Abstract
Objective: Although defense mechanisms are central concepts in psychiatry, whether individual disorders (or categories of disorders) are associated with a specific profile of defense mechanisms or whether defense mechanisms are general markers of severity of psychopathology is unknown.
Methods: We drew on data from the National Epidemiological Survey on Alcohol and Related Conditions (N = 43,093) to investigate associations of 12 pathological defense mechanisms with mood, anxiety, and substance use disorders. Logistic regressions were fit with mental disorders as predictors, defense mechanisms as outcomes, and respondent age, sex, and race/ethnicity as covariates.
Results: Compared to individuals with no disorders, those with mood, anxiety, or substance use disorders generally had a higher prevalence of defense mechanisms. Specifically, the prevalence of any pathological mechanism was 30.0% (95% CI, 29.4%–30.7%) for individuals with no disorders, 67.6% (95% CI, 65.9%–69.2%) for individuals with mood disorders, 62.8% (95% CI, 61.3%–64.2%) for individuals with anxiety disorders, and 49.8% (95% CI, 48.7%–51.0%) for individuals with substance use disorders. Broad diagnostic categories or individual psychiatric disorders were not associated with specific defense profiles.
Conclusion: Our findings suggest that defense mechanisms and psychiatric disorders represent correlated but different dimensions of psychopathology, which may respond to different treatment approaches.
J Clin Psychiatry 2025;86(2):24m15582
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