Defensive Functioning Among Women With Breast Cancer and Matched Community Controls.

OBJECTIVE: The general theory of defense mechanisms posits that stress is associated with using defenses lower on the hierarchy of defensive adaptation. Some have observed that individuals with cancer use certain defenses, such as repression, denial, and immature defenses. This cross-sectional study examined four hypotheses about defensive functioning in a sample of women who are mothers with a recent history of breast cancer (BC), compared to a matched sample of healthy mothers in the community. METHOD: We rated defenses from interview transcripts about interpersonal vignettes, using the Defense Mechanism Rating Scales quantitative method. Measures of symptoms and functioning were also gathered. RESULTS: The BC group displayed lower (z = 5.39, df = 1,231, p < .0001) overall defensive functioning than controls: 5.32 [95% CI: 5.13 to 5.51] versus 5.63 [95% CI: 5.50 to 5.76], which is equivalent to a medium effect size (0.62). Compared to controls, the BC group displayed more denial, idealization, displacement, isolation of affect, and splitting of others' images; conversely, they used less altruism, anticipation, intellectualization, and undoing. Controls used a mixture of high adaptive (35.5%), neurotic (43.0%), and immature defenses (21.4%). In contrast, the BC group used fewer high adaptive (30.7%) and neurotic (38.8%) and more immature defenses (30.5%). Both groups scored in relatively healthy ranges on other measures. Correlations with other measures supported the hierarchy of defense adaptiveness. CONCLUSIONS: The relationships among stress, defensive functioning, and adaptation were largely as predicted. Future studies should examine defenses in the process of seeking care, diagnosis, and treatment response for breast cancer.

Perfectionism dimensions and dependency in relation to personality vulnerability and psychosocial adjustment in patients with coronary artery disease.

The present study sought to illuminate self-criticism and personal standards dimensions of perfectionism and dependency as specific cognitive-personality vulnerability factors that might contribute to a better understanding of numerous psychosocial problem areas that are relevant to coronary artery disease (CAD). One hundred and twenty-three patients diagnosed with clinically significant CAD completed self-report questionnaires. Zero-order correlations and factor analysis results revealed that self-criticism was primarily related to personality vulnerability (aggression/anger/hostility, Type D negative affectivity) and psychosocial maladjustment (depressive symptoms, worry, avoidant coping, support dissatisfaction), whereas personal standards was primarily related to adaptive coping (problem-focused coping, positive reinterpretation) and dependency was primarily related to worry. Hierarchical regression results demonstrated the incremental utility of self-criticism, personal standards, and dependency in relation to (mal)adjustment over and above aggression/anger/hostility, negative affectivity, and social inhibition. Continued efforts to understand the role of perfectionism dimensions and dependency in CAD appear warranted.

[Childhood experiences of the Duplessis children: consequences 50 years later]. / Les expériences vécues par les enfants de Duplessis institutionnalisés : les conséquences après plus de 50 ans.

In this article, the authors present qualitative results, derived from questionnaires and semi-structured interviews, to describe past and present experiences of the Duplessis children. Examples representative of their experience and a detailed description of two cases are provided. Results indicate that childhood abuse and negligence are related to poorer long-term psychological adjustment. The findings also demonstrate that reporting at least four strengths in childhood can have long-term protective effects.

Depressive symptoms in relation to physical functioning in pulmonary hypertension.

OBJECTIVE: To investigate the association between depressive symptoms and physical functioning in pulmonary hypertension (PH) patients. METHODS: Fifty-two patients diagnosed with precapillary or postcapillary PH completed self-report questionnaires of depressive symptoms and physical functioning. Cardiac catheterization reports of patients were reviewed for hemodynamic variables. RESULTS: Physical functioning was significantly associated with depressive symptoms on bivariate analysis. On multivariate analysis, after controlling for demographic and hemodynamic variables, depressive symptoms accounted for 9% of variance in physical functioning. CONCLUSION: The association of depressive symptoms with decreased physical functioning in PH patients indicates the need for longitudinal research regarding the possible effect of depression on disease outcomes in this population.

How patients with less-advanced and more-advanced cancer deal with three death-related fears: an exploratory study.

The means used by cancer patients to cope with each of three death anxieties (i.e., fear of pain and suffering, loneliness, and the unknown) that contribute to their psychological distress have rarely been examined. Differences between cancer patients with Stage I or II disease (Group 1) and Stage III or IV disease (Group 2) were explored. T-tests revealed no difference between the groups. Age-controlled Pearson correlations were used to determine the relationship between all three death anxieties, and some recognized coping devices used by cancer patients, namely, coping styles, optimism, and religiosity/spirituality. Results showed that, for Group 1, avoidant coping correlated positively with fear of the unknown, and social diversion correlated positively with fear of pain and suffering. As for similarities between groups, with the exception of fear of pain and suffering for Group 2, emotion-focused coping correlated positively with all three death anxieties, and optimism correlated negatively with fear of the unknown. The advantage for researchers and clinicians of including measures or evaluation of the death anxieties in their considerations of the psychological distress of cancer patients is discussed.

[Consequences of an institutionalized childhood: the case of the "Duplessis orphans"]. / Répercussions d'une enfance vécue en institution : le cas des Enfants de Duplessis.

Whereas the immediate consequences of institutionalized placements on children have been documented, no study has investigated adults who were raised in orphanages or institutions. In Quebec, les enfants de Duplessis offer a unique testimony of the long term consequences of an institutionalized childhood. Stories collected from 40 men and 41 women who grew up in institution in Duplessis'era indicate a high number of abuse and aversive experiences, including physical, psychological and sexual aggressions. In addition, the environment was poor in stimulation and opportunities to develop positive attachment relationships with adults. When matched and compared to adults from the Santé-Québec survey, les enfants de Duplessis report a higher number of health problems associated with stress and more psychological distress. Moreover, our results indicate that those who had fewer strengths and aptitudes in childhood are the most affected by unfavourable experiences.

Seven institutionalized children and their adaptation in late adulthood: the children of Duplessis (Les Enfants de Duplessis).

War, societal and familial upheaval, disease, and natural disasters have resulted in orphaned children throughout time. One societal response to providing care for orphans has been institutionalization or the orphanage. We studied a sample of adults, known as les enfants de Duplessis or Duplessis's children, who were raised in Quebec institutions from birth onward and followed up in late adulthood. Systematic study indicated a high prevalence of adverse outcomes and found high levels of gross psychological trauma and adversity which, moderated by the childhood strengths of the individuals, had adverse effects on adult outcome (Sigal, Perry, Rossignol, & Ouimet, 2003; Perry, Sigal, Boucher, Paré, & Ouimet, 2005a; Perry, Sigal, Boucher, Paré, Ouimet, Norman, & Henry, 2005b). This report describes the experiences of seven individuals in the institutions and their subsequent life history and current functioning. The individual cases reflect a wide range of childhood strengths and experiences of trauma and other adversity in relationship to adult caretakers. While the group overall appears to have had seriously diminished functioning in late adulthood, several individuals had positive outcomes. We hope that by highlighting the potentially adverse effects of institutional rearing on subsequent development into late adulthood, these stories may inform those concerned with the care of orphans.

Personal strengths and traumatic experiences among institutionalized children given up at birth (Les Enfants de Duplessis--Duplessis' children): I: Early experiences.

We examined childhood and early adult strengths and adverse experiences of a group of orphans given up at or near birth and raised in Quebec institutions into early adulthood. A follow-up interview of 81 adults (41 women, 40 men) at a mean age of 59.2 years included retrospective assessments of childhood experiences. Most participants reported multiple early adverse experiences, including, in descending order, unfair rules and excessive punishment, physical abuse, emotional neglect, witnessing violence, verbal abuse, physical neglect, sexual abuse, and serious illness. Adverse experiences were mainly due to lay caretakers, not peers or nuns. Twelve childhood strengths, such as self-protectiveness and athletic talent, were scored at each of four age periods, yielding a median score equivalent to one strength at each period. Over half had significant childhood attachments, but of limited intimacy. Childhood variables correlated with their respective variables in later adulthood. Overall, these older adults reported a high prevalence of adverse or traumatic childhood experiences, counterbalanced by modest levels of individual strengths and attachment relationships. Institutionalization of children--if unavoidable--must build in effective safeguards against adverse experiences.

Personal strengths and traumatic experiences among institutionalized children given up at birth (Les Enfants de Duplessis--Duplessis' children): II: Adaptation in late adulthood.

In a companion article, we retrospectively examined the childhood strengths and adverse experiences of a group of orphans given up at or near birth and raised in Quebec institutions. This article examines the relationship of their early experiences to functioning and symptoms in later adulthood. The same follow-up interview of 81 adults (41 women, 40 men) at a mean age of 59.2 years included assessments of their current symptoms and functioning. The mean adult Social and Occupational Functioning Score (57.8; 95% CI, 54.7-61.0) indicated moderate difficulty. Psychiatric symptoms were significantly higher than in a matched population survey sample from Quebec. Mean overall defensive functioning indicated a neurotic (inhibited) level. Total trauma and childhood strengths predicted adult outcomes, but childhood strengths moderated the effects of trauma. Institutionalization of children--if unavoidable--must build in effective safeguards against adverse experiences, especially among children with few strengths, and foster children's strengths to avoid impaired adult outcomes.

Unwanted infants: psychological and physical consequences of inadequate orphanage care 50 years later.

Studies of the effects in middle-aged adults of institutionalization at birth or early childhood are rare. The results of this study show that members of a randomly selected, middle-aged group of orphans, most of whom were institutionalized at birth, were significantly more psychosocially dysfunctional and had significantly more chronic illnesses that could be stress related than a randomly selected, matched community sample.

Maternal preoccupation and parenting as predictors of emotional and behavioral problems in children of women with breast cancer.

PURPOSE: To test the hypothesis that differences between sicker and not-so-sick women in their preoccupation with their illness and parenting behavior can explain why some investigators find that children of breast cancer patients fare better than controls and other investigators find the reverse. PATIENTS AND METHODS: Forty-two women with metastasized breast cancer (sicker mothers) and 45 women with a first occurrence of nonmetastasized breast cancer (not-so-sick mothers) rated the degree of their preoccupation with the disease, their parenting behavior, mood, and social supports and the emotional and behavioral symptoms in one of their children. Their 12- to 18-year-old children rated their mothers' parenting behavior, their own emotional and behavioral symptoms, and their self-esteem. RESULTS: Sicker mothers reported relatively less preoccupation. They, and their children, reported less poor parenting and fewer externalizing symptoms in the children. Regression analyses revealed further differences between the groups. CONCLUSION: Less preoccupation with their illness and less poor parenting behavior by sicker mothers may explain why their children seem to fare better then those of not-so-sick mothers. Formulations concerning families of breast cancer patients should include consideration of the effect of the mothers' perception of the severity of their illness.