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To cite this article: Stacey M. Whyne Berman & Joseph T. McCann (1995) Defense Mechanisms and
Personality Disorders: An Empirical Test of Millon's Theory, Journal of Personality Assessment, 64:1,
132-144, DOI: 10.1207/s15327752jpa6401_9
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JOURNAL OF PERSONALITY ASSESSMENT, 1995,64(1), 132-144
Copyright O 1995, Lawrence Erlbaum Associates, lnc.
Joseph T. McCann
Binghamton, New York
In recent years, there has been renewed interest in the role of psychological
defense mechanisms in clinical manifestations of specific disorders. For
instance, Axis I1 of the Diagnostic and Statistical Manual of Mental Disor-
ders (3rd ed., rev. [DSM-111-R]; American Psychiatric Association, 1987)
DEFENSES AND PERSONALITY DISORDERS 133
can now be utilized to code defenses that are prominent in a particular case.
The notion of defense mechanisms mediating various forms of psychopa-
thology is not new, however. Freud noted that there may be an intimate
connection between specific defenses and particular forms of emotional
disturbance (Freud, 193611959). Subsequently, a number of prominent theo-
rists have speculated on the relationship between utilization of specific
defense mechanisms and the existence of particular personality disorders.
Millon (1986a, 1986b) hypothesized that there exists an extensive matrix of
relationships between defense mechanisms and personality disorders. Al-
though Millon notes that a given defense mechanism may be utilized by
individuals with various personality disorders, he maintains that each patho-
logical character style is linked to one primary defense mechanism (see
Table 1). Although the possible relationships between defense mechanisms
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TABLE 1
Hypothesized Relationships Among Personality Disorders, Specific Defense
Mechanisms, and DM1 Defense Categories
DMZ
Personality Dtorder Millon's Proposed Defenw Defense
-
-
Intellectualization - --
PRN
Schizoid
Avoidant -- Fantasy 4
- REV
Dependent
Histrionic
-
- Introjection
Dissociation 4
TAS
REV
Narcissistic
Antisocial -
-
Rationalization
Acting-Out
4
-
- PRN
TAO
Aggressive/Sadistic
Obsessive-Compulsive
Passive-Aggressive
-
--
IsoIation
Reaction Formation
Displacement
-- PRN
REV
TAO
-
Self-Defeating (Masochistic)
Schizotypal
Borderline -
- Devaluation
Undoing
Regression
-
-
TAS
REV
TAO
Paranoid - Projection - PRO
-
Note. DM1 = Defense hlechanism Inventory, PRN = Principalization,REV = Reversal,
TAS = Turning Against Self, TAO = Turning Against Other, PRO = Projection.
134 BERMAN AND McCANN
sublimation, suppression, and humor) are thought to cope with stress well
and to respond to conflict in an adaptive manner. Researchers have also
found that psychopathology tends to be associated with the utilization of
immature defense mechanisms (as defined by G. E. Vaillant, 1971). Individ-
uals who rely on immature defenses (e.g., fantasy, projection, and hypochon-
driasis) are believed to have difficulty resolving conflict as well as a
tendency to become overwhelmed by stress.
More specific examinations of the relationship between particular diagno-
ses and defense mechanisms have also been carried out. However, there has
been no comprehensive study on the relationship between personality disor-
ders and defenses. Some studies have exclusively focused on clinical syn-
dromes (e.g., Andrews, Pollock, & Stewart, 1989; Schueler, 1981; Steiner,
1990), whereas others have examined only one or two personality disorders
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(e.g., Cooper, Perry, & Arnow, 1988; Lerner & Lerner, 1982; Salwen,
Reznikoff, & Schwartz, 1989). Still others have employed subjective assess-
ment methods (G. E. Vaillant & Drake, 1985) or used broad diagnostic
categories rather than specific diagnoses (Bond & J. S. Vaillant, 1986). Thus,
any relationships that may exist between defense mechanisms and petsonal-
ity disorders become blurred. In general, previous research has either been
too narrow in its focus or too broad in its scope.
The purpose of this study is to examine the relationship between individ-
ual defense mechanisms and particular personality disorders. Specifically,
this study focuses on Millon's hypothesized relationships, as outlined in
Table 1. However, other associations between defense mechanisms and per-
sonality disorders are examined in order to obtain a more complete picture
of possible relationships.
METHOD
Subjects
The subjects were 130 psychiatric patients from both inpatient (n = 66) and
outpatient (n = 64) settings. A total of 42 men and 88 women made up the
sample, and the mean age was 33.6 years (SD = 10.7) for the entire sample.
Although the subject group was predominantly White (90%), 7% of the
subjects were Black, and 4% were from other varied racial groups. The
majority of subjects were never married (46%), followed by married (26%),
divorced (13%), separated (7%), and widowed (1%). The mean education
level was 13.7 years (SD = 2.7).
The inpatient sample was taken from three acute-care psychiatric units in
a large general hospital in Western New York and two acute-care psychiatric
units from a hospital in Southern Ontario. Patients were randomly admitted
to these units based on bed availability. The outpatient sample was drawn
from a nonprofit community mental health clinic in Western New York as
DEFENSES AND PERSONALITY DISORDERS 135
Instruments
In total, there are 200 items that are presented in groups of 5. Subjects
respond to each group of items by selecting one item that is most representa-
tive of their reaction and one that is least representative of their reaction. A
more comprehensive depiction of the DM1 defense categories along with a
description of the DM1 model and information pertaining to the DMI's
reliability and validity can be found in Ihilevich and Gleser's (1986) manual.
Cramer (1988) provides a more thorough review of existing DM1 reliability
and validity data.
Procedure
All patients completed the MCMI-I1 (Millon, 1987) and the DM1 (Ihilevich
& Gleser, 1986). Each subject gave informed consent to participate. All test
instruments were administered in the standard manner outlined in the respec-
tive manual for each instrument, under controlled conditions at either the
hospitals or the outpatient clinic. The completion time for this task was
approximately 60 min.
Because the DM1 measures five defense mechanism categories, rather
than the range of individual defense mechanisms proposed by Millon, exam-
ination of the data required a three-step process. First, a statistical analysis
of the relationships between the defense mechanism categories of the DM1
and the personality disorders, as measured by the MCMI-11, was carried out.
Second, to test Millon's hypotheses, the five DM1 defense categories were
matched with an individual defense mechanism (see Table 1). Finally, the
empirical data were compared to the relationships hypothesized in Table 1,
to determine if the results supported Millon's hypotheses. Although initially
it had been our intent to compare the clinicians' Axis I1 diagnoses to the
subjects' highest scores on the MCMI-I1 scales, to serve as a validity check,
this was not carried out due to the fact that many of the clinicians' diagnoses
lacked specificity. That is, a large proportion of the study's subjects were
DEFENSES AND PERSONALITY DISORDERS 137
because Millon views both acting out and regression as defense mechanisms,
they were considered to be representative of TAO for this study. Although
Ihilevich and Gleser did not classify fantasy, they did include denial under
the rubric of REV. Because fantasy is often referred to as "denial in fantasy"
(e.g., Freud, 193711966), it seemed that REV was the proper classification.
Because undoing (a symbolic gesture designed to negate objectionable
thoughts, feelings, or actions) is most closely aligned with negation, which
Ihilevich and Gleser subsumed under the REV defense category, undoing
was classified under REV. Similarly, dissociation is most akin to repression
in that both entail a lack of conscious awareness of disturbing thought,^,
feelings, or experiences. Consequently, because repression is subsumed
under REV in Ihilevich and Gleser's schema, dissociation was aligned with
REV as well. Finally, introjection (which reduces conflict by internalizing
another's viewpoint) seems most consistent with the DM1 defense category
of TAS, which Ihilevich and Gleser (1986) have defined to include intrapuni-
tive maneuvers that protect or enhance self-esteem by creating "the impres-
sion that one can thereby gain the acceptance and approval of internalized
significant others" (p. 21).
RESULTS
TABLE 2
Correlation Coefficients for MCMI-I1 Personality Disorder Scales
and DM1 Defense Categories
lated with REV, the Paranoid scale was positively correlated with PRO, the
Passive-Aggressive scale was positively correlated with TAO, and finally,
the Self-Defeating scale was positively correlated with TAS. Although not
significant by thestandards here employed, there was also a trend toward
significance in the relationship between the Dependent Personality scale and
TAS ( p < .01). None of the other relationships that were predicted in Table 1
were supported by the data. However, a number of interesting relationships
other than those hypothesized by Millon (1986a, 1986b) were revealed
through analysis of the data (see Table 2).
Although a number of the predicted relationships were not corroborated,
even those that were supported by the data were not particularly strong. In
an attempt to better understand the reasons for these findings, an exploratory
factor analysis was conducted, primarily to examine the effects of method
variance (see Morey & LeVine, 1988). Method variance occurs when differ-
ences in the measures employed interfere with the detection of relationships
between two or more constructs. This results because different instrument
formats can cause a subject to display divergent response patterns on items
measuring similar constructs. The MCMI-I1 is a measure of personality, one
dimension of which is defensive structure. The DM1 is a measure of defen-
sive style, which is one among many personality constructs. Consequently,
DEFENSES AND PERSONALITY DISORDERS 1319
TABLE 3
Factor Loadings for Combined MCMI-II and DM1 Factor Analysis
-
Scale Factor 1 Factor 2 Factor 3 Factor 4 Factor 5
-
MCMI-I1
Self-Defeating .92 .03 .04 .00 - .Of!
Borderline .75 .41 .13 -.ll - .08
Avoidant .75 - .08 .24 .43 - .13
Passive-Aggressive .69 .46 .33 .19 -03
Schizotypal .69 .15 .15 .46 .OIL
Dependent .56 - .54 - .44 .00 .IT
one would expect the MCMI-I1 and the DM1 to possess some common
factors. If this is the case, the factor analysis should result in scales from the
two inventories loading on some of the same factors. Conversely, if the two
measures possess idiosyncratic representations of the constructs, factors
should emerge with high loadings from one scale set and much lower loacl-
ings from the other scale set.
The 13 MCMI-I1 personality disorder scores and the 5 DM1 defense
scores were simultaneously entered into the same factor analysis. Afive-fac-
tor solution was obtained, accounting for 77.6% of the total variance (see
Table 3). As the table shows, each factor contained high loadings on scales
from only one of the two inventories. These results point to the presence of
method variance.
140 BERMAN A N D M c C A N N
DISCUSSION
cantly related to isolation via PRN in the opposite direction from what was
predicted. It may also account for the finding that a significant negative
relationship between the schizotypal personality disorder and undoing via
REV was found, although a positive relationship was hypothesized. Simd-
larly, the unexpected negative relationship between the avoidant personality
disorder and fantasy via REV may also be understood in this way. The lack
of relationship between the histrionic personality disorder and dissociation
via REV may also be accounted for in this manner. Thus, although the Dh4I
has been shown to be both a reliable and valid instrument for measuring
defensive functioning, collapsing individual defense styles into five global
categories may act to obscure some of the relationships tested in this study.
A third factor that may have contributed to the limited results is method
variance. The factor analysis revealed that the scales from the two instru-
ments loaded on divergent factors. Thus, it is possible that the limited results
are due, at least in part, to variation in measuring style. Fourth, given that
defense mechanisms are generally believed to be intrapsychic phenomena,
and therefore difficull to operationally define and measure with a pencjl-
and-paper inventory, psychometric limitations may also have contributed to
the lack of support for some of the hypotheses.
Finally, and perhaps most noteworthy, there was a tendency for elevations
on one personality disorder scale to be associated with elevations on a
number of other personality disorder scales. Consequently, when an assess-
ment of the relationship between a particular personality disorder and a
specific defense mechanism was attempted, other personality scale eleva-
tions may have acted as confounds (due to the forced choice format of the
DM1 and the resultant lack of independence between the scales). Whereas
this may result from a lack of specificity on the part of the MCMI-11, it is
quite possible that it reflects the true nature of personality pathology-that
is, a more global disturbance with few pure types.
A number of interesting, but unpredicted, relationships between personal-
ity disorders and defense mechanisms were revealed through data analysis.
The Aggressive/Sadistic Personality scale was found to be positively come-
142 BERMAN AND McCANN
lated with TAO. Because sadistic individuals take delight in the pain of
others, this relationship makes intuitive sense. Similarly, given that narcis-
sistic individuals are extremely self-righteous and have little regard for the
needs and feelings of others, it is not surprising to find that they are inclined
to overuse TAO as a defense and to underuse TAS. In addition, individuals
with dependent personality traits were found to be significantly less likely
than others to use TAO as a defense. This fits with clinical experience, which
suggests that dependent individuals are loath to offend others for fear of
rejection. The negative correlation between PRN and each of the three
MCMI-I1 severe personality pathology scales (i.e., schizotypal, borderline,
and paranoid) also makes sense because PRN appears to be the healthiest
among DM1 defense styles. The TAS defense was found to be dis-
proportionately selected by individuals with schizoid, avoidant, and
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ACKNOWLEDGMENT
This article is based in part on the doctoral dissertation of the first authlor,
carried out under the supervision of the second author. An earlier version of
this article was presented at the lOlst Annual Convention of the American
Psychological Association in Toronto, Ontario, Canada.
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