Relationship between psychodynamic functioning, defensive mechanisms, and trauma in patients with post-traumatic stress disorder (PTSD)

Abstract Objectives: Patients with post-traumatic stress disorder (PTSD) present a variety of symptoms, with different intensities, causing impairment in individual, social, and occupational functioning. The aim of this study was to understand the psychodynamic functioning of patients with PTSD, exploring relationships between symptom severity, quality of life, subjective suffering, conflicts, and psychic structure and sociodemographic characteristics, styles, and defensive mechanisms. Methods: This is a cross-sectional quantitative study with 60 participants. The following instruments were used: a sociodemographic questionnaire, the Operationalized Psychodynamic Diagnosis-2 (OPD-2), and the Defensive Style Questionnaire (DSQ-40). Results: Participants had moderate to high symptom severity, with significant subjective suffering and isolation. The main conflict was need for care vs. self-sufficiency and the level of total structure was moderate/low. Use of immature, neurotic, and mature defensive styles was observed. More primitive personality structures, more rigid defenses, and greater dependence were found in patients with history of past trauma. Other mental disorders were also associated. Conclusion: The OPD-2 was effective for assessment of the psychodynamic functioning characteristics of patients with PTSD. Therapeutic treatment should focus on the psychic structure and not only on symptom control. Prevention strategies should target vulnerability factors while strengthening protective factors.