Objective: The aim of this study was to investigate the relationship between defense mechanisms and a history of self-harming behaviors (SHB) and suicide attempts (SA) in patients with opioid-use disorder (OUD).
Method: The study group consisted of 100 inpatients diagnosed with OUD. A Sociodemographic and Clinical Data Form, Defense Style Questionnarie-40 (DSQ-40), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were applied to all participants.
Results: Subscale scores for passive aggression (p=0.001), somatization (p<0.001), and immature factor (p=0.004) were higher in OUD patients with a SHB history than in those without. The anticipation subscale score was higher in patients with SHB and no relationship was found between other mature defense mechanisms and SHB (p=0.013). There was no significant relationship between SHB and BAI and BDI scores. Passive aggression (p=0.048), somatization (p=0.001), and immature factor (p=0.044) defense mechanism subscale scores were higher in patients with a history of SA. There was no relationship between SA history and mature defense mechanisms in OUD patients. BDI (p=0.05) and BAI (p=0.05) scores were higher in the presence of a SA history. In logistic regression analysis, passive aggression subscale scores and younger age determined the history of SHB in OUD patients. A history of SA was determined by lower age and suppression, dissociation, somatization, BAI, low idealization, projection, devaluation, splitting, and rationalization scores.
Conclusion: This study showed that immature defense styles were used more frequently by patients with a history of SHB and SA, and a history of SA was associated with higher anxiety and depression scores; SHB history was used as a kind of coping mechanism and was not associated with anxiety and depression scores in OUD. Association of a history of SHB or SA with the use of immature defense mechanisms may require consideration of the application of therapeutic programs that include a more effective use of mature defenses in addition to specific pharmacotherapies for patients with OUD. Therapeutic success rates could be increased if it is considered during planning pharmacotherapy that a history of SA is related with high anxiety and depression scores.
Amaç: Bu çalışmanın amacı, kendine zarar verici davranış (KZVD) ve intihar girişimi (İG) öyküsü olan opioid kullanım bozukluğu (OKB) tanılı hastalarda savunma biçimlerinin bu davranışlarla ilişkisini araştırmaktır.
Yöntem: OKB tanısı almış yatarak tedavi gören 100 kişiden çalışma grubu oluşturuldu. Çalışmaya katılan tüm katılımcılara Sosyodemografik ve Klinik Veri Formu, Savunma Biçimleri Testi-40 (SBT-40), Beck Depresyon Envanteri (BDE) ve Beck Anksiyete Envanteri (BAE) uygulandı.
Bulgular: OKB ve KZVD öyküsü olanlarda KZVD öyküsü olmayanlara göre pasif saldırganlık (p≤0.001), somatizasyon (p<0.001) ve immatür faktör (p=0.004) alt ölçek puanları daha yüksekti. Olgun savunma mekanizmalarından beklenti alt ölçek puanı KZVD öyküsü olanlarda, olmayanlara göre daha yüksekken (p=0.013), diğer olgun savunma mekanizmalarıyla KZVD öyküsü arasında ilişki bulunamadı. KZVD öyküsü ile BDE ve BAE arasında anlamlı bir ilişki yoktu. İG öyküsü olanlarda pasif saldırganlık (p=0.048), somatizasyon (p=0.001), immatür faktör (p=0.044) savunma mekanizmaları alt ölçek puanları daha yüksekti. OKB tanılı hastalarda İG öyküsü ile olgun savunma mekanizmaları arasında ilişki tespit edilemedi. İG öyküsü yüksek BDE puanı (p≤0.05) ve yüksek BAE puanı (p≤0.05) ile ilişkiliydi. Lojistik regresyon analizinde OKB tanılı hastalarda pasif saldırganlık alt ölçek puanı küçük yaşla birlikte KZVD öyküsünü belirledi. İG öyküsünü ise küçük yaşla birlikte düşük idealleştirme, yansıtma, değersizleştirme, bölünme ve rasyonalizasyon puanları ile baskılama, inkâr, disosiyasyon, bedenselleştirme ve BAE puanları belirledi.
Sonuç: Çalışmada OKB tanısı olup KZVD öyküsü ve İG öyküsü olan hastalarda olgun olmayan savunma mekanizmalarının daha çok kullanıldığı, İG öyküsünün yüksek anksiyete ve depresyon puanlarıyla ilişkili olduğu ve KZVD’ın bir çeşit baş etme mekanizması olarak kullanılıp, anksiyete ve depresyon puanlarıyla ilişkili olmadığı gösterilmiştir. KZVD öyküsü ve İG öyküsünün olgun olmayan savunma mekanizmalarıyla ilişkili olduğu göz önünde bulundurularak OKB tanılı hastalarda spesifik farmakoterapinin yanısıra olgun savunma mekanizmalarının daha etkin kullanılmasına yönelik terapötik programlar uygulanması dikkate alınabilir. Farmakoterapi planlanırken İG öyküsünün yüksek anksiyete ve depresyon puanlarıyla ilişkili olduğunun göz önünde tutulması tedavinin başarı oranının artırabilir.
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