{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:35:27Z","timestamp":1791884127959,"version":"4.3.4"},"reference-count":52,"publisher":"PAGEPress Publications","issue":"3","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["RES PSYCHOTHER-PSYCH"],"abstract":"<jats:p>The paper revisits defense mechanisms as central regulators of emotional life and self-coherence in contemporary clinical practice, showing how a classical psychodynamic construct has evolved into an empirically measurable, transdiagnostic dimension of functioning. After outlining the historical development of the concept, the authors present the hierarchical model of defenses, operationalized through the Defense Mechanisms Rating Scale (DMRS), as the current reference framework for assessment of thirty individual defenses across seven levels of adaptiveness. Empirical studies using the DMRS \u2013 also in its observer-rated Q-sort and self-report versions \u2013 indicate that shifts toward more mature defenses predict better outcomes across different treatment orientations, suggesting that changes in defensive functioning may represent a common factor underlying psychotherapeutic change. These advances are integrated with dimensional and transdiagnostic approaches, including the Psychodynamic Diagnostic Manual, Third Edition (PDM-3), in which defenses play a pivotal role in evaluating personality organization on Axis P and mental capacities on Axis M, thereby complementing symptom-focused systems such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) and the International Classification of Diseases (ICD-11). The paper also discusses conceptual overlaps with coping and emotion regulation, the limitations of cross-sectional and self-report methodologies, and the need for longitudinal, cultural, and neuro-psychodynamic research, proposing defense mechanisms as a unifying language that links psychodynamic theory, empirical psychology, and neuroscience.<\/jats:p>","DOI":"10.4081\/ripppo.2025.877","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T13:02:04Z","timestamp":1766408524000},"source":"Crossref","is-referenced-by-count":2,"title":["Revisiting defense mechanisms in contemporary clinical practice: evidence and perspectives"],"prefix":"10.4081","volume":"28","author":[{"given":"Vittorio","family":"Lingiardi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Madeddu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"34550","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787"},{"key":"34551","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2019.04.021"},{"key":"34552","unstructured":"B\u00e8k\u00e8s, V., Prout, T. A., Di Giuseppe, M., Ammar, L. W., Kui, T., Arsena, G., & Conversano, C. (2021). Initial validation of the Defense Mechanisms Rating Scales Q-sort: A comparison of trained and untrained raters. 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(1936). Ego and defense mechanisms. In The writings of Anna Freud (Vol. 2, pp. 3-191). International Universities Press."},{"key":"34566","unstructured":"Freud, S. (1894). The neuro-psychosis of defence. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud. W.W. Norton & Company."},{"key":"34567","unstructured":"Ginot, E. (2009). Neuropsychological trauma, dissociation and the self: The neurobiology of defensive states. Psychoanalytic Psychology, 26(2), 196-209."},{"key":"34568","unstructured":"Ginot, E. (2015). The neuropsychology of the unconscious: Integrating brain and mind in psychotherapy. W. W. Norton & Company."},{"key":"34569","doi-asserted-by":"publisher","DOI":"10.1080\/15294145.2023.2257718"},{"key":"34570","doi-asserted-by":"publisher","DOI":"10.1177\/000306516701500309"},{"key":"34571","unstructured":"Kernberg, P. F. (1994). Mechanisms of defense: Development and research perspectives. 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