Defense mechanisms associated with borderline personality disorder

Area of Science:

• Psychiatry
• Clinical Psychology
• Personality Disorders

Background:

• Defensive functioning is crucial in understanding personality disorders.
• Previous research has not fully elucidated the specific defense mechanisms differentiating borderline personality disorder (BPD) from other Axis II conditions.

Purpose of the Study:

• To assess and compare the defensive functioning of borderline patients with that of patients with other Axis II psychopathology.
• To identify specific defense mechanisms that may serve as clinical markers for BPD.

Main Methods:

• Administered the Defense Style Questionnaire (DSQ) to 362 Axis II inpatients.
• Diagnoses were confirmed using semistructured interviews.
• Compared defense style scores between 290 borderline patients and 72 patients with other Axis II disorders.

Main Results:

• Borderline patients showed significantly higher scores in self-sacrificing, maladaptive action, and image-distorting defense styles.
• They also scored higher on eight specific defense mechanisms, including acting out, emotional hypochondriasis, and undoing.
• A model using acting out, emotional hypochondriasis, and undoing demonstrated high sensitivity (.95) and positive predictive power (.86) for BPD diagnosis.

Conclusions:

• The defensive profile of borderline patients is distinct from other Axis II psychopathologies.
• The defense triad of acting out, emotional hypochondriasis, and undoing may be a valuable clinical marker for identifying borderline personality disorder, especially in high-prevalence settings.