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Published Online: 1 January 2013

Defense Mechanisms Reported by Patients With Borderline Personality Disorder and Axis II Comparison Subjects Over 16 Years of Prospective Follow-Up: Description and Prediction of Recovery

Abstract

Objective

The authors assessed the defensive functioning of 290 patients with borderline personality disorder and compared it with that of 72 patients with other forms of axis II psychopathology over 16 years of prospective follow-up. They also assessed the relationship between time-varying defenses and recovery from borderline personality disorder.

Method

The Defense Style Questionnaire, a self-report measure with demonstrated criterion validity and internal consistency, was initially administered at study entry. It was readministered at eight contiguous 2-year follow-up periods.

Results

Borderline patients had significantly lower scores than axis II comparison subjects on one mature defense mechanism (suppression) and significantly higher scores on seven of the other 18 defenses studied: one neurotic-level defense (undoing), four immature defenses (acting out, emotional hypochondriasis, passive aggression, and projection), and two image-distorting/borderline defenses (projective identification and splitting). Over the follow-up period, borderline patients showed significant improvement on 13 of the 19 defenses studied, with significantly higher scores over time on one mature defense (anticipation) and significantly lower scores on two neurotic defenses (isolation and undoing), all immature defenses, and all image-distorting/borderline defenses except primitive idealization. In addition, four time-varying defense mechanisms were found to predict time to recovery: humor, acting out, emotional hypochondriasis, and projection.

Conclusions

Taken together, these results suggest that the longitudinal defensive functioning of borderline patients is distinct and improves substantially over time. They also suggest that immature defenses are the best predictor of time to recovery.

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Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 111 - 120
PubMed: 23223866

History

Received: 3 February 2012
Revision received: 24 June 2012
Accepted: 30 July 2012
Published online: 1 January 2013
Published in print: January 2013

Authors

Details

Mary C. Zanarini, Ed.D.
From McLean Hospital, Belmond, Mass.
Frances R. Frankenburg, M.D.
From McLean Hospital, Belmond, Mass.
Garrett Fitzmaurice, Sc.D.
From McLean Hospital, Belmond, Mass.

Notes

Address correspondence to Dr. Zanarini ([email protected]).

Competing Interests

All authors report no financial relationships with commercial interests.

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