TABLE 4.

Neurotic defense level: Definition, function and DMRS-Q items of defenses repression, dissociation, reaction formation, and displacement.

Defense mechanism	DMRS-Q items
Repression	ITEM 13: The subject keeps unpleasant things vague: he or she has trouble remembering or can’t recall specific examples, when at least some should be forthcoming. This may include loss of memory for whole periods of time (e.g., childhood). ITEM 47: At points when a topic is emotionally loaded, the subject forgets what he or she is talking about and seems to get lost while talking. ITEM 50: When discussing a topic that brings up negative, conflicting feelings, the subject prefers to keep things vague, reflected in very vague, general or inexact statements. ITEM 108: The subject cannot remember certain facts which would normally not be forgotten, such as a distressing incident, reflecting some uneasy feelings about the topic. ITEM 136: When certain feelings or wishes would arise, the subject gives some evidence of them – such as crying or appearing anxious but cannot clearly identify in words the specific feeling or the specific ideas that give the wish a clear meaning.
Dissociation	ITEM 8: The subject behaves or says something in a very uncharacteristic way that expresses an uninhibited impulse operating out of the subject’s usual control, yet the subject is surprised by it (e.g., “I threw a glass of water in my friend’s face, but I don’t know what made me do it’). ITEM 27: The individual describes fugue states, amnesia (not alcoholic blackouts), multiple personality, spontaneous trance states, or temporary loss of sensory or motor function. ITEM 30: In response to an emotionally charged situation, the subject suddenly becomes confused, depersonalized, “spaced out,” or can’t think or talk about the topic. Consciousness becomes clouded to a lesser or greater extent. ITEM 41: In response to a distressing topic or situation, the subject develops a symptom, such as headache, stomach pain, or loss of an ability to do something, which temporarily eclipses awareness of what was distressing. The symptom may have a symbolic relationship to the type of distress. ITEM 73: The subject associates with or is fascinated by people who do very uninhibited, dramatic, or socially outrageous things, which appear to express some of the subject’s own inhibited wishes. Nonetheless, the subject is unaware of any such connection.
Reaction formation	ITEM 52: When confronting a personal wish about which the subject may feel guilty, the subject does not acknowledge or express it, but substitutes an opposite attitude against the wish, for instance, a desire is supplanted by renunciation or anger at anything to do with the desire. ITEM 55: The subject is very compliant, agreeing to most everything the interviewer points out, when some disagreement and discussion would be expected. ITEM 74: In dealing with people who are angry or abusive, the subject is cooperative and nice and eager to please, failing to express any negative feelings which might be expected. ITEM 96: In relationships, the subject has an attitude of giving much more than he or she receives but is unaware of the imbalance. ITEM 99: In fearful situations, the subject does not show expected fear, but reacts with exaggerated enthusiasm or courage, failing to acknowledge the fear.
Displacement	ITEM 1: In dealing with an important problem that makes the anxious, the subject prefers to focus on minor or unrelated matters instead, which distracts the subject away from the central problem, for example, cleaning or organizing rather than working on projects that need to be done. ITEM 64: The subject directs strong feelings toward a person or object who has little to do with the subject but who may bear similarities to someone significant to the subject. The subject may be somewhat puzzled by the ‘reason’ for the strength of these feelings. ITEM 69: When confronting emotionally charged topics, the subject tends not to address concerns directly and fully but wanders off to tangentially related topics that are emotionally easier for the subject to discuss or prefers to pay attention to someone else dealing with a similar situation. This can include preferring to read or watch a film portraying people dealing with similar problems. ITEM 122: When discussing an affect-laden event, the subject expresses more feelings directed toward incidental details or issues than about the major point or effect of the event, perhaps appearing “picky.” ITEM 125: The subject gets irritated easily by minor things that bother him or her and tends to lose a focus on the main things that need attention.