MANUAL FOR THE DEFENSE STYLE QUESTIONNAIRE (DSQ)

MICHAEL BOND, M.D.

STEVEN WESLEY, M.D.

Copyright 1996
 DEVELOPMENT OF THE DEFENSE STYLE QUESTIONNAIRE

The development of the DSQ has been based on the premise that people are sufficiently

aware of the way they respond to situations of conflict and stress to provide information that can

be classified as evidence of types of defensive functioning. Bond et al.1 developed the original

version of the DSQ with the objective of assessing conscious derivatives of defensive

functioning, the intention being "to elicit manifestations of a subject's characteristic style of

dealing with conflict, either conscious or unconscious, based on the assumption that persons can

accurately comment on their behavior from a distance".

Initially, a pool of statements was designed to reflect behaviors suggestive of the

following defense or coping mechanisms: acting out, pseudoaltruism, as-if-behavior, clinging,

humor, passive-aggressive behavior, regression, somatization, suppression, withdrawal,

dissociation, denial, displacement, omnipotence-devaluation, inhibition, intellectualization,

identification, primitive idealization, projection, reaction formation, repression, splitting,

sublimation, and turning against the self. These statements were subjected to an initial test of

face validity by having two psychologists and one psychiatrist (of whom two of the three are

psychoanalysts) to independently match up each statement with its relevant defense mechanism.

Only statements on which they all could agree formed the 97-statement questionnaire. A

sample of 98 patients and 111 nonpatient control subjects were asked to indicate their degree of

agreement or disagreement with each statement on a nine-point scale: 1 indicated strong

1
disagreement and 9 indicated strong agreement. All scales were constructed such that a high

score on any one defense measure/variable indicated the subject to be using that defense (to a

significant degree).

In a pilot project, 30 patients were tested on this first version of this questionnaire.

Internal consistency among statements designed to measure the same defense was assessed

through item-to-total correlations. Only statements correlating with their parent group at a

significance level of greater than .001 were retained. On this basis, 81 of the initial 97

questionnaire statements were retained.

The hypotheses tested were (1) factor analysis would demonstrate separate clusters of

defense mechanisms, i.e., defensive styles, and (2) defenses thought to be immature (such as

acting out, projection, withdrawal, and passive-aggressive behavior) would cluster at one end of

a continuum, whereas defenses thought to be mature (such as humor, suppression, and

sublimation) and would cluster at the opposite end.

Results

As in the pilot project, item-to-total correlations were carried out for each question and

for the total score of the questions attributed to each defense mechanism in relation to the factor

to which it belonged to ensure that reliability had been retained and that the statements still

correlated with the other statements in the relevant defense category. All correlations remained

at a level greater than .001.

Principal component factor analyses (type PA1, quatrimax rotation)2 were carried out on

the 24 sets of defense statements for the entire sample and for the patient and nonpatient samples

taken separately. The size of the eigenvalues indicated a four factor solution provided an

2
adequate representation of the data for both the combined group and for the patient and

nonpatient samples taken separately. (See Table 1; other data available on request.) Whether

the factor analysis was carried out on the combined group or on the patient and nonpatient

samples taken separately, the same defenses clustered together.

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 Table 1

Factor Loadings on Defenses (Combined Sample)*

___________________________________________________________________________
Defense Factor Factor Factor Factor
1 2 3 4
___________________________________________________________________________

Acting out .76 .11 -.10 -.23

Regression .67 -.01 -.09 -.29
Passive-aggressive behavior .74 .10 -.02 -.09
Withdrawal .75 -.17 -.11 -.05
Projection .69 .31 .02 -.41
Inhibition .69 -.20 .17 -.01
Omnipotence-devaluation .17 .70 -.10 .21
Splitting .38 .60 -.05 -.20
Primitive idealization .36 .54 .36 .15
Pseudoaltruism .33 -.08 .62 .06
Reaction formation .36 -.07 .56 .06
Sublimation -.09 .12 .17 .64
Humor -.14 .02 -.27 .63
Suppression -.10 .02 .00 .62
As-if behavior .62 .05 .07 .32
Clinging .64 .34 .04 .02
Denial .33 .04 .52 -.05
Displacement .49 .15 -.19 .05
Dissociation .63 .22 .15 -.17
Identification .45 .32 .19 .29
Intellectualization .49 -.12 -.11 .33
Repression .53 -.08 .05 -.17
Somatization .56 .19 .11 .10
Turning against self .61 -.26 .02 -.03
___________________________________________________________________________

* Type PA1, Quartimax rotation.

Defensive style 1 (factor 1) consisted of apparent derivatives of defense mechanisms

usually viewed as immature, namely, withdrawal, acting out, regression, inhibition, passive

aggression, and projection. All of the above produced factor loadings greater than .65.

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Defensive style 2 (factor 2) consisted of apparent derivatives of omnipotence, splitting, and

primitive idealization. All three loaded greater than .50. Defensive style 3 (factor 3) consisted

of apparent derivatives of only two defense mechanisms: reaction formation and pseudoaltruism.

These loaded .56 and .62 respectively. Defensive style 4 (factor 4) consisted of apparent

derivatives of suppression, sublimation, and humor, all of which loaded at a greater than .50

level. From the original 24 defense mechanisms, the 14 mentioned above were again factor

analyzed, resulting in the factor structure and loadings shown in Table 2. The total number of

items remaining was 67.

Table 2

Factor Loadings of Selected Self-reported Defense Derivatives*

___________________________________________________________________________

Defense Factor Factor Factor Factor

1 2 3 4
____________________________________________________________________________

Acting out .78 .21 -.02 -.14

Passive-aggression .76 .18 .06 .00
Regression .76 -.05 .10 -.19
Withdrawal .75 -.03 .22 .10
Inhibition .68 -.15 .23 -.01
Projection .69 .39 .06 -.32
Omnipotence-devaluation .06 .75 -.08 .26
Primitive idealization .25 .54 .34 .10
Splitting .29 .70 .06 -.17
Pseudoaltruism .22 -.04 .70 .03
Reaction formation .27 -.01 .60 .08
Humor -.10 -.04 -.27 .70
Suppression -.17 .09 .09 .61
Sublimation -.06 .05 .11 .73
____________________________________________________________________________

* Quartimax rotation with Kaiser normalization.

The developmental level which these defense styles reflected was assessed in a number
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of ways. Table 3 shows that defense style 1 has a significant negative correlation with style 4,

which may indicate that these two styles represent two extreme poles of a continuum of defense

adaptiveness. The patient sample had significantly higher mean scores than the nonpatient

sample on style 1 through 3 defenses, thought to represent the immmature end of the defense

spectrum. The nonpatient sample had a significantly higher mean score on style 4, representing

mature defenses.

Table 3

Intercorrelations of Defense Styles

_____________________________________________________________

Style 2 Style 3 Style 4

_____________________________________________________________

Style 1 .39* .37* -.28*

Style 2 .... .18 .07

Style 3 .... .... -.02

_____________________________________________________________

*p.001.

Table 4 shows the correlations of the four defense styles with two measures indicative of

ego maturity, the Ego Function Questionnaire (EFQ) and the Sentence Completion Test of

Leovinger. The relative relationships of these indicates that defense styles 1 through 4 can be

ranked in that order; that is, the ego strength score derived from the EFQ has high negative

correlation with style 1, a lower negative correlation with styles 2 and 3, and a significantly

positive correlation with style 4. The same pattern holds for the ego development score (the

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Loevinger test). When the ego strength and ego development scores were factor analyzed (type

PA1, quartimax rotation) along with the separate defenses that constitute the four defense styles,

a four-factor solution resulted with the ego strength and ego development scores loading

negatively with style 1 defenses and positively with style 4 defenses.

Table 4

Correlations of Defense Styles With Loevinger's Ego Development

and Ego Strength Measures of Brown and Gardner*

________________________________________________________________

Defense Defense Defense Defense

Style 1 Style 2 Style 3 Style 4
________________________________________________________________

Ego strength -.91 -.37 -.38 .32

Loevinger's
ego development -.42 -.22 -.29 .19
_______________________________________________________________

*R.D. Brown, MD, and S.T.G., written communication, Jan. 15, 1980.
p.001,
p.01.

In 1986, eleven items were added to the original 67-item version of the DSQ,

representing 6 defense or coping mechanisms of undoing, help-rejecting complaining,

consummatory behavior, isolation, task orientation, affiliation. This revised 78-item

questionnaire was not at that time shown to possess the same psychometric properties of its

predecessor. However, in a study of 131 men involved in a longitudinal research project of

defenses and psychological health, Vaillant et al.3 found that the 78-item version of the DSQ

identified the same defense styles that were identified 7 years earlier by clinical assessment. In

addition, scores from the immature and intermediate grouping of defense styles (1 through 3) on
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the 78-item version were found to significantly correlate with an observer-rated measure of the

same level of defenses in a study of 156 outpatient psychiatry patients4. In 39 patients from this

study the DSQ was repeated 6 months later. The test-retest reliability for the four defense styles

was highly significant (p = 0.001); for style 1, r = .73; for style 2, r = .71; for style 3, r = .68; and

for style 4, r = .69.

The Relationship of the DSQ to other Measures of Mental Health

The above discussion has demonstrated the considerable validity of the DSQ as a

measure of several dimensions of defensive maturity. In addition to having cross-validated with

other measures of defensive and ego functioning, the DSQ has been correlated to a variety of

mental health measures in a manner which reveals both its unique properties and its consistency

with defense theory.

The DSQ has correlated in a theoretically expected direction with several different

measures of each of the following; general psychopathologic symptomatology4,5,6, general

medical symptomatology4,5, anxiety5,7,8, depression7,9, personality disorder10,11,12, life stress4,13,5,

eating disorders14,15, neuroticism10,16, and coping17,18. It has been demonstrated to successfully

differentiate between clinical and nonclinical samples in the following disorders: anorexia14,15,19,

bulimia14,15,19, anxiety5,8,20, depression9,20, impotence21, delinquency17, psychosomatic

disorders17, child abusers22, and personality disorders10,13,20. The DSQ has also been correlated

with inpatient status10 and severity of mental illness23. Translated versions of the measure have

been used in psychopathology studies in the native languages of the following countries;

Norway20, Finland23, Holland8, Germany24, Italy21, Switzerland (French)25, China26, and Egypt27.

This body of research offers encouraging support for the validity of the DSQ, but it also

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raises the question of whether the DSQ is more than just a measure of general psychopathology.

Defense theory generally conceives of defensive functioning as a relatively stable aspect of

personality organization but does allow for some correlation with affective state. In general,

measures of personality traits are known to be influenced by affective state28. Research from

social psychology has made it clear that affects and emotions can profoundly influence coping

behavior29. The conventional view of defense theory is that patients tend to "regress" when they

become ill and are said to adopt a more mature defense pattern as they recover30. Several DSQ

studies have shown that patients who recover from affective/symptom disorders demonstrate

decreased reliance on immature defense functioning6,9,31. The DSQ has also been demonstrated

to significantly correlate in a theoretically expected direction with two different measures of life

stress4,5. That is, life stress correlates positively with the immature-range defenses and

negatively with the mature-range defenses. The impact of life stress on defensive functioning

may be modulated by its influence on the state variables of affect and cognition. Such variables

may in turn impact on defensive functioning by influencing the selection and interpretation of

the contextual cues which activate the specific defense processes. However, it has been

suggested that defensive functioning should not be synonymous with affective symptomatology

since it would therefore add little information beyond the present DSM-IV, Axis I-based

diagnostic criteria31.

The result of several DSQ studies indicate that, although elements of defensive

functioning are influenced by affective symptomatology, it is an aspect of mental functioning

which is to some degree independent of, and more stable than such symptomatology. In one

study of patients treated for depression9,, recovered patients showed the theoretically expected

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improvements in immature and mature defense factors, but continued to use less mature and

more intermediate defensive functioning than nonclinical controls, despite having normalized

their affective symptomatology. In addition, patients with secondary diagnoses used more

intermediate-range defenses and showed less improvement in affective symptomatology.

A study of bulimic patients6 demonstrated that personality disorder classification accounted for

more variance in DSQ socres than any other measures of psychopathology, which included

measures of depression, general psychopathological symptomatology, and three measures of

eating disorder symptomatology. Patients who relied more heavily on immature defense

functioning demonstrated less improvement in eating disorder symptomatology. These studies

indicate tht DSQ findings are consistent with the theoretical notion that defensive functioning

does vary with symptomtology but is also in some measure independent of it. They also suggest

that defensive functioning (and the DSQ) may have prognostic significance beyond

symptomatology.

DSQ and Personality

More evidence for the trait-like aspect of DSQ scores comes from studies of personality

disorder. Several studies have demonstrated a consistently robust relationship between

personality disorder symptomatology and the DSQ. In a study of 150 personality disorder

patients the DSQ revealed borderline personality disorder patients to use significantly more

immature and significantly less mature range defenses than nonborderline personality disorder

patients11. This finding is consistent with theoretical views of borderline personality disorder

presented by Kernberg35. A Norwegian study20 demonstrated personality disorder patients to use

more immature-range and less mature-range defensive functioning than a group of patients

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comprising panic disorder and depressed patients. This study also demonstrated greater use of

immature defensive functioning amongst cluster A and B personality disorders than cluster C

personality disorders. The DSQ has also been showns to correlate significantly with personality

disorder symptomatology in nonclinical populations. In a study of 106 undergraduate students

the DSQ immature and mature-range defenses correlated in a theoretically expected direction

with the Personality Disorder Questionnaire (PDQ-R) composite index12. In addition, each

PDQ-R subscale showed a unique pattern of association with the different defense factors.

Perhaps the most compelling demonstration of the DSQs' power to tap trait-like aspects

of psychopathology comes from a study comparing its ability to account for the variance in

personality disorder symptomatology with that of a self-report measure of the widely supported,

dimensionally-based, Five Factor Model (FFM) of personality10. This model of personality is

based on the results of extensive factor-analytic studies of a large number of existing personality

measures and of lexical analysis of adjectival descriptors of personality32. Proponents of this

model contend that the basic dimensions of personality description can be represented by five

factors which "are both necessary and reasonably sufficient for describing at a global level the

major features of personality"33. The nature of these five factors can be summarized by the

broad concepts of: Surgency/Extroversion, Agreeableness, Conscientiousness, Emotional

Stability versus Neuroticism, and Openness to Experience34. It has also been stated/proposed

that the FFM "is fully adequate to account for the dimensions of abnormal personality"35. The

comparison study of a measure of this FFM and the DSQ involved 257 psychiatric outpatients

and included 109 personality disorder patients who had no Axis-I pathology which required

focused treatment (e.g.-depression, substance abuse, neurological impairment). It demonstrated

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the DSQ to have greater power in accounting for the variance in an interview-based measure of

personality disorder symptomatology than did the FFM measure. The DSQ was also shown to

contribute substantial additional variance in explaining the degree of personality pathology

beyond that of the FFM measure. These findings are particularly significant in that the FFM and

related models of personality have in recent years garnered considerable support as

dimensionally-based alternatives to the current categorically-based diagnosis and classification

of personality disorders36. They suggest that models of personality organization which more

specifically account for the dynamics of affect regulation may have greater validity in the

explanation of psychopathology.

Prognostic and Therapeutic Value

The data thus far presented on the DSQ suggests that it may tap aspects of psychological

functioning which have significant and unique implications for psychopathology. However,

prospectively designed research is necessary to appropriately validate its ability to contribute

prognostically useful information beyond that provided by DSM-IV-based axes. Although more

studies are needed, several have demonstrated the DSQ to possess some measure of predictive

utility. As previously mentioned, a study of patients treated for depression revealed that patients

using more immature and intermediate-range defensive functioning did not respond as well to

treatment despite similar baseline affective symptomatology15. A similar result was found in a

study of eating disorder patients where greater use of immature-range defensive functioning

predicted poorer response to treatment9. Andrews has observed that patients with anxiety

disorders whose defense style profile deviates less than 1 Standard Deviation from normal seem

to respond well to minimal intervention, whereas those with a low mature and high neurotic

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(intermediate) and immature defense pattern seem to require considerably more treatment16.

This area is currently being prospectively studied by the Andrews group. A study of depressed

and neurotic outpatients37 revealed the DSQ to be one of only two out of fifteen measures

investigated to significantly predict response to psychotherapeutic interventions. The two

predictor scores were statistically independent of one another and were not significantly

related to initial severity of disturbance. A 6-year follow-up study of eating disorder patients

demonstrated that levels of mature-range defensive functioning were found to significantly

predict long-term/6 year outcome39. In an ongoing prospective study, Ungerer et al. measured

the defense style of pregnant women and suggested that patterns of defense style are predictive

of impaired mother/baby interactions and impaired development of the self-regulation in the

baby38. Taken together, these studies suggest that the DSQ, and by implication defense

functioning, has considerable power in explaining the variability in outcome of specific

diagnostic groups. Adequate knowledge of defensive functioning can therefore improve the

ability to predict course of illness and individualize treatment. Ultimately the assessment of

defensive functioning will complement the assessment of symptomatology to form a more

therapeutically and prognostically useful profile of patients.

In summary, the evidence which has thus far accumulated on the DSQ indicates it to

be a valid measure of three general dimensions of defense functioning and maturity. The

research suggests that these dimensions represent unique and prognostically useful aspects of

psychological functioning which are conceptually concordant with defense theory. Although

further psychometric refinement is required, it is proposed that the DSQ can be a tool for

suggesting the direction of future research in the realm of defensive functioning. It is

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recommended, however, that the effort of different research groups be coordinated so as to

improve the yield of useful information from future studies and psychometric refinements. To

this end, the Bond group of investigators at McGill University is currently collating data from a

number of existing studies for the purposes of more definitively establishing/elaborating the

psychometric characteristics of the DSQ.

Current Scoring Instructions

There are four defense styles which have been named:

1. Maladaptive action defense style
2. Image-distorting defense style
3. Self-sacrificing defense style
4. Adaptive defense style
The following is a key to which items cluster of each style

Maladaptive Action Image-Distorting Self-sacrificing Adaptive

2, 4, 9, 10, 12, 11, 18, 23, 24, 1, 13, 16 3, 5, 8,
17, 19, 21, 22, 25, 30, 37, 42, 43, 47, 52, 59, 61,
27, 28, 29, 32, 33, 51, 53, 58, 64, 56, 63, 65 68, 86
35, 36, 40, 41, 46, 66, 76, 83
49, 50, 54, 55, 60,
62, 67, 69, 73, 75,
82, 85, 88

The total scores of the items in each cluster are added up to obtain the score on that style.

The score of different categories of subjects can thus be compared. Alternatively, one can

obtain correlations between style scores and other measures. Also, one can compare subjects'

scores to standard scores listed in Table 6.

There are some items which are in the DSQ which don't significantly correlate with one

of the 4 factors and thus are not in the above key. These items were left in the DSQ so as not to

change the original context of the questionnaire.

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Relationships to Specific Defense Mechanisms

Appendix A indicates which mechanism each statement was designed to represent. Some

items represent social desirability or "lie scale" items. These do not belong to any defense style.

When DSQ items were correlated with judges' ratings of specific defense mechanisms

using Perry's DMRS method, the following items were significantly positively correlated.

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 Table 5

Questionnaire items which are positively correlated (p 0.05)

with individual defense mechanisms as rated by DMRS (Defense Mechanism Rating Scale)

Defense mechanism DSQ Item

Neurotic denial 16, 52

Nondelusional projection 12, 25, 55, 87
Passive aggression 45
Acting out 21, 27, 46
Splitting of other's image 64
Projective identification 60
Omnipotence 18, 42
Undoing 88
Affiliation 86
Somatization 62
Hypochondriasis 69, 75, 82

Table 6

Standard Scores

Different samples of subjects yield different average scores on the various defense styles.

DSQ - Means and Standard Deviations (By Item)

Personality Borderline
Defense Non- Disordered Personality All
Style Patients (non-BPD) Disordered Patients

Maladaptive 3.6 ( 1.2) 4.3 ( 1.1) 5.15 ( 1.1) 4.8 ( 1.4)

Image-distorting 2.5 ( 1.0) 3.0 ( 0.9) 3.5 ( 1.1) 3.4 ( 1.2)
Self-sacrificing 2.9 ( 0.6) 4.2 ( 1.1) 4.1 ( 1.2) 4.1 ( 1.2)
Adaptive 4.7 ( 1.0) 5.0 ( 1.3) 4.4 ( 1.2) 4.3 ( 0.6)

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 DEFENSE STYLE QUESTIONNAIRE

INSTRUCTIONS:

This questionnaire consists of 88 statements each of which is followed by a rating scale:

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Rate the degree to which you agree or disagree with each statement and write your rating
from one to nine on the answer sheet.

Eg. Montreal is a city in Canada

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

You would choose 9 and write 9 on the answer sheet beside the statement number.

17
18
 APPENDIX A

Pseudo-Altruism 1. I get satisfaction from helping others and if this were taken away from me I would get
depressed.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Passive-Aggressive 2. People often call me a sulker.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Suppression 3. I'm able to keep a problem out of my mind until I have time to deal with it.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Projection 4. I'm always treated unfairly.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Sublimation 5. I work out my anxiety through doing something constructive and creative like
painting or woodwork.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Lie 6. Once in a while I put off until tomorrow what I ought to do today.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Acting-Out 7. I keep getting into the same type of frustrating situations and I don't know why

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Humour 8. I'm able to laugh at myself pretty easily.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Regression 9. I act like a child when I'm frustrated.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

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Inhibition 10. I'm very shy about standing up for my rights with people.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Omnipotence 11. I am superior to most people I know.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Projection 12. People tend to mistreat me.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Reaction-Formation 13. If someone mugged me and stole my money, I'd rather he'd be helped than punished.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Lie 14. Once in a while I think of things too bad to talk about.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Lie 15. Once in a while I laugh at a dirty joke.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Denial 16. People say I'm like an ostrich with my head buried in the sand. In other words, I tend
to ignore unpleasant facts as if they didn't exist.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Inhibition 17. I stop myself from going all out in a competition.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Omnipotence/ 18. I often feel superior to people I'm with.

Devaluation
Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Projective 19. Someone is robbing me emotionally of all I've got.

Identification
Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

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Lie 20. I get angry some times.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Acting-Out 21. I often am driven to act impulsively.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Passive-Aggressive 22. I'd rather starve than be forced to eat.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Omnipotence 23. I ignore danger as if I were Superman.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Omnipotence/ 24. I pride myself on my ability to cut people down to size.

Devaluation
Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Projection 25. People tell me I have a persecution complex.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Lie 26. Sometimes when I am not feeling well I am cross.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Acting-Out 27. I often act impulsively when something is bothering me.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Somatization 28. I get physically ill when things aren't going well for me.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Inhibition 29. I'm a very inhibited person.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Omnipotence/ 30. I'm a real put-down artist.

Devaluation
Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree
Lie 31. I do not always tell the truth.
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 Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Withdrawal 32. I withdraw from people when I feel hurt.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Acting-out 33. I often push myself so far that other people have to set limits for me.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Humour 34. My friends see me as a clown.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Withdrawal 35. I withdraw when I'm angry.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Projection 36. I tend to be on my guard with people who turn out to be more friendly than I would
have suspected.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Omnipotence 37. I've got special talents that allow me to go through life with no problems.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Lie 38. Sometimes at elections I vote for someone about whom I know very little.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Passive Aggressive 39. I'm often late for appointments.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Fantasy 40. I work more things out in my daydreams than in my real life.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Inhibition 41. I'm very shy about approaching people.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Denial 42. I fear nothing.

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 Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Splitting 43. Sometimes I think I'm an angel and other times I think I'm a devil.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Lie 44. I would rather win than lose in a game.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Passive-Aggressive 45. I get very sarcastic when I'm angry.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Acting-Out 46. I get openly aggressive when I feel hurt.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Reaction Formation 47. I believe in turning the other cheek when someone hurts me.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Lie 48. I do not read every editorial in the newspaper every day.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Withdrawal 49. I withdraw when I'm sad.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Inhibition 50. I'm shy about sex.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Primitive 51. I always feel that someone I know is like a guardian angel.
Idealization
Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Denial 52. My philosophy is, "Hear no evil, do no evil, see no evil"

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

23
Splitting 53. As far as I'm concerned, people are either good or bad.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Passive Aggressive 54. If my boss bugged me, I might make a mistake in my work or work more slowly
so as to get back at him.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Projection 55. Everyone is against me.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Reaction Formation 56. I try to be nice to people I don't like.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Denial (lie) 57. I would be very nervous is an airplane in which I was flying lost an engine.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Primitive 58. There is someone I know who can do anything and who is absolutely fair and just.
Idealization
Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Suppression 59. I can keep the lid on my feelings if it would interfere with what I'm doing if I were to
let them out.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Projection 60. Some people are plotting to kill me.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Humour 61. I'm usually able to see the funny side of an otherwise painful predicament.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Somatization 62. I get a headache when I have to do something I don't like.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

24
Reaction-Formation 63. I often find myself being very nice to people who by all rights I should be angry at.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Splitting 64. There's no such thing as "finding" a little good in everyone". If you're bad, you're
all bad.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Reaction Formation 65. We should never get angry at people we don't like.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Projection 66. I am sure I get a raw deal from life.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Regression 67. I fall apart under stress.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Anticipation 68. When I know that I will have to face a difficult situation, like an exam or a job
interview, I try to imagine what it will be like and plan ways to cope with it.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Help-rejecting 69. Doctors never really understand what is wrong with me.
complaining
Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Isolation 70. When someone close to me dies, I don't feel upset.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Undoing 71. After I fight for my rights, I tend to apologize for my assertiveness.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Projection 72. Most of what happens to me is not my responsibility.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

25
Consumption 73. When I'm depressed or anxious, eating makes me feel better.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Task Orientation 74. Hard work makes me feel better

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Help-Rejecting 75. My doctors are not able to help me really get over my problems.
Complaining
Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Isolation 76. I'm often told that I don't show my feelings.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Isolation 77. I believe that people usually see more meaning in films, plays or books than is
actually there.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Undoing 78. I have habits or rituals which I feel compelled to do or else something terrible will
happen.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Consumption 79. I take drugs, medicine or alcohol when I'm tense.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Affiliation 80. When I feel bad, I try to be with someone.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Anticipation 81. If I can predict that I'm going to be sad ahead of time, I can cope better.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Help-rejecting 82. No matter how much I complain, I never get a satisfactory response.
Complaining
Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

26
Isolation 83. Often I find that I don't feel anything when the situation would seem to warrant
strong emotions.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Task Orientation 84. Sticking to the task at hand keeps me from feeling depressed or anxious.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Consumption 85. I smoke when I'm nervous.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Affiliation 86. If I were in a crisis, I would seek out another person who had the same problem.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Projection 87. I cannot be blamed for what I do wrong.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

Undoing 88. If I have an aggressive thought, I feel the need to do something to compensate for it.

Strongly Disagree 1 2 3 4 5 6 7 8 9 Strongly Agree

27
 REFERENCES

1. Guldberg CA, Hoglend P, Perry JC: Scientific methods for assessing psychological defenses.
Nordic Journal of Psychiatry 1993; 47: 435-446.

2. Mehllman E, Slane S: Validity of Self-Report Measures of Defenses Mechanisms.

Assessment 1994; 1: 189-197.

3. Vaillant GE: Ego Mechanisms of Defense and Personality Psychopathology. Journal of

Abnormal Psychology 1994; 103: 44-50.

4. Perry JC, Cooper SH: An Empirical Study of Defense Mechanisms. Archives of General
Psychiatry 1989; 46: 444-452.

5. Skodol AE, Perry JC: Should an Axis for Defense Mechanisms Be Included in DSM-IV?
Comprehensive Psychiatry 1993; 34: 108-119.

6. Lee KA, Vaillant GE, Torrey WC, Elder GH: A 50-Year Prospective Study of the
Psychological Sequelae of World War II Combat. American Journal of Psychiatry 1995; 152(4):
516-522.

7. Mischel W, Shoda Y: A Cognitive-Affective System Theory of Personality:

Reconceptualizing Situations, Dispositions, Dynamics, and Invariance in Personality Structure.
Psychological Review 1995; 102: 246-268.

8. Bond M, Gardner ST, Christian J, Sigal JJ: Empirical Study of Self-rated Defense Styles.
Archives of General Psychiatry 1983; 40: 333-338.

9. Plutchik R, Kellerman H, Conte HR: A Structural Theory of Ego Defenses and Emotions.
C.E. Izard (Ed.), Emotions in Personality and Psychopathology (pp. 229-257). New York:
Plenum Press.

10. Bond M, Perry JC et al.: Validating the Self-Report of Defense Styles. Journal of
Personality Disorders 1989; 3: 101-112.

11. Vaillant GE, Bond M, Vaillant CO: An Empirically Validated Hierarchy of Defense
Mechanisms. Archives of General Psychiatry 1986; 43: 786-794.

12. Andrews G, Pollock C, Stewart G: The Determination of Defense Style by Questionnaire.

Archives of General Psychiatry 1989; 46: 455-460.

13. Nie NH, Hull CH, Jenkins JG, et al.: Statistical package for the Social Sciences, ed 2. New
York, McGraw-Hill Book Co.1975; pp. 484-485.
28
14. A Draft Glossary of Defense Mechanisms for DSM-III-R, in Vaillant GE (ed): Empirical
Studies of Ego Mechanisms of Defense. Washington, DC, American Psychiatric Press Inc.
1986; pp. 103-105.

15. Kim JO: Factor-Analysis, in Nie NH, Hull CH, Jenkins JG, at al. (eds): Statistical package
for the Social Sciences, ed. 2. New York, McGraw-Hill International Book Co, 1975;
pp. 468-514.

16. Smith GT, McCarthy DM: Methodological Considerations in the Refinement of Clinical
Assessment Instruments. Psychological Assessment 1995; 7(3): 300-308.

29
17. Steiner H, Nasserbakht A, Feldman S: The adaptation of the Defense Style Questionnaire for
the use in Adolescents 1993. In: Scientific Proceedings, 40th Annual Meeting of the AACAP,
9:51.

18. Clark LA, Watson D: Constructing Validity: Basic Issues in Objective Scale Development.
Psychological Assessment 1995; 7(3): 309-319.

19. Vaillant G: Theoretical Hierarchy of Adaptive Ego Mechanisms: A 30-year follow-up of

men selected for psychological health. Archives of General Psychiatry 1971; 24: 107-117.

20. Andrews G, Singh M, Bond M: The Defense Style Questionnaire. The Journal of Nervous
and Mental Disease 1993; 181(4): 246-256.

21. Foster SL, Cone JD: Validity Issues in Clinical Assessment. Psychological Assessment
1995; 7(3): 248-260.

22. Bond MP, Vaillant JS: An Empirical Study of the Relationship Between Diagnosis and
Defense Style. Archives of General Psychiatry 1986; 43: 285-288.

23. Pollock C, Andrews G: Defense Styles Associated with Specific Anxiety Disorders.
American Journal of Psychiatry 1989; 146(11): 1500-1502.

24. Floyd FJ, Widaman KF: Factor Analysis in the Development and Refinement of Clinical
Assessment Instruments. Psychological Assessment 1995; 7(3): 286-299.

25. Soldz S, Budman S, Demby A, Merry J: The Relationship of Defense Style to Personality
Pathology and the Big Five Personality Factors. Personal communication?

26. Flannery RB, Perry JC: Self-Rated Defense Styles, Life Stress, and Health Status: An
Empirical Assessment. Psychosomatics 1990; 31(3): 313-320.

27. Sammallahati P, Aaldberg V, Peentinsaari J-P: Does Defense style vary with severity of
mental disorder? 1994; 90:290-294. Acta Psychiatrica Scandinavica 1994.

28. Reister G, Mans R, Fellhauer R, Tress W: Validation of the German Version of Bond's
Questionnaire of Defense Styles, in Hentschel U, Smith GJW, Ehlers W, Draguns JG (eds): The
Concept of Defense Mechanisms In Contemporary Psychology: Theoretical Research, and
Clinical Perspectives. New York, Springer-Verlag International Book Co, 1993, pp 290-295.

29. Andreasen NC, Arndt S, Alliger R, Miller D, Flaum M: Symptoms of Schizophrenia:

Methods, Meanings, and Mechanisms. Archives of General Psychiatry 1995; 52:341-351.

30. Weiss DJ: Research Methodology: Further Considerations in Applications of Factor

Analysis. Journal of Counseling Psychology 1971; 18(1): 85-92.
30
31. McGill professor-personal communication.

32. Steiger H, Leung F, Thibaudeau J, Houle L, Ghadirian AM: Comorbid Features in Bulimics
Before and After Therapy: Are They Explained by Axis II Diagnoses, Secondary Effects of
Bulimia or Both? Comprehensive Psychiatry 1993; 34(1): 45-53.

33. Muris P, Merkelbach H: Defense Style, Trait anxiety, Worry, and Bodily Symptoms.
Personality and Individual Differences 1994; 16(2): 340-351.

34. Akkerman K, Carr V, Lewin T: Changes in Ego Defenses with Recovery from Depression.
The Journal of Nervous and Mental Disease 1992; 180: 634-638.

35. Bond M, Paris J, Zweig-Frank H: Defense Styles and Borderline Personality Disorder.
Journal of PersonalityDisorders 1994; 8(1): 28-31.

36. Johnson JG, Bornstein RF, Krukonis AB: Defense Styles as Predictors of Personality
Disorder Symptomatology. Journal of Personality Disorders 1992; 6(4): 408-416.

37. Smith C, Feldman SS, Nasserbakht A, Steiner H: Psychological Characteristics and DSM-
III-R Diagnoses at 6-year Follow-up of Adolescent Anorexia Nervosa. Journal of the American
Academy of Child and Adolescent Psychiatry 1993; 32(6): 1237-1245.

38. Steiner H, Feldman SS: Two Approaches to the Measurement of Adaptive Style:
Comparison of Normal, Psychosomatically ill, and Delinquesnt Adolescents. Journal of the
American Academy of Child and Adolescent Psychiatry 1995; 34(2): 180-190.

39. Endler NS, Parker JDA: Assessment of Multidimensional Coping: Task, Emotion, and
Avoidance Strategies. Psychological Assessment 1994; 6(1): 50-60.

40. Steiger H, Van der Feen J, Goldstein C, Leichner P: Defense Styles and Parental Bonding in
Eating-Disordered Women. International Journal of Eating Disorders 1989; 8(2): 131-140.

41. Steiger H, Goldstein C, Mongrain M, Van der Feen J: Description of Eating-Disordered,

Psychiatric, and Normal Women Along Cognitive and Psychodynamic Dimensions.
International Journal of Eating Disorders 1990; 9(2): 129-140.

42. Schmidt U, Slone G, Tiller J, Treasure J: Childhood Adversity and Adult Defense Style in
Eating Disorder Patients: A Controlled Study. British Journal of Medical Psychology 1993;
66(4): 353-362.

43. Guldberg CA, Wiborg I, Hoglend P, Bille H, Narud K, Lea PM: Self-Rated Defenses in
Norwegian Axis-I, Axis-II, and Normal Samples. Presented at the American Psychiatric
Association's Annual Meeting, Philadelphia, USA, May 22-May 29, 1994.
31
44. Orlandini A, Rizzi P, Fossati A, Parlangeli M, et al. : Psychogenic Impotence: Is it possible
to differentiate it from organic impotence with personality, psychopathological, and defensive
indexes? Sexuality and Disability 1993; 11(4): 259-267.

45. Brennan J, Andrews G, Morris-Yates A, Pollock C: An Examination of Defense Style in

Parents who abuse Children. The Journal of Nervous and Mental Disease 1990; 178: 592-595.

46. Swiss study-mentioned by visiting resident from Switzerland to Dr. Bond in summer 1995 -
reference as personal communication?

47. Dunyao L, Lijie Z, Rui Z, Mutao H: Report on Preliminary Application of Defense Style
Questionnaire. Chinese Mental Health Journal 1993; 7(2): 54-56.

48. Egyptian study - personal communication from Dr. G. Andrews.

49. Loranger AW: Are current self-report and interview measures adequate for epidemiological
studies of personality disorders? Journal of Personality Disorders 1992; 6: 313-325.

50. Hunt C: Vulnerability Factors and Long-Term Outcome After Cognitive-Behavioral

Treatment of Anxiety Disorders. Paper presented at the Fourth World Congress on Behavior
Therapy 1992, Gold Coast, Queensland, Australia.

51. FFM summary paper in Journal of Abnormal Psychology 1994.

52. McCrae RR, Costa PT: Clinical Assessment Can Benefit From Recent Advances in
Personality Psychology. American Psychologist 1986; 41: 1001-1003.

53. Block J: A Contrarian View of the Five-Factor Approach to Personality Description.

Psychological Bulletin 1995; 117(2): 187-215.

54. Costa PT, McCrae RR: The Five-Factor Model of Personality and its Relevance
toPersonality Disorders. Journal of Personality Disorders 1992; 6: 343-359.

55. Costa PT, Widiger TA (Eds.): Personality Disorders and the Five-Factor Model of
Personality 1994; Washington, DC, American Psychological Association.

56. Puper WE, DeCarufel F, Szkrumelak N: Patient Predictors of Process in Short-term

Individual Psychotherapy. Journal of Nervous and Mental Disease 1985; 173(12): 726-733.

57. Ungerer JA, Dolby R, Waters BG, Bannett B, Kelk N, Lewin V. The Early Development of
Empathy: Self-Regulation and Individual Differences in the First Year. Motivation Emotion
1990; 14: 93-106.

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