Abstract
Social adjustment is important for overall mental health (Tangney, Boone, and Baumeister 2004). Adjustment problems are connected to various aspects of our daily lives, such as work (Mundt et al. 2002), leisure activities (Weddell, Oddy, and Jenkins 1980), and family life (Mistry et al. 2002). Clinically, poor social adjustment has been associated with mood disorders (Leader and Klein 1996) and poor outcomes in psychotherapy (Weissman et al. 1974). A number of protective and risk factors have been reported in regard to social adjustment such as self-control (Tangney, Boone, and Baumeister 2004), chronic illness (Browne et al. 1990), coping (Felton and Revenson 1984), and defense mechanisms (Kramer et al. 2010).
Defense mechanisms, first proposed by Freud, are believed to be an important aspect of development and ego functioning (Freud 1894; A. Freud 1936). Defenses are intrapsychic and are automatic responses to threat (Kwon and Lemon 2000). The main role of defense mechanisms is to protect the individual from psychological distress and, more important, to preserve the individual’s self and self-esteem (Cramer 2006).
Defense styles, because they vary in their adaptive value, have important implications for one’s psychological health (Kwon 2002). Overreliance on immature defense styles that play a role in suppressing emotional awareness (e.g., displacement, isolation, projection, denial) is related to psychopathology, maladjustment (Vaillant 1994), and symptom severity (Høglend and Perry 1998). However, defense styles also serve an adaptive purpose. The use of mature defense style (e.g., humor, sublimation, altruism) is often associated with better mental and physical health (Bond and Perry 2004). Defenses are considered mature when they are used to deal with uncomfortable feelings and thoughts by actively transforming them into less threatening forms rather than pushing them aside. Importantly, immature and mature defense styles are conceptualized and measured as independent constructs rather than as occupying the same continuum (Granieri et al. 2017). Finally, neurotic defenses (e.g., reaction formation, intellectualization) may have short-term advantages in coping, but often lead to problems in the long term.
No previous studies have examined the association between social adjustment and defense style specifically in a community clinic sample. Studying a sample from a community clinic offers a unique opportunity to understand the prevalence of adjustment issues in people who have complaints about various physical and mental health issues and concerns. Moreover, community mental health samples are understudied, and subjects in them are likely to be struggling with social adjustment that could be better understood in the context of defense mechanisms (Folkman and Lazarus 1980). The current study examined the relationship between defense style and social adjustment in a sample of patients seen at a community clinic who presented with a wide array of mental health concerns.
It was hypothesized that individuals making greater use of immature defense styles will have significantly more problems in social adjustment, while those making greater use of mature defense styles will report fewer problems.
Method
Participants
The sample consisted of 140 self-referred adults with cognitive difficulties who visited a community-based clinic for psychological and neuropsychological assessment in order to be evaluated for either Learning Disability or Attention-Deficit/Hyperactivity Disorder. Participants completed a comprehensive evaluation consisting of both psychological and neuropsychological assessments, as both these areas are likely to impact the learning process and to account for cognitive difficulties. Participants were tested at a psychological service center at a private university in the northeast U.S. The mean age of the participants was 28.48 years (SD = 10.07); 68.80% were female. The sample was predominantly white (70.70%) and employed (95.00%) and had a mean education level of 14.10 years (SD = 2.00). Participants were not screened for medical conditions, but our evaluations showed that a majority had a learning disorder, followed in incidence by ADHD and mood disorder (see Table 1).
Sample demographics, diagnosis, and mean scores of study variables
Note: SAS-SR: The Social Adjustment Scale–Self Report
DSQ-40: Defense Style Questionnaire
Does not equal 100 due to comorbid diagnoses.
Procedure
The administered tests were part of a larger battery completed by the subjects upon presentation to the clinic. Measures were administered by graduate students in a clinical psychology Ph.D. program and were supervised by a licensed psychologist.
Measures
The Defense Style Questionnaire (DSQ-40; Andrews, Singh, and Bond 1993) is a 40-item self-report measure in a 9-point Likert scale format, ranging from “strongly agree” to “strongly disagree,” that categorizes 20 defense mechanisms into immature, neurotic, and mature defense styles. In our study, we included items assessing the defenses of sublimation, humor, anticipation, and suppression as mature defenses; the Cronbach’s alpha was .63. Undoing, pseudo-altruism, idealization, and reaction formation constituted the neurotic defenses scale; Cronbach’s alpha for this scale was .61. The immature defenses scale included projection, passive aggression, acting out, isolation, devaluation, dissociation, splitting, rationalization, somatization, autistic fantasy, denial, and displacement; Cronbach’s alpha was .81.
The Social Adjustment Scale–Self Report (SAS-SR; Weissmann et al. 1978) measures participants’ current level of satisfaction with their social situation. The overall score was obtained by summing the scores and dividing that sum by the total number of items answered. Each item was scored on a 5-point scale, where higher scores indicate greater impairment (1 = normal adjustment; 5 = severe maladjustment). The obtained mean values were converted to a T-Score Value (Mean = 50, Standard Deviation = 10). The questions were designed to measure performance over the past two weeks in six role areas: (1) work, (2) social and leisure activities, (3) relationships with extended family, (4) role as a marital partner, (5) parental role, and (6) role within the family unit, including perceptions about economic functioning (Gameroff, Wickramaratne, and Weissman 2012).
Results
Demographics for this sample and mean score of the study variables are presented in Table 1. Results of the hierarchical linear regression model are summarized in Table 2. Overall, the model was significant when examining the relationship between defense style and social adjustment while controlling for age, sex, and level of education. The model accounted for 14.5% of the total variance in social adjustment, F (6, 133) = 4.53, p < .05). Specifically, mature defenses were related to fewer adjustment problems (β = -2.95, p < .05) and immature defenses were associated with more adjustment problems (β = 4.56, p < .05). There was no association between neurotic defense style, years of education, age, or sex and social adjustment.
Regression model for social adjustment
Note: The dependent variable was the SAS-SR total scores.
Discussion
Our results are consistent with our initial hypotheses. Healthy social adjustment was associated with the use of mature defenses, and the use of immature defenses was associated with poor social adjustment.
Mature defense mechanisms are considered more developmentally advanced, requiring a higher level of ego functioning (McWilliams 2011). Immature and neurotic defense styles are associated with increased psychopathological symptom severity and decreased psychosocial adjustment (Ruuttu et al. 2006). Our study results suggest that clinician assessment of social adjustment and functioning requires consideration of the individual’s defense style. Social adjustment problems are connected to various aspects of our daily lives, including work, leisure activities (Mundt et al. 2002), and family life (Mistry et al. 2002). Psychotherapeutic treatment addressing the use of immature defense mechanisms with individuals experiencing difficulties with social adjustment may help them improve in various aspects of daily living.
There are several limitations to this study. The sample consisted primarily of employed Caucasian females. The results, therefore, cannot be generalized to a more ethnically, socioeconomically, and gender diverse population. Moreover, participants were outpatients who presented for psychological and neuropsychological testing motivated by self-reported cognitive difficulties; these results may therefore not generalize to populations not seeking psychological assistance. Finally, because the current study examined relationships between variables, the causal direction of the relationship remains unclear. Future studies should examine whether patients’ issues with social adjustment can be addressed through interventions that target defense mechanisms.