Journal of Rational-Emotive & Cognitive-Behavior Therapy

https://doi.org/10.1007/s10942-020-00357-0

Defense Mechanisms, Dissociation, Alexithymia

and Childhood Traumas in Chronic Migraine Patients

Filiz Özsoy1   · İrem Taşcı2

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
Objective  The aim of the present study was to investigate the childhood traumas,
dissociation and alexithymia levels and defense mechanisms used by migraine
patients.
Materials and Methods  This study included 100 patients diagnosed with migraine-
type headaches according to the International Pain Association criteria. Of these
100 patients, 66 (66%) had chronic migraine, 24 (24%) episodic migraine without
aura and 10 (10%) episodic migraine with aura. In addition, a control group of 90
age- and gender-matched healthy subjects was also included in the study. All par-
ticipants completed a Standardized Sociodemographic Data Collection Form, and
were administered multiple scales including Beck Depression Inventory, Toronto
Alexithymia Scale, Childhood Traumas Questionnaire, the Defensive Style Ques-
tionnaire and the Dissociative Experiences Scale.
Findings  The patients had significantly higher dissociation scores and were found
to more likely employ immature defense mechanisms compared to healthy controls
(p < 0.001 for both). Similarly, the alexithymia scores for the emotional abuse and
neglect subdimensions and the total alexithymia scores were higher in the patient
group compared to the control group (p < 0.001 for all).
Conclusion  These results indicated that migraine patients had a higher prevalence
of childhood traumas, tended to have higher alexithymia, depression and dissocia-
tion scores, and were likely to employ immature defense mechanisms compared to
healthy individuals. Based on these findings, we suggest that extensive evaluation
of migraine patients by healthcare practitioners could be highly beneficial to better
understand their clinical features, discover and treat their hidden psychiatric comor-
bidities, provide better assistance for these patients and improve their functionality.

Keywords  Alexithymia · Childhood trauma · Defense mechanisms · Dissociation ·

Migraine

* Filiz Özsoy
flzkoseoglu82@gmail.com
Extended author information available on the last page of the article

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 F. Özsoy, İ. Taşcı

Introduction

Migraine is a neurological disease characterized by recurrent headache attacks,

and affects women more frequently than men. The International Headache Society
(IHS) defined diagnostic criteria of episodic migraine without aura as manifesting
itself with characteristic unilateral-throbbing headaches lasting for 4–72  h which
are deteriorated by moderate or severe routine physical activity and accompanied
with nausea and/or headache with photophobia and phonophobia. According to this
definition, a minimum of five pain attacks are a prerequisite for establishing a diag-
nosis of migraine. Diagnostic criteria of episodic migraine with aura include gener-
ally, a recurrent condition developing slowly in 5–20 min and lasting for less than
60  min which manifests itself with reversible, focal neurological symptom attacks
in which aura symptoms are frequently followed by headache or less frequently by
headache without migraine characteristics or no headache at all. Diagnostic criteria
of chronic migraine, however, are defined as experiencing migraine for 15 or more
days a month for more than 3 months if there is no excess analgesic medication use,
and the pain not being associated with any other disease (Silberstein et al. 2005).
Genetic sensitivity and neuroanatomic and vascular changes are emphasized
in the etiology of migraine (Üçler 2018). Additionally, stressful life events and
childhood traumas were implicated (Demiryürek et al. 2017; Bottiroli et al. 2018;
Tietjen et al. 2010). Of these, childhood traumas may cause migraine by influenc-
ing the pathways related to pain (Bottiroli et al. 2018).
A number of comorbid psychiatric and mental disorders have been reported in
patients with migraine-type headaches, particularly mood disorders. Of these, major
depressive disorder (MDD) is the most common comorbidity with a prevalence
of 47.9% (Antonaci et  al. 2011; Ashina et  al. 2012). Moreover, it was shown that
bipolar affective disorder is a common comorbidity in patients with migraine-type
headaches, and that their symptoms are clinically overlapped (Fornaro and Stubbs
2015; Gordon-Smith et  al. 2015). In addition, the prevalence of anxiety has been
shown to be 2–5 times higher in migraine patients compared to the general popula-
tion (Baskin et al. 2006). On the other hand, migraine has also been associated with
some other diseases including restless leg syndrome, parasomnia, and sleep apnea
(Cevoli et  al. 2012). As a matter of fact, the coexistence of psychiatric disorders
in migraine patients may increase the frequency of migraine attacks and may also
lead to chronification of the disease. Therefore, the identification and treatment of
comorbid psychiatric disorders in migraine patients is of paramount importance for
preventing the chronification of the disease (Ashina et al. 2015; Peck et al. 2015).
Alexithymia is a personality feature defined as the difficulty in distinguish-
ing and expressing emotions, and limitations in creative processes, establishing
empathy and external thinking (Zhang et  al. 2017). Dissociation, on the other
hand, is the disruption of integrity of identity, consciousness and memory func-
tions by stressors, and represents an unconscious defense mechanism (Ameri-
can Psychiatric Association 2000). Both alexithymia and dissociation have been
extensively attributed to stressful life events and childhood traumas (Bernstein
and Putnam 1986; Frewen et al. 2008; Honkalampi et al. 2004).

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Defense Mechanisms, Dissociation, Alexithymia and Childhood…

Defense mechanisms are tactics developed by the ego to protect itself spiritually
against the events which cause anxiety and which are not desired by the ego (Freud
2004). Andrews et al. (1993) grouped defense mechanisms under three subdimen-
sions as immature, neurotic, and mature. In this classification, immature defenses
include passive aggression, reflection, isolation, excitation, trivialization, denial,
displacement, autistic fantasy, dissociation, somatization, division and adaptation
to logic, while neurotic defenses include artificial altruism, undoing, idealization,
counter-reaction development. Mature defenses, on the other hand, are humor, glori-
fication, expectation, and suppression.
Primary aim of the present study was to investigate the history of childhood
traumas and the alexithymia and dissociation levels in children diagnosed with
migraine-type headaches. This study also aimed to examine the defense mechanisms
used by these patients. Primary hypothesis of the study was that migraine patients
are more likely to have experienced stressful life events during childhood compared
to healthy individuals. The second hypothesis was that such patients are more prone
to dissociative symptoms and to alexithymia in certain dimensions compared to
healthy individuals. And the final hypothesis was that these patients are more likely
to employ immature defense mechanisms compared to healthy individuals.

Materials and Methods

Ethical Considerations

This study was evaluated and approved of by the Non-Invasive Local Ethics Com-
mittee of Gaziosmanpasa University based on all guidelines outlined in the Helsinki
Declaration on ethical principles for medical research involving human subjects.

Participants

This study included 100 patients that were diagnosed with migraine-type headaches
according to the International Pain Association criteria (Silberstein et  al. 2005) at
Malatya Training and Research Hospital Neurology Outpatient Clinic in 2017–2018
period. The 100 patients comprised 66 (66%) patients with chronic migraine, 24
(24%) patients with episodic migraine without aura, and 10 (10%) patients with
episodic migraine with aura. In addition, a control group including 90 age- and
gender-matched subjects with no signs of migraine or other headache types was
also included in the study. A written informed consent was obtained from each
participant.
Patients with chronic liver disease, chronic renal failure, diabetes mellitus (DM),
heart disease, mental retardation or neurodegenerative diseases, other primary head-
aches accompanying migraine or mixed-type headaches, ongoing chronic pain treat-
ment due to a non-migraine reason, a history of alcohol or substance abuse, psychi-
atric diseases, and patients with poor general condition and those who refused to
participate in the study were excluded from the study. Patients who met the criteria

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 F. Özsoy, İ. Taşcı

of episodic and chronic migraine with and without aura were asked to rate their pain
intensity on the Visual Analogue Scale (VAS). The VAS scores varied between 5
and 8.

Data Collection Tools

Data collection was achieved through administering multiple scales to each partici-
pant, including The Sociodemographic and Clinical Data Form, Beck Depression
Inventory (BDI), Toronto Alexithymia Scale (TAS-20), Childhood Traumas Ques-
tionnaire (CTQ), The Dissociative Experiences Scale (DES), and The Defensive
Style Questionnaire (DSQ-40).
The Sociodemographic and Clinical Data Form: The form was developed by the
authors based on the aims of the study and the data obtained via literature evalu-
ation. This form included items related to sociodemographic and clinical charac-
teristics of the participants such as age, marital status, educational status, residen-
tial area, work status, socioeconomic status, disease duration after the diagnosis of
migraine and history of psychiatric treatment.
Beck Depression Inventory (BDI): BDI is a self-reporting scale consisting of 21
items. This scale was developed by Beck et al. (1961) and was translated into Turk-
ish by Hisli-Sahin (1988). Each item in the scale is given a score between 0 and 3
and the total score ranges between 0 and 63.
Toronto Alexithymia Scale (TAS-20): It is a self-reporting scale consisting of 20
items. In this scale, a total score of 61 and over indicates the presence of alexithymic
traits. The scale has three subscales including difficulty in identifying emotions,
difficulty in verbalizing emotions, and externally oriented thinking style. TAS-20
was developed by Bagby et al. (1994) and was adapted into Turkish by Güleç et al.
(2009).
Childhood Traumas Questionnaire (CTQ) was developed by Bernstein et  al.
(1994) and was translated into Turkish by Sar et al. (2012). This scale has five sub-
scales including emotional, physical and sexual abuse, and emotional and physical
neglect. This scale consists of 28 items that are scored as a 5-point Likert-type scale.
The Dissociative Experiences Scale (DES): The form was developed by Bern-
stein and Putnam (1986) and the Turkish validity-reliability study of DES was con-
ducted by Yargiç et al. (1995). In this scale, the scores are averaged across items to
obtain an overall DES score (range: 0–100).
The Defensive Style Questionnaire (DSQ-40): This scale was developed by
Andrews et al. (1993) and was translated into Turkish by Yilmaz et al. (2007). DSQ-
40 is a self-assessment scale consisting of a total of 40 items and 20 defenses, which
evaluate the reflections of unconscious defenses employed at consciousness level.
The 20 defense types are evaluated in three subscales including immature, neurotic
and mature defenses.
Visual Analogue Scale (VAS): VAS is a scale usually composed of a 10-cm-
long horizontal or vertical line on which patients rate their pain intensity. This scale
begins with “No Pain (0)” and ends with “Unbearable Pain (10)” (Price et al. 1983).

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Defense Mechanisms, Dissociation, Alexithymia and Childhood…

Statistical Analyses

Data were analyzed using SPSS software for Windows ver. 20 (Statistical Package
for Social Sciences for Windows ver. 20). To provide information about the general
characteristics of the participants, descriptive analyses such as frequency, percent
distribution, mean ± standard deviation were calculated. Data from the continuous
variables were expressed as mean ± standard deviation while data from the categori-
cal variables were given as n (%).
Qualitative variables consisted of demographic characteristics of patients includ-
ing gender, age, educational status, socioeconomic status, history of suicide attempt,
comorbidities and psychiatric medication. Qualitative variables were compared
using crosstabs and Chi Square Test. Quantitative variables consisted of BDI, TAS-
20, CTQ, DSQ-40 and DES scores. Quantitative variables were compared using the
Significance Test for the Difference between Two Means, and Pearson’s Correlation
Coefficient. p value of 0.05 was considered significant.

Findings

Of the 170 patients diagnosed with migraine in our clinic, 30 patients were excluded
from the study since they refused to participate. Forty patients were excluded includ-
ing 10 patients who were illiterate, five patients who were present with comorbid
tension-type headache, seven patients who were receiving psychiatric medication,
eight patients who did not fill out the questionnaires/surveys, four patients who were
under observation for treatment due to heart failure, three patients who were hav-
ing hemodialysis due to a diagnosis of end-stage renal disease, and three patients
who had a history of alcohol abuse. The remaining 100 patients were included in
the study, comprising 66 (66%) patients with chronic migraine, 10 (10%) patients
with episodic migraine with aura and 24 (24%) patients with episodic migraine
without aura. Mean duration of disease was 1–30  years. Besides, a control group
of 90 healthy subjects was also included in the study. No significant difference was
detected between the two groups with regard to age, educational and marital status
(Table 1).
Mean BDI score was 9.22 ± 4.81 in the patient group and 5.18 ± 3.5 in the con-
trol group (p < 0.001). In addition, a significant difference was found between the
two groups with regard to total TAS-20 score and the scores for all subscales except
for externally oriented thinking style: mean difficulty in identifying emotions was
18.01 ± 6.8 in the patient group and 12.94 ± 4.5 in the control group (p < 0.001).
Mean difficulty in verbalizing emotions was 14.4 ± 3.52 in the patient group
and 12.02 ± 3.26 in the control group (p < 0.001). Mean total TAS-20 score was
57.53 ± 11.89 in the patient group and 49.39 ± 10.43 in the control group (p < 0.001).
Mean CTQ score for the emotional abuse subscales was 7.11 ± 3.32 in the patient
group and 5.66 ± 1.33 in the control group (p < 0.001) while mean score for the emo-
tional neglect subscales was 10.19 ± 3.81 in the patient group and 7.08 ± 2.55 in the
control group (p < 0.001). No significant difference was detected in other subscales.

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 F. Özsoy, İ. Taşcı

Table 1  Sociodemographic Control group Patient group p

features of the participants (n = 90) n (%) (n = 100) n (%)

Gender (F/M) 60/30 77/23 0.059

Marital status
(Married/single) 47/43 48/52 0.561
Having children
(Yes/no) 43/47 40/60 0.280
Educational status
University graduate 60 (%66.6) 56 (%56)
High school graduate 22 (%26.6) 27 (%27) 0.127
Primary school graduate 6 (%6.66) 17 (%17)
Working status
Working 70 (%77.7) 35 (%35)
Housewife 16 (%17.7) 51 (%51) 0.001
Retired 0 1 (%1)
Unemployed 4 (%4.4) 11 (%11)
Socioeconomic status
Low 10 (%11.1) 26 (%26)
Moderate 24 (%26.7) 43 (%43) 0.001
High 56 (%62.2) 31 (%31)

No additional comorbidities were detected in any of the participants

No psychiatric treatment was detected in any of the participants in
the past or during the study

On the other hand, mean total CTQ score was 34.55 ± 8.28 in the patient group and
30.24 ± 5.71 in the control group (p < 0.001).
Total DSQ-40 score for the immature defenses subscales was 101.41 ± 32.28 in the
patient group and 79.54 ± 23.99 in the control group (p < 0.001), while average score
was 8.55 ± 2.86 in the patient group and 6.57 ± 1.99 in the control group (p < 0.001).
Total score for the neurotic defenses subscales was 41.87 ± 11.5 in the patient group
and 37.54 ± 10.02 in the control group (p = 0.007) whereas the average score was
10.4 ± 2.96 in the patient group and 11.08 ± 7.6 in the control group (p = 0.409). For the
mature defense subscale, however, no significant difference was detected between the
groups. Total DES score was 533.95 ± 479.46 in the patient group and 268.44 ± 265.16
in the control group (p < 0.001) with an average score of 19.08 ± 17.19 in the patient
group and 10.66 ± 11.77 in the control group (p < 0.001) (Table 2). The Pearson’s Cor-
relation Coefficient results of the patients were given in Tables 3 and 4.

Discussion

The present study obtained several key findings. First, it revealed that migraine
patients are more likely to have experienced emotional neglect and abuse during
childhood. Second, these patients can be more alexithymic in certain subscales

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Defense Mechanisms, Dissociation, Alexithymia and Childhood…

Table 2  Distribution of quantitative variables according to the groups

The scale applied Control group (n = 90) Migraine patient group p
(mean ± SD) (n = 100) (mean ± SD)

Toronto alexithymia scale

Recognizing emotions 12.94 ± 4.5 18.01 ± 6.81* < 0.001
Expression emotions 12.02 ± 3.26 14.4 ± 3.52* < 0.001
Being extrovert 24.52 ± 5.49 25.49 ± 4.33 0.177
Total score 49.39 ± 10.43 57.53 ± 11.89* < 0.001
Childhood traumas questionnaire
Emotional neglect 7.08 ± 2.55 10.19 ± 3.81* < 0.001
Physical neglect 6.06 ± 2.37 6.45 ± 1.85 0.200
Emotional abuse 7.11 ± 3.32 5.66 ± 1.33* < 0.001
Physical abuse 5.36 ± 1.21 5.24 ± 1.01 0.478
Sexual abuse 5.77 ± 1.65 5.41 ± 1.39 0.107
Total score 34.55 ± 8.28 30.24 ± 5.71* < 0.001
Defensive Style Questionnaire
Immature defenses 79.54 ± 23.99 101.41 ± 32.28* < 0.001
Total score average 6.57 ± 1.99 8.55 ± 2.86* < 0.001
Neurotic defenses 41.87 ± 11.5 37.54 ± 10.02* 0.007
Total score average 11.08 ± 7.6 10.4 ± 2.96 0.409
Mature defenses 42.94 ± 11.91 43.38 ± 11.09 0.794
Total score average 10.73 ± 2.98 10.94 ± 2.59 0.614
Dissociative experiences scale
Total score 268.44 ± 265.16 533.95 ± 479.46* < 0.001
Average 10.66 ± 11.77 19.08 ± 17.19* < 0.001
Beck depression inventory 5.18 ± 3.5 9.22 ± 4.81* < 0.001

*p < 0.05

compared to healthy individuals. Third, these patients are more likely to employ
immature defense mechanisms and to show greater dissociation compared to healthy
individuals.
Numerous studies showed a correlation between childhood traumas and migraine-
type headaches (Üçler 2018; Kucukgoncu et al. 2004; Tietjen et al. 2007; Peterlin
et al. 2007; Fuller-Thomson et al. 2010). Tietjen et al. (2007) reported that 58% of
migraine patients were found to have experienced at least one childhood trauma.
Another study compared patients with tension- and migraine-type headaches and
healthy subjects, and reported that the childhood emotional abuse scores were signif-
icantly higher in these patients compared to control subjects (Peterlin et al. 2007). In
line with the literature, our patients also had a higher prevalence of childhood trau-
mas compared to healthy controls. Previous studies indicated that childhood traumas
could be associated with the frequency and severity of headaches experienced by
the patients (Üçler 2018; Peterlin et al. 2007). Moreover, a previous study showed
a positive correlation between the frequency of headaches in migraine patients and

13
 F. Özsoy, İ. Taşcı

Table 3  The correlation of alexithymia and childhood traumas with Defensive Style Questionnaire and
Dissociative Experiences Scale
DSQ-40 imma- DSQ-40 neurotic DSQ-40 mature DSQ-40 average
ture defence defence average defence average
average

TAS-20
Recognizing emotions 0.606* 0.296* 0.283* 0.523*
Expression emotions 0.373* 0.195 0.154 0.396*
Being extrovert 0.348* 0.362* 0.287* 0.303*
Total score 0.587* 0.356* 0.293* 0.549*
CTQ
Emotional neglect 0.064 0.049 -0.034 0.052
Physical neglect 0.059 0.082 0.085 0.007
Emotional abuse 0.107 0.100 0.124 0.281
Physical abuse 0.044 0.056 0.057 0.039
Sexual abuse 0.116 0.116 0.102 0.140
Total score 0.116 0.116 0.102 0.140
Beck depression inventory 0.217* 0.161 0.145 0.343*

TAS-20 Toronto Alexithymia Scale, CTQ Childhood Traumas Questionnaire, DSQ-40, Defensive Style
Questionnaire, DES Dissociative Experiences Scale
Values are shown as ­rp. *p < 0.05

Table 4  The correlation between alexithymia and childhood traumas

TAS-recognizing TAS-Expression TAS-Being TAS-total score
emotions emotions extrovert

CTQ
Emotional neglect 0.031 − 0.037 − 0.012 0.008
Physical neglect 0.120 0.062 0.206* 0.171
Emotional abuse 0.171 0.061 0.180 0.120
Physical abuse 0.007 − 0.093 − 0.080 − 0.086
Total score 0.118 − 0.017 0.029 0.070
Beck depression inventory 0.316* 0.238* 0.153 0.292*

TAS Toronto Alexithymia Scale, CTQ Childhood Traumas Questionnaire

Values are shown as ­rp. *p < 0.05

their exposure to physical and emotional abuse, physical neglect, as well as with
their total scores. In the same study, a positive correlation was also detected between
physical neglect and the duration of headaches (Üçler 2018). Another study reported
that as the pain chronicity increased, the frequency of psychopathologies, particu-
larly anxiety disorder and depressive disorder, also increased. The study also noted
that these two conditions occurred as a result of the effect of similar neurotrans-
mitters and biological pathways (Tütüncü and Hüseyin 2011). Depending on these
findings and on the literature data which suggests that there is no consensus as to

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Defense Mechanisms, Dissociation, Alexithymia and Childhood…

which of these two pathways triggers the other, the present study aimed to com-
pare migraine patients with healthy individuals. However, the study performed no
comparison between episodic and chronic migraine patients with regard to pain fre-
quency, severity and duration.
Stressful life events, which are considered to trigger migraine, can be experienced
by many individuals (Dodick 2009). These events, along with childhood traumas,
are believed to play a key role in the development of immature defense mechanisms
in subsequent years (Nickel and Egle 2006). Defense mechanisms are automatic psy-
chological processes that protect the individual against internal and external stress-
ors. These mechanisms are of three types: immature, neurotic and mature (Yılmaz
et  al. 2007). To our knowledge, there has been no study in the literature investi-
gating defense mechanisms in migraine patients. In our study, the results indicated
that defense mechanisms were less sophisticated in patients with chronic migraine,
particularly in childhood. It is commonly known that the presence of a pain leads
to labor loss, decreased quality of life and depressive symptoms in patients. On the
other hand, it was reported that patients with major depressive disorder are relatively
more likely to develop immature defense mechanisms (Colovic et al. 2016). Another
study showed that adolescents who have high depression scores despite the absence
of the signs of depression are more prone to developing immature defense mech-
anisms (Savilahti et  al. 2018). In our study, the TAS-20 scores were significantly
higher in the patient group compared to the control group. Moreover, a strong corre-
lation was found between the TAS-20 scale and the difficulty in identifying emotions
subdimension and between the total TAS-20 scores and immature defense mecha-
nisms. These findings implied that patients with migraine, which is a chronic and
painful disease, become more alexithymic as their depressive symptoms increase,
which in turn promotes the development of immature defenses and ultimately inten-
sifies depression and traps patients in a vicious cycle.
Dissociation is evaluated as an unconscious immature defense mechanism.
To our knowledge, dissociation was investigated in migraine patients in only one
study in the literature, which reported that dissociation scores of the patients were
higher than those of control subjects (Kucukgoncu et  al. 2004). Similarly, in our
study, the dissociation scores were also higher in the patient group compared to the
control group. Accordingly, it is safe to assert that migraine patients are likely to
have higher dissociation scores since they use immature defense mechanisms. On
the other hand, the dissociation scores of our patients showed a positive correlation
with their depression scores.
Alexithymia is a personality trait defined as difficulty in distinguishing and
expressing emotions. This trait is an important characteristic feature in migraine
patients. A previous study reported that nearly 70% of the participating patients
diagnosed with chronic migraine were alexithymic in certain fields (Galli et  al.
2017). Another study showed that migraine patients were alexithymic in all fields
including emotion recognition, expression, and outward thinking (Dikmen et  al.
2017). Similarly, Karsikaya et  al. (2013) showed that migraine patients were
more alexithymic compared to healthy controls. In contrast, Bottiroli et al. (2018)
showed that migraine patients had difficulty only in recognizing emotions. In our
study, the patients were alexithymic in the fields of recognizing and expressing

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 F. Özsoy, İ. Taşcı

emotions, which was consistent with the literature. Moreover, the total alexithy-
mia scores were higher in the patient group than in the control group.
In our study, the depression scores of migraine patients were significantly
higher than those of healthy controls, which was consistent with the findings of
many studies in the literature (Demiryürek et al. 2017; Kucukgoncu et al. 2004;
Fuller-Thomson et  al. 2010). In addition, the depression scores of the patients
had a correlation with their dissociation scores and immature defense mecha-
nism, which was also consistent with the literature (Louter et al. 2015; Peres et al.
2017). Besides, depression scores were positively correlated with the scores of
distinguishing and expressing the emotions subscales and total scores of Toronto
Alexithymia Scale. As the depression scores of the patients increased, their level
of ability to distinguish and express emotions were impaired. These findings were
also in parallel with those in the literature (Taycan et al. 2017). Although depres-
sion scores were high, lack of depression levels in patients sufficient for a depres-
sion diagnosis was explained by alexithymia. It is thought that the presence of
alexithymia in patients may have prevented them from feeling their depression.
Our study was limited in several ways. First, the study had a cross-sectional
nature and had a small patient population. Second, the questionnaires/surveys
were filled out by the participants themselves, and SCID-5-CV (Structured Clini-
cal Interview for DSM-5—Clinical Version) (American Psychiatric Associa-
tion 2000) was not administered to the participants. Finally, the educational status
of the patients and control subjects did not match. Due to these limitations, the
findings of our study may not be generalized to all migraine patients. Therefore,
further large-scale studies including neurocognitive evaluations are needed to
substantiate our findings.

Conclusion

Our results showed that compared to healthy controls migraine patients were
exposed to more childhood traumas. In addition, it was revealed that depression,
alexithymia and dissociation scores of the patients were high, and they tended
to adopt immature defense mechanisms. Thus, migraine patients could have
higher levels of psychiatric comorbidity rates, which could aggravate the disease
and impair the compliance with the treatment. Considering all these together, it
could be concluded that preventing the traumas of children in their developmen-
tal steps is crucial for sustaining the mental health of the community. In addi-
tion, neurology and psychiatry physicians should be in cooperation for evaluating
migraine patients and planning their treatment in order to better help and under-
stand the patients and to uncover their hidden psychiatric comorbid conditions. It
is thought that cognitive psychotherapy practices performed in regular intervals
could be very helpful for the treatment of these patients. With well-established
therapist-patient interactions, both the treatments and psychosocial adaptations of
the patients can be better achieved.

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Defense Mechanisms, Dissociation, Alexithymia and Childhood…

Compliance with Ethical Standards 

Conflict of interest  The authors declare no conflict of interest.

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Defense Mechanisms, Dissociation, Alexithymia and Childhood…

Affiliations

Filiz Özsoy1   · İrem Taşcı2
İrem Taşcı
tasciiirem@gmail.com
1
Clinic of Psychiatry, Tokat State Hospital, 60100 Yeni District, Tokat, Turkey
2
Clinic of Neurology, Malatya Education and Research Hospital, Ozalper Neighborhood, Turgut
Ozal Boulevard, Malatya, Turkey

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