Abstract

RIOS MARTINEZ, Blanca Patricia; CHAVEZ LEON, Enrique; RANGEL RODRIGUEZ, Gabriela Alejandra  and  PEDRAZA MOCTEZUMA, Luis Guillermo. Defense mechanisms in cardiovascular disease patients with and without panic disorder. Salud Ment [online]. 2010, vol.33, n.3, pp.219-227. ISSN 0185-3325.

Introduction Throughout the investigation of psychosocial factors in cardiovascular diseases, type A personality, anger, hostility, anxiety, and depression have been proved to participate in this kind of sufferings. Cardiac patients exposed more frequently to life stressing events than patients who do not suffer a cardiac disease might lack adaptive coping defense mechanisms to protect them or use maladaptive defense mechanisms that facilitate the pathogenic effects of anxiety. Few studies have been done in Mexico related to psychological defense mechanisms; none of them was related to medically ill patients. In the present study, the use of defense mechanisms by cardiac patients with panic disorder (panic attack) was compared to the use of defense mechanisms by patients that present similar cardiovascular pathologies but without mental disorders. Material and method The present investigation was made as a comparative and explanatory study with a nonexperimental design. The sample was constituted by two groups: one of 33 cardiac patients diagnosed with panic attack and another group, used as control, of 30 cardiac outpatients without psychiatric disorder; all attended the Instituto Nacional de Cardiología Ignacio Chávez (Mexico City). The 63 cardiac patients were evaluated using the Structured Interview for the Diagnosis of Axis I, Hamilton's Anxiety Scale, Hopkins's 90 Symptom Checklist and the Defensive Styles Questionnaire, self-report instrument whose reliability and validity has been established for Mexican patients with panic disorder. The statistical analysis was made through chi-square test, Student's t test, Pearson correlation and a gradual multiple regression analysis. Results Within the group of cardiac patients with panic attack, 72.73% were female patients and 27.27% male, with an average age of 38.52 ± 14.18 years and 5.73 ± 2.75 years of schooling. The group of cardiac patients used as control was formed by 30 subjects also in its majority female (56.7%), with an age of 45.27 ± 14.51 years and an average of 5.67 ± 3.31 years of schooling. The patients of the group with panic disorder had higher levels of anxiety and used more maladaptive defense mechanisms, such as social isolation and inhibition, tended to use more somatization and less the adaptive defenses (suppression, work orientation, sublimation, affiliation and humor), in comparison to the group without mental disorder. The criteria for panic disorder (DSM-IV) correlated directly with somatization; the ones from major depression correlated directly with regression and inversely with humor and socioeconomical level; the score in Hamilton's Anxiety Scale with maladaptive defenses as social isolation, acting out and somatization; the SCL-90 with the maladaptive defenses acting out, projection and regression. The multiple regression analysis determined that regression and somatization contributed to the panic disorder symptomatology, and leads to major depressive disorder; projection, somatization and social isolation to anxiety's intensity and reaction formation, humor, regression, fantasy, inhibition, projective identification, passive aggression and omnipotence in general to the psychiatric symptoms. Discussion The greater use of maladaptive defenses by the cardiac patients group with panic disorder allows to conclude that low level defenses are related to the symptoms of this mental disorder. This group showed relation between levels of anxiety, psychological discomfort and the use of maladaptive defenses such as social isolation, inhibition and somatization, tending to isolate themselves and presenting in a corporal or <<visceral>> form, through somatization, many physical symptoms. The observation of the use by cardiac patients without mental disorder of suppression, work orientation, sublimation, affiliation and humor, all of them adaptive defenses, reinforces this conclusion.

Keywords : Defense mechanism; defensive styles; cardiovascular disease; panic disorder; panic attacks.

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