FIELD TRIAL OF A DIAGNOSTIC AXIS FOR DEFENSE-MECHANISMS FOR DSM-IV

Following critiques that the DSM multiaxial system lacks psychodynamic information useful for treatment, an axis for defense mechanisms was developed for DSM-IV, including up to 7 individual defenses from a glo ssary of 27, and 3 predominant defense levels from a list of 7. We tes ted the feasibility, reliability, and discriminability of the proposed axis. Clinician and psychiatric resident volunteers were trained at t wo U.S. and one Norwegian sites. After conducting initial interviews o n 107 patients, they rated the DSM-III-R and defense axes, as did a se cond blind rater. Median kappa reliabilities were .42 (individual defe nses), and .47 (defense levels). A summary measure, Overall Defensive Functioning (ODF), had similar reliability to current GAF (I-R .68 vs. .62), similar 1-month stability (.75 vs. .78), but greater 6-month st ability (.51 vs. .17). Independent of Axis III, ODF had small to moder ate associations with other Axes and symptoms. Our findings indicate t hat the defense axis is a feasible, acceptably reliable, and nonredund ant addition to DSM-IV, which may prove useful for planning and conduc ting treatment.