Defense style as a predictor of change in interpersonal problems among patients attending day treatment for personality disorder.

BACKGROUND

Healthy interpersonal functioning, and a reduction of the distress associated with maladaptive interpersonal behavior, is a focus of treatment for personality disorder (PD). Patients with PD are also known to make a preferential use of immature defenses. We examined change in interpersonal problems as a critical outcome, and defense style as a predictor of this outcome.

METHODS

Consecutively admitted patients to a group-oriented day treatment (DT) program were recruited (N = 32). Predictor variables were represented by subscale scores from the 40-item Defense Style Questionnaire (DSQ-40); outcomes were represented by the global distress and interpersonal octant scores from the 64-item Inventory of Interpersonal Problems-Circumplex (IIP-C).

RESULTS

Significant inverse correlations were observed between Neurotic defenses and change in both interpersonal distress and problems associated with the Vindictive, Cold, Socially Inhibited, and Non-Assertive octants. Partial correlations, adjusting for baseline IIP-C scores, remained significant. Additional inverse relations between Neurotic defenses and improvement in the Domineering, Exploitable, and Overly Nurturant octants also emerged in the partial correlation analysis.

DISCUSSION: Neurotic defenses are oriented to "splitting off" the affective element of experience; in the case of patients with PD, this affective element may often involve hostility. An orientation to use of Neurotic defenses also appears to be more trait-like and thus resistant to change. The findings highlight developing skill in affective communication, and addressing maladaptive interpersonal behaviors in the here-and-now, as mechanisms of therapeutic change in DT of patients with PD.

LIMITATIONS: The sample was small and assessment of defense style and interpersonal problems relied on patient self-report.