Benítez CE, Chávez-León E, Ontiveros UMP, Yunes JA, Náfate LO

Language: English
References: 23
Page: 517-526
PDF size: 157.49 Kb.

ABSTRACT

SUMMARY
Otto Kernberg states three types of personality organizations, also named psychological functional levels. They reflect the patient’s predominant psychological characteristics: identity integration grade, defense mechanisms, and reality test. In mental disorders, thepredominant defensive style influences significantly in the severity and evolution of the suffering.
Objectives
The objective of the actual study was to determine the usage of defense mechanisms by patients with some mental disorder, grouping them according to personality organization levels or psychological functioning and the DSM-IV-TR Axis II diagnostic.
Sample
The sample included two groups: a) 102 hospitalized patients in the Instituto Nacional de Psiquiatría, 20 males and 82 females. b) A control group formed by 125 individuals, 48 males and 77 females; in all cases, they lived in Distrito Federal or Estado de México.
Method
The sample of this study was evaluated with the Defensive Style Questionnaire (DSQ-40) and the Personality Diagnostic Questionnaire (PDQ-4+); both instruments were applied as soon as patients were admitted to the hospital. The concepts of borderline psychological functioning and borderline personality disorder make reference to: The levels of personality organization or borderline psychological functioning characterized by an identity integration failure named identity diffusion, habitually reality judgment conserving and low level defenses supported on the splitting. b) The patients that were diagnosed with borderline personality disorder in agreement with the DSM-IV-TR. According to the personality organization, the psychotic disorders were grouped in the psychotic functioning level; the rest of the patients that suffered some anxiety or mood disorders were included in the borderline functioning level when they had also a diagnosis of borderline, narcissistic, antisocial, paranoid, schizoid, schizotypal, avoidant, dependent or histrionic personality disorder; in the neurotic functioning level those patients without personality disorder. The members of the control group were included in different academic level, labor and social scopes during the same period.
Results
The patients with a low level of personality organization (psychotic or borderline personality organization) used predominantly the immature or primitive defense mechanisms; patients with a high level of personality organization (neurotic level of psychological functioning) and members of the control group used predominantly mature or advanced defense mechanisms. Derived from the factorial analysis, three levels of defensive style were determined:mature/advanced, neurotic and immature/primitive. In the mature/advanced defensive style, the members of the control group were those that scored higher, followed by the psychotic patients and borderline. The scores of the neurotic defensive style were higher in the borderline and psychotic groups than the control group. In the immature/primitive defensive style, the borderline patients had higher scores than the psychotic and control group. The patients that were diagnosed through the PDQ-4+ with borderline personality disorder in agreement with the DSM-IV-TR had lower scores in the mature/advance defensive style and higher than the control group in neurotic and immature/primitive defensive style. The characteristics of personality of clusters A and B correlated positively with the following defensive styles: immature/ primitive and neurotic and negatively with the mature/advanced defensive style. The relation between the defensive styles and the characteristics of personality of cluster C was negative in the defensive style mature/advanced and positive in the neurotic and immature/ primitive.
Conclusions:
Through these findings a hierarchy between the levels of psychological functioning can be established, so that the lower the level of psychological functioning (borderline or psychotic), the higher is the use of immature mechanisms of defense and vice versa. The level of high psychological functioning (neurotic) used mature mechanisms of defense mainly; the borderline and psychotic levels of psychological functioning had major use of immature defenses, such as projection and autistic fantasy.

REFERENCES

1. Kernberg OF. Trastornos graves de la personalidad. México: Manual Moderno; 1999.

2. Caligor E, Kernberg OF, Clarkin JF. Handbook of dynamic psychotherapy for higher level personality pathology. Washington-London: American Psychiatric Publishing; 2007.

3. Clarkin JF, Yeomans FE, Kernberg OF. Psychotherapy for borderline personality focusing on object relations. Washington-London: American Psychiatric Publishing; 2006.

4. Kernberg OF. La teoría de las relaciones objetales y el psicoanálisis clínico. México: Paidós; 1998.

5. López-Ramírez ME, Chávez-León E. Relationship between defense mechanisms and personality disorders. New Research Abstracts, American Psychiatric Association, 157th Annual Meeting 2004; p.101.

6. Vaillant GE. Theoretical hierarchy of adaptive ego mechanisms. Arch Gen Psychiatry 1971;24:107-18.

7. Vaillant GE, Bond M, Vaillant CO. An empirical validated hierarchy of defense mechanisms. Arch Gen Psychiatry 1986;43:597-601.

8. Vaillant GE Ego mechanism of defense and personality psychopathology. J Abnor Psychol 1994;104:44-50.

9. Devens M, Erikson MT. The relationship between defense styles and personality disorders. J Personality Disord 1998;12:86-93.

10. Fransson P, Sundbom E. Gender differences and the Defense Mechanism Test. A comparative study of adolescents in psychiatric care and healthy controls. Scand J Psychol 1997;39:93-9.

11. Lingiardi V, Lonati C, Delucchi F et al. Defense Mechanisms and Personality Disorders. J Nerv Ment Dis 1999;187(4):224-8.

12. Zanarini MC, Weingeroff MA, Frankenburg F. Defense mechanisms associated with borderline personality disorder. J Personality Disord 2009;23(2):113-21.

13. López D. Psicoterapia focalizada en la transferencia para pacientes limítrofes. México: ETM; 2004.

14. López D, Cuevas P. Trastorno límite de la personalidad; tratamiento basado en evidencias. México: Architechtum Plus SC; 2007.

15. Cuevas P, Camacho J, Mejía R, Rosario I et al. Cambios en la psicopatología del trastorno limítrofe de la personalidad, en los pacientes tratados con psicoterapia psicodinámica. Salud Mental 2000;23(6):1-11.

16. López D, Cuevas P, Gómez A, Mendoza J. Psicoterapia focalizada en la transferencia para el trastorno límite de la personalidad. Un estudio con pacientes femeninas. Salud Mental 2004;27(4):44-53.

17. Bond M, Sight M, Andrews G. The Defense Style Questionnaire. J Nerv Ment Dis 1993;181(4):246-56.

18. Asociación Psiquiátrica Americana. Manual Diagnóstico y Estadístico de los Trastornos Mentales. Texto revisado. DSM-IV-TR. Barcelona: Masson; 2002.

19. Hernández R, Fernández C, Baptista P. Metodología de la investigación. México: Mc Graw Hill; 2003.

20. Chávez-León E. Relación de los mecanismos de defensa con los trastornos de angustia. Tesis. Universidad Nacional Autónoma de México. México, DF; 1998.

21. Chávez-León E, Lara-Muñóz MC, Ontiveros-Uribe MP. An empirical study of defense mechanisms in panic disorder. Salud Mental 2006;29(6):15-22.

22. López-Ramírez ME. Relación de los mecanismos de defensa y los trastornos de personalidad y su relevancia para la psicoterapia psicodinámica de apoyo en una población universitaria mexicana. Tesis. Universidad Anáhuac México Norte. Estado de México; 2003.

23. Vaillant GE. The historical Origins of Sigmund Freud’s concept of the mechanisms of defense. En: Vaillant GE. Ego mechanisms of defense. Washington: American Psychiatric Press; 1992.