Mariagrazia Di Giuseppe

Background/Objectives: Feeding and Eating Disorders (FEDs) are among the most challenging mental disorders due to their pervasive symptomatology and high relapse rates. While considerable research has focused on the role of personality in the onset and maintenance of FEDs, it remains unclear whether specific personality dimensions and emotion dysregulation mechanisms predict clinical severity and purging behaviors. This study aimed to explore the role of personality dimensions, emotion dysregulation, and purging behaviors in predicting psychological distress in patients with FEDs, adopting a dimensional and integrated perspective. Methods: A sample of cisgender women in a semi-residential treatment for FEDs or obesity (n = 124) was recruited in southern Italy and assessed using a psychodiagnostics survey, including the Eating Disorder Inventory-3 (EDI-3), the Symptom Checklist-90-R (SCL-90-R), and the Personality Inventory for DSM-5 (PID-5). Results: Patients with bulimia nervosa exhibited higher psychological distress compared to patients with other FEDs and Obesity, which was not significantly determined by the co-occurrence of personality disorders. Negative affectivity, detachment, and purging symptoms were significantly related to psychological distress in patients with FEDs and Obesity (p ranging from 0.028 to β = 0.107; p = 0.046). Conclusions: These findings suggest that specific personality dimensions, emotion dysregulation, and purging symptoms are associated with psychological distress in individuals with FEDs and Obesity. Therefore, it is necessary to reflect on the impact of these psychological components in planning tailored treatment for FED patients.

Research on muscle dysmorphia (MD), currently conceptualized as a clinical specifier for body dysmorphic disorder (BDD), is rapidly expanding. Although personality traits and disorders have been proposed as relevant risk factors for the development of BDD, their role in MD remains insufficiently understood. This scoping review aims to synthesize the existing empirical literature on the associations between MD and personality, while identifying key research gaps and clinical challenges. Following the PRISMA-ScR guidelines, a systematic search was conducted across PsycArticles, PubMed, Scopus, Web of Science, and Google Scholar between 1 October and 1 December 2024. A total of 15 studies met the inclusion criteria and were analyzed. Findings highlight the significant contribution of narcissism, neuroticism, and perfectionism to the development and severity of MD. In particular, traits associated with vulnerable narcissism consistently emerged as predictors of MD symptomatology. Sociocultural factors—such as the competitive environment of elite sports and early relational experiences—were also found to interact with personality-based vulnerabilities in shaping the onset and clinical expression of MD. However, most available studies relied on self-report measures, cross-sectional designs, and convenience samples predominantly composed of men, limiting the generalizability of the results. Despite these methodological limitations, this review emphasizes the importance of identifying personality-based vulnerabilities to enhance the understanding of MD and inform the development of person-centered prevention and intervention strategies.

The observer-rated Q-sort based on the gold-standard Defense Mechanisms Rating Scales (DMRS-Q) allows the investigation of defense mechanisms based on one session as a whole. The present study analyzed the reliability and validity of the DMRS-Q applied to three types of clinical interactions other than therapy sessions. Transcripts of three different clinical interviews, including a total of 233 adults (50 cancer patients who completed Mayman’s Early Memory Interview [EMI], 93 individuals without clinical diagnosis who completed McAdams’ Life Story Interview [LSI], and 90 pregnant women who completed the Working Model of the Child Interview [WMCI]), have already been coded on the DMRS. Our research team of expert raters conducted the DMRS-Q coding on these same transcripts and assessed the inter-rater reliability and the concurrent, convergent, and discriminant validity of DMRS-Q in these clinical interactions. Results showed good inter-rater reliability (intraclass correlation coefficient [ICC]=.70) for the Overall Defensive Functioning (ODF), although lower than reported using transcripts of psychotherapy sessions. Large correlations were found between ODF scales assessed with the DMRS-Q and the DMRS among the three samples (r=.43 to .59; p<.001), while small to moderate correlations were found between the DMRS-Q, sociodemographic, and psychological measures. The DMRS-Q ODF scale might be a valid and reliable measure to assess the overall maturity of defensive functioning in brief interviews. Its ease of use, supported by open-source software, enables the application of the gold-standard DMRS theory across a wide range of contexts beyond psychotherapy research.

Attachment style and emotion regulation (ER) patterns intertwine. Securely attached individuals employ more adaptive ER strategies, while individuals with avoidant, preoccupied, and disorganized styles rely on less adaptive strategies. Defense mechanisms are part of an experience-near, observable construct that parallels implicit ER. The evaluation of a patient’s defense mechanisms may therefore be a means of identifying and understanding the patient’s attachment classification. This article synthesizes recent empirical research and theory to delineate relationships among attachment styles, ER, and defense mechanisms. It then examines how development and culture shape attachment, discusses assessment strategies, and offers clinicians guidance for assessing attachment through a defense mechanism orientation. This clinical technique may assist clinicians in informed assessment and treatment and underscores the benefits of further integration of attachment research with that of defense mechanisms.

Background: Chronic immune-mediated diseases, such as Severe Allergic Asthma (SAA) and Hymenoptera Venom Anaphylaxis (HVA), significantly impact quality of life. Defense mechanisms, as implicit emotion-regulation strategies, shape an individual’s adaptation to chronic stressors. This cross-sectional study explored the relationship among defensive functioning, psychological symptoms, and perceived physical and mental health in patients with SAA and HVA.Methods: To explore the role of defensive functioning in perceived physical and mental health 34 patients with SAA and 32 with HVA were assessed with the Short-Form Health Survey, the Beck Depression Inventory, the Hamilton Anxiety Rating Scale, the Toronto Alexithymia Scale, and the Defense Mechanisms Rating Scales Self Report-30; between-group differences, and mediation analyses were performed.Results: Defensive functioning was positively associated with mental health and negatively related to depressive symptoms, anxiety and alexithymia. Males reported significantly higher physical and psychological health than females. Patients with SAA exhibited significantly higher defensive functioning but worse physical health than HVA patients. Mediation analysis revealed that defensive functioning correlated with disease type and physical health, accounting for 39% of the explained variances. Moreover, defensive functioning independently predicted mental health.Conclusion: This study highlights the influence of implicit emotional regulation on psychophysiological well-being in patients with chronic immune-mediated disorders. Despite reporting lower perceived physical health, patients with SAA exhibited higher defensive functioning, suggesting that chronic conditions may shape distinct psychological adaptation processes. These findings support the importance of defence mechanisms assessment to tailor psychological interventions promoting well-being in patients with chronic diseases.

Research into defensive functioning in psychotherapy has thus far focused on patients’ defense use. However, also the defensive functioning of therapists might be significant because of its potential in promoting changes in the patient’s overall defensive functioning by sharing their higher-level understanding of a given situation and letting the patient have the opportunity to learn how to cope more successfully. This exploratory case study is the first to examine therapist’s defense mechanisms and their relationship to changes in the patient’s defensive functioning evaluated at different times throughout psychoanalytic treatment. We assessed the use of defense mechanisms with the Defense Mechanisms Rating Scales in 20 sessions collected at three phases (early, middle and late) of the psychoanalytic treatment. For each session, we identified therapist’s and patient’s defenses, defense levels and overall defensive functioning, with particular attention to the sequence of consecutively activated defenses within the therapeutic dyad. Results showed that the patient’s defensive functioning tended to gradually improve over the course of the treatment, with a slight decrease at the end. Therapists’ overall defensive functioning remained stable throughout the treatment with values in the range of high-neurotic and mature defenses. Assessment of the dyadic interaction between therapist and patient’s use of defenses showed that within-session, the patient tended to use the same individual defenses that the therapist used, which was especially pronounced in the initial phases of the treatment. Towards the end of the treatment, once there was a stable shared knowledge, the patient started to explore using new, higher-level defenses on her own, independent from what defenses the therapist used. Our findings emphasized the analyst’s role in encouraging the development of more effective ways of coping in the patient, confirming previous theoretical and empirical research regarding the improvement of patient’s defensive functioning in psychotherapy. The alterations in these coping strategies, also called high-adaptive defenses, as part of the therapist-patient interaction demonstrate the importance of studying defenses as an excellent process-based outcome measure. The measurement of the degree to which the analyst models and illustrates these superior coping methods to the patient is a prime vehicle for supporting internalization of these skills by the patient.

Eating disorders (EDs) are difficult to treat in psychotherapy due to their pervasive symptomatology and frequent and rapid relapses. Restrictive anorexia nervosa (AN) is the most challenging ED, often associated with severe physical and mental conditions. Perceived as an ego-syntonic syndrome that somehow protects the patient from a number of developmental tasks, treating AN requires extensive multidisciplinary long-term intervention. As with other emotion regulation strategies, defense mechanisms mediate an individual's reaction to internal or external stressors, including those related to ED conditions. Improving defensive functioning adaptiveness predicts psychotherapy outcomes and is an essential component of the therapeutic process. In this study, we qualitatively described changes in the use of defense mechanisms, personality functioning (PF), and body mass index (BMI) in two patients with severe AN in treatment with intense dynamic psychotherapy. Changes in personality functioning and defense mechanisms were periodically assessed every 6 months using clinician report measures such as the Shedler-Westen Assessment Procedure-200 (SWAP-200) and the Defense Mechanisms Rating Scales Q-sort (DMRS-Q), respectively. BMI was also monitored throughout the treatment. A qualitative description of the patient's defensive profile and the quantitative score on all ranges of defense mechanisms were used for studying changes in patients' use of defenses during the treatment and relationships between defenses and outcome indexes. Personality and defensive functioning improved after 1 year of intense dynamic psychotherapy, independently from BMI improvement. All outcome indexes dramatically decreased before a scheduled interruption of the treatment, underling that an integrated therapeutic approach is essential for improving and eventually orienting toward complete ED symptoms remission. Long-term dynamic psychotherapy fosters self-awareness of psychological distress and enhances more mature ways of coping. Monitoring changes in personality and defense mechanisms helps in understanding patients' reactions to stressful life events and in developing specific therapeutic interventions.