Defense mechanisms are associated with mental health symptoms across six countries

Submitted: October 15, 2023
Accepted: November 15, 2023
Published: December 31, 2023
Abstract Views: 348
PDF: 154
Supplementary Material: 51
HTML: 17
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Defense mechanisms are adaptative processes that are related to mental health and psychological functioning and may play an important role in adaptation to distress, as well as in mental health interventions. The present study aimed to compare the use of defense mechanisms and their relationship to mental health symptoms across six countries. In a large-scale descriptive study, we collected data from community- based individuals (N=19,860) in the United States, Australia, Canada, Germany, Italy, and the United Kingdom about the use of defense mechanisms and experienced mental health symptoms during the early phase of the pandemic. We found that the use of defense mechanism categories was similar across countries. Moreover, lower defensive functioning, specifically, neurotic and immature defenses were related to experiencing higher distress across countries, whereas mature defenses were generally inversely related to symptoms. Furthermore, these findings were relatively similar across the six countries. Cross-cultural research on defense mechanisms and mental health has important clinical implications. Our results are consistent with the goal of promoting more adaptive defensive functioning to increase psychological well-being and mitigate the detrimental impact of situational stress



PlumX Metrics


Download data is not yet available.


Aldwin, C.M. (2009). Stress, coping, and development: An integrative perspective. Guilford press.
Babl, A., Grosse Holtforth, M., Perry, J.C., Schneider, N., Dommann, E., Heer, S., Stähli, A., Aeschbacher, N., Eggel, M., & Eggenberg, J. (2019). Comparison and change of defense mechanisms over the course of psychotherapy in patients with depression or anxiety disorder: evidence from a randomized controlled trial. Journal of Affective Disorders, 252, 212-220. doi: 10.1016/j.jad.2019.04.021 DOI:
Bailey, F.J., & Dua, J. (1999). Individualism - collectivism, coping styles, and stress in international and anglo-australian students: a comparative study. Australian Psychologist, 34(3), 177-182. doi: 10.1080/00050069908257451 DOI:
Békés, V., Prout, T. A., Di Giuseppe, M., Ammar, L. W., Kui, T., Arsena, G., & Conversano, C. (2021). Initial validation of the defense mechanisms rating scales Q-sort: a comparison of trained and untrained raters. Mediterranean Journal of Clinical Psychology, 9(2). doi: 10.13129/2282-1619/mjcp-3107
Békés, V., Starrs, C. J., & Perry, J. C. (2022). The COVID-19 pandemic as traumatic stressor: distress in older adults is predicted by childhood trauma and mitigated by defensive functioning. Psychological Trauma: Theory, Research, Practice, and Policy. doi: 10.1037/tra0001253 DOI:
Carone, N., Benzi, I. M. A., Muzi, L., Parolin, L. A. L., & Fontana, A. (2023a). Problematic Internet use in emerging adulthood to escape from maternal helicopter parenting: defensive functioning as a mediating mechanism. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(3), 693. doi: 10.4081/ripppo.2023.693 DOI:
Carone, N., Benzi, I. M. A., Parolin, L. A. L., & Fontana, A. (2023b). “I can’t miss a thing” – The contribution of defense mechanisms, grandiose narcissism, and vulnerable narcissism to fear of missing out in emerging adulthood. Personality and Individual Differences, 214, 112333. doi: 10.1016/j.paid.2023.112333 DOI:
Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2013). Applied multiple regression/correlation analysis for the behavioral sciences. Routledge. DOI:
Conversano, C., Di Giuseppe, M., & Lingiardi V. (2023) Case report: changes in defense mechanisms, personality functioning, and body mass index during psychotherapy with patients with anorexia nervosa. Frontiers in Psychology, 14, 1081467. doi: 10.3389/fpsyg.2023.1081467 DOI:
Derogatis LR, Lipman RS, Covi L. (1973). SCL-90: An outpatient psychiatric rating scale: Preliminary report. 9, 13-27.
Daly, M., Sutin, A.R., & Robinson, E. (2022). Longitudinal changes in mental health and the COVID-19 pandemic: Evidence from the UK Household Longitudinal Study. Psychological Medicine, 52(13), 2549-2558. doi: 10.1017/S0033291720004432 DOI:
Di Giuseppe, M., Perry, J.C., Lucchesi, M., Michelini, M., Vitiello, S., Piantanida, A., Fabiani, M., Maffei, S., & Conversano, C. (2020). Preliminary reliability and validity of the DMRS-SR-30, a novel self-report measure based on the defense mechanisms rating scales. Frontiers in Psychiatry, 11. doi: 10.3389/fpsyt.2020.00870 DOI:
Di Giuseppe, M., Perry, J.C., Prout, T.A., & Conversano, C. (2021). Editorial: recent empirical research and methodologies in defense mechanisms: defenses as fundamental contributors to adaptation. Frontiers in Psychology, 12. doi: 10.3389/fpsyg.2021.802602 DOI:
Di Giuseppe, M., Orrù, G., Gemignani, A., Ciacchini, R., Miniati, M., Conversano, C. (2022). Mindfulness and defense mechanisms as explicit and implicit emotion regulation strategies against psychological distress during massive catastrophic events. International Journal of Environmental Research and Public Health, 19, 12690. doi: 10.3390/ijerph191912690 DOI:
Giovanardi, G., Fiorini Bincoletto, A., Baiocco, R., Ferrari, M., Gentile, D., Siri, M., Tanzilli, A., & Lingiardi, V. (2022). Lockdown dreams: dream content and emotions during the COVID-19 pandemic in an Italian sample. Psychoanalytic Psychology, 39(2), 111-126. doi: 10.1037/pap0000385 DOI:
Hearne, B.N. (2022). Psychological distress across intersections of race/ethnicity, gender, and marital status during the COVID-19 pandemic. Ethnicity & Health, 27(8), 1932-1951. doi: 10.1080/13557858.2021.1969537 DOI:
Kidd, J.D., Jackman, K.B., Barucco, R., Dworkin, J.D., Dolezal, C., Navalta, T.V., Belloir, J., & Bockting, W.O. (2021). Understanding the impact of the COVID-19 pandemic on the mental health of transgender and gender nonbinary individuals engaged in a longitudinal cohort study. Journal of Homosexuality, 68(4), 592-611. doi: 10.1080/00918369.2020.1868185 DOI:
Høglend, P., & Perry, J.C. (1998). Defensive functioning predicts improvement in major depressive episodes. The Journal of nervous and mental disease, 186(4), 238-243. DOI:
Kuo, B.C.H. (2011). Culture’s consequences on coping: theories, evidences, and dimensionalities. Journal of Cross-Cultural Psychology, 42(6), 1084-1100. doi: 10.1177/0022022110381126 DOI:
Kramer, U., De Roten, Y., Michel, L., & Despland, J. N. (2009). Early change in defence mechanisms and coping in short‐term dynamic psychotherapy: relations with symptoms and alliance. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 16(5), 408-417. doi: 10.1002/cpp.616 DOI:
Laconi, S., Kalaitzaki, A., Spritzer, D.T., Hauck, S., Gnisci, A., Sergi, I., ... & Sahlan, R.N. (2022). A Cross-cultural exploration of problematic Internet use, pathological personality traits, defense mechanisms, coping strategies, and self-esteem in 14 countries. In Annales Médico-psychologiques, revue psychiatrique. Elsevier Masson. DOI:
Lee, S., & Waters, S. F. (2021). Asians and Asian Americans’ experiences of racial discrimination during the COVID-19 pandemic: Impacts on health outcomes and the buffering role of social support. Stigma and Health, 6(1), 70-78. doi: 10.1037/sah0000275 DOI:
Maffei, C., Fossati, A., Lingiardi, V., Madeddu, F., Borellini, C., & Petrachi, M. (1995). Personality maladjustment, defenses, and psychopathological symptoms in nonclinical subjects. Journal of Personality Disorders, 9(4), 330-345. doi: 10.1521/pedi.1995.9.4.330 DOI:
O’Connor, D.B., & Shimizu, M. (2002). Sense of personal control, stress and coping style: a cross-cultural study. Stress and Health, 18(4), 173-183. doi: 10.1002/smi.939 DOI:
Perry, J.C. (2014). Anomalies and specific functions in the clinical identification of defense mechanisms. Journal of Clinical Psychology, 70(5), 406-418. doi: 10.1002/jclp.22085 DOI:
Perry, J.C., Banon, E., & Bond, M. (2020). Change in defense mechanisms and depression in a pilot study of antidepressive medications plus 20 sessions of psychotherapy for recurrent major depression. The Journal of Nervous and Mental Disease, 208(4), 261-268. doi: 10.1097/NMD.0000000000001112 DOI:
Perry, J.C., & Bond, M. (2012). Change in defense mechanisms during long-term dynamic psychotherapy and five-year outcome. American Journal of Psychiatry, 169(9), 916-925. doi: 10.1176/appi.ajp.2012.11091403 DOI:
Perry, J.C., & Cooper, S.H. (1989). An empirical study of defense mechanisms: I. clinical interview and life vignette ratings. Archives of General Psychiatry, 46(5), 444-452. doi: 10.1001/archpsyc.1989.01810050058010 DOI:
Perry, J.C., & Henry, M. (2004). Studying defense mechanisms in psychotherapy using the defense mechanism rating scales. In Advances in Psychology (Vol. 136, pp. 165-192). Elsevier. doi: 10.1016/S0166-4115(04)80034-7 DOI:
Perry, J.C., Knoll, M., & Tran, V. (2019). Motives, defences, and conflicts in the dynamic formulation for psychodynamic psychotherapy using the idiographic conflict formulation method. In U. Kramer (Ed.), Case formulation for personality disorders: Tailoring psychotherapy to the individual client (pp. 203-224). Elsevier Academic Press. doi: 10.1016/B978-0-12-813521-1.00011-4 DOI:
Prout, T.A., Di Giuseppe, M., Zilcha-Mano, S., Perry, J.C., & Conversano, C. (2022). Psychometric Properties of the Defense Mechanisms Rating Scales-Self-Report-30 (DMRS-SR-30): internal consistency, validity and factor structure. Journal of Personality Assessment, 1-11. doi: 10.1080/00223891.2021.2019053 DOI:
Prout, T.A., Zilcha-Mano, S., Aafjes-van Doorn, K., Békés, V., Christman-Cohen, I., Whistler, K., Kui, T., & Di Giuseppe, M. (2020). Identifying predictors of psychological distress during COVID-19: a machine learning approach. Frontiers in Psychology, 11, 3063. doi: 10.3389/fpsyg.2020.586202 DOI:
Rajkumar, R.P. (2020). COVID-19 and mental health: a review of the existing literature. Asian Journal of Psychiatry, 52, Article 102066. doi: 10.1016/j.ajp.2020.102066 DOI:
Sundbom, E., Jacobsson, L., Kullgren, G., & Penayo, U. (1998). Personality and defenses: a cross-cultural study of psychiatric patients and healthy individuals in Nicaragua and Sweden. Psychological reports, 83(3_suppl), 1331-1347. doi: 10.2466/pr0.1998.83.3f.1331 DOI:
Sorrentino, R.M., Nezlek, J.B., Yasunaga, S., Kouhara, S., Otsubo, Y., & Shuper, P. (2008). Uncertainty Orientation and Affective Experiences: Individual Differences Within and Across Cultures. Journal of Cross-Cultural Psychology, 39(2), 129-146. doi: 10.1177/0022022107312586 DOI:
Tanzilli, A., Cibelli, A., Liotti, M., Fiorentino, F., Williams, R., & Lingiardi, V. (2022). Personality, defenses, mentalization, and epistemic trust related to pandemic containment strategies and the COVID-19 vaccine: a sequential mediation model. International Journal of Environmental Research and Public Health, 19(21), 14290. doi: 10.3390/ijerph192114290 DOI:
Torales, J., O'Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A. (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry, 66(4), 317-320. doi: 10.1177/0020764020915212 DOI:

How to Cite

Békés, V., Starrs, C. J., Perry, J. C., Prout, T. A., Conversano, C., & Di Giuseppe, M. (2023). Defense mechanisms are associated with mental health symptoms across six countries. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(3).

List of Cited By :

Crossref logo