title: Ego defense mechanisms in COPD: impact on health-related quality of life and dyspnoea severity.
abstract: OBJECTIVE
  To assess chronic obstructive pulmonary disorder (COPD) patients' defensive profile compared with healthy participants and to test whether specific ego defense mechanisms are associated with health-related quality of life (HRQoL) and self-reported dyspnoea severity.
  
  
  METHODS
  In a cross-sectional study, we assessed, in 80 patients with COPD and 80 age- and gender-matched healthy participants, psychological distress (Hospital Anxiety and Depression Scale) and defense mechanisms/styles (Defense Style Questionnaire). Patients had their HRQoL evaluated with the St. George's Respiratory Questionnaire and underwent a comprehensive clinical evaluation with determination of functional parameters and dyspnoea severity.
  
  
  RESULTS
  COPD patients presented higher scores in undoing, acting out, autistic fantasy, denial, and splitting defenses compared with healthy controls. Overall, patients showed a more immature (P = 0.001) and/or neurotic (P = 0.006) defensive profile. Higher scores of denial (P = 0.044), somatization (P = 0.009), and undoing (P = 0.032) defenses were associated with poorer HRQoL, independently of the anticipated significant associations of clinical and psychological distress variables with impaired HRQoL. Somatization was strongly independently associated with more severe self-reported dyspnoea.
  
  
  CONCLUSIONS
  COPD patients exhibit a relatively immature and neurotic defensive profile. Clinicians and consultation-liaison psychiatrists should consider the patients' underlying personality structure, especially somatization tendencies, since it is independently associated with HRQoL and dyspnoea severity.
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Rua Prof. Costa Mendes, 1608, 40 andar, 60430-040, Fortaleza, CE, Brazil.
authors.forename: Saulo C
authors.initials: SC
authors.lastname: Albuquerque
authors.forename: Eduardo R
authors.initials: ER
authors.lastname: Carvalho
authors.forename: Rebeka S
authors.initials: RS
authors.lastname: Lopes
authors.forename: Higor S
authors.initials: HS
authors.lastname: Marques
authors.forename: Danielle S
authors.initials: DS
authors.lastname: Macêdo
authors.forename: Eanes D
authors.initials: ED
authors.lastname: Pereira
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Hyphantis
authors.forename: Andre F
authors.initials: AF
authors.lastname: Carvalho
mesh_terms: D000368:Aged; D001938:Brazil; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003674:Defense Mechanisms; D004417:Dyspnea / Q000503:physiopathology*; D004532:Ego; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000523:psychology*; D011788:Quality of Life; D011795:Surveys and Questionnaires