Defence and coping in bipolar affective disorder: stability and change of adaptational processes.

Objectives: Defence mechanisms and coping have rarely been investigated from an integrative point of view. We are particularly interested in stability and change of these adaptational processes in clinical crisis situations of in-patients presenting with bipolar affective disorder.

Design: We conducted a controlled interview study including an in-patient and a matched control group; longitudinal data are provided by follow-up interviewing for all participants.

Methods: A total of N=18 participants per group (patients presenting with bipolar affective disorder and non-clinical controls) were recruited and interviewed twice. All interviews were transcribed and analysed according to observer-rater systems for coping (Coping Action Patterns) and defence mechanisms (Defence Mechanism Rating Scales). Symptom check list-90-R, as well as specific symptomatic measures, were used for symptomatic assessment and hierarchical linear modelling was used for statistical computation.

Results: Overall, defensive functioning remains stable over a 3 month period, whereas overall, coping functioning increases over the same period in-patients, as they are discharged from in-patient treatment; no such effect was found in controls.

Conclusions: Overall, stability in adaptational processes may be attributed to defensive functioning, whereas change over short periods of time are related to coping concepts in in-patients presenting with bipolar affective disorder.