Global Journal of

Psychology Research
Volume 03, Issue 1, (2013) 01-08
www.awer-center/gjpr

A comparison of social problems, thought problems, attention

problems and defence styles in two groups of adolescents with
affective and anxiety problems
Mohammad Ali Salehi Nezhad*, Department of Psychology, University of Tehran, P. O. Box 14155-6456,
Tehran, Iran.
Fatemeh Bagherian, Department of Psychology, Shahid Beheshti University, Tehran, Iran.
Mehrnaz Yekta, Department of Psychology, University of Tehran, P. O. Box 14155-6456, Tehran, Iran.
Maryam Bidadian, Department of Psychology, University of Tehran, P. O. Box 14155-6456, Tehran, Iran.
Hamid Bahramizade, Department of Psychology, University of Tehran, P. O. Box 14155-6456, Tehran,
Iran.

Suggested Citation:
Nezhad, S., A., M., Bagherian, F., Yekta, M., Bidadian, M. & Bahramizade, H. (2013). A comparison of social
problems, thought problems, attention problems and defense styles in two groups of adolescents
with affective and anxiety problems. Global Journal of Psychology Research. 3(1), 01-08.

Received 11 January, 2013; revised 02 March, 2013; accepted 30 April, 2013.

Selection and peer review under responsibility of Prof. Dr. Kobus Maree, University of Pretoria South
Africa.
©
2013 SPROC LTD. Academic World Education & Research Center. All rights reserved.

Abstract

This study was aimed to examine social problems, thought problems, attention problems and defense
mechanism styles in a sample of adolescents suffering from affective and anxiety problems. One hundred
and thirty eight undergraduate students (53 males, 85 females) were included in this study and completed
Defense Style Questionnaire (DSQ-40) in order to examine defense styles and Youth Self-report (YSR) for
diagnosing affective and anxity problems. The results revealed that both affective problems and anxiety
problems showed a significant association with social, thought and attention problems. Immature defense
styles had a significantly association with affective problems and anxiety problems. It can be concluded
that affective problems and anxiety problems have different effect on social, thought and attention
problems and defense styles.

Keywords: Affective problems, Anxiety problems, Social problems, Attention problems, defense
mechanisms.

*ADDRESS FOR CORRESPONDENCE: Mohammad Ali Salehi Nezhad, Department of Psychology, University of Tehran,
P. O. Box 14155-6456, Tehran, Iran. E-mail address: md_ali_salehi@ut.ac.ir
Nezhad, S., A., M., Bagherian, F., Yekta, M., Bidadian, M. & Bahramizade, H. (2013). A comparison of social problems, thought
problems, attention problems and defense styles in two groups of adolescents with affective and anxiety problems. Global Journal of
Psychology Research. 3(1), 01-08.

1. Introduction
The Child Behavior Checklist for Ages6–18 (CBCL/6-18) possesses newly developed DSM-
Oriented Scales, constructed through expert clinical judgment to match selected categories for
behavioral/emotional problems as described in the DSM-IV (Nakamura, Ebesutani, Bernstein &
Chorpita, 2009). The Child Behavior Checklist (CBCL) and Youth Self-Report are widely used
developed for a dimensional assessment of competences as well as behavioural and emotional
problems in children and adolescents (Eimecke, Remschmidt & Mattejat, 2011; Ferdinand, 2008)
particularly for affective and anxity problems. The CBCL has provided empirically derived
Syndrome and Competence and Adaptive Scales, as well as internalizing, externalizing, and total
scales (Nakamura, Ebesutani, Bernstein & Chorpita, 2009). Very strong and specific associations
were found between DSM diagnoses that cover disruptive behaviours and CBCL/YSR scales for
disruptive behaviours (Ferdinand, 2008). Concerning the more domain-specific CBCL Syndrome
Scales, research suggests significant and often clinically useful associations with both broad-
based (e.g., anxiety and affective disorders groups) and specific (e.g., Attention Deficit Disorder
and Conduct Disorder) diagnostic groups (Edelbrock & Costello, 1988; Kasius, Ferdinand, van
den Berg & Verhulst, 1997; Eiraldi, Power, Karustis & Goldstein, 2000). The extensive data
behind the CBCL’s standardized scores and clinical cutoffs have allowed for its use in a wide
variety of settings and have aided in current understandings of youth psychopathology
(Nakamura, Ebesutani, Bernstein & Chorpita, 2009).
Studies have provided support for CBCL syndrome scales and CBCL DSM-Oriented Scales in
diagnosing affective and anxiety disorders such as Major Depressive Disorder (MDD) and
General Anxiety Disorder (GAD). For example van Lang et al. (2005) examined the CBCL’s child-
report counterpart, the YSR, and found that a measure of Major Depressive Disorder (MDD)
corresponded more closely with the YSR DSM-Oriented affective problems scale than with
either the YSR Anxious/Depressed or Withdrawn/Depressed Syndrome Scale. Ferdinand (2008)
found that DSM-IV scale Anxiety Problems needs more attention with respect to its item
content. However, the CBCL/YSR DSM-IV scale Affective Problems showed very strong
convergent validity with DSM-IV diagnoses of major depressive disorder and dysthymia. In
summary, although the CBCL DSM-Oriented Scales have been criticized for not mapping strongly
to certain DSM diagnoses, these scales have nonetheless received some support in initial
investigations (Achenbach, Dumenci & Rescorla, 2003) and have aided in current understandings
of youth psychopathology (Ferdinand, 2008)
Anxiety and depressive disorders are among the most common psychiatric conditions
experienced by youth (Lewinsohn, Hops, Roberts, Seeley & Andrews, 1993). A study showed a
total prevalence rate of around 20% for psychopathological problems among youths with
anxious and depressive symptoms (Yao, Zhang, Zhu, Jing, McWhinnie & Abela, 2009). Anxiety
disorders are highly common forms of child and adolescent psychopathology and often lead to
considerable psychosocial impairment, e.g. in school or social relationships. Epidemiological
studies report their high prevalence over decades in the US and Europe (Pauschardt,
Remschmidt & Mattejat, 2010). In other hand Depressive disorders are very common in youth
psychopathology: about 10 % of adolescents experience a depressive episode by the age of
sixteen. Depressive disorders are associated with substantial psychosocial impairment, e.g. in
school or social relationships (Eimecke, Remschmidt & Mattejat, 2011). Perceptions of social
support from various sources are related to psychological well-being (Martinez, Aricak, Graves,
& Nellis, 2010). It is notable that depressive symptoms in adolescence and young adulthood is
mediated by their relationships with parents, peers, and romantic partners (Schoenfelder,
Sandler, Wolchik & MacKinnon, 2010) so that Social functioning and social relationships is
strongly affected by anxiety and depression and have effects on them as well and thus,
examining social problems in adolescent is significant. In addition of high rates of prevalence in
internalizing disorder (Costello, Egger & Angold, 2004), we also see high rates of comorbidity
between anxiety and depression (Wilmshurst, 2005) there has been significant debate over the
past two decades whether anxiety and depression represent distinct diagnostic categories or
whether symptoms might be better explained by a broad band notion of negative affectivity

2
Nezhad, S., A., M., Bagherian, F., Yekta, M., Bidadian, M. & Bahramizade, H. (2013). A comparison of social problems, thought
problems, attention problems and defense styles in two groups of adolescents with affective and anxiety problems. Global Journal of
Psychology Research. 3(1), 01-08.

(Wilmshurst, 2005). These debates show that there must be a better diagnose and
understanding of depression and anxiety disorders which is the aim of this study.
Anxiety disorders share features of chronic worry about current or future events and can
involve a number of common response patterns: behavioral (escape and avoidance), cognitive
(negative self-appraisals), and physiological (involuntary arousal: increased heart rate, rapid
breathing, tremors, and muscle tension) and results in significant impairment in social and
academic functioning (Wilmshurst, 2005) and use of immature defenses (Cramer, 2006). Anxiety
disorders may lead to chronic emotional or substance abuse problems if they would be left or
untreated (Pauschardt, Remschmidt & Mattejat, 2010). Depressive disorders commonly occur in
conjunction with other mental disorders, such as anxiety, oppositional defiant disorder,
substance use disorders and eating disorders and depressive symptoms are relevant component
of numerous psychiatric disorders such as adjustment disorders (Eimecke, Remschmidt &
Mattejat, 2011). Early detection of depressive disorders facilitates treatment in time. Therefore,
screening for depressive disorders is of vital importance. Given the significant functional
impairment and increased risk of continued psychopathology in adulthood, associated with
anxiety and depression in youth, assessment of such difficulties is imperative in aiding both
clinical and research efforts (Ebesutani, Chorpita, Higa-McMillan, Nakamura, Regan & Lynch,
2010) and measuring symptoms and problem behaviors in children and adolescents are
important as they can be used to screen for youth at high risk for emotional and behavioral
disorders in community samples; they also can provide clinicians with information about the
type and severity of psychiatric problems as well as response to treatment (Yao, Zhang, Zhu,
Jing, McWhinnie & Abela, 2009).
Another area influenced by affective and anxiety problems is defense mechanism. Cramer
(2009) stressed the influence of defense styles in youth and adolescence psychopathology and
in a broader view research in psychology has begun to include defense mechanisms as a
consideration for understanding aspects of personality, developmental, And clinical phenomena
(Cramer & Davidson, 1998). Studies show that there is relationship between defense preference
and behaviour (Cramer, 2002). In DSM-IV defense mechanisms, are defined as “automatic
psychological processes that protect the individual against anxiety and from the awareness of
internal or external stressors (Kronstorm, Salminen, Hietala, Kajander, & Vahlberg etal., 2009).
Considering that problematic relationships in adolescents may be associated with immature
defense styles (Araujo, Ryst & Steiner, 1998) and regarding that defense styles have
independent effect on depression and dysphoria (Kwon, 1999) and anxiety problems, thus
assessing defense styles in both anxiety and affective disorders can aid in better recognizing the
differences in both disorders. Based on these reasons this study was aimed to investigate the
problematic areas such as, social, thought and attention problems and defense styles, in order
to better understand and differentiate adolescents with anxiety and affective problems.

2. Method
2.1. Participants
The participants of present study consisted of 130 undergraduate students (53 males, 85
females) that were selected randomly from different colleges and fields. Their mean age was
18years. The ones whose scores were clinically significant for affective and anxiety problems
were identified.

2.2. Instruments
2.2.1. Defense Style Questionnaire (DSQ-40)- The DSQ-40 (Bond, Perry, Gautier, Goldenberg,
Openheimer & Simand, 1989) is a 40-item self-report questionnaire that ask participants to
indicate their level of agreement with certain statements that represent various defense
mechanisms which is rated on a 9-point Likert-type scale ranging from 1 (strongly disagree) to 9
(strongly agree). DSQ was designed to assess behavior indicative of conscious derivatives of
defensive styles (Hyphantis, 2010). The scoring system of DSQ-40 yields scores for three levels of
3
Nezhad, S., A., M., Bagherian, F., Yekta, M., Bidadian, M. & Bahramizade, H. (2013). A comparison of social problems, thought
problems, attention problems and defense styles in two groups of adolescents with affective and anxiety problems. Global Journal of
Psychology Research. 3(1), 01-08.

defense styles: mature (8 items), neurotic (8 items), and immature (16 items). Internal
consistency, test-retest reliability, and convergent and divergent validity of scale have been
reported adequate.
2.2.2. Youth Self-report (YSR)-The YSR is one of the forms of Child Behavior Checklist for ages
6-18 (Achenbach & Rescorla, 2001). The YSR is a 113-item self report questionnaire which is
rated on a 3-point Likert-type scale ranging from 0 (not true), 1 (somewhat or sometimes true),
and 2 (very true or often true). Validity and reliability are excellent and extensive normative data
are available for children ranging from 6 to 18 (Ferdinand, 2008). The CBCL DSM-Oriented Scales
that are supplement the CBCL Syndrome Scales was used to diagnose affective and anxiety
problems. Within clinical settings, the CBCL has demonstrated remarkable utility, particularly
with respect to being able to distinguish between referred and non-referred populations
(Nakamura, Ebesutani, Bernstein & Chorpita, 2009). Psychometric properties of the DSM-
Oriented Scales were generally similar to those of the Syndrome Scales when comparing among
the same large national sample of referred and non- referred children (Achenbach, Dumenci &
Rescorla, 2003) and is internationally validated (Achenbach, Dumenci & Rescorla 2003).

2.3. Procedure
Participants from different colleges were invited to take part in this study. Those who
approved, gave verbal consent prior to commencement of the study and completed all of the
self-report questionnaires. Participant were debriefed about the study and thanked for taking
part.

2.4. Statistical analysis

The data was analyzed employing Pearson`s correlation in order to estimate the associations
between variables, regression analysis and ANOVA in order to assess the percentage of
explained variance by social problems, attention problems, thought problems and defense styles
as predictor variables, and multivariate analysis of variance in order to examine the differences
in sex difference.

3. Results
Pearson’s correlation coefficients show that, both affective problems and anxiety problems
are negatively correlated with mature defenses and positively correlated with immature
defenses and both correlation coefficients are statistically significant (p<0.001). According to the
results, affective problems are strongly correlated with social and attention problems and
anxiety problems have strong relationship with social problems. The results of Pearson’s
correlation are presented in table 1. Regression Analysis and ANOVA were computed to
determine the contribution of social problems, thought problems, attention problems and
defense styles in variability of each variable of affective problems and anxiety problems as
criterion variables. Statistical properties of regression analysis and results of ANOVA, are
presented in table 2.
Table 1. Intercorrelation among variables
Variables 1 2 3 4 5 6
7 8
1. Affective problems 1
2. Anxiety problems 0.464 1
3. Social problems 0.439 0.429 1
4. Thought problems 0.270 0.229 0.379 1
5. Attention problems 0.419 0.346 0.481 0.347 1
6. Mature defenses -0.243 -0.236 -0.089 0.027 -0.119 1
7. Immature defenses 0.375 0.238 0.358 0.416 0.504
4
Nezhad, S., A., M., Bagherian, F., Yekta, M., Bidadian, M. & Bahramizade, H. (2013). A comparison of social problems, thought
problems, attention problems and defense styles in two groups of adolescents with affective and anxiety problems. Global Journal of
Psychology Research. 3(1), 01-08.

0.113 1
8. Neurotic defenses 0.010 -0.044 0.110 0.089 0.058
0.400 0.256 1
* P< 0.01
The results of ANOVA for affective problems, revealed that the scores of social problems (F =
29.360, p < 0.001), thought problems (F = 9.894, p < 0.001) and attention problems (F = 27.733,
p < 0.001) are significant but as showed in table 2, regression analyse reveal that attention
problems (F = 29.980, p < 0.001) and social problems (F = 20.688, p < 0.001) could mostly predict
affective problems and accounted for 26% of the variance in affective problems. Among defense
styles immature defenses (t = 4.565, ß = 0.383) are significantly accounted for variance of
affective disorders and finally among the syndrome scales, anxious/depressed (t = 7.626, ß =
0.567) is significantly accounted for 32% of the variance of affective problems. The results for
anxiety problems show that according to results of ANOVA, scores of social problems (F =
23.350, p < 0.001), thought problems (F = 6.987, p < 0.001) and attention problems (F = 17.970,
p < 0.001) are significant but as showed in table 2 regression analyse reveal that only social
problems can significantly account for 17% of the variance in anxiety problems (F = 25.071, p <
0.001). Among defense styles immature defenses (t = 4.565, ß = 0.383) are significantly
accounted for variance of affective disorders and finally among the syndrome scales,
anxious/depressed (t = 9.273, ß = 0.643) is significantly accounted for 40% of the variance of
affective problems. Multivariate analysis of variance was used to compare the male and female
athletes on the variables and the results showed no significant sex difference between
participants.

Table 2. Stepwise regression analysis and analysis of variance (ANOVA) of defense mechanism
Affective problems F* R R2 SE ß
t*
Regression model

Attention problems 29.985 0.452 0.204 0.376

0.452 5.476
Social problems 20.688 0.513 0.263 0.364
0.279 3.045
Immature defenses 20.840 0.383 0.142 0.390
0.383 4.565
Anxious/depressed 58.151 0.567 0.321 0.332
0.567 7.626

Anxiety problems F* R R2 SE ß
t*
Regression model

Social problems 25.071 0.422 0.176 0.313

0.422 5.007
Immature defenses 7.775 0.383 0.147 0.390
0.383 4.565
Anxious/depressed 85.997 0.643 0.402 0.250
0.643 9.273
* P< 0.01

5
Nezhad, S., A., M., Bagherian, F., Yekta, M., Bidadian, M. & Bahramizade, H. (2013). A comparison of social problems, thought
problems, attention problems and defense styles in two groups of adolescents with affective and anxiety problems. Global Journal of
Psychology Research. 3(1), 01-08.

4. Discussion

The present study found that the most common problems in affective problems are attention
and social problems while in the anxiety problems, social problems are seen as common
problems. In both affective and anxiety problems, thought problems have the least contribution
among social, attention and thought problems which is in consistent with previous studies.
Eimecke, Remschmidt & Mattejat (2011) emphasized the substantial impairment of affective
problems in social relationships and functioning. Anxiety disorders also often lead to
considerable psychosocial impairment, e.g. in school or social relationships (Pauschardt
Remschmidt, H. & Mattejat, 2010). The investigation of defense style showed that in both
anxiety and affective problems, immature defenses were predominant and, mature defenes
were in opposite of affective and anxiety problems which is again in consistent with previous
studies (Cramer, 2009; McMahon, Barnett, Kowalenko & Tennant, 2005). Among the defenses,
displacement and projection that are regarded as immature defenses had the most contribution
in the variance of affective disorders and in affective problems, autistic fantasy which is again an
immature defense, had the most contribution in variance of anxiety problems. Examination of
syndrome scales in CBCL showed that, anxious/depressed scale could mostly predict both
affective and anxiety problems which is totally in consistent with previous studies and theories.
Eimecke, Remschmidt & Mattejat (2011), indicated that Anxious/depressed can predict a
depressive disorder an affective problems. They argued that the clinical utility of
Anxious/depressed and affective problems scales for applying outpatient and inpatient
psychiatric settings for predicting primary depressive disorders are approved. Indeed using the
Anxious/Depressed and the Affective Problems scale as predictors, both showed similar results
(Eimecke, Remschmidt & Mattejat, 2011) which approved the significance of this syndrome
scale in affective problems.
The use of immature defenses in both anxiety and affective problems has some explanations
and debates. Cramer (2002) argued that behavioural indication of psychological immaturity is
associated with use of immature defense. Affective and anxiety problems which lead to
problematic behaviour are related with use of immature defenses. Indeed immature defense
mechanisms are mediated in relations of psychological problems such as social and though
problems and affective and anxiety problems thus immature defenses are negatively related
with adjustment (Cramer, 2002). Regarding social problems, previous studies have found that
the use of immature defenses are related to social maladjustment and unhappiness, while the
use of mature defenses is related to social competence and self-esteem (Cramer, 2009; Vaillant,
1977). The associations between personality and defense mechanism (Cramer, 2002) and the
associations among personality with behavioural adjustment in adolescent (Slobodskaya, 2007)
can explain the psychological and social problems in adolescents. For example, Extraversion and
Neuroticism were two best predictors of peer problems for both self- and parent reports;
Neuroticism was the best predictor of Emotional Problems (Slobodskaya, 2007). Indeed
personality dimentions can be mediated in relations of defense styles and affective and anxiety
problems. Another explanation for adolescent affective and anxiety problems state that types of
conflict resolution in adolescent is related to adolescent adjustment. The Negative resolution
type, characterized by high levels of conflict engagement, exit, withdrawal, and, to a lesser
extent, compliance, was related to more conflicts with fathers and with mothers and was
related to significantly higher levels of aggression, depression, and anxiety than the other types
(Branje, van Doornm, van der Valk, & Meeus, 2009). Withdrawal, compliance and conflicts with
fathers and with mothers is associated with immature defenses (Cramer, 2002) and social
problems.
In summary, the present study indicates the significance positive relationship of immature
defenses with both affective problems and anxiety problems. We also found that social
problems was the most predominant in both affective and anxiety problems although
prevalence of attention and thought problems were also significant. We note that the present
findings are based on a relatively small number of adolescents, thus, the results must be viewed
cautiously. Furthermore the limitations of this study include the use of self-report measures to

6
Nezhad, S., A., M., Bagherian, F., Yekta, M., Bidadian, M. & Bahramizade, H. (2013). A comparison of social problems, thought
problems, attention problems and defense styles in two groups of adolescents with affective and anxiety problems. Global Journal of
Psychology Research. 3(1), 01-08.

assess both affective/anxiety problems and defensive style. Compared to depression specific
questionnaires, the advantage of the CBCL and YSR is that they cover a wide range of problems,
ranging from internalizing to externalizing. We should note that in contrast to YSR affective
problems, use of YSR anxiety problems needs more attention with respect to its item content
(Ferdinand, 2008). We suggest that by measuring symptoms and problem behaviors in
adolescents clinicians can screen for youth at high risk for emotional and behavioral disorders in
community samples; they also can provide clinicians with information about the type and
severity of psychiatric problems as well as response to treatment (Yao, Zhang, Zhu, Jing,
McWhinnie & Abela, 2009). In addition prospective studies should be more useable and
generalizable by including findings on the behavior problems scales (Total problems,
Internalizing and Externalizing Behavior) as well as the narrow band scores would provide
a more comprehensive picture.

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Psychology Research. 3(1), 01-08.

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