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May 1989

An Empirical Study of Defense MechanismsI. Clinical Interview and Life Vignette Ratings

Author Affiliations

From the Department of Psychiatry, Cambridge (Mass) Hospital, and Harvard Medical School, Boston.

Arch Gen Psychiatry. 1989;46(5):444-452. doi:10.1001/archpsyc.1989.01810050058010

• The Defense Mechanism Rating Scales (DMRS) measure the use of defense mechanisms based on clinical interview or life vignette data. Using nonprofessional raters observing videotaped psychodynamic interviews of individuals with personality and affective disorders, the median intraclass interrater reliability (IR) of the defense scales was.36 but was.57 for group consensus ratings and.74 when related defenses were grouped into defense summary scales. When follow-up data on life vignettes were rated, the median interrater IR was.55 for those defenses occurring at least 5% of the time and.66 for the defense summary scales. In relation to follow-up data, so-called immature defenses (denial, projection, acting out, hypochondriasis, passive-aggression) were associated with higher levels of symptoms, poorer global functioning, and higher proportion of time impaired in psychosocial role functioning. Borderline defenses (splitting, projective identification) displayed a similar pattern. Among narcissistic and neurotic defenses, only devaluation was associated with poorer functioning, whereas intellectualization was associated with higher functioning. Finally, action and borderline defenses demonstrated significant correlations across methods and across time (video vs life vignettes), whereas obsessional, disavowal, and narcissistic defenses showed nonsignificant trends. Overall, these results support the model of a hierarchy of defenses.