implications for psychopathology. However, prospectively designed research is necessary to appropriately validate its ability to contribute prognostically useful information beyond that provided by DSM-IV-based axes. Although more studies are needed, several have demonstrated the DSQ to possess some measure of predictive utility. As previously mentioned, a study of patients treated for depression revealed that patients using more immature and intermediate-range defensive functioning did not respond as well to 15
treatment despite similar baseline affective symptomatology . A similar result was found in a study of eating disorder patients where greater use of immature-range defensive functioning 9
predicted poorer response to treatment . Andrews has observed that patients with anxiety disorders whose defense style profile deviates less than 1 Standard Deviation from normal seem to respond well to minimal intervention, whereas those with a low mature and high neurotic 12
16
(intermediate) and immature defense pattern seem to req uire considerably more treatment . This area is currently being prospectively studied by the Andrews group. A study of depressed 37
and neurotic outpatients revealed the DSQ to be one of only two out of fifteen measures investigated to significantly predict response to psychotherapeutic interventions. The two predictor scores were statistically independent of one another and were not significantly related to initial severity of disturbance. A 6-year follow-up study of eating disorder patients demonstrated that levels of mature-range defensive functioning were found to significantly 39
predict long-term/6 year outcome . In an ongoing prospective study, Ungerer et al. measured the defense style of pregnant women and suggested that patterns of defense style are predictive of impaired mother/baby interactions and impaired development of the self-regulation in the 38
baby . Taken together, these studies suggest that the DSQ, and by implication defense functioning, has considerable power in explaining the variability in outcome of specific diagnostic groups. Adequate knowledge of defensive functioning can therefore improve the ability to predict course of illness and individualize treatment. Ultimately the assessment of defensive functioning will complement the assessment of symptomatology to form a more therapeutically and prognostically useful profile of patients. In summary, the evidence which has thus far accumulated on the DSQ indicates it to be a valid measure of three general dimensions of defense functioning and maturity. The research suggests that these dimensions represent unique and prognostically useful aspects of psychological functioning which are conceptually conco rdant with defense theory. Although further psychometric refinement is required, it is proposed that the DSQ can be a tool for suggesting the direction of future research in the realm of defensive functioning. It is 13
recommended, however, that the effort of different research groups be coordinated so as to improve the yield of useful information from future studies and psychometric refinements. To this end, the Bond group of investigators at McGill University is currently co llating data from a number of existing studies for the purposes of more definitively establishing/elaborating the psychometric characteristics of the DSQ. Current Scoring Instructions
There are four defense styles which have been named: 1. Maladaptive action defense style 2. Image-distorting defense style 3. Self-sacrificing defense style 4. Adaptive defense style The following is a key to which items cluster of each style Maladaptive Action
Image-Distorting
Self-sacrificing
Adaptive
2, 4, 9, 10, 12, 17, 19, 21, 22, 25, 27, 28, 29, 32, 33, 35, 36, 40, 41, 46, 49, 50, 54, 55, 60, 62, 67, 69, 73, 75, 82, 85, 88
11, 18, 23, 24, 30, 37, 42, 43, 51, 53, 58, 64, 66, 76, 83
1, 13, 16 47, 52, 56, 63, 65
3, 5, 8, 59, 61, 68, 86
The total scores of the items in each cluster are added up to obtain the score on that style. The score of different categories of subjects can thus be compared. Alternatively, one can obtain correlations between style scores and other measures. Also, one can compare subjects' scores to standard scores listed in Table 6. There are some items which are in the DSQ which don't significantly correlate with one of the 4 factors and thus are not in the above key. These items were left in the DSQ so as not to change the original context of the questionnaire.
14
Relationships to Specific Defense Mechanisms
Appendix A indicates which mechanism each statement was designed to represent. Some items represent social desirability or "lie scale" items. These do not belong to any defense style. When DSQ items were correlated with judges' ratings o f specific defense mechanisms using Perry's DMRS method, the following items were significantly positively correlated.
15
Table 5 Questionnaire items which are positively correlated ( p 0.05) with individual defense mechanisms as rated by DMRS (Defense Mechanism Rating Scale)
Defense mechanism
DSQ Item
Neurotic denial Nondelusional projection Passive aggression Acting out Splitting of other's image Projective identification Omnipotence Undoing Affiliation Somatization Hypochondriasis
16, 52 12, 25, 55, 87 45 21, 27, 46 64 60 18, 42 88 86 62 69, 75, 82 Table 6 Standard Scores
Different samples of subjects yield different average scores on the various defense styles.
DSQ - Means and Standard Deviations (By Item)
Defense Style
NonPatients
Personality Disordered (non-BPD)
Maladaptive Image-distorting Self-sacrificing Adaptive
3.6 (± 1.2) 2.5 (± 1.0) 2.9 (± 0.6) 4.7 (± 1.0)
4.3 (± 1.1) 3.0 (± 0.9) 4.2 (± 1.1) 5.0 (± 1.3)
Borderline Personality Disordered
All Patients
5.15 (± 1.1) 3.5 (± 1.1) 4.1 (± 1.2) 4.4 (± 1.2)
4.8 (± 1.4) 3.4 (± 1.2) 4.1 (± 1.2) 4.3 (± 0.6)
16
DEFENSE STYLE QUESTIONNAIRE
INSTRUCTIONS:
This questionnaire consists of 88 statements each of which is followed by a rating scale: Strongly Disagree
1
2
3
4
5
6
7
8
9
Strongly Agree
Rate the degree to which you agree or disagree with each statement and write your rating from one to nine on the answer sheet.
Eg. Montreal is a city in Canada
Strongly Disagree
1
2
3
4
5
6
7
8
9
Strongly Agree
You would choose 9 and write 9 on the answer sheet beside the statement number.
17
18
APPENDIX A
Pseudo-Altruism
1. I get satisfaction from helping others and if this were taken away from me I would get depressed. Strongly Disagree
Passive-Aggressive
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
5
6
7
8
9
Strongly Agree
5
6
7
8
9
Strongly Agree
8. I'm able to laugh at myself pretty easily. Strongly Disagree
Regression
7
7. I keep getting into the same type of frustrating situations and I don't know why Strongly Disagree
Humour
6
6. Once in a while I put off until tomorrow what I ought to do today. Strongly Disagree
Acting-Out
5
5. I work out my anxiety through doing something constructive and creative like painting or woodwork. Strongly Disagree
Lie
4
4. I'm always treated unfairly. Strongly Disagree
Sublimation
3
3. I'm able to keep a problem out of my mind until I have time to deal with it. Strongly Disagree
Projection
2
2. People often call me a sulker. Strongly Disagree
Suppression
1
1
2
3
4
9. I act like a child when I'm frustrated. Strongly Disagree
1
2
3
4
19
Inhibition
10. I'm very shy about standing up for my rights with people. Strongly Disagree
Omnipotence
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
5
6
7
8
9
Strongly Agree
8
9
Strongly Agree
18. I often feel superior to people I'm with. Strongly Disagree
Projective Identification
8
17. I stop myself from going all out in a competition. Strongly Disagree
Omnipotence/ Devaluation
7
16. People say I'm like an ostrich with my head buried in the sand. In other words, I tend to ignore unpleasant facts as if they didn't exist. Strongly Disagree
Inhibition
6
15. Once in a while I laugh at a dirty joke. Strongly Disagree
Denial
5
14. Once in a while I think of things too bad to talk about. Strongly Disagree
Lie
4
13. If someone mugged me and stole my money, I'd rather he'd be helped than punished. Strongly Disagree
Lie
3
12. People tend to mistreat me. Strongly Disagree
Reaction-Formation
2
11. I am superior to most people I know. Strongly Disagree
Projection
1
1
2
3
4
19. Someone is robbing me emotionally of all I've got. Strongly Disagree
1
2
3
4
5
6
7
20
Lie
20. I get angry some times. Strongly Disagree
Acting-Out
Lie
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
8
9
Strongly Agree
7
1
2
3
4
5
6
7
8
9
Strongly Agree
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
Strongly Disagree 1 2 31. I do not always tell the truth.
3
4
5
6
7
8
9
Strongly Agree
29. I'm a very inhibited person. Strongly Disagree
Omnipotence/ Devaluation
9
28. I get physically ill when things aren't going well for me. Strongly Disagree
Inhibition
8
27. I often act impulsively when something is bothering me. Strongly Disagree
Somatization
7
26. Sometimes when I am not feeling well I am cross. Strongly Disagree
Acting-Out
6
25. People tell me I have a persecution complex. Strongly Disagree
Lie
5
24. I pride myself on my ability to cut people down to size. Strongly Disagree
Projection
4
23. I ignore danger as if I were Superman. Strongly Disagree
Omnipotence/ Devaluation
3
22. I'd rather starve than be forced to eat. Strongly Disagree
Omnipotence
2
21. I often am driven to act impulsively. Strongly Disagree
Passive-Aggressive
1
1
30. I'm a real put-down artist.
21
Strongly Disagree Withdrawal
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
5
6
7
8
9
Strongly Agree
41. I'm very shy about approaching people. Strongly Disagree
Denial
Strongly Agree
40. I work more things out in my daydreams than in my real life. Strongly Disagree
Inhibition
9
39. I'm often late for appointments. Strongly Disagree
Fantasy
8
38. Sometimes at elections I vote for someone about whom I know very little. Strongly Disagree
Passive Aggressive
7
37. I've got special talents that allow me to go through life with no problems. Strongly Disagree
Lie
6
36. I tend to be on my guard with people who turn out to be more friendly than I would have suspected. Strongly Disagree
Omnipotence
5
35. I withdraw when I'm angry. Strongly Disagree
Projection
4
34. My friends see me as a clown. Strongly Disagree
Withdrawal
3
33. I often push myself so far that other people have to set limits for me. Strongly Disagree
Humour
2
32. I withdraw from people when I feel hurt. Strongly Disagree
Acting-out
1
1
2
3
4
42. I fear nothing. 22
Strongly Disagree Splitting
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
6
7
8
9
Strongly Agree
4
5
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
51. I always feel that someone I know is like a guardian angel. Strongly Disagree
Denial
9
50. I'm shy about sex. Strongly Disagree
Primitive Idealization
8
49. I withdraw when I'm sad. Strongly Disagree
Inhibition
7
48. I do not read every editorial in the newspaper every day. Strongly Disagree
Withdrawal
6
47. I believe in turning the other cheek when someone hurts me. Strongly Disagree
Lie
5
46. I get openly aggressive when I feel hurt. Strongly Disagree
Reaction Formation
4
45. I get very sarcastic when I'm angry. Strongly Disagree
Acting-Out
3
44. I would rather win than lose in a game. Strongly Disagree
Passive-Aggressive
2
43. Sometimes I think I'm an angel and other times I think I'm a devil. Strongly Disagree
Lie
1
1
2
3
4
5
6
7
8
9
Strongly Agree
52. My philosophy is, "Hear no evil, do no evil, see no evil" Strongly Disagree
1
2
3
4
5
6
7
8
9
Strongly Agree
23
Splitting
53. As far as I'm concerned, people are either good or bad. Strongly Disagree
Passive Aggressive
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
5
6
7
8
9
Strongly Agree
1
2
3
4
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
61. I'm usually able to see the funny side of an otherwise painful predicament. Strongly Disagree
Somatization
8
60. Some people are plotting to kill me. Strongly Disagree
Humour
7
59. I can keep the lid on my feelings if it would interfere with what I'm doing if I were to let them out. Strongly Disagree
Projection
6
58. There is someone I know who can do anything and who is absolutely fair and just. Strongly Disagree
Suppression
5
57. I would be very nervous is an airplane in which I was flying lost an engine. Strongly Disagree
Primitive Idealization
4
56. I try to be nice to people I don't like. Strongly Disagree
Denial (lie)
3
55. Everyone is against me. Strongly Disagree
Reaction Formation
2
54. If my boss bugged me, I might make a mistake in my work or work more slowly so as to get back at him. Strongly Disagree
Projection
1
1
2
3
4
5
6
7
8
9
Strongly Agree
62. I get a headache when I have to do something I don't like. Strongly Disagree
1
2
3
4
5
6
7
8
9
Strongly Agree
24
Reaction-Formation
63. I often find myself being very nice to people who by all rights I should be angry at. Strongly Disagree
Splitting
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
71. After I fight for my rights, I tend to apologize for my assertiveness. Strongly Disagree
Projection
8
70. When someone close to me dies, I don't feel upset. Strongly Disagree
Undoing
7
69. Doctors never really understand what is wrong with me. Strongly Disagree
Isolation
6
68. When I know that I will have to face a difficult situation, like an exam or a job interview, I try to imagine what it will be like and plan ways to cope with it. Strongly Disagree
Help-rejecting complaining
5
67. I fall apart under stress. Strongly Disagree
Anticipation
4
66. I am sure I get a raw deal from life. Strongly Disagree
Regression
3
65. We should never get angry at people we don't like. Strongly Disagree
Projection
2
64. There's no such thing as "finding" a little good in everyone". If you're bad, you're all bad. Strongly Disagree
Reaction Formation
1
1
2
3
4
5
6
7
8
9
Strongly Agree
9
Strongly Agree
72. Most of what happens to me is not my responsibility. Strongly Disagree
1
2
3
4
5
6
7
8
25
Consumption
73. When I'm depressed or anxious, eating makes me feel better. Strongly Disagree
Task Orientation
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
81. If I can predict that I'm going to be sad ahead of time, I can cope better. Strongly Disagree
Help-rejecting Complaining
8
80. When I feel bad, I try to be with someone. Strongly Disagree
Anticipation
7
79. I take drugs, medicine or alcohol when I'm tense. Strongly Disagree
Affiliation
6
78. I have habits or rituals which I feel compelled to do or else something terrible will happen. Strongly Disagree
Consumption
5
77. I believe that people usually see more meaning in films, plays or books than is actually there. Strongly Disagree
Undoing
4
76. I'm often told that I don't show my feelings. Strongly Disagree
Isolation
3
75. My doctors are not able to help me really get over my problems. Strongly Disagree
Isolation
2
74. Hard work makes me feel better Strongly Disagree
Help-Rejecting Complaining
1
1
2
3
4
5
6
7
8
9
Strongly Agree
82. No matter how much I complain, I never get a satisfactory response. Strongly Disagree
1
2
3
4
5
6
7
8
9
Strongly Agree
26
Isolation strong
83. Often I find that I don't feel anything when the situation would seem to warrant emotions. Strongly Disagree
Task Orientation
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
1
2
3
4
5
6
7
8
9
Strongly Agree
6
7
8
9
Strongly Agree
87. I cannot be blamed for what I do wrong. Strongly Disagree
Undoing
4
86. If I were in a crisis, I would seek out another person who had the same problem. Strongly Disagree
Projection
3
85. I smoke when I'm nervous. Strongly Disagree
Affiliation
2
84. Sticking to the task at hand keeps me from feeling depressed or anxious. Strongly Disagree
Consumption
1
1
2
3
4
5
88. If I have an aggressive thought, I feel the need to do something to compensate for it. Strongly Disagree
1
2
3
4
5
6
7
8
9
Strongly Agree
27
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14. A Draft Glossary of Defense Mechanisms for DSM-III-R, in Vaillant GE (ed): Empirical Studies of Ego Mechanisms of Defense. Washington, DC, American Psychiatric Press Inc. 1986; pp. 103-105. 15. Kim JO: Factor-Analysis, in Nie NH, Hull CH, Jenkins JG, at al. (eds): Statistical package for the Social Sciences, ed. 2. New York, McGraw-Hill International Book Co, 1975; pp. 468-514. 16. Smith GT, McCarthy DM: Methodological Considerations in the Refinement of Clinical Assessment Instruments. Psychological Assessment 1995; 7(3): 300-308.
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17. Steiner H, Nasserbakht A, Feldman S: The adaptation of the Defense Style Questionnaire for the use in Adolescents 1993. In: Scientific Proceedings, 40th Annual Meeting of the AACAP, 9:51. 18. Clark LA, Watson D: Constructing Validity: Basic Issues in Objective Scale Development. Psychological Assessment 1995; 7(3): 309-319. 19. Vaillant G: Theoretical Hierarchy of Adaptive Ego Mechanisms: A 30-year follow-up of men selected for psychological health. Archives of General Psychiatry 1971; 24: 107-117. 20. Andrews G, Singh M, Bond M: The Defense Style Questionnaire. The Journal of Nervous and Mental Disease 1993; 181(4): 246-256. 21. Foster SL, Cone JD: Validity Issues in Clinical Assessment. Psychological Assessment 1995; 7(3): 248-260. 22. Bond MP, Vaillant JS: An Empirical Study of the Relationship Between Diagnosis and Defense Style. Archives of General Psychiatry 1986; 43: 285-288. 23. Pollock C, Andrews G: Defense Styles Associated with Specific Anxiety Disorders. American Journal of Psychiatry 1989; 146(11): 1500-1502. 24. Floyd FJ, Widaman KF: Factor Analysis in the Development and Refinement of Clinical Assessment Instruments. Psychological Assessment 1995; 7(3): 286-299. 25. Soldz S, Budman S, Demby A, Merry J: The Relationship of Defense Style to Personality Pathology and the Big Five Personality Factors. Personal communication? 26. Flannery RB, Perry JC: Self-Rated Defense Styles, Life Stress, and Health Status: An Empirical Assessment. Psychosomatics 1990; 31(3): 313-320. 27. Sammallahati P, Aaldberg V, Peentinsaari J-P: Does Defense style vary with severity of mental disorder? 1994; 90:290-294. Acta Psychiatrica Scandinavica 1994. 28. Reister G, Mans R, Fellhauer R, Tress W: Validation of the German Version of Bond's Questionnaire of Defense Styles, in Hentschel U, Smith GJW, Ehlers W, Draguns JG (eds): The Concept of Defense Mechanisms In Contemporary Psychology: Theoretical Research, and Clinical Perspectives. New York, Springer-Verlag International Book Co, 1993, pp 290-295. 29. Andreasen NC, Arndt S, Alliger R, Miller D, Flaum M: Symptoms of Schizophrenia: Methods, Meanings, and Mechanisms. Archives of General Psychiatry 1995; 52:341-351. 30. Weiss DJ: Research Methodology: Further Considerations in Applications of Factor Analysis. Journal of Counseling Psychology 1971; 18(1): 85-92. 30
31. McGill professor-personal communication. 32. Steiger H, Leung F, Thibaudeau J, Houle L, Ghadirian AM: Comorbid Features in Bulimics Before and After Therapy: Are They Explained by Axis II Diagnoses, Secondary Effects of Bulimia or Both? Comprehensive Psychiatry 1993; 34(1): 45-53. 33. Muris P, Merkelbach H: Defense Style, Trait anxiety, Worry, and Bodily Symptoms. Personality and Individual Differences 1994; 16(2): 340-351. 34. Akkerman K, Carr V, Lewin T: Changes in Ego Defenses with Recovery from Depression. The Journal of Nervous and Mental Disease 1992; 180: 634-638. 35. Bond M, Paris J, Zweig-Frank H: Defense Styles and Borderline Personality Disorder. Journal of PersonalityDisorders 1994; 8(1): 28-31. 36. Johnson JG, Bornstein RF, Krukonis AB: Defense Styles as Predictors of Personality Disorder Symptomatology. Journal of Personality Disorders 1992; 6(4): 408-416. 37. Smith C, Feldman SS, Nasserbakht A, Steiner H: Psychological Characteristics and DSMIII-R Diagnoses at 6-year Follow-up of Adolescent Anorexia Nervosa. Journal of the American Academy of Child and Adolescent Psychiatry 1993; 32(6): 1237-1245. 38. Steiner H, Feldman SS: Two Approaches to the Measurement of Adaptive Style: Comparison of Normal, Psychosomatically ill, and Delinquesnt Adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 1995; 34(2): 180-190. 39. Endler NS, Parker JDA: Assessment of Multidimensional Coping: Task, Emotion, and Avoidance Strategies. Psychological Assessment 1994; 6(1): 50-60. 40. Steiger H, Van der Feen J, Goldstein C, Leichner P: Defense Styles and Parental Bonding in Eating-Disordered Women. International Journal of Eating Disorders 1989; 8(2): 131-140. 41. Steiger H, Goldstein C, Mongrain M, Van der Feen J: Description of Eating-Disordered, Psychiatric, and Normal Women Along Cognitive and Psychodynamic Dimensions. International Journal of Eating Disorders 1990; 9(2): 129-140. 42. Schmidt U, Slone G, Tiller J, Treasure J: Childhood Adversity and Adult Defense Style in Eating Disorder Patients: A Controlled Study. British Journal of Medical Psychology 1993; 66(4): 353-362. 43. Guldberg CA, Wiborg I, Hoglend P, Bille H, Narud K, Lea PM: Self-Rated Defenses in Norwegian Axis-I, Axis-II, and Normal Samples. Presented at the American Psychiatric Association's Annual Meeting, Philadelphia, USA, May 22-May 29, 1994. 31
