https://doi.org/10.4081/ripppo.2025.854
Defense mechanisms and inflammatory bowel diseases: a narrative review
Submitted: January 29, 2025
Accepted: March 26, 2025
Published: April 3, 2025
Accepted: March 26, 2025
Abstract Views: 773
PDF: 351
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.
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.
Authors
Growing evidence highlights the crucial role of defense mechanisms in the context of chronic diseases. However, few studies have evaluated the impact of these implicit emotion regulation strategies on the adaptation processes related to inflammatory bowel diseases (IBD). This narrative review aimed to explore the role of defense mechanisms in patients with IBD and clarify their association with related psychological and physical symptoms. A literature search was conducted using PubMed and PsycINFO databases to select studies considering defense mechanisms in patients with IBD. Inclusion criteria were English language articles, diagnosis of Crohn’s disease or ulcerative colitis, and use of validated assessment instruments specifically related to defense mechanisms. Six studies, including a total of 664 patients, were deemed eligible. Immature defense mechanisms were commonly detected in IBD patients, with significant effects on psychological and physical health. Significant associations were found between defense mechanisms, perceived health-related quality of life (HR-QoL), and psychological distress. Findings suggested that immature defense mechanisms may negatively impact the management of disease, leading to lower perceived HR-QoL, decreased treatment adherence, and increased risk of psychopathological symptoms. Considering these findings, we suggest that an integrated clinical evaluation, including an in-depth investigation of defense mechanisms, may promote more effective psychological treatments and improve psychological well-being in patients suffering from IBD.
Abram, H. S. (1972). The psychology of chronic illness. Journal of Chronic Diseases, 25(12), 659–664. doi: 10.1016/0021-9681(72)90001-X
Akyirem, S., Forbes, A., Wad, J. L., & Due-Christensen, M. (2022). Psychosocial interventions for adults with newly diagnosed chronic disease: a systematic review. Journal of Health Psychology, 27(7), 1753–1782. doi: 10.1177/1359105321995916
Albuquerque, S. C., Carvalho, E. R., Lopes, R. S., Marques, H. S., Macêdo, 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(9), 1401–1410. doi: 10.1007/s11136-011-9884-9
Amaslidou, A., Ierodiakonou-Benou, I., Bakirtzis, C., Nikolaidis, I., Tatsi, T., Grigoriadis, N., & Nimatoudis, I. (2023). Multiple sclerosis and mental health related quality of life: the role of defense mechanisms, defense styles and family environment. AIMS Neuroscience, 10(4), 354–375. doi: 10.3934/Neuroscience.2023027
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (American Psychiatric Association, Ed.; 4th ed.). Available from: https://psycnet.apa.org/record/1994-97698-000
Barberio, B., Zamani, M., Black, C. J., Savarino, E. V, & Ford, A. C. (2021). Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology, 6(5), 359–370. doi: 10.1016/S2468-1253(21)00014-5
Békés, V., Aafjes-van Doorn, K., Spina, D., Talia, A., Starrs, C. J., & Perry, J. C. (2021). The relationship between defense mechanisms and attachment as measured by observer-rated methods in a sample of depressed patients: A pilot study. Frontiers in Psychology, 12, 648503. doi: 10.3389/fpsyg.2021.648503
Békés, V., Prout, T. A., Di Giuseppe, M., Wildes Ammar, L., 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., Perry, J. C., Starrs, C. J., 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). doi: 10.4081/ripppo.2023.729
Berk, E. (2020). The relationship between disease severity and defense mechanisms in fibromyalgia syndrome. Turkish Journal of Physical Medicine and Rehabilitation, 66(1), 47–53. doi: 10.5606/tftrd.2020.3331
Bisgaard, T. H., Allin, K. H., Keefer, L., Ananthakrishnan, A. N., & Jess, T. (2022). Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment. Nature Reviews Gastroenterology & Hepatology, 19(11), 717–726. doi: 10.1038/s41575-022-00634-6
Blanco, C., Kampe, L., Wall, M. M., Liu, S.-M., Wang, S., Caligor, E., & Olfson, M. (2023). Approximating defense mechanisms in a national study of adults: prevalence and correlates with functioning. Translational Psychiatry, 13(1), 21. doi: 10.1038/s41398-022-02303-3
Bond, M. (1983). Empirical study of self-rated defense styles. Archives of General Psychiatry, 40(3), 333. doi: 10.1001/archpsyc.1983.01790030103013
Bond, M. (2004). Empirical studies of defense style: relationships with psychopathology and change. Harvard Review of Psychiatry, 12(5), 263–278. doi: 10.1080/10673220490886167
Braunstein, L. M., Gross, J. J., & Ochsner, K. N. (2017). Explicit and implicit emotion regulation: a multi-level framework. Social Cognitive and Affective Neuroscience, 12(10), 1545–1557. doi: 10.1093/scan/nsx096
Caputo, A., Vicario, C.M., Cazzato, V. and Martino, G. (2022) Editorial: Psychological Factors as Determinants of Medical Conditions. Frontiers in Psychology, 13(2), 865235. doi: 10.3389/fpsyg.2022.865235
Cemin, T. M., Godoy, R. F. D., & Fiuza, W. M. (2024). Psychology in the hospital context: Experiences of patients with non-communicable chronic diseases. Estudos de Psicologia (Campinas), 41, e210184. doi: 10.1590/1982-0275202441e210184
Cho, C. W., You, M. W., Oh, C. H., Lee, C. K., & Moon, S. K. (2022). Long-term disease course of Crohn’s disease: changes in disease location, phenotype, activities, and predictive factors. Gut and Liver, 16(2), 157. doi: 10.5009/GNL210118
Conte, H. R., & Apter, A. (1995). The life style index: a self-report measure of ego defenses. In Ego Defenses: Theory and Measurement.
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
Cooper, J. M., Collier, J., James, V., & Hawkey, C. J. (2010). Beliefs about personal control and self-management in 30–40 year olds living with Inflammatory Bowel Disease: a qualitative study. International Journal of Nursing Studies, 47(12), 1500–1509. doi: 10.1016/j.ijnurstu.2010.05.008
Cramer P. (2015a). Understanding defense mechanisms. Psychodynamic Psychiatry, 43(4), 523–552. doi: 10.1521/pdps.2015.43.4.523
Cramer, P. (2006). Protecting the Self: Defense Mechanisms in Action. Guilford Press, New York. Available from: https://www.guilford.com/books/Protecting-the-Self/Phebe-Cramer/9781593852986
Cramer, P. (2015b). Defense mechanisms: 40 years of empirical research. Journal of Personality Assessment, 97(2), 114–122. doi: 10.1080/00223891.2014.947997
D’Amico, F., Fasulo, E., Jairath, V., Paridaens, K., Peyrin-Biroulet, L., & Danese, S. (2024). Management and treatment optimization of patients with mild to moderate ulcerative colitis. Expert Review of Clinical Immunology, 20(3), 277–290. doi: 10.1080/1744666X.2023.2292768
Di Giuseppe, M. (2024). Transtheoretical, transdiagnostic, and empirical-based understanding of defense mechanisms. Mediterranean Journal of Clinical Psychology, 12(1). doi: 10.13129/2282-1619/mjcp-4036
Di Giuseppe, M., & Perry, J. C. (2021). The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning With the Defense Mechanisms Rating Scales Q-Sort. Frontiers in Psychology, 12, 718440. doi: 10.3389/fpsyg.2021.718440
Di Giuseppe, M., Conversano, C. (2022). Psychological components of chronic diseases: the link between defense mechanisms and alexithymia. Mediterranean Journal of Clinical Psychology 10(3). doi: 10.13129/2282-1619/mjcp-3602
Di Giuseppe, M., & Tanzilli, A. (2025). Defenses and Attachment in Clinical Practice: What Came First? Journal of Personality Assessment, 107(1), 140–141. doi: 10.1080/00223891.2024.2431126
Di Giuseppe, M., Aafjes-van Doorn, K., Békés, V., Gorman, B.S., Stukenberg, K., & Waldron, S. (2024). Therapists’ defense use impacts their patients’ defensive functioning: a systematic case study. Research in Psychotherapy: Psychopathology, Process and Outcome, 27(2), 797. doi: 10.4081/ripppo.2024.797
Di Giuseppe, M., Ciacchini, R., Micheloni, T., Bertolucci, I., Marchi, L., & Conversano, C. (2018). Defense mechanisms in cancer patients: a systematic review. Journal of Psychosomatic Research, 115, 76–86. doi: 10.1016/j.jpsychores.2018.10.016
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
Dorrian, A., Dempster, M., & Adair, P. (2009). Adjustment to inflammatory bowel disease: the relative influence of illness perceptions and coping. Inflammatory Bowel Diseases, 15(1), 47–55. doi: 10.1002/ibd.20583
Ekehammar, B., Zuber, I., & Simonsson‐Sarnecki, M. (2002). The Defence Mechanism Test (DMT) revisited: experimental validation using threatening and non‐threatening pictures. European Journal of Personality, 16(4), 283-294. doi: 10.1002/PER.457
Fiorentino, F., Lo Buglio, G., Morelli, M., Chirumbolo, A., Di Giuseppe, M., Lingiardi, V., Tanzilli, A. (2024). Defensive functioning in individuals with depressive disorders: A systematic review and meta-analysis. Journal of Affective Disorders, 357, 42-50. doi: 10.1016/j.jad.2024.04.091
Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in a middle-aged community sample. Journal of Health and Social Behavior, 21(3), 219. doi: 10.2307/2136617
Fribergh, H., Träskman‐Bendz, L., Øjehagen, A., & Regnéll, G. (1992). The Meta-Contrast Technique - a projective test predicting suicide. Acta Psychiatrica Scandinavica, 86(6), 473–477. doi: 10.1111/J.1600-0447.1992.TB03300.X
Gajendran, M., Loganathan, P., Catinella, A. P., & Hashash, J. G. (2018). A comprehensive review and update on Crohn’s disease. Disease-a-Month, 64(2), 20–57. doi: 10.1016/j.disamonth.2017.07.001
Gao, H., Zheng, S., Yuan, X., Xie, J., & Xu, L. (2023). Causal association between inflammatory bowel disease and 32 site-specific extracolonic cancers: a Mendelian randomization study. BMC Medicine, 21(1), 389. doi: 10.1186/s12916-023-03096-y
Ge, L., Liu, S., Li, S., Yang, J., Hu, G., Xu, C., & Song, W. (2022). Psychological stress in inflammatory bowel disease: psychoneuroimmunological insights into bidirectional gut–brain communications. Frontiers in Immunology, 13. doi: 10.3389/fimmu.2022.1016578
Giorgianni, C. M., Martino, G., Brunetto, S., Buta, F., Lund-Jacobsen, T., Tonacci, A., Gangemi, S., & Ricciardi, L. (2024). Allergic Sensitization and Psychosomatic Involvement in Outdoor and Indoor Workers: A Preliminary and Explorative Survey of Motorway Toll Collectors and Office Employees. Healthcare (Basel, Switzerland), 12(14), 1429. doi: 10.3390/healthcare12141429
Gleser, G. C., & Ihilevich, D. (1969). An objective instrument for measuring defense mechanisms. Journal of Consulting and Clinical Psychology, 33(1), 51–60. doi: 10.1037/h0027381
Hentschel, U., Draguns, J. G., Ehlers, W., & Smith, G. (2004). Chapter 1 Defense mechanisms: current approaches to research and measurement. Advances in Psychology, 136(C), 3–41. doi: 10.1016/S0166-4115(04)80026-8
Hwang, Y., & Oh, J. (2024). Relationship between depression, anxiety, stress, and health-related quality of life in adults with and without chronic diseases: a cross-sectional study. Medicine, 103(2), e36967. doi: 10.1097/MD.0000000000036967
Hyphantis, T. N., Christou, K., Kontoudaki, S., Mantas, C., Papamichael, G., Goulia, P., Konitsiotis, S., & Mavreas, V. (2008). Disability status, disease parameters, defense styles, and ego strength associated with psychiatric complications of multiple sclerosis. The International Journal of Psychiatry in Medicine, 38(3), 307–327. doi: 10.2190/PM.38.3.g
Hyphantis, T. N., Tomenson, B., 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(3), 724–732. doi: 10.1007/s10620-009-0762-z
Hyphantis, T. N., Triantafillidis, J. K., Pappa, S., Mantas, C., Kaltsouda, A., Cherakakis, P., Alamanos, Y., Manousos, O. N., & Mavreas, V. G. (2005). Defense mechanisms in inflammatory bowel disease. Journal of Gastroenterology, 40(1), 24–30. doi: 10.1007/s00535-004-1491-x
Jiakponna, E. C., Agbomola, J. O., Ipede, O., Karakitie, L., Ogunsia, A. J., Adebayo, K. T., & Tinuoye, M. (2024). Psychosocial factors in chronic disease management: Implications for health psychology. International Journal of Science and Research Archive, 12(02), 117-128. doi: 10.30574/ijsra.2024.12.2.1219
Kemp, A. H., Tree, J., Gracey, F., & Fisher, Z. (2022). Editorial: improving wellbeing in patients with chronic conditions: theory, evidence, and opportunities. Frontiers in Psychology, 13, 868810. doi: 10.3389/fpsyg.2022.868810
Kernberg, O. F. (1988). Object relations theory in clinical practice. The Psychoanalytic Quarterly, 57(4). doi: 10.1080/21674086.1988.11927218
Kobayashi, T., Siegmund, B., Le Berre, C., Wei, S. C., Ferrante, M., Shen, B., Bernstein, C. N., Danese, S., Peyrin-Biroulet, L., & Hibi, T. (2020). Ulcerative colitis. Nature Reviews Disease Primers 2020 6:1, 6(1), 1–20. doi: 10.1038/s41572-020-0205-x
Kütmeç Yilmaz, C., & Kara, F. Ş. (2021). The effect of spiritual well-being on adaptation to chronic illness among people with chronic illnesses. Perspectives in Psychiatric Care, 57(1), 318–325. doi: 10.1111/PPC.12566
Lagrange, J., Lacolley, P., Wahl, D., Peyrin-Biroulet, L., & Regnault, V. (2021). Shedding light on hemostasis in patients with inflammatory bowel diseases. Clinical Gastroenterology and Hepatology, 19(6), 1088-1097.e6. doi: 10.1016/j.cgh.2019.12.043
Leone, D., Gilardi, D., Corrò, B. E., Menichetti, J., Vegni, E., Correale, C., Mariangela, A., Furfaro, F., Bonovas, S., Peyrin-Biroulet, L., Danese, S., & Fiorino, G. (2019). Psychological characteristics of inflammatory bowel disease patients: a comparison between active and nonactive patients. Inflammatory Bowel Diseases, 25(8), 1399–1407. doi: 10.1093/ibd/izy400
Li, L., Cheng, R., Wu, Y., Lin, H., Gan, H., & Zhang, H. (2024). Diagnosis and management of inflammatory bowel disease. Journal of Evidence-Based Medicine, 17(2), 409–433. doi: 10.1111/JEBM.12626
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(2), 85–89. doi: 10.1016/j.paid.2013.01.025
Marchini, F., Caputo, A., Napoli, A., Balonan, J. T., Martino, G., Nannini, V., & Langher, V. (2018). Chronic illness as loss of good self: underlying mechanisms affecting diabetes adaptation. Mediterranean Journal of Clinical Psychology, 6(3), 2282–1619. doi: 10.6092/2282-1619/2018.6.1981
Marks, E., Moghaddam, N., De Boos, D., & Malins, S. (2023). A systematic review of the barriers and facilitators to adherence to mindfulness‐based cognitive therapy for those with chronic conditions. British Journal of Health Psychology, 28(2), 338-365. doi: 10.1111/bjhp.12628
Martino, G., Bellone, F., Vicario, C. M., Gaudio, A., Corica, F., Squadrito, G., Lund-Jacobsen, T., Schwarz, P., Lo Coco, G., Morabito, N., & Catalano, A. (2023). Interrelations between clinical-psychological features and bone mineral density changes in post-menopausal women undergoing anti-osteoporotic treatment: a two-year follow-up. Frontiers in Endocrinology, 14, 1151199. doi: 10.3389/fendo.2023.1151199
Martino, G., Caputo, A., Bellone, F., Quattropani, M. C., & Vicario, C. M. (2020a). Going beyond the visible in type 2 diabetes mellitus: defense mechanisms and their associations with depression and health-related quality of life. Frontiers in Psychology, 11, 519034. doi: 10.3389/fpsyg.2020.00267
Martino, G., Caputo, A., Schwarz, P., Bellone, F., Fries, W., Quattropani, M. C., & Vicario, C. M. (2020b). Alexithymia and Inflammatory Bowel Disease: A Systematic Review. Frontiers in Psychology, 11, 1763. doi: 10.3389/fpsyg.2020.01763
Martino, G., Catalano, A., Bellone, F., Sardella, A., Lasco, C., Caprì, T., Langher, V., Caputo, A., Fabio, R. A., & Morabito, N. (2018). Vitamin D status is associated with anxiety levels in postmenopausal women evaluated for osteoporosis. Mediterranean Journal of Clinical Psychology, 6(1). doi: 10.6092/2282-1619/2018.6.1740
Martino, G., Viola, A., Vicario, C. M., Bellone, F., Silvestro, O., Squadrito, G., Schwarz, P., Lo Coco, G., Fries, W., & Catalano, A. (2023). Psychological impairment in inflammatory bowel diseases: the key role of coping and defense mechanisms. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(3). doi: 10.4081/ripppo.2023.731
Masci, F., Spatari, G., Giorgianni, C.M., Bortolotti, S., Rosecrance, J., Colosio, C. (2022). A Wearable Device to Assess the Spine Biomechanical Overload in a Sample of Loggers. In: Black, N.L., Neumann, W.P., Noy, I. (eds) Proceedings of the 21st Congress of the International Ergonomics Association (IEA 2021). IEA 2021. Lecture Notes in Networks and Systems, vol 223. Springer, Cham. doi: 10.1007/978-3-030-74614-8_19
Moneta, M. E., & Kaechele, H. (2023). A theoretical and clinical perspective of an embodied view in psychotherapy of somatic symptoms disorders. Research in Psychotherapy: Psychopathology, Process and Outcome 26(2), 605. doi: 10.4081/ripppo.2023.605
Mrozowicz-Wrońska M. (2023). Defense mechanisms in affective disorders - the state of the art. Mechanizmy obronne w zaburzeniach afektywnych – stan wiedzy. Psychiatria Polska, 57(1), 197–206. doi: 10.12740/PP/145919
Murdaca, G., Paladin, F., Casciaro, M., Vicario, C. M., Gangemi, S., & Martino, G. (2022). Neuro-Inflammaging and Psychopathological Distress. Biomedicines, 10(9), 2133. doi: 10.3390/biomedicines10092133.
Neeleman, J., Bijl, R., & Ormel, J. (2004). Neuroticism, a central link between somatic and psychiatric morbidity: path analysis of prospective data. Psychological Medicine, 34(3), 521–531. doi: 10.1017/S0033291703001193
Nóbrega, V. G., Silva, I. N. D. N., Brito, B. S., Silva, J., Silva, M. C. M. D., & Santana, G. O. (2018). The onset of clinical manifestations in inflammatory bowel disease patients. Arquivos de Gastroenterologia, 55(03), 290-295. doi: 10.1590/s0004-2803.201800000-73
Palmela, C., Peerani, F., Castaneda, D., Torres, J., & Itzkowitz, S. H. (2018). Inflammatory bowel disease and primary sclerosing cholangitis: a review of the phenotype and associated specific features. Gut and Liver, 12(1), 17–29. doi: 10.5009/gnl16510
Patierno, C., Fava, G. A., & Carrozzino, D. (2023). Illness denial in medical disorders: a systematic review. Psychotherapy and Psychosomatics, 92(4), 211–226. doi: 10.1159/000531260
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
Perry, J. C. (1990). Defense Mechanism Rating Scales (DMRS) (5th ed.). Cambridge, MA, Perry, JC.
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
Perry, J. C., Hoglend, P., Shear, K., Vaillant, G. E., Horowitz, M., Kardos, M. E., Bille, H., & Kagan, D. (1998). Field trial of a diagnostic axis for defense mechanisms for DSM-IV. Journal of Personality Disorders, 12(1), 56–68. doi: 10.1521/pedi.1998.12.1.56
Perry, J. C., Kardos, M. E., & Pagano, C. J. (1993). The study of defenses in psychotherapy using the defense mechanism rating scales (DMRS). In The Concept of Defense Mechanisms in Contemporary Psychology (pp. 122–132). Springer, New York, NY. doi: 10.1007/978-1-4613-8303-1_8
Peyrin-Biroulet, L., Panés, J., Sandborn, W. J., Vermeire, S., Danese, S., Feagan, B. G., Colombel, J.-F., Hanauer, S. B., & Rycroft, B. (2016). Defining disease severity in inflammatory bowel diseases: current and future directions. Clinical Gastroenterology and Hepatology, 14(3), 348-354.e17. doi: 10.1016/j.cgh.2015.06.001
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, 104(6), 833–843. doi: 10.1080/00223891.2021.2019053
Ricciardi, L., Silvestro, O., Martino, G., Catalano, A., Vicario, C. M., Lund-Jacobsen, T., Schwarz, P., Sapienza, D., Gangemi, S., Pioggia, G., & Giorgianni, C. M. (2024). Health-related quality of life in severe hypersensitivity reactions: focus on severe allergic asthma and hymenoptera venom anaphylaxis-a cross-sectional study. Frontiers in Psychology, 15, 1394954. doi: 10.3389/fpsyg.2024.1394954
Rice, T. R., & Hoffman, L. (2014). Defense mechanisms and implicit emotion regulation: a comparison of a psychodynamic construct with one from contemporary neuroscience. Journal of the American Psychoanalytic Association, 62(4), 693–708. doi: 10.1177/0003065114546746
Richardson, E., Beath, A., & Boag, S. (2024). The Development of the Attachment Defenses Questionnaire (ADQ-50): A Preliminary Examination of Reliability, Validity, and Factor Structure. Journal of Personality Assessment, 107(1), 58–72. doi: 10.1080/00223891.2024.2353142
Ridolfi A. (2024). Psychological interventions in the Italian national health system: appropriateness and accountability. Research in Psychotherapy: Psychopathology, Process and Outcome 27(2), 820. doi: 10.4081/ripppo.2024.820
Roda, G., Chien Ng, S., Kotze, P. G., Argollo, M., Panaccione, R., Spinelli, A., Kaser, A., Peyrin-Biroulet, L., & Danese, S. (2020). Crohn’s disease. Nature Reviews Disease Primers, 6(1), 1–19. doi: 10.1038/s41572-020-0156-2
Rossi, C., Oasi, O., & Colombo, B. (2024). Personality characteristics, music-listening, and well-being: a systematic and scoping review. Research in psychotherapy: Psychopathology, Process and Outcome 27(1), 742. doi: 10.4081/ripppo.2024.742
Rozich, J. J., Holmer, A., & Singh, S. (2020). Effect of lifestyle factors on outcomes in patients with inflammatory bowel diseases. American Journal of Gastroenterology, 115(6), 832–840. doi: 10.14309/ajg.0000000000000608
Rubino, I. A., Biancone, L., Zardo, E., Zanna, V., Saya, A., & Ciani, N. (1999). Perceptual defense mechanisms in crohn’s disease and panic disorder. Perceptual and Motor Skills, 88(3), 733–743. doi: 10.2466/pms.1999.88.3.733
Saeid Seyedian, S., Nokhostin, F., & Dargahi Malamir, M. (2019). A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. Journal of Medicine and Life, 12(2), 113–122. doi: 10.25122/jml-2018-0075
Saez, A., Gomez-Bris, R., Herrero-Fernandez, B., Mingorance, C., Rius, C., & Gonzalez-Granado, J. M. (2021). Innate lymphoid cells in intestinal homeostasis and inflammatory bowel disease. International Journal of Molecular Sciences, 22(14), 7618. doi: 10.3390/ijms22147618
Saez, A., Herrero-Fernandez, B., Gomez-Bris, R., Sánchez-Martinez, H., & Gonzalez-Granado, J. M. (2023). Pathophysiology of Inflammatory Bowel Disease: Innate Immune System. International Journal of Molecular Sciences, 24(2), 1526. doi: 10.3390/ijms24021526
Sajadinejad, M. S., Asgari, K., Molavi, H., Kalantari, M., & Adibi, P. (2012). Psychological issues in inflammatory bowel disease: an overview. Gastroenterology Research and Practice, 2012, 1–11. doi: 10.1155/2012/106502
Sergi, A., Giorgianni, C. M., Giacobello, M. L., & Martino, G. (2024). Synchronicity: An Unfinished Journey. Mediterranean Journal of Clinical Psychology 12(2). doi: 10.13129/2282-1619/mjcp-4301
Sergi, A. (2024). On the Biological Basis for Psychodynamic Collective Principles. Mediterranean Journal of Clinical Psychology 12(3). doi: 10.13129/2282-1619/mjcp-4574.
Sergi, A., Messina, A., Vicario, C. M., & Martino, G. (2023). A Quantum-Classical Model of Brain Dynamics. Entropy (Basel, Switzerland), 25(4), 592. doi: 10.3390/e25040592
Sergi, A., Messina, A., Saija, R., Martino, G., Caccamo, M. T., Kuo, M.-F., & Nitsche, M. A. (2025). Time-Irreversible Quantum-Classical Dynamics of Molecular Models in the Brain. Symmetry, 17(2), 285. doi: 10.3390/sym17020285
Shah, S. C., & Itzkowitz, S. H. (2022). Colorectal cancer in inflammatory bowel disease: mechanisms and management. Gastroenterology, 162(3), 715-730.e3. doi: 10.1053/J.GASTRO.2021.10.035
Shorey, S., Demutska, A., Chan, V., & Siah, K. T. H. (2021). Adults living with irritable bowel syndrome (IBS): A qualitative systematic review. Journal of Psychosomatic Research, 140, 110289. doi: 10.1016/J.JPSYCHORES.2020.110289
Silverman, J., & Aafjes-van Doorn, K. (2023). Coping and defense mechanisms: A scoping review. Clinical Psychology: Science and Practice, 30(4), 381–392. doi: 10.1037/cps0000139
Silvestro, O., Lund-Jacobsen, T., Ferraù, F., Blanca, E. S., Catalano, A., Sparacino, G., Schwarz, P., Cannavò, S., & Martino, G. (2024). Anxiety, depression and acromegaly: a systematic review. Journal of Endocrinological Investigation, 1-20. doi: 10.1007/s40618-024-02483-3
Skodol, A. E., & Perry, J. C. (1993). Should an axis for defense mechanisms be included in DSM-IV? Comprehensive Psychiatry, 34(2), 108–119. doi: 10.1016/0010-440X(93)90055-9
Smith, G. J. W., van der Meer, G., Ursing, B., Prytz, H., & Benoni, C. (1995). Psychological profile of patients suffering from Crohn’s disease and ulcerative colitis. Acta Psychiatrica Scandinavica, 92(3), 187–192. doi: 10.1111/j.1600-0447.1995.tb09566.x
Spatola, C. A. M., Rapelli, G., Giusti, E. M., Cattivelli, R., Goodwin, C. L., Pietrabissa, G., Malfatto, G., Facchini, M., Cappella, E. A. M., Varallo, G., Martino, G., & Castelnuovo, G. (2024). Effects of a brief intervention based on Acceptance and Commitment Therapy versus usual care for cardiac rehabilitation patients with coronary heart disease (ACTonHEART): a randomised controlled trial. BMJ open, 14(6), e084070. doi: 10.1136/bmjopen-2024-084070
Sugaya, N. (2024). Work-related problems and the psychosocial characteristics of individuals with irritable bowel syndrome: an updated literature review. BioPsychoSocial Medicine, 18(1), 1–10. doi: 10.1186/S13030-024-00309-5/TABLES/2
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
Tanzilli, A., Di Giuseppe, M., Giovanardi, G., Boldrini, T., Caviglia, G., Conversano, C., & Lingiardi, V. (2021). Mentalization, attachment, and defense mechanisms: A Psychodynamic Diagnostic Manual-2-oriented empirical investigation. Research in Psychotherapy: Psychopathology, Process and Outcome, 24(1), 531. doi: 10.4081/ripppo.2021.531
Vaillant, G. E. (1997). The Wisdom of the Ego: Sources of Resilience in Adult Life. Harvard University Press. Available from: https://www.hup.harvard.edu/books/9780674953734
Ziadni, M. S., Jasinski, M. J., Labouvie-Vief, G., & Lumley, M. A. (2017). Alexithymia, defenses, and ego strength: cross-sectional and longitudinal relationships with psychological well-being and depression. Journal of Happiness Studies, 18(6), 1799–1813. doi: 10.1007/s10902-016-9800-7
Zimmerman, T. N., Porcerelli, J. H., & Arterbery, V. E. (2019). Defensive functioning in cancer patients, cancer survivors, and controls. Psychoanalytic Psychology, 36(3), 259–262. doi: 10.1037/pap0000225
How to Cite
Silvestro, O., Vicario, C. M., Costa, L., Sparacino, G., Lund-Jacobsen, T., Spatola, C. A. M., … Martino, G. (2025). Defense mechanisms and inflammatory bowel diseases: a narrative review. Research in Psychotherapy: Psychopathology, Process and Outcome. https://doi.org/10.4081/ripppo.2025.854
Copyright (c) 2025 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.