By Mariagrazia Di Giuseppe & John Christopher Perry

    The DMRS-Q

    The DMRS is an observer-rated method for assessing defense mechanisms developed by John Christopher Perry. The DMRS is close to a criterion standard measure, from which the qualitative Provisional Defense Axis in Appendix B of the DSM-IV) was largely modeled. The DMRS provides definitions of 30 non-psychotic level defenses, including descriptions of the function of each and how each defense may be discriminated from other similar defenses.

    Hierarchy of Defense Mechanisms in the DMRS

     

    The DMRS comprises four different levels of scoring:

    1) individual defense score (percentage score of each of the thirty defenses);

    2) defense level scores (percentage scores of each of the seven defense levels);

    3) Overall Defensive Functioning (summary score of defensive maturity); and

    4) qualitative scale of definite and probable examples of the defense.

     

    The DMRS showed good convergent and discriminant validity for the overall hierarchy of defense mechanisms and acceptable to very good inter-rater reliability for all quantitative scores.

    To use the DMRS method a clinical interview or therapy session video/audio recorded and transcribed is required. A specific training for raters is also necessary for reducing inference biases. Because of these time-consuming and often unavailable requirements, the DMRS has been mostly applied in research, while rarely used for clinical purposes.

     

    The DMRS Q-sort (DMRS-Q)

    With the aim of providing clinicians and researchers with a reliable and valid measure for detecting defense mechanisms, we created the DMRS-Q, a computerized Q-sort version of the DMRS.

    The advantage of the DMRS-Q is that it does not require any specific intensive training nor transcripts of clinical interviews. However, to use the DMRS-Q, a rater should have clinical experience and a basic knowledge of the theory of defense mechanisms as conceptualized in the DMRS manual.

    The DMRS-Q rating requires sufficient data about the evaluated subject, such as one or more clinical interviews or therapy sessions. After conducting or observing the subject, it takes about 30 minutes to complete a DMRS-Q rating. The original software is not available online, although the WebApp allows you to complete the rating process.

    Defensive Profile Narratives of Mr. A at certain time X

    After completing the rating, the DMRS-Q web-app provides you the Defensive Profile Narratives, a qualitative profile of the subject’s defensive functioning, based on the most salient defenses rated (see the example besides).

    Your rating will be processed by Authors using the DMRS-Q software, after which we send you a report containing both numeric and graphic scores of the 30 defense mechanisms, the 7 defense levels, and the Overall Defensive Functioning (see the example below).

    Defense Level Scores of Mr. A at certain time X

    The Authors

    Mariagrazia di Giuseppe

    Mariagrazia Di Giuseppe, Ph.D

    Department of History, Humanities and Society, University of Rome Tor Vergata, Rome, Italy. 

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    John Perry

    John Christopher Perry, M.P.H., M.D.

    Institute of Community & Family Psychiatry, Sir Mortimer B. Davis Jewish General Hospital and McGill University

    References

    1. DMRS-Q MANUAL: Di Giuseppe, M. & Perry, J. C.  (2021). The hierarchy of defense mechanisms: Assessing defensive functioning with the Defense Mechanisms Rating Scales Q-Sort. Frontiers in Psychology,12:718440. https://doi.org/10.3389/fpsyg.2021.718440
    2. VALIDATION STUDY: Békés, V., Prout, T. A., Di Giuseppe, M., Wildes Ammar, L., Kui, T., Arsena, G., & Conversano, C. (2021). Initial validation of the Defense Mechanisms Rating Scales Q-sort: A comparison of trained and untrained raters. Mediterranean Journal of Clinical Psychology, 9(2). https://doi.org/10.13129/2282-1619/mjcp-3107
    3. Conversano, C., Di Giuseppe, M., & Lingiardi V. (2023) Case report: Changes in defense mechanisms, personality functioning, and body mass index during psychotherapy with patients with anorexia nervosa. Frontiers in Psychology, 14, 1081467. https://doi.org/10.3389/fpsyg.2023.1081467  
    4. Tanzilli, A., Di Giuseppe, M., Giovanardi, G., Boldrini, T., Caviglia, G., Conversano, C., & Lingiardi, V. (2021). Mentalization, attachment, and defense mechanisms: a Psychodynamic Diagnostic Manual-2-oriented empirical investigation. Research in Psychotherapy: Psychopathology, Process and Outcome, 31-41. https://doi.org/10.4081/ripppo.2021.531
    5. Di Giuseppe, M., Prout, T. A., Rice, T., Hoffman, L. (2020). Regulation-Focused Psychotherapy for Children (RFP-C): Advance in the treatment of ADHD and ODD in childhood and adolescence. Frontiers in Psychology, 11, 572917. https://doi.org/10.3389/fpsyg.2020.572917
    6. Di Giuseppe, M., Miniati, M., Miccoli, M., Ciacchini, R., Orrù, G., Lo Sterzo, R., Di Silvestre, A., Conversano, C. (2020). Defensive responses to stressful life events associated with cancer diagnosis. Mediterranean Journal of Clinical Psychology, 8(1), 1-22. https://doi.org/10.6092/2282-1619/mjcp-2384
    7. 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. https://doi.org/10.1177/2055102919854667
    8. 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, 452-465. https://doi.org/10.1002/jclp.22089 

     

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    What is DMRS-Q sort?

    The Defense Mechanisms Rating Scale Q-sort version (DMRS-Q) has been developed with the aim of providing clinicians with an easy-to-use measure for identifying defense mechanisms in clinical practice. The DMRS-Q is inspired by the original Defense Mechanisms Rating Scale, which is the closest method to a criterion for identifying defenses. It has been translated and validated in several languages. The DMRS-Q does not require transcriptions nor specific intensive training for raters, but just sufficient information about the subject under evaluation and a basic knowledge of the theory of defense mechanisms. The DMRS-Q rater may deal with missing information by using inference consistent with the information that is avaialable.

    The DMRS-Q rating is guided by a WebApp and it takes an average time of 30 minutes to be completed. The software provides a qualitative description of the patient’s defensive profile and quantitative scores of 30 individual defenses, 7 defense levels, and Overall Defensive Functioning. All instructions of the DMRS-Q rating process are explained in the DMRS-Q tutorial.

    To use the DMRS-Q free WebApp, you must register here. We will send you an e-mail with information about your username and password for accessing to the DMRS-Q WebApp. If a rating is not complete you might save your progress and get back to the rating later. Please note that the software does not process incomplete ratings. When your rating is complete, you send it to the Authors by clicking the "Save and Send" button. We will process your rating with the DMRS-Q software and send you the output as soon as possible.

    Thank you for choosing the DMRS-Q. Your feedback is important for improving the instrument.

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