Defense mechanisms and Somatization: The effect of defense hierarchy on somatization

Document Type : Research Paper


1 Department of Psychology, Faculty of Psychology and Education Sciences, University of Tehran, Tehran, Iran

2 Department of Psychology, Faculty of psychology and Educational Sciences, University of Tehran, Tehran, Iran

3 Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran


The aim of present study was to evaluate the possible role of dominant defense styles in predicting somatization symptoms and general health. 253 university in students, including 149 female and 104 male, were studied with Defense Style Questionnaire (Andrews, 1993), Symptoms of Somatization (Rief and Hiller, 1998), and General Health Questionnaire (Goldberg, 1979). The results showed that defense mechanisms act as a predictor of somatization symptoms and general health. Mature defense styles negatively predicted somatization and positively predicted general health. Immature defenses were positive predictor of somatization and neurotic styles were negative predictor of general health. Moreover, autistic fantasy, acting out, isolation, and undoing defenses, specifically and positively predicted somatization symptoms. The results are an evidence for the possible role of defense styles in an inducing and a relapsing of psychosomatic disorders. Psychotherapies can reduce somatization and improve general health by focusing on the defense styles which have an important role in.

Afzali, M. H., FathiAshtiani, A., &Azadfallah, P. (2009). The Study of defense styles & mechanisms in patients with Obsessive -compulsive disorder, generalized anxiety disorder & social phobia disorder. Journal of Clinical Psychology, 1, 79-93. In Persian.
Albuquerque, S. C., Carvalho, E. R., Lopes, R. S., Marques, H. S., Macedo, D. S., Pereira, E. D., Hyphantis, T. N., &Carvalho, A. F.(2011). Ego defense mechanisms in COPD: impact on health-related quality of life and dyspnoea severity. Quality of Life Research, 20, 1401–1410.
Ali AkbariDehkordi, M., Salehi, SH.,&Rezaee, A. (2013). Comparison of Irrational Beliefs and Defensive Styles among Coronary Heart Patients and Normal Individuals. Journal of Health Psychology, 2(6), 18-32. In Persian.
Andrews, G., Singh, M., & Bond, M. (1993). The defense  style questionnaire. Journal of Nervousand Mental Disease, 181(4), 246-256.
 Besharat, M. A., Sharifi, M., & Ivarani, M. (2001). Investigating the Relationship between Attachment Styles and Defensive Mechanisms. Journal of Psychology, 3(19), 277-289. In Persian.
Bond, M., & Perry, J. C. (2004). Long-Term Changes in Defense Styles With PsychodynamicPsychotherapy for Depressive, Anxiety, and Personality Disorders. The American Journal of Psychiatry, 161, 1665–1671.
Carvalho, A. F., Ramirez, S. P., Macedo, D. S., Sales, P. M. G., Rebouc, J. C., Daher, E. F.,  &Hyphantis, T. N. (2013). The Psychological Defensive Profile of Hemodialysis Patients and Its Relationship to Health-Related Quality of Life. The Journal of Nervous and Mental Disease, 201(7), 621-628.
Chabrol, H.,  Rousseau, A., Rodgers, R., Callahan, S., Pirlot, G., &Sztulman, H. (2005). A study of the face validity of the 40 item version of the Defense Style Questionnaire (DSQ-40).  Journal of Nervous and Mental Disease, 193, 756-759.
Davanloo, H. (1990). Unlocking the nconcious. New York, NY: Wiley.
Elfant, E., Burns, J., &Zeichner, A. (2007). Repressive coping style and suppression of pain-relatedthoughts: effects on responses to acute pain induction. Cognition and Emotion, 22(4), 671–696.
Fredrickson, J. (2013). Co-Creating Change, Effective Dynamic Therapy Techniques. Kansas city, Seven Leaves Press.
Ghorbani, N., Watson, P. J., & Morris, R. (2000). Personality, Stress and mental health.: evidence of relationship in a sample of Iranian managers. Personality and Individual Differences, 28, 647-670.
Giese-Davis, J., Conrad, A., Nouriani, B., & Spiegel, D. (2008). Exploring Emotion-Regulation and Autonomic Physiology in Metastatic Breast Cancer Patients: Repression, Suppression, an Restraint of Hostility. Personality and Individual Differences, 44(1), 226–237.
Giese-Davis, J., & Spiegel, D. (2003). Handbook of Affective Sciences. Oxford, Oxford University Press.
HeidariNasab, L., Mansour, M, Azad Falah, P., &Shaeri, M. R. (2007). Validity and reliability of defense style questionnaire (DSQ-40) in Iranian samples. DaneshvarRaftar, 14(22), 11-26. In Persian.
Hiller, W., Rief, W., &Brahler, E. (2006). Somatization in the population: from mild bodily misperceptions to disabling symptoms. Social Psychiatry and Psychiatric Epidemiology, 41, 704–712.
Hyphantis, T., Traintafillidis, J. K., Pappa, S., Mantas, C., Kaltsouda, A., Cherakakis, P., Alamanos, Y., Manousos, O. N., &Mavreas, V. (2005). Defense Mechanisms in InflamatoryBowel Disease Journal of Gastroenterology, 40, 24-30.
Hyphantis, T., Tomenson, T., Bai, M., Tsianos, E., Mavreas, V., & Creed, F. (2010). Psychological Distress, Somatization, and Defense Mechanisms Associated with Quality of Life in Inflammatory Bowel Disease Patients. Digestive Diseases and Sciences, 55, 724–732.
Hyphantis, T., Goulia, P., Carvalho, A. F. (2013). Personality traits, defense mechanisms and hostility features associate with somatic symptom severity in both health and disease. Journal of Psychosomatic Research, 75, 362–369.
Hyphantis, T. N., Taunay, T. C., Macedo, D. S., Soeiro-de-Souza, M. G., Bisol, L. W., Fountoulakis, K. N., Lara, D. R., &Carvalho, A. F. (2013). Affective temperaments and ego defense mechanisms associated with somatic symptom severity in a large sample. Journal of Affective Disorders, 150, 481–489.
Jamil, L., AtefVahid, M., Dehghani, M., &Habibi, M. (2015). The Mental Health Through Psychodynamic Perspective: The Relationship between the Ego Strength, The Defense Styles, and the Object Relations to Mental Health. Iranian Journal of Psychiatry and Clinical Psychology, 21(2), 144-154. In Persian.
Kapalan, H., Sado, B., & Ruiz, P. (2015). Synapsis of psychiatry: Behavioral Sciences/ Clinical Psychiatry. 11th edition. Wolters Kluwer. 
Kashanaki, H., Ghorbani, N., &Hatami, J. (2016). Studying the Effect of Feeling Suppression and Psychological and Physical Symptoms According to Integrative Self-Knowledge, Mindfulness, Self-Compassion, Social Desirability and Self-Control. Applied Psychological Research Quarterly, 7(3), 55-70. In Persian.
Larsen, A., Bøggild, H., Mortensen, J. T., Foldager, L., Hansen, J., & Christensen, A. (2010). Psychopathology, defense mechanisms, and the psychosocial work environment. International Journal of Social Psychiatry, 56, 563–577.
Malone, J. C., Cohen, S., Liu, S. R., Vaillant, G. E., &Waldinger, R. J. (2013).  Adaptive midlife defense mechanisms and late-life health. Personality and Individual Differences, 55, 85–89.
Manzaritavakoli, V., Hashemizadeh, V., Salehi, S., &Salajegheh, S. (2014). Defensive Styles: Consequence of Emotional Self-Efficacy and Self-Esteem. Applied Psychological Research Quarterly, 4(4), 27-39. In Persian.
Noorbala, A. A., BagheriYazdi, S. A.,&Kazem, M. (2009). The Validation of General Health Questionnaire- 28 as a Psychiatric Screening Tool .Hakim Health System Research, 11(4), 47-53. In Persian.
Pappa, C., Hyphantis, T., Pappa, S., Aspiotis, M., Stefaniotou, M., &Kitsos, G. (2006). Psychiatricmanifestations and personality traits associated with compliance with glaucomatreatment. Journal of Psychosomatic Research, 61, 609–17.
Prasertsri, N., Holden, J., Keefe, F. J., &Wilkie, D. J. (2011). Repressive coping style: Relationships with depression, pain, and pain coping strategies in lung cancer out patients. Lung Cancer, 71(2), 235-40.
Rief,W., & Hiller, W. (2003). A New Approach to the Assessment of the Treatment Effects of Somatoform Disorders. Psychosomatics, 44, 492–498.
Vaillant, G. E. (2000). Adaptive mental mechanisms. Their role in a positive psychology. American Psychologist, 55, 89–98.
Vaillant, G. E., &Mukamal, K. (2001). Successful aging. American Journal of Psychiatry, 158, 839–847.
Vigna-Taglianti, M., &Arfelli, P. (2014). Confusion of tongues: A defense mechanism and a complexcommunication of unwelcome children with an early broken intimacy. International Forum of Psychoanalysis, 23, 30-36.
Wild, J. (2004). Relationship between Cognitive Distortions and Anger. The Rational Emotive Behavioral Therapists, 11(1), 61-82.
Zahedi-Tajrishi, K., Besharat, M. A. (2014). The Comparison of Ego Defense Styles in Patients with Somatization, Anxiety, and Normal Individuals. Journal of Clinical Psychology, 6(4), 61-70. In Persian.