Ego defense mechanisms in COPD: impact on health-related quality of life and dyspnoea severity

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.

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.

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.

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.