The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning With the Defense Mechanisms Rating Scales Q-Sort

Abstract

The psychodynamic concept of defense mechanisms is nowadays considered by professionals with various theoretical orientations of great importance in the understanding of human development and psychological functioning. More than half century of empirical research has demonstrated the impact of defensive functioning in psychological well-being, personality organization and treatment process-outcome. Despite the availability of a large number of measures for their evaluation, only a few instruments assess the whole hierarchy of defenses, based on the Defense Mechanisms Rating Scales (DMRS), which arguably offers an observer-rated gold standard of assessment. The present article illustrates the theoretical and methodological background of the DMRS-Q, the Q-sort version of the DMRS for clinical use. Starting from the definition and function of the 30 defense mechanisms included in the hierarchy, we extracted 150 items that captured a full range of defensive manifestations according to the DMRS theory. The DMRS-Q set is described in this paper with reference to the DMRS manual. Directions are also provided for using the DMRS-Q online software for the free and unlimited coding of defense mechanisms. After each coding, the DMRS-Q software provides a report including qualitative and quantitative scores reflecting the individual’s defensive functioning. Qualitative scores are displayed as the Defensive Profile Narratives (DPN), while quantitative scores are reported as Overall Defensive Functioning (ODF), defensive categories, defense levels, and individual defense mechanisms. Syntax for the scoring is displayed in the results and a clinical vignette of a psychotherapy session coded with the DMRS-Q is provided. The DMRS-Q is an easy-to-use, free, computerized measure that can help clinicians in monitoring changes in defense mechanisms, addressing therapeutic intervention, fostering symptoms decreasing and therapeutic alliance. Moreover, the DMRS-Q might be a valid tool for teaching the hierarchy of defense mechanisms and increase the observer-rated assessment of this construct in several research fields.

Assessing children’s defense mechanisms with the Defense Mechanisms Rating Scales Q-sort for Children

“…Adaptive defenses, such as altruism, humour, and sublimation, are in maintaining physical and mental health across the lifespan (Beresford, 2012 ; Conversano, 2021 ; Malone et al ., 2013 ; Metzger, 2014 ). Conversely, over-reliance on immature defenses, such as projective identification and splitting, is associated with greater symptom severity (Boldrini et al ., 2020 ; Prout et al ., 2020), suicide risk (Hovanesian et al ., 2009 ), personality disorders (Lingiardi & Giovanardi, 2017 ; Maffei et al ., 1995 ; Kempe et al ., 2021 ), insecure attachment (Békés et al ., 2021a ; Tanzilli et al ., 2021), negative physical health outcomes (Di Giuseppe et al ., 2018 ) and high level of stress (Aafjes-Van Doorn et al ., 2021 ; Di Giuseppe et al ., 2021 a).…”

“…Among the most popular, the Defense Mechanisms Manual is used to rate three defense mechanisms - denial, projection, and identification - as revealed in stories told to TAT and CAT cards (Cramer, 1991 ). This measure has demonstrated validity and reliability (Hibbard & Porcerelli, 1998 ; Porcerelli et al ., 2010 ), however it provides limited information due to the small number of defenses assessed (Nimroody et al ., 2019 ; Di Giuseppe et al ., 2021 b). Another method is the comprehensive assessment of defense style (CADS) (Laor et al ., 2001 ), a 72-item questionnaire for assessing 28 defenses organized into three factors - other-oriented, self-oriented, and mature.…”

Editorial: Recent Empirical Research and Methodologies in Defense Mechanisms: Defenses as Fundamental Contributors to Adaptation

“…Defense mechanisms higher in the hierarchy (i.e., high adaptive defenses) do not follow the differential criteria described in Cramer's theory (Beresford, 2012). More than 30 years research with the Defense Mechanisms Rating Scales (DMRS; Perry, 1990) and its derivative measures (DMRS-Q; Di Giuseppe et al, 2014;Di Giuseppe and Perry, 2021;DMRS-SR-30;Di Giuseppe et al, 2020a) have demonstrated that individuals using mature defenses can: (1) be partially or fully aware of their activation (e.g., altruism, self-assertion, or self-observation); (2) intentionally use an adaptive defensive strategy to deal with internal conflict or stressful situations (e.g., anticipation or suppression); and…”

“…Defense mechanisms higher in the hierarchy (i.e., high adaptive defenses) do not follow the differential criteria described in Cramer's theory (Beresford, 2012 ). More than 30 years research with the Defense Mechanisms Rating Scales (DMRS; Perry, 1990 ) and its derivative measures (DMRS-Q; Di Giuseppe et al, 2014 ; Di Giuseppe and Perry, 2021 ; DMRS-SR-30; Di Giuseppe et al, 2020a ) have demonstrated that individuals using mature defenses can: (1) be partially or fully aware of their activation (e.g., altruism, self-assertion, or self-observation); (2) intentionally use an adaptive defensive strategy to deal with internal conflict or stressful situations (e.g., anticipation or suppression); and (3) increase the probability of a gratifying resolution of the internal or external stressors without reality distortion (e.g., self-assertion or sublimation). In light of these findings, we affirm that the hierarchy of defense mechanisms (Vaillant, 1992 ; American Psychiatric Association, 1994 ; Perry, 2014 ; Di Giuseppe and Perry ) is a comprehensive description of both more adaptive (i.e., mature defenses, overlapping in function with coping strategies) and less adaptive (i.e., immature and neurotic defenses) way of automatically responding.…”

“…Defense mechanisms are also associated with gender. Women use more neurotic and immature-depressive defenses to deal with internal or external stressors, while in similar conditions men tend to rely more on obsessional and immature-non depressive defenses (see Di Giuseppe and Perry, 2021 , for review on the hierarchy of defenses). These findings were confirmed also in individuals diagnosed with gender dysphoria, indicating that the individual's dominant defensive functioning is related to the gender to which one chooses instead of the gender assigned at birth ( Giovanardi et al ).…”