DEFENSE-MECHANISMS IN SEVERE ADOLESCENT ANOREXIA-NERVOSA

Objective: To compare ego defense mechanisms in adolescents with anore xia nervosa and other major psychiatric disorders, to defenses in heal thy adolescents. Method: Thirty-seven patients with anorexia nervosa, 30 with major depressive disorder, 20 with obsessive-compulsive disord er, 53 with borderline personality disorder, 60 with schizophrenia, an d 81 healthy controls were assessed with Pfeffer's Ego Defense Scale. Results: Regression, denial, projection, repression, introjection, and total defenses were common to all psychiatric patients and distinguis hed them from normal adolescents. In addition to these defenses, anore ctic patients also used intellectualization more frequently than norma l adolescents and psychiatric patients. They used sublimation more tha n other psychiatric patients. Patients with disorders, apart from obse ssive-compulsive disorder, that are considered to be often comorbid wi th anorexia did not have different defenses than schizophrenic patient s, Conclusions: Anorectic adolescents overutilize relatively more matu re defenses than do psychiatrically ill adolescents, and they overutil ize immature defenses compared with normal adolescents. This combinati on of mature and immature defenses may be related to the uniquely hete rogeneous ego functioning seen in anorectic patients, and it may provi de insight into the nature of the psychopathology of anorexia nervosa. It also could have important psychotherapeutic and prognostic value.