TABLE 8.

Action defense level: Definition, function and DMRS-Q items of defenses acting out, help-rejecting complaining, and passive aggression.

Defense mechanism>	DMRS-Q items>
Passive aggression	ITEM 45: At times when expressing an opinion or wish might be helpful, the subject fails to express himself adequately, instead finding indirect, even annoying ways to show his or her opposition to the influence of others, for example, being silent. ITEM 88: The subject fails to stand up for his or her interests and seems to let bad things happen to him or herself that could be prevented, maybe even assuming a “martyr” role. ITEM 89: While outwardly cooperative or compliant, the individual procrastinates and refuses to do things on time or as asked, even when it would be easy to do so. ITEM 102: When angry toward someone significant, the subject takes anger out on himself instead of expressing it directly. ITEM 116: The subject has “a chip on his or her shoulder” or a grudge, and seems to find reasons to feel unfairly treated, even when he or she is not.
Help-rejecting complaining	ITEM 21: The subject complains spontaneously about how others don’t really care, or have made his or her problems worse, even when there is clear evidence that others have tried to help. ITEM 84: The subject recites a litany of issues and problems but does not appear to be engaged in solving them, but rather prefers to complain. ITEM 127: The subject tends to exaggerate his or her complaints about a life problem or somatic symptom, making them seem worse or more significant than they are. ITEM 130: The subject complains about life issues or problems as if each were insoluble, and systematically rejects others’ suggestions about ways of handling them. ITEM 149: When the subject brings up a problem to discuss, others try to address the problem, but in response the subject skips to a different problem, thereby dismissing rather than engaging others in any suggestions offered.
Acting out	ITEM 5: The subject loses his or her temper easily. ITEM 76: In response to interpersonal disappointment or disagreement the subject tends to act impulsively, without reflection or considering the negative consequences. ITEM 80: The subject is often inhibited from expressing him or herself, but sometimes acts in uncontrolled ways to get or do something he or she wants, ignoring normal constraints. ITEM 118: Whenever the subject feels angry, disappointed or rejected by someone, the subject resorts to uncontrolled behaviors as an escape from distressing feelings, such as binge-eating, drinking, sexual escapades, drug use, reckless driving, or getting into trouble. ITEM 144: The subject tends to express feelings, wishes or impulses directly in behavior, not only words, without prior thought. However, afterward, he or she may feel guilty or expect some punishment.