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Research Article
Defence Mechanisms of Fertile and Infertile Women

  Jaan U1*      Sultan A2   

1Department of Psychology, Jammu and Kashmir Higher Education, Srinagar, Jammu and Kashmir, India
2Department of Psychology, University of Kashmir, Srinagar, Jammu and Kashmir, India

*Corresponding author: Jaan U, Department of Psychology, Jammu and Kashmir Higher Education, Srinagar, Jammu and Kashmir, India, E-mail:


The act of bearing the children is one of the most important factors that make marriages satisfactory and successful. However, some women are unable to ever bear a child either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth. This becomes a turning point, which lead to various psychological consequences which can be social psychological or existential. This study was undertaken to examine these consequences and for that defence mechanisms among fertile and infertile women (primary and secondary infertile). A sample of 177 females was taken for the purpose of this study from various hospitals of district Srinagar of Kashmir Valley. Out of 177 women 55 females were fertile, 55 females had primary infertility and 67 had secondary infertility. The tools used in the study were Defense Style Questionnaire (DSQ) by Thygesen, Drapeau, Trijsburg, Lecours, & de Roten. Data was analysed using Analysis of Variance (ANOVA) and 30 dimensions or defence mechanisms were attained. Our results were three fold in nature: one these establish new findings in the area by explaining precise usage of defence mechanisms by infertile population; second these confirm the factorial design and their majority of loadings as set by Bond et al. in there factor analysis of DSQ; and third these also confirm theoretical perspective given by Thygesen et al. in conceptualization of nature of defence mechanisms. Moreover post hoc tests detailed and pointed the exact difference between the fertile, primary and secondary infertile couples.


Defence mechanisms; Infertility; Global Defence Functioning (GDF)


Infertility is defined as the inability to achieve live birth after one year of unprotected intercourse [1]. However in case of age more than 35 years, the time period changes to the six months of unprotected intercourse on the basis of primary prevention [2].

Infertility can be primary or secondary in nature. Primary infertility is defined as not being able to give a live birth or bear a child ever and secondary infertility is defined as not being able to give birth after a previous successful birth [3]. Female infertility can be the result of ovulation problems, polycystic ovarian syndrome, Endometriosis, blocked fallopian tubes and other causes [4].

Psychologists devoted to infertility gathered crucial information for the understanding of this problem. Infertile women wishing to reproduce present higher levels of psychological suffering in comparison to normal women [5]. Among infertile couples passive coping and dissatisfaction with social support are associated with increasing health complaints and higher anxiety and depression levels [6]; infertile women present high levels of social stigma [7]; psychological consequences due to infertility persist for decades, with negative marital, sexual and social impacts [8]; however many studies negate dissatisfaction among infertile couples [9]; quality of the relationship and communication with the partner seems to impact on the emotional status of infertile women [10].

Unravelling unconscious of chronic patients, in our case infertile women is a novel endeavour and research in this particular area mostly focuses on surface level problems. However, nature of problems - likes of which are mentioned above- with infertility tells us that it also features itself at deeper levels. However, these are ignored from psychological discussion and research [11]. Defence mechanisms are the variables which explain ones unconscious, particularly ones personal mental unconscious [12]. Thus, defence mechanism should be brought forth in the form of research problems and its nature should be elucidated.

Defence mechanisms are the forms of unconscious processes that form the mental group operations that are responsible for protecting the individual from experiencing excessive anxiety and protecting self and self-esteem [13]. These are involuntary in nature and shield us from various changes in mood, reality, relationship or conscience [14].

There are almost 44 different types of defence mechanisms, categorized under different hierarchies and theoretical perspectives [13,15-18]. Some of them are: compensation, denial, displacement, identification, intellectualization, interjection, minimization, projection, rationalization, reaction formation, regression, repression, sublimation, substitution and undoing etc., among these, sublimation is considered to be the highest level of defence mechanism that runs civilizations [19].

Defence mechanisms are related to ones physical and psychological problems. It seems that the understanding of psychological mechanisms used by persons treated for infertility may be helpful in the diagnosis of various problems [20]. Previous literature [12] has stated role of defence mechanisms in predicting the level of individual adaptation to significant psychological problems. Similarly, increased use of defence mechanisms by infertile couples with respect to fertile couples have been also reported by researchers [21]. Research also suggests stiffness in utility of defence mechanisms in infertile male and female couples with respect to normal couples [11].

Purpose of the Study

It is an endeavour, which is fundamental in nature and quantitative in method. Its purpose is to provide research based data about nature of defence mechanisms deployment of infertile women and provide theoretical data for the generation of various intervention strategies for mental health practitioners. Beside the study will contribute data available on the issue.


The population forms three groups: fertile, primary infertile and secondary infertile. The total respondents were 177 married women out of which 55 were or fertile that at least had a live birth of child, 55 were primary infertile and 67 were secondary infertile. The average age of the fertile group was 31.05 years, of the primary group 31.58 years and of the secondary group was 34.36. Further details about the sample are in Table 1.

Demographic Variables Range Frequency Percentage
Fertility Status Fertile 55 31.07
  Primary Infertile 55 31.07
  Secondary Infertile 67 37.85
Age 20-30 55 31.07
  30-40 101 57.06
  40-50 25 14.12
Domicile Rural 110 62.14
  Urban 67 37.85
Family Status Nuclear 127 71.75
  Joint 47 28.24

Table 1: Sample Details.

Defence Style Questionnaire (DSQ) - 60 developed by Thygesen et al. [22], represents an abridged variant of the original one, devised by Bond in 1986. The DSQ 60 scale address each of the 30 individual defence mechanisms of the DSM IV (APA, 2003/2000) [23]. This questionnaire also measures a single score called global defence functioning (GDF), 30 defence mechanisms, three defence styles and 7 level hierarchy of the estimating scale for the defence mechanisms [24].

Evaluation of obtained scores can be done by several ways, in our case it was done by adding 30 individual defence mechanisms or dimensions, which is acceptable [15]. Psychometric properties explicit that Cronbach’s alpha for the three dimensions image distorting nature affect regulating nature and healthy defences was .64, .72, and .61, respectively. The reliability (Cronbach’s alpha) of the scale on our sample was 0.88.

The data collected from the respondents was analysed by using Statistical Package for Social Sciences 20 (SPSS). ANOVA and Post Hoc test were used for the analysis.


The tables below show the results found in the research. Table 2 gives us the ANOVA summary across the three groups namely: fertile, females with primary infertility and females with secondary infertility. Table 3 gives the post hoc revelations explicating significant groups.

Defence Mechanisms   Sum of Squares df* Mean Square F** Sig.
  Splitting Other Between Groups 136.232 2 68.116 5.908   .003
Within Groups 2006.085 174 11.529  
Total 2142.316 176    
  Humor Between Groups 185.086 2 92.543 4.847   .009
Within Groups 3321.830 174 19.091  
Total 3506.915 176    
  Projection Between Groups 728.364 2 364.182 13.722   .000
Within Groups 4617.941 174 26.540  
Total 5346.305 176    
  Reaction Formation Between Groups 60.564 2 30.282 3.197   .043
Within Groups 1648.159 174 9.472  
Total 1708.723 176    
  Self Observation Between Groups 140.248 2 70.124 6.562   .002
Within Groups 1859.391 174 10.686  
Total 1999.638 176    
Between Groups 88.566 2 44.283 3.156   .045
Within Groups 2441.367 174 14.031  
Total 2529.932 176    
  Self Assertion Between Groups 90.465 2 45.232 3.601   .029
Within Groups 2185.411 174 12.560  
Total 2275.876 176    
  Devaluation/ Self Between Groups 498.491 2 249.245 13.581   .000
Within Groups 3193.351 174 18.353  
Total 3691.842 176    
  Fantasy Between Groups 270.933 2 135.466 4.570   .012
Within Groups 5157.711 174 29.642  
Total 5428.644 176    
  Splitting Self Between Groups 203.890 2 101.945 6.471   .002
Within Groups 2741.172 174 15.754  
Total 2945.062 176    
Help- Rejecting Complaining Between Groups 1069.240 2 534.620 30.308   .000
Within Groups 3069.302 174 17.640  
Total 4138.542 176    
  Affiliation Between Groups 127.401 2 63.700 3.582   .030
Within Groups 3094.441 174 17.784  
Total 3221.842 176    

Table 2: showing ANOVA summary of defence mechanisms.
* df is the degree of freedom & **F is the ANOVA value.

Among the 30 defence mechanisms measured by DSQ–60 only 12 are found significantly differing across fertile females, females with primary infertility and females with secondary infertility. These are splitting other, humor, projection, reaction formation, self-observation, projective identification, self-assertion, devaluation/self, fantasy, splitting self, help rejecting complaining and affiliation (Table 3).

Dependent Variables Group (I) Group (J) Mean Difference Standard Error Sig.
 Splitting other Fertile Primary -.32727 .64749 .869
Secondary -1.95278* .61782 .005
Primary Fertile .32727 .64749 .869
Secondary -1.62551* .61782 .025
Secondary Fertile 1.95278* .61782 .005
Primary -1.62551* .61782 .025
Humor Fertile Primary -2.14545* .83320 .029
Secondary -2.25807* .79501 .014
Primary Fertile 2.14545* .83320 .029
Secondary -.11262 .79501 .989
Secondary Fertile 2.25807* .79501 .014
Primary .11262 .79501 .989
 Projection Fertile Primary -4.34545* .98239 .000
Secondary -4.41357* .93737 .000
Primary Fertile 4.34545* .98239 .000
Secondary -.06811 .93737 .997
Secondary Fertile 4.41357* .93737 .000
Primary .06811 .93737 .997
 Reaction Formation Fertile Primary .78182 .58689 .379
Secondary -.63419 .56000 .495
Primary Fertile -.78182 .58689 .379
Secondary -1.41601* .56000 .033
Secondary Fertile .63419 .56000 .495
Primary 1.41601* .56000 .033
 Self Observation Fertile Primary 1.98182* .62337 .005
Secondary .11099 .59480 .981
Primary Fertile -1.98182* .62337 .005
Secondary -1.87083* .59480 .006
Secondary Fertile -.11099 .59480 .981
Primary 1.87083* .59480 .006
Fertile Primary -.78182 .71429 .519
Secondary -1.70366* .68156 .035
Primary Fertile .78182 .71429 .519
Secondary -.92185 .68156 .368
  Secondary Fertile 1.70366* .68156 .035
Primary .92185 .68156 .368
  Self Assertion Fertile Primary 1.41818 .67581 .093
Secondary 1.62795* .64484 .033
 Primary Fertile -1.41818 .67581 .093
Secondary .20977 .64484 .943
  Secondary Fertile -1.62795* .64484 .033
Primary -.20977 .64484 .943
Devaluation/ Self  Fertile Primary -2.92727* .81693 .001
Secondary -3.97612* .77949 .000
 Primary Fertile 2.92727* .81693 .001
Secondary -1.04885 .77949 .372
  Secondary Fertile 3.97612* .77949 .000
Primary 1.04885 .77949 .372
 Fantasy Fertile Primary -2.72727* 1.03822 .025
Secondary -2.62632* .99064 .024
Primary Fertile 2.72727* 1.03822 .025
Secondary .10095 .99064 .994
Secondary Fertile 2.62632* .99064 .024
Primary -.10095 .99064 .994
 Splitting Self Fertile Primary -1.41818 .75688 .149
Secondary -2.59810* .72220 .001
Primary Fertile 1.41818 .75688 .149
Secondary -1.17992 .72220 .234
Secondary Fertile 2.59810* .72220 .001
Primary 1.17992 .72220 .234
 Help- Rejecting Complaining Fertile Primary -4.65455* .80090 .000
Secondary -5.69932* .76420 .000
Primary Fertile 4.65455* .80090 .000
Secondary -1.04478 .76420 .360
Secondary Fertile 5.69932* .76420 .000
Primary 1.04478 .76420 .360
 Affiliation Fertile Primary 2.09091* .80417 .027
Secondary 1.46052 .76732 .141
Primary Fertile -2.09091* .80417 .027
Secondary -.63039 .76732 .690
Secondary Fertile -1.46052 .76732 .141
Primary .63039 .76732 .690

Table 3: Tukey’s test showing post hoc revelations of significant groups.

Post Hoc test reveals significant differences between fertile females and females with secondary infertility, and likewise females with primary infertility in comparison to secondary infertility in using the splitting other defence mechanism.

Also significant difference was found between fertile females and females with primary infertility, and fertile females and females with secondary infertility in using humor, projection, devaluation/ self, fantasy and help rejecting complaining defence mechanisms.

Significant difference was found between the fertile females and females with secondary infertility in using projective identification, self-assertion and splitting/self defence mechanisms.

In the group fertile females and females with primary infertility, and the group females with primary infertility and secondary infertility self-observation was found significant. Reaction formation was found significantly differing just between females with primary infertility and females with secondary infertility. Similarly, affiliation was also found differing just between fertile and females with primary infertility group.

Defence mechanisms like altruism, passive aggression, suppression, sublimation, rationalization, denial, devaluation of other, dissociation, omnipotence, acting out, withdrawal, intellectualization, displacement, repression, idealization, isolation, undoing and anticipation which form other dimension of DSQ 60 were found insignificant across the three groups.


Defence mechanisms seems obvious to all population, but research [17] and conventional wisdoms tell us that there might be some provisions that are particular to the infertile population. Results revealed in Tables 1 and 2 clearly explain these provisions across the three groups as far as their fecundity is concerned. Moreover, the results that were found by the researchers are of three fold in nature. One these establish new findings in the area by explaining particular usage of defence mechanisms by infertile population. Second, these confirm the factorial design and their majority of loadings set by Bond et al. [25] in there factor analysis of DSQ. Lastly, these also confirm theoretical perspective given by [22] in conceptualization of nature of defence mechanisms. Following is a brief elucidation of these three points.

First, previous research gives us a small view of defence mechanisms deployment by infertile females. Researchers simply suggest that usage of defence mechanism in infertile females is more than fertile females [16,26,27]. Coleman [28] in his study reported that infertile women use immature defence mechanisms more than fertile women. Justo et al. [14] suggest that there lies defensive inflexibility among infertile couples due to reproductive stress. Neither of these studies gives detailed viewpoint regarding particular usage of defence mechanisms as provided by our study. Our study points out 12 particular defence mechanisms out of 30 and their usage by fertile and infertile population.

Secondly, Out of 12 significantly differing defence mechanisms in our sample, help rejecting complaining, splitting of self, splitting of other, projection, and projective identification are conceptualized under image distorting nature; characterized by distortions in the image of the self, body, or others that may be employed to regulate self-esteem [23]. Fantasy was reasoned to be an affect regulating nature; can be helpful in resolving inner and outer conflicts. Self observation, humour, affiliation and self assertion are conceptualized under healthy defenses; considered under adaptive defences [23] these result in optimal adaptation in handling stressors, maximizing conscious awareness and gratification. These three theoretical concepts, given by [22] Thygesen et al., namely image distortion, affect regulating and healthy defence, and what comprises them are exactly consistent with our results. Thus, providing quantitative validation or justification of the three-stage model provided by Thygesen et al.

Third and lastly, Thygesen et al., [22] in their factor analysis of DSQ 60 loaded all the thirty-defence mechanism and as an outcome came up with the same defence mechanisms except reaction formation and devaluation. Again forming a reciprocal relationship with our results and the results attained by Thygesen et al. [22].

Implication of research in Defence mechanisms helps in understanding coping and overcoming the barriers to facilitate the treatment [20]. These also make us capable to understand the psyche of an infertile woman facing resulting consequences like marital dissatisfaction, depression, stress etc. Not only this, to assist in their problems and make them adapt to this trauma, counselling programs made in the light of this research and other related researches would be help them and would be reward to our work. Limitations of this study include the non-homogeneity across the three groups of sample and failure to explain reasons behind the infertility of the affected. Similarly, the significant differences found across the three groups are partial in nature.


  1. Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, et al. (2009) International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertil Steril 92: 1520-1524. [Ref.]
  2. ASRM (2008) Definitions of infertility and recurrent pregnancy loss. Fertil Steril 90: S60. [Ref.]
  3. WHO (2012) Premier of Infertility. World Health Organization, Geneva. [Ref.]
  4. Chohan A (2010) Fundamentals of Psychology. MAR, Pakistan.
  5. Jacob MC, McQuillan J, Greil AL (2007) Psychological distress by type of fertility barrier. Hum Reprod 22: 885-894. [Ref.]
  6. Lechner L, Bolman C, van Dalen A (2007) Definite involuntary childlessness: associations between coping, social support and psychological distress. Hum Reprod 22: 288-294. [Ref.]
  7. Slade P, O’Neill C, Simpson AJ, Lashen H (2007) The relationship between perceived stigma, disclosure patterns, support and distress in new attendees at an infertility clinic. The relationship between perceived stigma, disclosure patterns, support and distress in new attendees at an infertility clinic 22: 2309-2317. [Ref.]
  8. Wirtberg I, Möller A, Hogström L, Tronstad SE, Lalos A (2007) Life 20 years after unsuccessful infertility treatment. Hum Reprod 22: 598-604. [Ref.]
  9. Bahranain SA , Nazemi F, Dadkhah A (2009) The comparison of marital satisfaction between fertile and infertile women. Iranian Rehabilitation Journal 7: 11-16. [Ref.]
  10. Kleanthi G, Katerina L, Grigorios V (2012) Increased anxiety and depression in Greek infertile women results from feelings of marital stress and poor marital communication. Health Science Journal 6: 70-81. [Ref.]
  11. de Miranda JDMR, MeloVanessa ALC, Sousa FDA (2010) Defense mechanisms of infertile couples vs. fertile couples. International Journal of Developmental and Educational Psychology 2: 433-442. [Ref.]
  12. Lotfi KF, Shahram V, Kazemi ZN, Aghdam SS (2014) Defense Styles, Defense Mechanisms and Post-Traumatic Growth in Patients Suffering from Cancer. Procedia - Social and Behavioral Sciences 159: 228-231. [Ref.]
  13. Cramer P (2008) Seven Pillars of Defence Mechanism Theory. Journal of Social and Personality Compass 2: 1963-1981 [Ref.]
  14. Vaillant GE (2000) Adaptive mental mechanisms. Am Psychol 55: 89-98. [Ref.]
  15. Trijsburg RW, van t’ Spijker A, Van HL, Hesselink AJ, Duivenvoorden HJ (2000) Measuring overall defensive functioning with the Defense Style Questionnaire. J Nerv Ment Dis 188: 432-439. [Ref.]
  16. Vaillant GE (1977) Adaptation to life. Boston: Little, Brown. [Ref.]
  17. Vaillant G (1994) Ego mechanisms of defence and personality psychopathology. Journal of Abnormal Psychology 103: 44-50. [Ref.]
  18. Wastell C (1999) Defensive focus and the defense style questionnaire. The Journal of Nervous and Mental Disease 187: 217-223. [Ref.]
  19. Morgan C, Schopler J, Weisz J, King R (1993) Introduction of Psychology. Tata Mc Graw Hill, New York. [Ref.]
  20. Podolska MZ, Bidzan M (2011) Infertility as a psychological problem. Ginekol Pol 82: 44-49. [Ref.]
  21. Shahrzad K, Mahtab H, Naeime B, Fatemeh R (2010) The Study of Irrational Beliefs, Defense Mechanisms and Marital Satisfaction in Fertile and Infertile women. Journal of Family and Reproductive Health 4: 129-133. [Ref.]
  22. Thygesen KL, Drapeau M, Trijsburg RW, Lecours S, de Roten Y (2008) Assessing Defense Styles: Factor Structure and Psychometric Properties of the New Defense Style Questionnaire 60 (DSQ-60). International Journal of Psychology and Psychological Therapy 8: 171-181. [Ref.]
  23. APA (2003) Diagonostic and Statistical Manual IV. American Psychological Association. [Ref.]
  24. Crașovan DI, Maricuțoiu LP (2012) Adaptation of the defensive style questionnaire 60 (dsq-60) within a Romanian sample. Cognition, Brain, Behavior. An Interdisciplinary Journal XVI: 509 -528. [Ref.]
  25. Vaillant GE, Bond M, Vaillant CO (1986) An empirically validated hierarchy of defense mechanisms. Arch Gen Psychiatry 43: 786-794. [Ref.]
  26. Greil AL (1997) Infertility and psychological distress: A Critical Review of the Literature. Soc sci med. 45: 1679-1704. [Ref.]
  27. Callaway JR (2006) Infertility& depression. Bella online. [Ref.]
  28. Coleman JV, Patrick DL (1976) Integrating mental health Services into Primary Medical care. Med Care 14: 654-661. [Ref.]

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Article Information

Article Type: Research Article

Citation: Jaan U, Sultan A (2017) Defence Mechanisms of Fertile and Infertile Women. J Psychiatry Ment Health 3(1): doi

Copyright: © 2017 Jaan U, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, p

Publication history: 

  • Received date: 08 Aug 2017

  • Accepted date: 26 Sep 2017

  • Published date: 03 Oct 2017