Investigating defensive functioning and alexithymia in substance use disorder patients

Abstract

Background Substance Use Disorder (SUD) causes a great deal of personal suffering for patients. Recent evidence highlights how defenses and emotion regulation may play a crucial part in the onset and development of this disorder. The aim of this study was to investigate potential differences in the defensive functioning between SUD patients and non-clinical controls. Secondly, we aimed at investigating the relationships between alexithymia and maladaptive/assimilation defenses. Methods The authors assessed defensive functioning (Response Evaluation Measure-71, REM-71), personality (MMPI-II), and alexithymia (TAS-20) of 171 SUD patients (17% female; mean age = 36.5), compared to 155 controls. Authors performed a series of ANOVAs to investigate the defensive array in SUD patients compared to that of non-clinical controls. Student t test for indipendent samples was used to compare clinical characteristics between the SUD group and the controls. To investigate the role of single defenses in explaining alexithimia’s subscores, stepwise multiple regression analysis were carried out on socio-demographic characteristics of participants (gender, age, and years of education), with REM-71 defenses as predictors. Results SUD patients presented a more maladaptive/assimilation (Factor 1) defensive array (p < .001). Among SUD sub-groups, Alcohol Use Disorder patients showed more disfuncional defenses. Factor 1 defenses were related to a worse psychological functioning. In addition, alexyhimia (particularly DIF) was strongly related to Factor 1 defenses, expecially Projection (38% of variance explained, β = .270, p < .001). Conclusion The REM-71 and the TAS-20 might be useful screening instruments among SUD patients.

Heavy Study Investment: An Analysis of the Defense Mechanisms Characterizing Studyholism and Study Engagement

“…Moreover, omnipotence and sublimation are negative predictors of Studyholism, in contrast with the studies concerning SUD, which found that they have higher omnipotence and sublimation levels than a control group [ 38 , 39 ]. The results concerning lower sublimation and higher regression in Studyholics are in line with the studies concerning OCD [ 20 , 29 ] and, regarding lower sublimation only, with the studies about IAD [ 43 , 44 ].…”

“…Additionally, through a critical analysis of all the defense mechanisms that proved to be statistically significant predictors of Studyholism, it has been shown that the OCD-related framework is adequate for the conceptualization of Studyholism, in line with previous studies (e.g., [ 7 , 12 , 15 ]). Moreover, we found that omnipotence and sublimation are negative predictors of Studyholism (in contrast with SUD, which is characterized by higher levels of omnipotence and sublimation [ 38 , 39 ]). Additionally, the results regarding lower sublimation and higher regression are in line with OCD studies [ 20 , 29 ] and, regarding lower sublimation only, with IAD studies [ 43 , 44 ].…”

“…Instead, the subjects addicted to alcohol have a more maladaptive style, as they use a broader set of defenses: acting-out and fantasy, but also omnipotence, projection, and undoing. Interestingly, Taurino et al [ 39 ], even recognizing that Grebot and Dardar [ 38 ] previously found higher levels of sublimation in SUD, suggest that this finding could be due to a methodological issue concerning the REM-71 sublimation scale, which has low internal reliability. However, besides the methodological issues of the two studies (non-clinical sample for Grebot and Dardar [ 38 ] and low reliability of the REM-71 scale for Taurino et al [ 39 ]), two studies, using two different scales, find some evidence for higher sublimation—an adaptive defense—in SUD.…”

“…Finally, a recent study [ 39 ] used the Response Evaluation Measure (REM-71) [ 40 ], which is a self-report evaluating 21 single defense mechanisms and two styles: maladaptive and adaptive defenses. They involved three different types of SUD: alcohol, cocaine (stimulant), and heroin (opioid).…”

“…When comparing the SUD group (all types merged) with the control group, it showed higher levels of acting-out, fantasy, omnipotence, projection, and undoing (maladaptive defenses), higher levels of sublimation, and lower levels of intellectualization (adaptive defenses). Concerning differences between the three SUD groups, Taurino et al [ 39 ] concluded that stimulants and opioid addictions are both characterized by a defense pattern comprehending the use of acting-out, fantasy, and sublimation. Instead, the subjects addicted to alcohol have a more maladaptive style, as they use a broader set of defenses: acting-out and fantasy, but also omnipotence, projection, and undoing.…”