Eating disorders (EDs) are difficult to treat in psychotherapy due to their pervasive symptomatology and frequent and rapid relapses. Restrictive anorexia nervosa (AN) is the most challenging ED, often associated with severe physical and mental conditions. Perceived as an ego-syntonic syndrome that somehow protects the patient from a number of developmental tasks, treating AN requires extensive multidisciplinary long-term intervention. As with other emotion regulation strategies, defense mechanisms mediate an individual\'s reaction to internal or external stressors, including those related to ED conditions. Improving defensive functioning adaptiveness predicts psychotherapy outcomes and is an essential component of the therapeutic process. In this study, we qualitatively described changes in the use of defense mechanisms, personality functioning (PF), and body mass index (BMI) in two patients with severe AN in treatment with intense dynamic psychotherapy. Changes in personality functioning and defense mechanisms were periodically assessed every 6 months using clinician report measures such as the Shedler-Westen Assessment Procedure-200 (SWAP-200) and the Defense Mechanisms Rating Scales Q-sort (DMRS-Q), respectively. BMI was also monitored throughout the treatment. A qualitative description of the patient\'s defensive profile and the quantitative score on all ranges of defense mechanisms were used for studying changes in patients\' use of defenses during the treatment and relationships between defenses and outcome indexes. Personality and defensive functioning improved after 1 year of intense dynamic psychotherapy, independently from BMI improvement. All outcome indexes dramatically decreased before a scheduled interruption of the treatment, underling that an integrated therapeutic approach is essential for improving and eventually orienting toward complete ED symptoms remission. Long-term dynamic psychotherapy fosters self-awareness of psychological distress and enhances more mature ways of coping. Monitoring changes in personality and defense mechanisms helps in understanding patients\' reactions to stressful life events and in developing specific therapeutic interventions.

The paper explores the impact of the corona virus disease-19 (COVID-19) pandemic on the Saudi higher education system. The research focuses on the relationship between digital learning in COVID-19 time, life satisfaction, and stress among female students. The study discusses measures, practices, defense mechanisms, and coping strategies to face challenges. Using an online survey based on psychological effects and its role in defense mechanisms and coping strategies, findings show that digital learning provides flexibility in terms of time and offers resources at a lower cost compared to traditional learning. In addition, results show that the coping strategy perception is higher in obtaining a good score and succeeding than to get over the pandemic and recovering from the illness itself. Finally, results confirm that a positive attitude influences positively life satisfaction.

The mental health burden of COVID-19 and associated quarantine can be enormous for the elderly. Being at higher risk for serious illnesses results in them being further isolated at a time of prolonged social distancing. In the following suicide-attempt cases, we examine the effects of quarantine and a global pandemic that expose the elderly to increased risk for negative mental health outcomes. Examining defense mechanisms and the effects of quarantine may help healthcare professionals better identify individuals at higher risk during times of crises that warrant isolation and quarantine, and provide appropriate interventions.

Researchers often question the validity of multi-informant assessments among adolescents with child welfare involvement. Yet, within other clinical populations, prior research finds that multi-informant reports have a discernable structure characterized by discrete patterns of agreement and disagreement. This structure \"tracks\" contextual displays of behavior and clinical severity. We examined the structure of multi-informant reports (i.e., adolescent, caregiver, teacher) of adolescent externalizing and internalizing problems in a sample of adolescents with a history of child welfare involvement. Across problem domains and informants, reporting patterns mirrored those observed in other clinical populations, and displayed characteristics robustly present in meta-analytic work on cross-informant correspondence. Specifically, informants agreed more on reports of externalizing problems than internalizing problems and caregiver-teacher dyads agreed more than adolescent-caregiver dyads. Overall, we found robust, replicable patterns of multi-informant reports among child welfare involved adolescents. These reporting patterns may facilitate use and interpretation of multi-informant evidence-based assessments among this population.

The field of psychodynamic psychotherapy would benefit from a comprehensive model that integrates its constructs with neurobiology. Research on the autonomic nervous system activity during the psychotherapeutic process is necessary because it is key in affective experiences and defensive behavior. The current case study reports physiological findings on heart rate dynamics in a patient suffering from panic disorder during two therapeutic sessions in which we used Davanloo\'s Intensive Short-term Dynamic Psychotherapy. We looked at various metrics of heart rate variability during the therapeutic process leading to breakthrough of unconscious feelings. The measurements included sympathetic and parasympathetic indices, vagal tone, and their responses. Our results suggest that the sympathetic system activates during defensive responses associated with anxiety and during the passage of unconscious-aggressive impulses. Following the experience of unconscious guilt, there is an increased vagal tone corresponding to the phase of reunification with the attachment figure. Findings are discussed integrating developmental neurobiology and clinical psychodynamics.

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Cognitive dissonance theory shares much in common with other perspectives that address anomalies, uncertainty, and general expectancy violations. This has led some theorists to argue that these theories represent overlapping psychological processes. If responding to dissonance and uncertainty occurs through a common psychological process, one should expect that the behavioral outcomes of feeling uncertain would also apply to feelings of dissonance, and vice versa. One specific prediction from the meaning maintenance model would be that cognitive dissonance, like other expectancy violations, should lead to the affirmation of unrelated beliefs, or the abstraction of unrelated schemas when the dissonant event cannot be easily accommodated. This article presents 4 studies (N = 1124) demonstrating that the classic induced-compliance dissonance paradigm can lead not only to a change of attitudes (dissonance reduction), but also to (a) an increased reported belief in God (Study 2), (b) a desire to punish norm-violators (Study 1 and 3), (c) a motivation to detect patterns amid noise (Study 3), and (d) polarizing support of public policies among those already biased toward a particular side (Study 4). These results are congruent with theories that propose content-general fluid compensation following the experience of anomaly, a finding not predicted by dissonance theory. The results suggest that dissonance reduction behaviors may share psychological processes described by other theories addressing violations of expectations.

Brain fag was originally described as a culture-bound syndrome among West African students. The term \"brain fag\" literally means \"brain fatigue.\" Available literature indicates that brain fag symptoms usually present in formal academic settings when African students are required to transit to a reliance on written literature (as opposed to more traditional oral forms of information transmission) and to adapt to westernized, individualistic systems of education that, at times, oppose the values of relatively collectivistic African societies. Based on detailed observation of two typical and two nontypical cases of brain fag, the authors suggest that the syndrome may not be solely related to tensions in the academic sphere, but may function more generally as an expression of psychological distress that results from societal pressures that exceed the coping capacity of the individual. The brain fag symptoms, including lack of concentration, sensations of internal heat in the head and body, heaviness, and multiple somatic complaints, may constitute a defensive process which helps prevent a full-fledged decompensation.

BACKGROUND: The technical demands of reconstructive hand transplantation (RHT) and need for complex multidisciplinary care have led to intense research efforts to improve patient care and outcomes. However, RHT is an extraordinary life event which carries the potential for long-term consequences including psychological distress, which invokes coping and defense mechanisms.
METHODS: Little is known about the relationship between psychological defense mechanisms and health outcomes in RHT patients. In an effort to elucidate this relationship, we studied seven RHT patients who underwent standardized psychological assessment either pre- or post transplantation.
RESULTS: No single defense concept was identified as common to all patients, which we suspect was due in part to the varied mechanisms of hand loss. All seven patients demonstrated diverse psychological reactions to RHT. The self-reported defense styles were associated with psychological adjustment. The patients who reported defenses that distorted reality described less adaptive functioning and psychological well-being.
CONCLUSIONS: These preliminary findings reveal the varied psychological mechanisms invoked in RHT patients. An assessment of defense mechanisms should be part of multicenter evaluation protocols that address unique psychosocial aspects of RHT in large samples, in order to better guide psychological management.

Obsessive-compulsive disorder (OCD) is a complex condition with biological, genetic, and psychosocial causes. Traditional evidence-based treatments include cognitive-behavioural therapy, either alone or in combination with serotonin-specific reuptake inhibitors (SSRI\'s), other serotonergic agents, or atypical antipsychotics. These treatments, however, often do not lead to remission, and therefore, it is crucial to explore other less conventional therapeutic approaches. This paper describes a case study in which psychodynamic, narrative, existential, and metaphor therapy in combination with more conventional treatments led to a dramatic remission of severe OCD in a 12 year old hospitalized on a psychiatric inpatient unit. The paper, which is written partly in the form of a story to demonstrate on a meta-level the power of narrative, is also intended to illustrate the challenges of countertransference in the treatment of patients with severe OCD, and the ways in which a reparative therapeutic alliance can lead to unexpected and vital change.