{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T16:03:49Z","timestamp":1771257829887,"version":"3.50.1"},"reference-count":82,"publisher":"PAGEPress Publications","issue":"3","license":[{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"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>While a substantial number of studies investigate the nuances and clinical relevance of attachment styles and defense mechanisms separately, relatively few studies have explored the relationship between attachment styles and defense mechanisms. We aimed to provide a narrative review of empirical studies that used validated measures to assess the relationship between defense mechanisms and attachment styles in adolescents or adults. Twenty peer-reviewed studies published over the past 30 years were included. Except for one study involving high school students, all others focused on adults, mostly from community samples, with a few including clinical populations. Most studies employed various self-report questionnaires, though several used observer-rated or interview-based methods, with the majority using a cross-sectional design; a few studies used experimental and longitudinal designs as well. The studies\u2019 findings indicate an association between insecure attachment and greater use of immature defenses, while secure attachment is associated with more mature defenses. Anxious attachment was particularly linked to defenses such as projection, splitting, and devaluation, whereas avoidant attachment was associated with emotional suppression and denial. A subset of studies examined changes in these constructs during psychotherapy, suggesting that both defense mechanisms and attachment security may improve over time, and indicating the potential importance of reflective functioning as a mediator, as well as depressive immature defenses as obstacles to change. These results underscore the clinical relevance of assessing both attachment and defensive functioning and highlight the importance of addressing them as potential mechanisms of change in clinical contexts.<\/jats:p>","DOI":"10.4081\/ripppo.2025.879","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T15:24:31Z","timestamp":1770305071000},"source":"Crossref","is-referenced-by-count":0,"title":["The relationship between defense mechanisms and attachment: a narrative review"],"prefix":"10.4081","volume":"28","author":[{"given":"Rose","family":"Howell","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vera","family":"B\u00e9k\u00e9s","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2025,12,31]]},"reference":[{"key":"35460","doi-asserted-by":"crossref","unstructured":"Ainsworth, M. D. S. (1978). The Bowlby-Ainsworth attachment theory. Behavioral and Brain Sciences, 1, 436\u2013438. doi: 10.1017\/S0140525X00075828","DOI":"10.1017\/S0140525X00075828"},{"key":"35461","doi-asserted-by":"crossref","unstructured":"Ainsworth, M. D. S., & Bowlby, J. (1991). An Ethological Approach to Personality Development. American Psychologist, 46(4), 333-341. doi: 10.1037\/0003-066X.46.4.333","DOI":"10.1037\/0003-066X.46.4.333"},{"key":"35462","doi-asserted-by":"crossref","unstructured":"Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: a test of a four-category model. Journal of Personality and Social Psychology, 61(2), 224-226. doi: 10.1037\/0022-3514.61.2.226","DOI":"10.1037\/0022-3514.61.2.226"},{"key":"35463","doi-asserted-by":"crossref","unstructured":"B\u00e9k\u00e9s, V., Aafjes-van Doorn, K., Spina, D., Talia, A., Starrs, C. J., & Perry, J. C. (2021a). The Relationship Between Defense Mechanisms and Attachment as Measured by Observer-Rated Methods in a Sample of Depressed Patients: A Pilot Study. Frontiers in Psychology, 12, 648503. doi: 10.3389\/fpsyg.2021.648503","DOI":"10.3389\/fpsyg.2021.648503"},{"key":"35464","unstructured":"B\u00e9k\u00e9s, V., Prout, T. A., Di Giuseppe, M., Wildes Ammar, L., Kui, T., Arsena, G., & Conversano, C. (2021b). Initial validation of the Defense Mechanisms Rating Scales Q-sort: A comparison of trained and untrained raters. Mediterranean Journal of Clinical Psychology, 9(2). doi: 10.13129\/2282-1619\/mjcp-3107"},{"key":"35465","doi-asserted-by":"crossref","unstructured":"B\u00e9k\u00e9s, V., Starrs, C. J., Perry, J. C., Prout, T. A., Conversano, C., & Di Giuseppe, M. (2024). Defense mechanisms are associated with mental health symptoms across six countries. Research in Psychotherapy: Psychopathology, Process, and Outcome, 26(3), 729. doi: 10.4081\/ripppo.2023.729","DOI":"10.4081\/ripppo.2023.729"},{"key":"35466","doi-asserted-by":"crossref","unstructured":"Berant, E., & Wald, Y. (2009). Self-reported attachment patterns and Rorschach-related scores of ego boundary, defensive processes, and thinking disorders. Journal of Personality Assessment, 91(4), 365\u2013372. doi: 10.1080\/00223890902936173","DOI":"10.1080\/00223890902936173"},{"key":"35467","doi-asserted-by":"crossref","unstructured":"Berney, S., de Roten, Y., Beretta, V., & Kramer, U. (2014). Identifying psychotic defenses in a clinical interview. Journal of Clinical Psychology, 70, 428\u2013439. doi: 10.1002\/jclp.22087","DOI":"10.1002\/jclp.22087"},{"key":"35468","doi-asserted-by":"crossref","unstructured":"Bincoletto, A. F., Liotti, M., Di Giuseppe, M., Fiorentino, F., Nimbi, F. M., Lingiardi, V., & Tanzilli, A. (2025). An investigation into the interplay of epistemic trust, defensive mechanisms, interpersonal problems, and sintomatology: a mediation model. Personality and Individual Differences, 233, 112893. doi: 10.1016\/j.paid.2024.112893","DOI":"10.1016\/j.paid.2024.112893"},{"key":"35469","unstructured":"Bowlby, J. (1969). Attachment and loss (No. 79). Random House."},{"key":"35470","unstructured":"Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss, sadness and depression. The Hogarth Press and the Institute of Psycho-Analysis."},{"key":"35471","unstructured":"Bowlby, J. (1987). Defensive processes in light of attachment theory. In J. Sacksteder & D. P. Schwartz (Eds.), Attachment and the Therapeutic Process: Essays in Honor of Otto Allen Will, Jr., MD. International Universities Press."},{"key":"35472","unstructured":"Bowlby, J. (1988). A Secure Base: Parent-Child Attachment and Healthy Human Development. 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Maternal attachment state of mind and defensive functioning in pregnancy: predicting mother\u2013infant relationship at 6 months through the PDM-2 Infancy and Early Childhood section. Frontiers in Psychology, 16, 1568620. doi: 10.3389\/fpsyg.2025.1568620","DOI":"10.3389\/fpsyg.2025.1568620"},{"key":"35476","doi-asserted-by":"crossref","unstructured":"Ciocca, G., Rossi, R., Collazzoni, A., Gorea, F., Vallaj, B., Stratta, P., Longo, L., Limoncin, E., Mollaioli, D., Gibertoni, D., Santarnecchi, E., Pacitti, F., Niolu, C., Siracusano, A., Jannini, E. A., & Di Lorenzo, G. (2020). The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis. Journal of affective disorders, 273, 384\u2013390. doi: 10.1016\/j.jad.2020.05.014","DOI":"10.1016\/j.jad.2020.05.014"},{"key":"35477","doi-asserted-by":"crossref","unstructured":"Collins, N. L., & Read, S. J. (1990). 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