Defensive responses to stressful life events associated with cancer diagnosis

Mariagrazia Di Giuseppe, Mario Miniati, Mario Miccoli, Rebecca Ciacchini, Graziella Orrù, Rosa Lo Sterzo, Annarita Di Silvestre, Ciro Conversano


Objectives: Stressful life events (SLEs) are common in patients who developed both physical and psychological syndromes. Research shown the role of psychological defense mechanisms in cancer progression and survival probability. The present study analyzed recent SLEs and defense mechanisms as characteristic of cancer patients and tested their role as potential predisposing factors to cancer development.

Methods: This cross-sectional study enrolled 145 participants: 48 recently diagnosed cancer patients (CP), 43 recently diagnosed benign tumor patients (BT), and 54 healthy subjects (HC). Non-blinded raters assessed participants’ defense mechanisms using the Defense Mechanisms Rating Scales Q-sort version (DMRS-Q). Groups were compared on the presence of SLEs and on the maturity of defensive functioning. Significant associations between SLE and defense mechanisms as related to cancer diagnosis were explored.

Results: Higher overall defensive functioning was associated with good physical conditions. Recent SLEs, higher use of neurotic defenses and lower use of obsessional defenses characterized cancer patients. CP showed higher use of suppression, repression, dissociation, rationalization and passive aggression and lower use of affiliation, sublimation, undoing, and devaluation of self-image as compared to controls. Hierarchical regression analysis showed that recent SLEs and defense mechanisms of suppression, repression, dissociation, displacement and omnipotence were associated with cancer diagnosis.

Discussion: Recent SLEs and repressive defensive functioning characterized the CP’s defensive response to stress. Despite the relevance of present findings, this study shows several limitations. Prospective and longitudinal studies are needed to confirm these results and to investigate the potential role played by SLEs and defense mechanisms in cancer development.


Defense mechanism; Dissociation; DMRS; Trauma; cancer; Psychosomatic.

Full Text:



Afari, N., Ahumada, S., Wright, L. J., Mostoufi, S., Golnari, G., Reis, V., & Cuneo, J. G. (2014). Psychological Trauma and Functional Somatic Syndromes: A Systematic Review and Meta-Analysis. Psychosomatic Medicine, 76, 2-11. Doi: 10.1097/PSY.0000000000000010

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. American Psychiatric Press, Washington, DC.

Barberis, N., Quattropani, M. C., & Cuzzocrea, F. (2019). Relationship between motivation, adherence to diet, anxiety symptoms, depression symptoms and quality of life in individuals with celiac disease. Journal of psychosomatic research, 124, 109787. Doi:

Beresford, T., Alfersm J., Mangum, L., Clapp, L., & Martin, B. (2006). Cancer Survival Probability as a Function of Ego Defense (Adaptive) Mechanisms Versus Depressive Symptoms. Psychosomatics, 47, 247–253. Doi: 10.1176/appi.psy.47.3.247

Boscarino, J. A., & Figley, C. R. (2009). The Impact of Repression, Hostility, and Post-Traumatic Stress Disorder on All-Cause Mortality A Prospective 16- Year Follow-up Study. Journal of Nervous and Mental Disease, 197, 461-466. Doi: 10.1097/NMD.0b013e3181a61f3e

Butow, P. N., Hiller, J. E., Price, M. A., Thackway, S. V., Kricker, A., & Tennant, C. C. (2000). Epidemiological evidence for a relationship between life events, coping style, and personality factors in the development of breast cancer. Journal of Psychosomatic Research, 49, 169-181. Doi: 10.1016/s0022-3999(00)00156-2

Cabaniols, C., Giorgi, R., Chinot, O., Ferahta, N., Spinelli, V., Barrie, M., & Lehucher-Michel, M. P. (2011). Link between private habits, psychological stress and brain cancer: a case-control pilot study in France. Journal of Neuro-Oncology, 103(2), 307-316. Doi: 10.1007/s11060-010-0388-1

Carmassi, C., Bertelloni, C. A., Gesi, C., Conversano, C., Stratta, P., Massimetti, G., ... & Dell’Osso, L. (2017). New DSM-5 PTSD guilt and shame symptoms among Italian earthquake survivors: Impact on maladaptive behaviors. Psychiatry research, 251, 142-147.

Carmassi, C., Shear, M. K., Massimetti, G., Wall, M., Mauro, C., Gemignani, S., Conversano, C., & Dell’Osso, L. (2014a). Validation of the Italian version Inventory of Complicated Grief (ICG): a study comparing CG patients versus bipolar disorder, PTSD and healthy controls. Comprehensive Psychiatry, 55, 1322-1329. Doi: 10.1016/j.comppsych.2014.03.001

Carmassi, C., Stratta, P., Massimetti, G., Bertelloni, C. A., Conversano, C., Cremone, I. M., ... & Dell'Osso, L. (2014b). New DSM-5 maladaptive symptoms in PTSD: gender differences and correlations with mood spectrum symptoms in a sample of high school students following survival of an earthquake. Annals of general psychiatry, 13(1), 28.

Catalano, A., Martino, G., Bellone, F., Papalia, M., Lasco, C., Basile G., Sardella A., Nicocia G., Morabito N., Lasco A. (2019a). Neuropsychological assessment in elderly men with benign prostatic hyperplasia treated with dutasteride”. Clinical Drug investigation, 39(1), 97-102. Doi: 10.10007/s40261-018-0720-7.

Catalano, A., Sardella, A., Bellone, F., Lasco, C.G., Martino, G., & Morabito, N. (2019b). Executive functions predict fracture risk in postmenopausal women assessed for osteoporosis. Aging Clinical and Experimental Research. Doi: 10.1007/s40520-019-01426-w.

Chida, Y., Hamer, M., Wardle, J., & Steptoe, A. (2008). Do stress-related psychosocial factors contribute to cancer incidence and survival? Nature Clinical Practice Oncology, 5(8), 466-475. Doi: 10.1038/ncponc1134

Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease. Journal of the American Medical Association, 298, 1685-1687. Doi: 10.1001/jama.298.14.1685

Conversano, C. (2019). Psychological common factors in chronic diseases. Frontiers in Psychology, 10, 2727. Doi: 10.3389/fpsyg.2019.02727

Conversano, C., Carmassi, C., Carlini, M., Casu, G., Gremigni, P., & Dell’Osso, L. (2015). Interferon α therapy in patients with chronic hepatitis C infection: quality of life and depression. Hematology reports, 7(1).

Coughlin, S. S. (2011). Post-traumatic stress disorder and cardiovascular disease. Open Cardiovascular Medicine Journal, 5, 164-170. Doi: 10.2174/1874192401105010164

de Vries, A. M. M., Gholamrezaee, M. M., Verdonck de Leeuw, I. M., Passchier, J., Stiefel, F., Despland, J. N., & de Roten, Y. (2017). Patient satisfaction and alliance as a function of physician self-regulation, physician stress, and content of consultation in cancer care. Psycho-oncology, 26(7), 927-934. Doi: 10.1002/pon.4233

de Vries, A. M. M., Gholamrezaee, M. M., Verdonck de Leeuw, I. M., de Roten, Y., Despland, J. N., Stiefel, F., & Passchier, J. (2018). Physician's emotion regulation during health care communication with advanced cancer patients. Psycho-oncology ,27(3), 929-936. Doi: 10.1002/pon.4614

Dell’Osso, L., Casu, G., Carlini, M., Conversano, C., Gremigni, P., & Carmassi, C. (2012). Sexual obsessions and suicidal behaviors in patients with mood disorders, panic disorder and schizophrenia. Annals of general psychiatry, 11(1), 27.

Dell’Osso, L., Stratta, P., Conversano, C., Massimetti, E., Akiskal, K. K., Akiskal, H. S., Rossi, A., & Carmassi, C. (2014). Lifetime mania is related to post-traumatic stress symptoms in high school students exposed to the 2009 L'Aquila earthquake. Comprehensive Psychiatry, 55(2), 357-362. Doi: 10.1016/j.comppsych.2013.08.017

Di Giuseppe, M., Ciacchini, R., Micheloni, T., Bertolucci, I., Marchi, L., & Conversano, C. (2018). Defense mechanisms in cancer patients: a systematic review. Journal of Psychosomatic Research, 115, 76-86. Doi: 10.1016/j.jpsychores.2018.10.016

Di Giuseppe, M., Di Silvestre, A., Lo Sterzo, R., Hitchcott, P., Gemignani, A., & Conversano, C. (2019). Qualitative and quantitative analysis of the defense profile in Breast Cancer women: A pilot study. Health Psychol Open, Jan-Jun 6(1):2055102919854667. Doi: 10.1177/2055102919854667

Di Giuseppe, M., Gemignani, A., & Conversano, C. (2020). Psychological resources against the traumatic experience of COVID-19. Clinical Neuropsychiatry, 17, 69-71. Doi: 10.36131/CN20200207

Di Giuseppe, M., Gennaro, A., Lingiardi, V., & Perry, J. C. (2019). The role of defense mechanisms in emerging personality disorders in clinical adolescents. Psychiatry, 82(2), 128-142. Doi: 10.1080/00332747.2019.1579595

Di Giuseppe, M., Perry, J. C., Petraglia, J., Janzen, J., & Lingiardi, V. (2014). Development of a Q-sort version of the defense mechanisms rating scales (DMRS-Q) for clinical use. Journal of Clinical Psychology, 70(5), 452-465. Doi: 10.1002/jclp.22089

Di Giuseppe. M., Ciacchini. R., Piarulli, A., Nepa, G., & Conversano, C. (2019). Mindfulness disposition and defense style as positive responses to psychology distress in oncology professionals. European Journal of Oncology Nursing, 40, 104-110. Doi: 10.1016/j.ejon.2019.04.003

Di Riso D., Gennaro, A. & Salcuni, S. (2015). Defensive mechanisms and personality structure in an early adolescent boy: process and outcome issues in a non-intensive psychoanalytically oriented psychotherapy. Research in psychotherapy: psychopathology, process and outcome, 18(2), 114-128. Doi: 10.7411/RP.2015.101

Drageset, S., & Lindstrøm, T. C. (2003). The mental health of women with suspected breast cancer: The relationship between social support, anxiety, coping and defence in maintaining mental health. Journal of Psychiatric and Mental Health Nursing, 10(4), 401-409. Doi: 10.1046/j.1365-2850.2003.00618.x

Eberhard-Gran, M., Schei, B., & Eskid, A. (2007). Somatic symptoms and diseases are more common in women exposed to violence. Journal of General Internal Medicine, 22(12), 1668-1673. Doi: 10.1007/s11606-007-0389-8

Gangemi, A., Caprì, T., Fabio, R. A., Puggioni, P., Falzone, A. M., & Martino, G. (2018). Transcranial direct current stimulation (tdcs) and cognitive empowerment for the functional recovery of diseases with chronic impairment and genetic etiopathogenesis. Adv. Genet. Res, 18, 179-196.

Garssen, B. (2004). Psychological factors and cancer development: Evidence after 30 years of research. Clinical Psychology Review, 24(3), 315–338. Doi: 10.1016/j.cpr.2004.01.002

Gennaro, A. (2011). The building of models as pathway to understand the therapeutic process. In Integrative Psychological and Behavioral Science, 45(3), 355-365. Doi: 10.1007/s12124-011-9181-8

Gennaro, A., Salvatore, S., Rocco., D. (2017). Deconstructive and Constructive processes in the therapeutic action a focus on the relational modalities and patient thinking processes. Journal of Constructivist Psychology 30(2), 105-126.

Giantin V., Valentini E., Iasevoli M., Falci C., Siviero P., De Luca E., Maggi S., Martella B., Orrù G., Crepaldi G., Monfardini S. (2013). Does the Multidimensional Prognostic Index (MPI), based on a Comprehensive Geriatric Assessment (CGA), predict mortality in cancer patients? Results of a prospective observational trial. Journal of geriatric oncology, 4(3), 208-217. Doi: 10.1016/j.jgo.2013.04.008

Giese-Davis, J. C. (2008). Exploring emotion-regulation and autonomic physiology in metastatic breast cancer patients: Repression, suppression, and restraint of hostility. Personality and Individual Difference, 44(1), 226-237. Doi: 10.1016/j.paid.2007.08.002

Harburg, E., Julius, M., Kaciroti, N., Gleiberman, L., & Schork, M. A. (2003). Expressive/suppressive anger-coping responses, gender, and types of mortality: a 17-year follow-up (Tecumseh, Michigan, 1971-1988). Psychosomatic Medicine, 65(4), 588-597. Doi: 10.1097/01.psy.0000075974.19706.3b

Ho, S. M. Y., & Shiu, W. C. T. (1995). Death Anxiety and Coping Mechanisms of Chinese Cancer Patients. Omega, 31(1), 59-65. Doi: 10.2190/7E1E-LRRG-LTF5-Y8X3

Hyphantis, T., Almyroudi, A., Paika, V., Degner, L. F., Carvalho, A. F., & Pavlidis, N. (2013). Anxiety, depression and defense mechanisms associated with treatment decisional preferences and quality of life in non- metastatic breast cancer: a 1-year prospective study. Psycho-oncology; 22(11), 2009–2015. Doi: 10.1002/pon.3308

Hyphantis, T., Goulia, P., & Carvalho, A. F. (2013). Personality traits, defense mechainisms and hostility features associated with somatic symptoms severity in both health and disease. Journal of Psychosomatic Research, 75(4), 362-369. Doi: 10.1016/j.jpsychores.2013.08.014

Hyphantis, T., Goulia, P., Zerdes, I., Solomou, S., Andreoulakis, E., Carvalho, A. F., & Pavlidis, N. (2016). Sense of Coherence and Defense Style Predict Sleep Difficulties in Early Non-metastatic Colorectal Cancer. Digestive Diseases and Sciences, 61(1), 273-82. Doi: 10.1007/s10620-015-3843-1

Hyphantis, T., Paika, V., Almyroudi, A., Kampletsas, E. O., & Pavlidis, N. (2011). Personality variables as predictors of early non-metastatic colorectal cancer patients’ psychological distress and health-related quality of life: A one-year prospective study. Journal of Psychosomatic Research, 70(5), 411-421. Doi: 10.1016/j.jpsychores.2010.09.011

Iasevoli, M., Giantin, V., Voci, A., Valentini, E., Zurlo, A., Maggi, S., Siviero, P., Orrù, G., Crepaldi, G., Pegoraro, R. and Manzato, E. (2012). Discussing end-of-life care issues with terminally ill patients and their relatives: comparisons among physicians, nurses and psychologists. Aging clinical and experimental research, 24(3 Suppl), 35-42.

Kohn, R., Levav, I., Liphshitz, I., Barchana, M., & Keinan-Boker, L. (2014). Cancer incidence and mortality following exposure to distal and proximal major stressors. Social Psychiatry and Psychiatric Epidemiology, 49(5), 703-709. Doi: 10.1007/s00127-013-0805-9

Krause-Ulz, A., & Elzinga, B. (2018). Current Understanding of the Neural Mechanisms of Dissociation in Borderline Personality Disorder. Current Behavioral Neuroscience Reports, 5(1), 113-123. Doi: 10.1007/s40473-018-0146-9

Kreitler, S., Chaitchik, S., & Kreitlers, H. (1993). Repressiveness: Cause or Result of Cancer? Psycho-oncology, 2(1), 43-54. Doi: 10.1002/pon.2960020107

Lenzo, V., Sardella, A., Martino, G., Quattropani, M.C. (2020). A Systematic Review of Metacognitive Beliefs in Chronic Medical Conditions. Frontiers in Psychology,10:2875. Doi: 10.3389/fpsyg.2019.02875.

Lingiardi, V., Gazzillo, F., Colli, A., De Bei, F., Tanzilli, A., Di Giuseppe, M., Nardelli, N., Caristo, C., Condino, V., Gentile, D., Dazzi, N., 2010. Diagnosis and assessment of personality, therapeutic alliance and clinical exchange in psychotherapy research. Research in Psychotherapy, 2, 97-124.

Malone, J. C., Choen, S., Liu, S. R., Vaillant, G. E., & Waldinger, R. J. (2013). Adaptive midlife defense mechanisms and late-life health. Personality and Individual Differences, 55(2), 85-89. Doi: 10.1016/j.paid.2013.01.025

Marazziti, D., Tomaiuolo, F., Dell’Osso, L., Demi, V., Campana, S., Piccaluga, E., ... & Picano, E. (2015). Neuropsychological testing in interventional cardiology staff after long-term exposure to ionizing radiation. Journal of the International Neuropsychological Society, 21(9), 670-676.

Marchini, F., Caputo, A., Napoli, A., Balonan, J. T., Martino, G., Nannini, V., Langher, V. (2018). Chronic illness as loss of good self: underlying mechanisms affecting diabetes adaptation. Mediterranean Journal of Clinical Psychology, 6(3), 1-25. Doi: 10.6092/2282-1619/2018.6.1981.

Martino, G., Bellone, F., Langher, V., Caputo, A., Catalano, A., Quattropani, M. C., & Morabito, N. (2019a). Alexithymia and Psychological Distress Affect Perceived Quality of Life in Patients with Type 2 Diabetes Mellitus. Mediterranean Journal of Clinical Psychology, 7(3). Doi: 10.6092/2282-1619/2019.7.2328

Martino, G., Catalano, A., Agostino, R. M., Bellone, F., Morabito, N., Lasco, C. G., ... & Feldt-Rasmussen, U. (2020). Quality of life and psychological functioning in postmenopausal women undergoing aromatase inhibitor treatment for early breast cancer. PloS one, 15(3), e0230681. Doi: 10.1371/journal.pone.0230681

Martino, G., Caputo, A., Bellone, F., Quattropani, M.C., Vicario, C. (2020). Going Beyond the Visible in Type 2 Diabetes Mellitus: Defense Mechanisms and their Associations with Depression and Health-Related Quality of Life. Frontiers in Psychology. Doi: 10.3389/fpsyg.2020.00267.

Martino, G., Catalano, A., Bellone, F., Russo, G. T., Vicario, C. M., Lasco, A., Quattropani, M. C., Morabito, N. (2019b). As Time Goes by: Anxiety Negatively Affects the Perceived Quality of Life in Patients With Type 2 Diabetes of Long Duration. Frontiers in Psychology, 10:1-8. Doi: 10.3389/fpsyg.2019.01779.

Martino, G., Langher, V., Cazzato, V., & Vicario, C. M. (2019). Psychological factors as determinants of medical conditions. Frontiers in psychology, 10, 2502. Doi: 10.3389/fpsyg.2019.02502.

Martino, G., Sardella, A., Bellone, F., Lasco, G., Langher, V., Cazzato, V., Penna, A., Vicario C.M., Morabito, N., Catalano, A. (2019c). Executive functions and bone health: a focus on cognitive impulsivity and bone mineral density. Mediterranean Journal of Clinical Psychology, 7(2),1-13. Doi: 10.6092/2282-1619/2019.7.2167.

McFarlane, A. C. (2010). The long-term costs of traumatic stress: intertwined physical and psychological consequences. World Psychiatry, 9(1), 3-10. Doi: 10.1002/j.2051-5545.2010.tb00254.x

Merlo, E. M. (2019a). Adolescent phobia as a “mask object”. Mediterranean Journal of Clinical Psychology, 7(1). Doi: 10.6092/2282-1619/2019.7.2241

Merlo, E. M. (2019b). Opinion Article: The role of psychological features in chronic diseases, advancements and perspectives. Mediterranean Journal of Clinical Psychology, 7(3). Doi: 10.6092/2282-1619/2019.7.2341

Merlo, E. M., McNabney, S. M., Frisone, F., Sicari, F., Paunica, M., Motofei, C., & Settineri, S. (2020). Compassion and suppression in caregivers: twin masks of tragedy and joy of caring. Journal of Mind and Medical Sciences, 7:11. Doi: 10.22543/7674.71.P6168

Mula, M., Pini, S., Monteleone, P., Iazzetta, P., Preve, M., Tortorella, A., ... & Cassano, G. B. (2008). Different temperament and character dimensions correlate with panic disorder comorbidity in bipolar disorder and unipolar depression. Journal of anxiety disorders, 22(8), 1421-1426.

Neeleman, J. B., Biji, R., & Ormel, J. (2004). Neuroticism, a central link between somatic and psychiatric morbidity: path analysis of prospective data. Psychological Medicine, 34(3), 521-531. Doi: 10.1017/s0033291703001193

Nicholson, A. A., Friston, K. J., Zeidman, P., Harricharan, S., McKinnon, M. C., Densmore, M., Neufeld, R. W. J., Théberge, J., Corrigan, F., Jetly, R., Spiegel, D., & Lanius, R. A. (2017). Dynamic causal modeling in PTSD and its dissociative subtype: Bottom-up versus top-down processing within fear and emotion regulation circuitry. Human Brain Mapping, 38, 5551-5561. Doi: 10.1002/hbm.23748

Nielsen, N. R., & Grønbaek, M. (2006). Stress and breast cancer: a systematic update on the current knowledge. Nature Clinical Practice Oncology, 3(11), 612-620. Doi: 10.1038/ncponc0652

Paika, V., Almyroudi, A., Tomenson, B., Creed, F., Kampletsas, E. O., Siafaka, V., Gkika, S., Mavreas, V., Pavlidis, N., & Hyphantis, T. (2010). Personality variables are associated with colorectal cancer patients’ quality of life independent of psychological distress and disease severity. Psycho-oncology, 19(3), 273-282. Doi: 10.1002/pon.1563

Palagini, L., Carmassi, C., Conversano, C., Gesi, C., Bazzichi, L., Giacomelli, C., & Dell’Osso, L. (2016). Transdiagnostic factors across fibromyalgia and mental disorders: sleep disturbances may play a key role. A clinical review. Clinical and Experimental Rheumatology, 34(2), 140-144.

Perry, J. C., & Bond, M. (2012). Change in defense mechanisms during long-term dynamic psychotherapy and five-years outcome. American Journal of Psychiatry,169(9), 916-925. Doi: 10.1176/appi.ajp.2012.11091403

Perry, J. C., & Henry, M. (2004). Studying defense mechanisms in psychotherapy using the Defense Mechanism Rating Scales. In U. Hentschel, G. Smith, J.G. Draguns, & W. Ehlers (Eds.), Advances in psychology,136. Defense mechanisms: Theoretical, research and clinical perspectives, 165-192. Amsterdam: Elsevier. Doi: 10.1016/S0166-4115(04)80034-7

Perry, J. C., Knoll, M., & Tran, V. (2019). Motives, defenses, and conflicts in the dynamic formulation for psychodynamic psychotherapy using the Idiographic Conflict Formulation method. In U. Kramer, U. (Ed.), Case Formulation for Personality Disorders. New York: Elsevier, 203-224.

Perry, J. C., Metzger, J., & Sigal, J. J. (2015). Defensive Functioning Among Women With Breast Cancer and Matched Community Controls. Psychiatry, 78(2), 156–169. Doi: 10.1080/00332747.2015.1051445

Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense Mechanisms in Schizotypal, Borderline, Antisocial, and Narcissistic Personality Disorders. Psychiatry, 76(1), 32-52. Doi: 10.1521/psyc.2013.76.1.32

Perry, J. C., Sigal, J. J., Boucher, S., Paré, N., Ouimet, M. C., Normand, J., & Henry, M. (2005). Personal strengths and traumatic experiences among institutionalized children given up at birth: II: Adaptation in late adulthood. Journal of Nervous and Mental Disease, 193, 783-789. Doi: 10.1097/01.nmd.0000188960.30816.25

Perry, J.C. (1990). Defense Mechanism Rating Scales (DMRS), fifth edition. Cambridge, MA: Author.

Piccinni, A., Origlia, N., Veltri, A., Vizzaccaro, C., Marazziti, D., Catena-Dell'Osso, M., ... & Dell'Osso, L. (2012). Plasma β-amyloid peptides levels: a pilot study in bipolar depressed patients. Journal of affective disorders, 138(1-2), 160-164.

Porcerelli, J. H., Cramer, P., Porcerelli, D. J., & Arterbery, V. E. (2017). Defense Mechanisms and Utilization in Cancer Patients Undergoing Radiation Therapy. A Pilot Study. Journal of Nervous and Mental Disease, 205(6), 466-470. Doi: 10.1097/NMD.0000000000000674

Price, M.A., Tennant, C.C., Butow, P.N., Smith, R.C., Kennedy, S.J., Kossoff, M.B., & Dunn, S.M. (2001). The role of psychosocial factors in the development of breast carcinoma: Part II. Life event stressors, social support, defense style, and emotional control and their interactions. Cancer, 91(4), 686-697.

Radziej, K., Schmid, G., Dinkel, A., Zwergal, A., & Lahmann, C. (2015). Psychological traumatization and adverse life events in patients with organic and functional vestibular symptoms. Journal of Psychosomatic Research, 79(2), 123-129. Doi: 10.1016/j.jpsychores.2015.05.005

Renzi, C., Perinel, G., Arnaboldi, P., Gandini, S., Vadilonga, V., Rotmensz, N., Tagini, A., Didier, F., Pravettoni, G. (2017). Memories of paternal relations are associated with coping and defense mechanisms in breast cancer patients: an observational study. BMC Psychology, 5,37. Doi: 10.1186/s40359-017-0206-z

Rigby, J. E., Morris, J. A., Lavelle, J., Stewart, M., & Gatrell, A. C. (2002). Can physical trauma cause breast cancer? European Journal of Cancer Prevention, 11(3), 307-311. Doi: 10.1097/00008469-200206000-00014

Schauer, M., & Elbert, T. (2010). Dissociation following traumatic stress. Journal of Psychology, 218, 109-127.

Settineri, S., Frisone, F., Alibrandi, A., & Merlo, E. M. (2019). Emotional suppression and oneiric expression in psychosomatic disorders: early manifestations in emerging adulthood and young patients. Frontiers in psychology, 10, 1897. Doi: 10.3389/fpsyg.2019.01987

Settineri, S., Frisone, F., & Merlo, E. M. (2019). The Mask object in psychotherapy: Presentation and Representation. Mediterranean Journal of Clinical Psychology, 7(1). Doi: 10.6092/2282-1619/2019.7.2232

Settineri, S., Frisone, F., Merlo, E. M., Geraci, D., Martino, G. (2019). Compliance, Adherence, Concordance, Empowerment, Self-Management. Five words to manifest a relational misadjustment in diabetes. Differences to be known in the approach to the diabetic adolescent compared to the adult. Journal of Multidisciplinary Healthcare, 12, 299-314. Doi: 10.2147/JMDH.S193752. 24

Vaillant, G. E. (1977). Adaptation to life. Little, Brown, Boston.

Vaillant, G. E. (1992). Ego Mechanisms of Defense: A Guide for Clinicians and Researchers. American Psychiatric Press, Washington D.C.

Veltri, A., Scarpellini, P., Piccinni, A., Conversano, C., Giacomelli, C., Bombardieri, S., Bazzichi, L., & Dell’Osso, L. (2012). Methodological approach to depressive symptoms in fibromyalgia patients. Clinical and Experimental Rheumatology, 30(6 Suppl 74), 136-142.

Vicario, C. M., Salehinejad, M. A., Felmingham, K., Martino, G., & Nitsche, M. A. (2019). A systematic review on the therapeutic effectiveness of non-invasive brain stimulation for the treatment of anxiety disorders. Neuroscience & Biobehavioral Reviews, 96, 219-231. Doi: 10.1016/j.neubiorev.2018.12.012

Zimmerman, T. N., Porcerelli, J. H., & Arterbery, V. E. (2019). Defensive functioning in cancer patients, cancer survivors, and controls. Psychoanalytic Psychology, 36(3), 259. Doi: 10.1037/pap0000225



  • There are currently no refbacks.