Specificities of Defense Mechanisms in Bipolar Affective Disorder

Departments of Psychology, University Hospitals of Lausanne, University of Lausanne, Switzerland.
The Journal of nervous and mental disease (Impact Factor: 1.69). 09/2009; 197(9):675-81. DOI: 10.1097/NMD.0b013e3181b3b224
Source: PubMed


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

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    ABSTRACT: Defence mechanisms and coping have rarely been investigated from an integrative point of view. We are particularly interested in stability and change of these adaptational processes in clinical crisis situations of in-patients presenting with bipolar affective disorder. We conducted a controlled interview study including an in-patient and a matched control group; longitudinal data are provided by follow-up interviewing for all participants. A total of N=18 participants per group (patients presenting with bipolar affective disorder and non-clinical controls) were recruited and interviewed twice. All interviews were transcribed and analysed according to observer-rater systems for coping (Coping Action Patterns) and defence mechanisms (Defence Mechanism Rating Scales). Symptom check list-90-R, as well as specific symptomatic measures, were used for symptomatic assessment and hierarchical linear modelling was used for statistical computation. Overall, defensive functioning remains stable over a 3 month period, whereas overall, coping functioning increases over the same period in-patients, as they are discharged from in-patient treatment; no such effect was found in controls. Overall, stability in adaptational processes may be attributed to defensive functioning, whereas change over short periods of time are related to coping concepts in in-patients presenting with bipolar affective disorder.
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    ABSTRACT: Several patient-related variables have already been investigated as predictors of change in psychodynamic psychotherapy. Defensive functioning is one of them. However, few studies have investigated adaptational processes, encompassing defence mechanisms and coping, from an integrative or comparative viewpoint. This study includes 32 patients, mainly diagnosed with adjustment disorder and undergoing time-limited psychodynamic psychotherapy lasting up to 40 sessions, and will focus on early change in defence and coping. Observer-rater methodology was applied to the transcripts of two sessions of the first part of the psychotherapeutic process. It is assumed that the contextual-relational variable of therapeutic alliance intervenes as moderator on change in adaptational processes. Results corroborated the hypothesis, but only for coping, whereas for defences, overall functioning remained stable over the first 20 sessions of psychotherapy. These results are discussed within the framework of disentangling processes underlying adaptation, i.e., related to issues on trait and state aspects, as well as the role of the therapeutic alliance.
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