Am J Psychiatry 1993; 150:1194-1198
Copyright © 1993 by American Psychiatric Association
An empirical study of defense mechanisms in dysthymia
AL Bloch, MK Shear, JC Markowitz, AC Leon and JC Perry
Payne Whitney Clinic, New York, NY.
OBJECTIVE: The psychodynamic approach to understanding dysthymia has rarely
been empirically tested. In this pilot study the Defense Mechanism Rating
Scales were used to examine psychodynamic data from patients with dysthymia
and patients with panic disorder in order to test the hypotheses that 1)
dysthymic patients would be similar to panic patients in endorsing
primarily lower-maturity defense mechanisms, 2) dysthymic patients would
use a distinct pattern of defense mechanisms, different from that of panic
patients, and 3) dysthymic patients would endorse more frequently than
panic patients four individual defenses that tend to handle anger and low
self-esteem poorly: devaluation, passive aggression, projection, and
hypochondriasis. METHOD: Twenty-two subjects meeting the DSM-III-R criteria
for primary early-onset dysthymia and 22 subjects meeting the DSM-III-R
criteria for primary panic disorder were interviewed on videotape and rated
on the Defense Mechanism Rating Scales. RESULTS: The dysthymic subjects
scored significantly higher on narcissistic, disavowal, and action defense
levels and on the four individual defenses of devaluation, projection,
passive aggression, and hypochondriasis, as predicted, as well as on two
additional defenses, acting out and projective identification. Both groups
tended to use lower-maturity defense mechanisms. CONCLUSIONS: The defense
mechanism profile identified for dysthymia differs from that for panic
disorder and supports particular psychodynamic hypotheses about chronic
depression. It could be useful in devising treatment strategies and as a
measure of treatment efficacy.
