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Defense Mechanisms and Personality

Disorders: An Empirical Test of Millon's
Theory
Stacey M. Whyne Berman & Joseph T. McCann
Published online: 10 Jun 2010.

To cite this article: Stacey M. Whyne Berman & Joseph T. McCann (1995) Defense Mechanisms and
Personality Disorders: An Empirical Test of Millon's Theory, Journal of Personality Assessment, 64:1,
132-144, DOI: 10.1207/s15327752jpa6401_9

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 JOURNAL OF PERSONALITY ASSESSMENT, 1995,64(1), 132-144
Copyright O 1995, Lawrence Erlbaum Associates, lnc.

Defense Mechanisms and Personality

Disorders: An Empirical Test of
Millon's Theory
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Stacey M. Whyne Berman

Peel Memorial Hospital
Brampton, Ontario

Joseph T. McCann
Binghamton, New York

The purpose of this study was to investigate Millon's hypothesized relation-

ships between particular personality disorders and specific defense mecha-
nisms. One hundred thirty psychiatric inpatients and outpatients, all diagnosed
with an Axis I1 personality disorder, completed the Millon Clinical Multiaxial
Inventory-I1 (MCMI-11; Millon, 1987) and the Defense Mechanism Inventory
(DMI; Ihilevich & Gleser, 1986). Analyses revealed strong corroborating evi-
dence for a number of the hypothesized relationships, including significant
correlations between antisocial traits and acting out, obsessive-compulsive
traits and reaction formation, paranoid traits and projection, passive-aggressive
traits and displacement, and self-defeating traits and devaluation. There was
also a trend suggesting the presence of a relationship between dependent per-
sonality traits and introjection. A factor analysis was also performed that sug-
gested that method variance may be responsible for either lowered correlations
between the MCMI-I1 and DM1 or lack of significance for some predicted
relationships. Results are discussed in terms of existing theory and research,
and implications for treatment and future research are briefly addressed.

In recent years, there has been renewed interest in the role of psychological
defense mechanisms in clinical manifestations of specific disorders. For
instance, Axis I1 of the Diagnostic and Statistical Manual of Mental Disor-
ders (3rd ed., rev. [DSM-111-R]; American Psychiatric Association, 1987)
 DEFENSES AND PERSONALITY DISORDERS 133

can now be utilized to code defenses that are prominent in a particular case.
The notion of defense mechanisms mediating various forms of psychopa-
thology is not new, however. Freud noted that there may be an intimate
connection between specific defenses and particular forms of emotional
disturbance (Freud, 193611959). Subsequently, a number of prominent theo-
rists have speculated on the relationship between utilization of specific
defense mechanisms and the existence of particular personality disorders.
Millon (1986a, 1986b) hypothesized that there exists an extensive matrix of
relationships between defense mechanisms and personality disorders. Al-
though Millon notes that a given defense mechanism may be utilized by
individuals with various personality disorders, he maintains that each patho-
logical character style is linked to one primary defense mechanism (see
Table 1). Although the possible relationships between defense mechanisms
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and personality disorders have been extensively elucidated in the theoretical

literature, there is an overall dearth of empirical research in this area.
In recent years, psychological defense mechanisms and their relationshi~p
to diagnosis have been of increasing interest. A number of studies have
examined the relationship between defensive functioning and overall ment,al
health (Bond, Gardner, Christian, & Sigal, 1983; Perry & Cooper, 1989;
Stein, Golombek, Marton, & Korenblum, 1986; G. E. Vaillant, 1976; G. 1:.
Vaillant & Drake, 1985). Such researchers have typically found ment,al
health to be associated with the use of mature defense mechanisms (as
defined by G. E. Vaillant, 1971). Individuals utilizing mature defenses (e.g.,

TABLE 1
Hypothesized Relationships Among Personality Disorders, Specific Defense
Mechanisms, and DM1 Defense Categories
DMZ
Personality Dtorder Millon's Proposed Defenw Defense
-
-

Intellectualization - --
PRN
Schizoid
Avoidant -- Fantasy 4

- REV
Dependent
Histrionic
-
- Introjection
Dissociation 4
TAS
REV
Narcissistic
Antisocial -
-
Rationalization
Acting-Out
4

-
- PRN
TAO
Aggressive/Sadistic
Obsessive-Compulsive
Passive-Aggressive
-
--
IsoIation
Reaction Formation
Displacement
-- PRN
REV
TAO
-
Self-Defeating (Masochistic)
Schizotypal
Borderline -
- Devaluation
Undoing
Regression
-
-
TAS
REV
TAO
Paranoid - Projection - PRO
-
Note. DM1 = Defense hlechanism Inventory, PRN = Principalization,REV = Reversal,
TAS = Turning Against Self, TAO = Turning Against Other, PRO = Projection.
 134 BERMAN AND McCANN

sublimation, suppression, and humor) are thought to cope with stress well
and to respond to conflict in an adaptive manner. Researchers have also
found that psychopathology tends to be associated with the utilization of
immature defense mechanisms (as defined by G. E. Vaillant, 1971). Individ-
uals who rely on immature defenses (e.g., fantasy, projection, and hypochon-
driasis) are believed to have difficulty resolving conflict as well as a
tendency to become overwhelmed by stress.
More specific examinations of the relationship between particular diagno-
ses and defense mechanisms have also been carried out. However, there has
been no comprehensive study on the relationship between personality disor-
ders and defenses. Some studies have exclusively focused on clinical syn-
dromes (e.g., Andrews, Pollock, & Stewart, 1989; Schueler, 1981; Steiner,
1990), whereas others have examined only one or two personality disorders
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(e.g., Cooper, Perry, & Arnow, 1988; Lerner & Lerner, 1982; Salwen,
Reznikoff, & Schwartz, 1989). Still others have employed subjective assess-
ment methods (G. E. Vaillant & Drake, 1985) or used broad diagnostic
categories rather than specific diagnoses (Bond & J. S. Vaillant, 1986). Thus,
any relationships that may exist between defense mechanisms and petsonal-
ity disorders become blurred. In general, previous research has either been
too narrow in its focus or too broad in its scope.
The purpose of this study is to examine the relationship between individ-
ual defense mechanisms and particular personality disorders. Specifically,
this study focuses on Millon's hypothesized relationships, as outlined in
Table 1. However, other associations between defense mechanisms and per-
sonality disorders are examined in order to obtain a more complete picture
of possible relationships.

METHOD

Subjects

The subjects were 130 psychiatric patients from both inpatient (n = 66) and
outpatient (n = 64) settings. A total of 42 men and 88 women made up the
sample, and the mean age was 33.6 years (SD = 10.7) for the entire sample.
Although the subject group was predominantly White (90%), 7% of the
subjects were Black, and 4% were from other varied racial groups. The
majority of subjects were never married (46%), followed by married (26%),
divorced (13%), separated (7%), and widowed (1%). The mean education
level was 13.7 years (SD = 2.7).
The inpatient sample was taken from three acute-care psychiatric units in
a large general hospital in Western New York and two acute-care psychiatric
units from a hospital in Southern Ontario. Patients were randomly admitted
to these units based on bed availability. The outpatient sample was drawn
from a nonprofit community mental health clinic in Western New York as
 DEFENSES AND PERSONALITY DISORDERS 135

well as from a psychiatric day treatment program in a general hospital in

Southern Ontario. Criteria for selection in the study included those patients
who, based on chart review, carried an Axis I1 personality disorder diagnosis
and were neither psychotic nor organically impaired. Data from 157 subjects
were initially examined; however, 27 subjects completed the Millon Clinical
Multiaxial Inventory-11 (MCMI-11; Millon, 1987) and/or the Defense Meclh-
anism Inventory (DMI; Ihilevich & Gleser, 1986) in an invalid or incomplete
manner, and thus were not included in the analyses.

Instruments

MCMI-11. The MCMI-I1 was developed by Millon (1987) to measure

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personality disorders and psychopathology. It is a paper-and-pencil test that

is composed of 175 affirmative statements to which the respondent can
answer "true" or "false." The items are organized into 22 clinical scales that
are further grouped into four categories of various psychopathological sever-
ity. The inventory also contains three validity scales. For the purpose of this
study, only two of the four categories are of relevance: clinical personality
pattern (10 scales) and severe personality pathology (3 scales), as these are
the two scale sets that measure personality disorder characteristics. The
MCMI-I1 was designed with the goal of coordinating the scales directly with
DSM-111-R (American Psychiatric Association, 1987) diagnoses. The theory
underlying the development of the MCMI-11, as well as detailed descriptions
of the scales and reliability and validity data, are outlined in the test manu<al
(Millon, 1987).

DMI, The DMI, developed by Ihilevich and Gleser (1986), provides am

index of an individual's defense mechanisms. The DM1 is a paper-and-pencil
forced choice test that is comprised of 10 vignettes depicting conflictuid
situations designed to elicit defensive behavior from respondents. Five areas
of conflict are purportedly measured by the 10 vignettes-situational, au-
thority, independence, competition, and masculinity/femininity. A given
conflict area is depicted in two stories. Each vignette is followed by fom
questions concerning the respondent's overt behavioral reaction, fantasy or
impulsive response, thoughts, and feelings toward the vignettes. Each ques-
tion is then followed by five possible responses that are designed to tap five
distinct defense categories.
The five defense mechanism categories assessed by the DM1 are:

1. Turning Against Object (TAO), which refers to the expression of

direct or indirect aggression aimed at mastering perceived external
threats or masking inner conflicts that are too painful to confront
consciously.
 BERMAN AND McCANN

Projection (PRO), which describes a strategy of attributing negative

intent or traits to other individuals without sufficient justification
and subsequently using this attribution to justify the expression of
hostility toward the other.
Principalization (PRN), which refers to the falsification of reality
through reinterpretation.
Turning Against Self (TAS), which denotes intrapunitive tactics used
to falsify reality in an attempt to reduce perceived threats to one's
self-esteem.
Reversal (REV), which represents responses to internal threats that
act to minimize the severity of perceived threats or conflicts and
results in failure to recognize the presence of otherwise obvious
dangers.
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In total, there are 200 items that are presented in groups of 5. Subjects
respond to each group of items by selecting one item that is most representa-
tive of their reaction and one that is least representative of their reaction. A
more comprehensive depiction of the DM1 defense categories along with a
description of the DM1 model and information pertaining to the DMI's
reliability and validity can be found in Ihilevich and Gleser's (1986) manual.
Cramer (1988) provides a more thorough review of existing DM1 reliability
and validity data.

Procedure

All patients completed the MCMI-I1 (Millon, 1987) and the DM1 (Ihilevich
& Gleser, 1986). Each subject gave informed consent to participate. All test
instruments were administered in the standard manner outlined in the respec-
tive manual for each instrument, under controlled conditions at either the
hospitals or the outpatient clinic. The completion time for this task was
approximately 60 min.
Because the DM1 measures five defense mechanism categories, rather
than the range of individual defense mechanisms proposed by Millon, exam-
ination of the data required a three-step process. First, a statistical analysis
of the relationships between the defense mechanism categories of the DM1
and the personality disorders, as measured by the MCMI-11, was carried out.
Second, to test Millon's hypotheses, the five DM1 defense categories were
matched with an individual defense mechanism (see Table 1). Finally, the
empirical data were compared to the relationships hypothesized in Table 1,
to determine if the results supported Millon's hypotheses. Although initially
it had been our intent to compare the clinicians' Axis I1 diagnoses to the
subjects' highest scores on the MCMI-I1 scales, to serve as a validity check,
this was not carried out due to the fact that many of the clinicians' diagnoses
lacked specificity. That is, a large proportion of the study's subjects were
 DEFENSES AND PERSONALITY DISORDERS 137

given clinical diagnoses of Personality Disorder Not Otherwise Specified, 0s-

tensively because the clinicians' exposure to the subjects was insufficient (typi-
cally one or two interviews) to provide enough data to allow for a more
definitive formulation.
Although Ihilevich and Gleser provide linkages between the majority of
defense mechanisms examined in this study and their corresponding defense
categories, six were not explicitly associated with respective defense catego-
ries. Thus, it was necessary to rationally generate connections between th~e
remaining defense mechanisms included in Millon's theory that are unac-
counted for in the DM1 manual. Ihilevich and Gleser acknowledge that
acting out and regression were considered for inclusion under the TAO
category, but this was decided against because these authors were not confi-
dent that either was a clear example of a defense mechanism. However,
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because Millon views both acting out and regression as defense mechanisms,
they were considered to be representative of TAO for this study. Although
Ihilevich and Gleser did not classify fantasy, they did include denial under
the rubric of REV. Because fantasy is often referred to as "denial in fantasy"
(e.g., Freud, 193711966), it seemed that REV was the proper classification.
Because undoing (a symbolic gesture designed to negate objectionable
thoughts, feelings, or actions) is most closely aligned with negation, which
Ihilevich and Gleser subsumed under the REV defense category, undoing
was classified under REV. Similarly, dissociation is most akin to repression
in that both entail a lack of conscious awareness of disturbing thought,^,
feelings, or experiences. Consequently, because repression is subsumed
under REV in Ihilevich and Gleser's schema, dissociation was aligned with
REV as well. Finally, introjection (which reduces conflict by internalizing
another's viewpoint) seems most consistent with the DM1 defense category
of TAS, which Ihilevich and Gleser (1986) have defined to include intrapuni-
tive maneuvers that protect or enhance self-esteem by creating "the impres-
sion that one can thereby gain the acceptance and approval of internalized
significant others" (p. 21).

RESULTS

To examine the magnitude and direction of the relationships between partic-

ular personality disorders and individual defense mechanisms, Pearson r
coefficients were generated. An alpha of .05 was determined to be an appro-
priate level of significance. Taking into account that multiple correlationis
increase the risk of Type 1 errors, the desired alpha was arrived at by
dividing the overall alpha (.05) by the number of correlations generated
(Bonferroni correction), resulting in an individual significance level of .0011.
Results from the correlation analysis of the MCMI-I1 personality disorde:r
scales and the DM1 defense categories are presented in Table 2.
As predicted by Millon's hypotheses, the Antisocial scale was positively
correlated with TAO, the Obsessive-Compulsive scale was positively corre-
 138 BERMAN AND McCANN

TABLE 2
Correlation Coefficients for MCMI-I1 Personality Disorder Scales
and DM1 Defense Categories

DMI Defense Categories

MCMI-II Scale TAO PRO PRN TAS REV
1. Schizoid - .18 .01 - .06 .27** .03
2. Avoidant - .02 .21* - .30** .34** -.21*
3. Dependent - .38** -.07 .17 .22* .22*
4. Histrionic .23* .15 - .09 - .20* - .16
5. Narcissistic .29** .20 -.I3 -.29** -.I6
6A. Antisocial .29** .22* -.31** -.09 - .20
6B. Aggressive/Sadistic .38** .27* - .25* -.I7 - .31**
7. Obsessive-Compulsive - .34** - .ll .24* .07 .28**
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8A. Passive-Aggressive .32** .34** - .38** .07 - .39**

8B. Self-Defeating - .03 .12 - .29** .35** -.I6
9. Schizotypal - .01 .27* - .Be* .27** - .22*
10. Borderline .15 .I6 - .308* .20* - .27*
11. Paranoid .I5 .29** -.28** .DO - .18
Note. MCMI-I1 = Millon Clinical Multiaxial Inventory-11, DM1 = Defense Mechanism
Inventory, TAO = Turning Against Other, PRO = Projection, PRN = Principalization,
TAS = Turning Against Self, REV = Reversal.
*p < .01.**p < .m1.

lated with REV, the Paranoid scale was positively correlated with PRO, the
Passive-Aggressive scale was positively correlated with TAO, and finally,
the Self-Defeating scale was positively correlated with TAS. Although not
significant by thestandards here employed, there was also a trend toward
significance in the relationship between the Dependent Personality scale and
TAS ( p < .01). None of the other relationships that were predicted in Table 1
were supported by the data. However, a number of interesting relationships
other than those hypothesized by Millon (1986a, 1986b) were revealed
through analysis of the data (see Table 2).
Although a number of the predicted relationships were not corroborated,
even those that were supported by the data were not particularly strong. In
an attempt to better understand the reasons for these findings, an exploratory
factor analysis was conducted, primarily to examine the effects of method
variance (see Morey & LeVine, 1988). Method variance occurs when differ-
ences in the measures employed interfere with the detection of relationships
between two or more constructs. This results because different instrument
formats can cause a subject to display divergent response patterns on items
measuring similar constructs. The MCMI-I1 is a measure of personality, one
dimension of which is defensive structure. The DM1 is a measure of defen-
sive style, which is one among many personality constructs. Consequently,
 DEFENSES AND PERSONALITY DISORDERS 1319

TABLE 3
Factor Loadings for Combined MCMI-II and DM1 Factor Analysis
-
Scale Factor 1 Factor 2 Factor 3 Factor 4 Factor 5
-

MCMI-I1
Self-Defeating .92 .03 .04 .00 - .Of!
Borderline .75 .41 .13 -.ll - .08
Avoidant .75 - .08 .24 .43 - .13
Passive-Aggressive .69 .46 .33 .19 -03
Schizotypal .69 .15 .15 .46 .OIL
Dependent .56 - .54 - .44 .00 .IT

Aggressive .07 .87 .22 - .09 .10

Narcissistic - .02 .79 .02 - .42 .211
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Antisocial .15 .74 .28 - .23 -.Ill

Paranoid .44 .70 - .05 .13 .25
DM1
TAO - .09 .17 .82 - .13 .30
REV - .17 - .08 - .79 .03 -.It;
PRN - .25 - .17 - .68 - .09 .Oti
MCMI-I1
Schizoid .31 - .14 - .O1 .81 - .10
Histrionic .12 .47 .03 - .78 .14
Compulsive - .09 - .06 - .53 .58 .2fi
DM1
TAS .35 -.I3 - .02 .18 - .7!i
PRO .21 .ll .45 .06 .73
-
Note. Scales are grouped according to their highest factor loadings. MCMI-I1 = Millon
Clinical Multiaxial Inventory-11, DM1 = Defense Mechanism Inventory, TAO = Turning
Against Other, REV = Reversal, PRN = Principalization, TAS = Turning Against Self,
PRO = Projection.

one would expect the MCMI-I1 and the DM1 to possess some common
factors. If this is the case, the factor analysis should result in scales from the
two inventories loading on some of the same factors. Conversely, if the two
measures possess idiosyncratic representations of the constructs, factors
should emerge with high loadings from one scale set and much lower loacl-
ings from the other scale set.
The 13 MCMI-I1 personality disorder scores and the 5 DM1 defense
scores were simultaneously entered into the same factor analysis. Afive-fac-
tor solution was obtained, accounting for 77.6% of the total variance (see
Table 3). As the table shows, each factor contained high loadings on scales
from only one of the two inventories. These results point to the presence of
method variance.
 140 BERMAN A N D M c C A N N

DISCUSSION

Although the study uncovered relationships between personality disorders

and defense categories, this does not provide direct evidence for linkages
between character styles and specific defense mechanisms. Nevertheless,
based on the results of this study, there is indirect support for some of
Millon's hypotheses. The data suggest that individuals with antisocial per-
sonality disorders may disproportionately rely on acting out as a defense.
Similarly, individuals with obsessive-compulsive personalities appear to be
more prone to utilize reaction formation as a defense. In addition, those with
paranoid personalities may be more likely to use projection as a defense,
whereas those with passive-aggressive personalities seem to rely on dis-
placement as a defense. Finally, those with self-defeating personality disor-
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ders may be inclined to overuse devaluation as a defense. There is also some

indication that individuals with dependent personalities may employ intro-
jection as a defense more often than others do, although statistics revealed
only a trend in this direction. It should be noted that the correlation coeffi-
cients between the personality disorders and defense mechanisms just men-
tioned were not particularly large (ranging from .22 to .35). Thus, although
a propensity for particular defense mechanisms to be employed by individu-
als with specific personality disorders appears to exist, an unequivocal
connection between one personality style and one defense mechanism can-
not be made. Nevertheless, the findings presented here provide some support
for Millon's conceptualization of the relationship between defense mode and
personality style.
A number of hypothesized relationships were not supported by the data.
More specifically, no support was provided for a relationship between schiz-
oid personality disorder and the use of intellectualization, avoidant person-
ality disorder and fantasy, histrionic personality disorder and dissociation,
narcissistic personality disorder and rationalization, aggressive/sadistic per-
sonality disorder and isolation, schizotypal personality disorder and undo-
ing, or borderline personality disorder and regression. One possible reason
for these findings is that the range of possible defenses tapped by the
DMI-five in total-was quite restricted. In some instances, the individual
defense mechanisms described by Millon were "squeezed," rather than nat-
urally fit, into one of the DM1 cqtegories. Principalization, defined as the
falsification of reality through reinterpretation, appeared to be the most
problematic defense category, in that none of the predicted relationships
involving this particular defense were significant. This broad category may
not properly reflect the more subtle nuances of isolation and intellectualiza-
tion that are subsumed under it. Similarly, regression may not be a proper fit
under TAO. Thus, tbe constricted range of defense categories tapped may be
responsible for some of the unsupported hypotheses.
Along the same lines, PRN and REV, as compared to TAO, PRO, and
TAS, seem to be measured by items that have a positive valence, thus
 DEFENSES AND PERSONALITY DISORDERS 141

representing "higher level" defenses as opposed to "lower level" defenses.

Support for this interpretation is provided by Ihilevich and Gleser's (1986)
finding that groups of individuals given social desirability instructions had
significantly higher scores on PRN and REV than groups of individuarls
given regular instructions. Further substantiation for this comes from the
positive correlations found between the MCMI-11's Desirability scale and
PRN (r = .25, p < .01) and REV (r = .25, p < .01) in this study. Consequently,
individuals with more severe psychopathology may not have selected the
responses that are representative of PRN or REV because their actual de-
fense mechanisms were not adequately captured by the DM1 items. That is,
the DM1 response options may have assessed healthier defense mechanisnns
than is typical of these individuals' coping methods. This may be the case for
the aggressive/sadistic personality disorder, which was found to be signifi-
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cantly related to isolation via PRN in the opposite direction from what was
predicted. It may also account for the finding that a significant negative
relationship between the schizotypal personality disorder and undoing via
REV was found, although a positive relationship was hypothesized. Simd-
larly, the unexpected negative relationship between the avoidant personality
disorder and fantasy via REV may also be understood in this way. The lack
of relationship between the histrionic personality disorder and dissociation
via REV may also be accounted for in this manner. Thus, although the Dh4I
has been shown to be both a reliable and valid instrument for measuring
defensive functioning, collapsing individual defense styles into five global
categories may act to obscure some of the relationships tested in this study.
A third factor that may have contributed to the limited results is method
variance. The factor analysis revealed that the scales from the two instru-
ments loaded on divergent factors. Thus, it is possible that the limited results
are due, at least in part, to variation in measuring style. Fourth, given that
defense mechanisms are generally believed to be intrapsychic phenomena,
and therefore difficull to operationally define and measure with a pencjl-
and-paper inventory, psychometric limitations may also have contributed to
the lack of support for some of the hypotheses.
Finally, and perhaps most noteworthy, there was a tendency for elevations
on one personality disorder scale to be associated with elevations on a
number of other personality disorder scales. Consequently, when an assess-
ment of the relationship between a particular personality disorder and a
specific defense mechanism was attempted, other personality scale eleva-
tions may have acted as confounds (due to the forced choice format of the
DM1 and the resultant lack of independence between the scales). Whereas
this may result from a lack of specificity on the part of the MCMI-11, it is
quite possible that it reflects the true nature of personality pathology-that
is, a more global disturbance with few pure types.
A number of interesting, but unpredicted, relationships between personal-
ity disorders and defense mechanisms were revealed through data analysis.
The Aggressive/Sadistic Personality scale was found to be positively come-
 142 BERMAN AND McCANN

lated with TAO. Because sadistic individuals take delight in the pain of
others, this relationship makes intuitive sense. Similarly, given that narcis-
sistic individuals are extremely self-righteous and have little regard for the
needs and feelings of others, it is not surprising to find that they are inclined
to overuse TAO as a defense and to underuse TAS. In addition, individuals
with dependent personality traits were found to be significantly less likely
than others to use TAO as a defense. This fits with clinical experience, which
suggests that dependent individuals are loath to offend others for fear of
rejection. The negative correlation between PRN and each of the three
MCMI-I1 severe personality pathology scales (i.e., schizotypal, borderline,
and paranoid) also makes sense because PRN appears to be the healthiest
among DM1 defense styles. The TAS defense was found to be dis-
proportionately selected by individuals with schizoid, avoidant, and
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schizotypal personality traits. This interesting finding can be understood in

light of the fact that these three disorders comprise Millon's detached per-
sonality pattern category and reflect propensities toward social withdrawal
and self-blame.
With respect to clinical value, these findings can help inform decisions
regarding mode of treatment. Based on the understanding that clients who
utilize the more primitive defenses may best be served by a directivelsup-
portive therapy, and those employing higher level defenses might be more
optimally availed by uncovering or insight-oriented psychotherapy, the
MCMI-II can be utilized to assist with treatment planning. For instance,
given the positive relationship between the Paranoid Personality scale and
PRO, which is a primitive level defense, individuals who score high on this
MCMI-I1 scale might best be treated with a directivelsupportive form of
therapy. Similarly, taking into account the positive correlation between the
Obsessive-Compulsive Personality scale and reaction formation, which is a
higher level defense, individuals who score high on this MCWI-I1 scale
might best be served by insight-oriented therapy. Finally, the results can be
useful in alerting clinicians to the possible utilization by some personality
disordered patients of particular defensive processes in the therapeutic rela-
tionship. Careful attention by the therapist to these processes will affect the
progress of therapy in a positive manner.
Given the clinical relevance of these results, further work in this area is
recommended. A study employing a similar design but utilizing a method
that is able to tap individual defense mechanisms directly is needed to
explore Millon's hypothesized relationships further. Moreover, repeating
this study using a defense scoring system based on Rorschach responses
(e.g., the Rorschach Defense Scales described by Cooper et al., 1988) would
enable intrapsychic factors to be tapped more directly.
Although the MCMI-I1 appears to be of value in assessing personality
functioning along a number of personality traits, the results of this study
suggest that it may not be sensitive to many defensive processes. It may be
more appropriate to develop separate inventories with each designed to
 DEFENSES AND PERSONALITY DISORDERS 1143

measure one specific attribute of personality (e.g., defenses, interpersonal

relationships, etc.). These instruments could then be used to examine partic-
ular personality domains.

ACKNOWLEDGMENT

This article is based in part on the doctoral dissertation of the first authlor,
carried out under the supervision of the second author. An earlier version of
this article was presented at the lOlst Annual Convention of the American
Psychological Association in Toronto, Ontario, Canada.
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Stacey M. Whyne Berman

Department of Psychology
Peel Memorial Hospital
20 Lynch Street
Brampton, Ontario, L6W 228
Canada

Received January 5, 1994

Revised May 18, 1994