Case report: Changes in defense mechanisms, personality functioning, and body mass index during psychotherapy with patients with anorexia nervosa

Abstract

Eating disorders (EDs) are difficult to treat in psychotherapy due to their pervasive symptomatology and frequent and rapid relapses. Restrictive anorexia nervosa (AN) is the most challenging ED, often associated with severe physical and mental conditions. Perceived as an ego-syntonic syndrome that somehow protects the patient from a number of developmental tasks, treating AN requires extensive multidisciplinary long-term intervention. As with other emotion regulation strategies, defense mechanisms mediate an individual's reaction to internal or external stressors, including those related to ED conditions. Improving defensive functioning adaptiveness predicts psychotherapy outcomes and is an essential component of the therapeutic process. In this study, we qualitatively described changes in the use of defense mechanisms, personality functioning (PF), and body mass index (BMI) in two patients with severe AN in treatment with intense dynamic psychotherapy. Changes in personality functioning and defense mechanisms were periodically assessed every 6 months using clinician report measures such as the Shedler-Westen Assessment Procedure-200 (SWAP-200) and the Defense Mechanisms Rating Scales Q-sort (DMRS-Q), respectively. BMI was also monitored throughout the treatment. A qualitative description of the patient's defensive profile and the quantitative score on all ranges of defense mechanisms were used for studying changes in patients' use of defenses during the treatment and relationships between defenses and outcome indexes. Personality and defensive functioning improved after 1 year of intense dynamic psychotherapy, independently from BMI improvement. All outcome indexes dramatically decreased before a scheduled interruption of the treatment, underling that an integrated therapeutic approach is essential for improving and eventually orienting toward complete ED symptoms remission. Long-term dynamic psychotherapy fosters self-awareness of psychological distress and enhances more mature ways of coping. Monitoring changes in personality and defense mechanisms helps in understanding patients' reactions to stressful life events and in developing specific therapeutic interventions.

Psychological impairment in inflammatory bowel diseases: the key role of coping and defense mechanisms

“…In summary, these findings suggest that particular attention should be paid to adaptation strategies such as coping and defense mechanisms, which play a key role in promoting therapeutic compliance and psychological well-being (Conversano et al ., 2023 ). Tailoring therapeutic intervention based on improving individual’s adaptive responses to stressful disease-related consequences could effectively enhances patient’s mental health and overall higher QoL.…”

Modeling the Relationship Between Reality Testing and Object Relations with Psychological Well-being Through the Mediation of Defense Mechanisms in Grief Disorder

“…These individuals have the ability to change stressful situations into safe ones, maintain composure in the face of challenges, making problem confrontation not a difficult task. They can also accurately identify efficient and situation-specific coping mechanisms to reduce internal anxiety (Brody & Carson, 2012;Conversano et al, 2023). Individuals with positive temporal attitudes are optimistic, focusing on positives rather than dwelling on negatives, regretting the past, or fearing the future, thus preparing them to accept reality and live in the present.…”

“…Disturbances in object relations undermine the foundations of personal security and lead to increased vulnerability to grief (Ahadian fard et al, 2017;Orang et al, 2018). Numerous studies have confirmed the hypothesis that mental health is significantly related to defense mechanisms (Besharat, 2008;Blanco et al, 2023;Brockman et al, 2016;Brody & Carson, 2012;Conversano et al, 2023;Cramer, 1987Cramer, , 2002Giuseppe & Perry, 2021;Jamilian et al, 2014;Jun et al, 2015;Lee et al, 2020;Lotfi-Hajilo et al, 2017;Mesgarian et al, 2017;Poshtareh et al, 2023;Rubino et al, 2007). More mature defenses enable an individual to act more adaptively and with fewer anxiety symptoms in anxiety-provoking situations, such as social scenarios, while immature defense mechanisms lead to the emergence of anxiety and avoidance in these situations (Jamilian et al, 2014;Lee et al, 2020).…”

Defense mechanisms are associated with mental health symptoms across six countries

“…The defense mechanism hierarchy incorporates three overarching defense categories: Mature defense mechanisms that are the most adaptive, neurotic defenses, which reflect mental inhibition, and Immature defenses, that involve more distortion of inner and outer reality (Perry, 2014 ). Furthermore, the immature category can be divided into depressive and non-depressive defenses (Perry et al ., 2020 ), and there is some evidence indicating that depressive defenses are especially strongly associated with mental health symptoms and psychopathology (Maffei et al ., 1995 ; Høglend & Perry, 1998 ; Conversano et al ., 2023 ). See Supplementary Figure 1 for a review of the DMRS-based defense hierarchy.…”