Abstract
DEFENSE MECHANISMS AND SOCIAL ANXIETY AS RISK FACTORS FOR
COLLEGE ALCOHOL ABUSE AND BINGE DRINKING
by Rachel L. Patrick
Review of the literature will show that the presence of social anxiety is often
linked to the presence of alcohol abuse. Additionally, previous work has focused on the
link between the use of different defense mechanisms and alcohol abuse. The current
study aims to merge these two perspectives and discover if the use of certain defense
mechanisms and the presence of social anxiety, in a college-aged population, can be seen
as risk factors for alcohol abuse and binge drinking. 286 students were recruited to
complete measures on social anxiety, defense mechanisms, and drinking patterns.
Results show that individuals low in social anxiety who employ immature defense
mechanisms were more likely to have score highly on a measure of alcoholism, and
individuals low in social anxiety who use either mature or immature defenses were more
likely to binge drink. Additional analyses were also conducted, including a brief look at
some demographic variables. Possible explanations of these findings, and limitations are
discussed.
DEFENSE MECHANISM AND SOCIAL ANXIETY AS RISK FACTORS FOR
COLLEGE ALCOHOL ABUSE AND BINGE DRINKING
A Thesis
Submitted to the Faculty
of Miami University
in partial fulfillment of
the requirements for
the degree of
Master of Arts
Department of Psychology
by
Rachel Lynn Patrick
Miami University
Oxford OH
2005
Advisor: ____________________________
Karen Maitland-Schilling, Ph.D.
Reader: _____________________________
Terri Messman-Moore, Ph.D.
Reader: ______________________________
Heather Claypool, Ph.D.
Defense mechanisms and social anxiety as risk factors for college alcohol abuse and
binge drinking
Recently, there has been an increased focus on problem drinking among college
students (Brower, 2002; Read, Wood, Christopher, Maddock, & Palfai, 2003; Wechsler,
Lee, Kuo, & Lee, 2000). Much of the research, as well as national media reports, seem to
focus on binge drinking among college students or report alarmingly high prevalence of
regular consumption of alcohol in amounts that seem problematic (Keeling, 2002;
Pitkanen, 1999; Read et al., 2003; Wechsler, Dowdall, Davenport, & Castillo, 1995;
Wechsler et al., 2000). Broadly-based education or prevention programs that have been
put in place have met with mixed success. Clearly, normative expectations play a part in
the alcohol abuse in this population (Carey, 1993; Hussong, 2003; Keeling, 2002; Lewis
& O'Neill, 2000). The cultural supports for alcohol use in this population are prevalent
(Hussong, 2003; Keeling, 2002), so much so that many adolescents may equate going off
to college with freedom to consume alcohol. It has been reported that college student
binge drinkers, and college student alcoholics make up 10% of the adult population who
drink, and account for 60% of all alcohol consumed (Wolburg & Treise, 2004).
However, even within what seems to be a normative age- or stage-related
understanding of alcohol use and abuse, it is obvious that other factors come into play in
influencing who will and who will not abuse alcohol. Differences in values—liberal or
conservative, religious or non religious for example—relate to likely patterns of abuse as
does the role of self-esteem (Hull & Schnurr, 1986). Many researchers have attempted to
establish links between various personality factors and alcohol abuse. Patterns of
responses on the MMPI have shown alcoholics to score relatively high on scale 4, which
is a measure of Psychopathic Deviance (Graham & Strenger, 1988; Kammeier, Hoffman,
& Loper, 1973; Overall, 1973). Younger alcoholics have been shown to have higher
scale 4 elevations when compared to older alcoholics (Graham & Strenger, 1988). Data
on youthful alcohol abusers have also shown that the most common code type is a 24/42,
which means that the individual generally tries to create a favorable impression, but
secretly holds back his/her own feelings of inadequacy, self-consciousness, passive
dependency, and discomfort in social interactions (Graham, 1987; Graham & Strenger,
1
1988; Kammeier et al., 1973). Research has identified different negative and positive
reinforcing properties of alcohol connected to different personality dispositions toward
negative and positive affectivity. People with negative affectivity may use alcohol to
suppress negative affects, whereas people with positive affectivity may use alcohol for
stimulation (Widiger, Verheul, & van den Brink, 1999). Unfortunately, most of these
studies shed light on the more global problem of alcohol abuse across the lifespan and
may do little to help us understand risk factors for alcohol abuse in a college-age
population.
Psychodynamic formulations of personality are based in a developmental
understanding of the role of defense mechanisms underlying personality structures, which
allow an individual to adjust their conscious thoughts in order to attain the highest level
of positive affect and the lowest level of negative affect (Fenichel, 1945; Westen &
Gabbard, 1999), may be useful in identifying risk factors for alcohol abuse in a college
sample. If the transition to college is understood as a time of particular stress, with a
variety of new demands for adaptation placed upon the individual, adequacy of
adaptation and adjustment would likely relate to adequacy of preexisting personality
structure as manifested in defensive styles (Westen & Gabbard, 1999). Defense
mechanisms have long been thought of as being grouped into hierarchical levels (Freud,
1936), where defenses that are seen as pathological are usually used most frequently by
individuals with severe pathology, but they can also be utilized by healthy individuals
when brought under stress (Westen & Gabbard, 1999). For a college age student, stress
can be brought on by the demands of adjustment to new social contexts as well as new
demands of performance in an academic context, both of which relate directly to
adequacy of functioning in the social domain.
Some college students may feel that there is pressure to drink to fit in with a new
culture, or they may feel that drinking will help them deal with their new anxieties. This
drinking manages to be a problem for some college students, while others are able to
keep it under control. In social situations, it is assumed that many people will feel some
level of anxiety. Excessive social anxiety is a form of psychopathology, and in
psychodynamic traditions it has been related to the use of different defense mechanisms
(Foley, Heath, & Chabot, 1986; Mulder, Joyce, Sellman, Sullivan, & Cloninger, 1996;
2
Pollock & Andrews, 1989). The defense mechanisms that you have at your disposal will
determine whether or not you deal successfully with the anxiety. More adequate defenses
will allow you to function in the anxiety provoking situation with little or no sign that you
are actually anxious. Less adequate defense mechanisms, on the other hand, will allow
the anxiety to manifest itself in the form of social anxiety (Pollock & Andrews, 1989).
The transition to college is accompanied by new anxieties and challenges. These
new situations may challenge even the defense structure of someone with
mature/adequate defense mechanisms. Those with inadequate defense mechanisms will
be even more prone to experience anxiety with this transition. One way to deal with the
anxiety that is associated with using inadequate defenses is to self-medicate with alcohol
(Carrigan & Randall, 2003). The atmosphere of college, with drinking being more
permissible, and even encouraged, may put students at an increased risk to turn to alcohol
to self-medicate the new anxieties that their defenses are not equipped to handle.
Viewing social anxiety as a risk factor for possible problematic drinking among
college students, I have decided to look at defense mechanisms as a possible means for
differentiating among college students who may be more prone to engage in problematic
drinking behaviors.
Social Anxiety
Social anxiety (or social phobia) is the marked and persistent fear of one or more
social or performance situations in which the person is exposed to unfamiliar people or to
possible scrutiny by others (Biedel, Turner, & Morris, 1995). It is the most common of
all the anxiety disorders (Westenberg, 1999), and recent work has found it to be the third
most common psychiatric disorder (Ham, Hope, White, & Rivers, 2002) with a lifetime
prevalence in the general population estimated between 7% and 13% (Ham et al., 2002;
Wittchen & Fehm, 2001). According to Antony and Swinson (1998), the experience of
social anxiety can be thought of as being on a continuum, with some people appearing to
never experience it, while others experience it so severely that they avoid social situations
altogether. This could even go so far as to influence going to work, and spending time
with one’s own family. Sufferers are more likely to be unemployed, live alone, be
unmarried or divorced, and of a lower socio-economic status (Lepine & Pelissolo, 2000).
3
There are several criteria that professionals use to define social anxiety disorder.
These include: the experience of intense fear of one or more performance situations, in
which the person fears they will do something embarrassing or show signs of anxiety;
becoming anxious or panicky when exposed to a feared social situation; recognizing that
the fear is out of proportion to the real danger; avoiding the situation, or enduring it with
intense discomfort; the anxiety leads to significant interference in functioning; the
problem has lasted at least six months; and the social anxiety is not due to another
problem (Antony & Swinson, 1998). A person who has an immediate family member
with social anxiety is at a much higher risk of developing social anxiety when compared
to the average person. It is still unclear if there is a biological basis for this relationship,
or if it is a result of modeling (Antony & Swinson, 1998; Wittchen, 2000).
Sufferers hold negative beliefs about self worth that are circumscribed to social
situations, as opposed to being more global (Norton, Buhr, Cox, Norton, & Walker,
2000). There are two subtypes of social anxiety disorder. The first type is the
generalized type, in which the individual fears a multitude of social and performance
situations. This type is generally recognized as the most disabling form of the disorder
(Lepine & Pelissolo, 2000; Wittchen & Fehm, 2001), and accounts for 75% of social
anxiety diagnoses (Lydiard, 2001). The second subtype is the non-generalized form, in
which only two or three situations are feared (Westenberg, 1999). Public speaking seems
to be the most common fear-provoking situation in this subtype of social phobia
(Wittchen & Fehm, 2001). In both subtypes, avoidance of the feared social situation(s) is
a common coping strategy (Wittchen & Fehm, 2001).
The onset of social anxiety is almost always in childhood or adolescence, with most
cases emerging by age 19 (Crum & Pratt, 2001; Lepine & Pelissolo, 2000; Wittchen,
2000; Wittchen & Fehm, 2001). The condition is chronic, and has an average duration of
about 20 years (Westenberg, 1999). It also appears to affect women twice as often as
men (Lepine & Pelissolo, 2000; Lydiard, 2001), and some suggest higher rates among
African Americans (Crum & Pratt, 2001).
Despite growing awareness of the prevalence of social anxiety, it is often left
undetected, and therefore untreated (Crum & Pratt, 2001; Lepine & Pelissolo, 2000). A
treatment plan that includes social skills training, graduated exposure, systematic
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desensitization, imaginal flooding, and other cognitive-behavioral therapies may prove to
be effective (McKeehan & Martin, 2002).
Social Anxiety and Problem Drinking
Additional difficulties associated with social phobia can occur when the individual
begins to use alcohol as a coping mechanism. Some individuals with social anxiety state
that they find alcohol helpful in relieving anxiety in feared social situations (Lepine &
Pelissolo, 1998). Social anxiety, along with other forms of interpersonal dysfunction,
have been found to be significant factors in determining problem drinking, especially if
the individual is in a stressful social situation (Hartman, 1986).
The prevalence of alcohol problems in patients with social phobia is generally
reported at 10-20%, though some studies find as high as 57%, and The National
Comorbidity Survey found a lifetime prevalence of 24% (Lepine & Pelissolo, 1998).
Individuals with social anxiety disorder are two to three times more likely then those who
do not have the disorder to have had alcohol abuse problems (Ham et al., 2002; Lepine &
Pelissolo, 1998). Those who have alcohol abuse problems and suffer from social phobia
seem to view the social phobia as being their greater problem (Stravynski, Lamontagne,
& Lavallee, 1986).
Some researchers believe that the use of alcohol may be due to a tendency to selfmedicate, and relieve some of the tensions arising from social anxiety disorder (Crum &
Pratt, 2001; McKeehan & Martin, 2002; Stravynski et al., 1986). The self-medication
hypothesis makes three assumptions: (1) the anxiety must predate the use of alcohol; (2),
the alcohol should somehow relieve the symptoms of the social anxiety; and (3), this
symptom relief leads to continued and excessive use of alcohol (Chutuape & de Wit,
1995). A similar hypothesis is known as the tension-reduction hypothesis, and it states
that the consumption of alcohol is reinforced by the reduction in the intensity of an
unpleasant emotional state (Hartman, 1986). These hypotheses are both a bit of a
paradox, though, because some have noted that alcohol can actually increase anxiety
(Schuckit et al., 1997). Still, it is expected that if the individual believes that drinking
will alleviate feelings of stress, then it is predictable that social situations that are
perceived as stressful will lead to increases in drinking (Hartman, 1986).
5
It has been noted that the presence of interpersonal dysfunction and social anxiety
are important determinants of problem drinking. This social anxiety can be most salient
in stressful social situations (Hartman, 1986). One study found no significant difference
in the amounts of alcohol consumed by alcoholics and non-alcoholics in non-stressful
social situations. Yet, when both groups (alcoholics and non-alcoholics) were told that
their responses in similar social situations were inadequate, the alcoholics drank more
(Miller, Hersen, Eisler, & Hilsman, 1974).
Stravynski et al., (1986) found that 30% of patients in an alcoholism rehabilitation
program viewed their social anxiety as the main problem, which was equal to the
percentage that actually viewed alcoholism as their main problem. Eighty percent of the
patients with the co-morbid disorder reported that being observed in groups was their
most difficult situation, and feeling vulnerable and sensitive to the opinion of others was
their ultimate fear.
One potentially stressful time in the life of an individual may be when that person
enters college. Along with the new freedoms of college life come new responsibilities,
decisions, and situations that may be anxiety provoking. If individuals enter college with
social anxiety, they will most likely be at a greater risk for developing alcohol abuse
problems, if they don’t already have them. Because alcohol is generally available at
many social functions in college, it is considered to be socially appropriate to participate
in drinking. These functions may trigger social anxiety for certain individuals, and the
availability of alcohol, along with alcohol’s high level of social acceptance, make some
individuals vulnerable to using it to alleviate anxiety (Carrigan & Randall, 2003).
College Drinking
Parties, on-campus living, athletics, and social interactions are all considered
desirable aspects of going to college, unfortunately they are also all closely tied to binge
drinking in college students (Wechsler et al., 1995). Binge drinking has most currently
been defined differently for males and females. In men, consuming five or more drinks
in a row once in a two week period is considered binge drinking. For women binge
drinking occurs when four or more drinks are consumed in a row at least once in a two
week period (Wechsler et al., 2000). 37% of college students are considered moderate
6
drinkers, and 19% are considered heavy drinkers (O'Hare, 1990). Only about 10% of
students on college campuses report that they do not drink at all (Brower, 2002).
Heavy episodic, or binge drinking, is the leading cause of preventable death on
college campuses (McCabe, 2002). Students who attend college are at a higher risk for
such heavy episodic drinking than their peers who do not attend college (Wechsler et al.,
1995) and entrance into college sets the ground for a rapid increase in alcohol
consumption (Turner, Larimer, & Sarason, 2000). It is estimated that almost 90% of
college students use alcohol, with as many as 45% of college students being considered
binge drinkers (Turner et al., 2000). Just over 28% are considered frequent binge
drinkers, meaning binge drinking three or more times in a two week period (Wechsler et
al., 1995; Wechsler et al., 2000).
In a college sample, being white, male, and single elevates the risk of bingedrinking (Wechsler et al., 1995), as well as residence in a fraternity house (McCabe,
2002). Having a 3.0 GPA or lower may also be related to binge drinking, and majoring
in business is also predictive of college binge drinking (Wechsler et al., 1995).
A college student does not need to participate in binge drinking to have problems
with alcohol use. It has been reported that nearly 80% of college students who drink at
all have experienced some form of negative consequence as a result of their alcohol use
(Engs, 1977). If a student continues to drink, even with the threat of personal, legal,
professional, and academic difficulties, then they are considered to have an alcohol abuse
problem (Brower, 2002). It is estimated that 40% of college students would fulfill the
criteria of having an alcohol abuse problem (Burke & Stephens, 1999).
Defense Mechanisms
Overview
Defense mechanisms are patterned feelings, thoughts, or behaviors that are
relatively involuntary and arise in response to perceptions of psychic dangers. They are
designed to hide or alleviate the conflicts or stresses that give rise to the anxiety signal
(Vaillant, 1986; Wastell, 1999). The term defense mechanism is used to describe not
only an unconscious intrapsychic process, but also to describe behavior that is either
consciously or unconsciously designed to reconcile internal drive with external demands
(Bond, 1986). You can’t point to a particular behavior and simply state that it is a sign of
7
an underlying defense. Everything must be set within the context of the individual’s
other actions, expressions of meaning, and affect (Hauser, 1986). Coping and defense
mechanisms may be differentiated on the basis of their status as conscious or unconscious
processes and on the basis of their being intentional or unintentional operations (Cramer,
2000).
Three major categories of defense mechanisms are commonly noted: immature,
neurotic, and mature (Bond, 1986). Individuals seem to utilize the different types of
defenses in a developmental way, utilizing the defenses in a hierarchical fashion as they
age (Bond, 1986; Freud, 1936; Westen & Gabbard, 1999). There is a shift from
preoccupation with control of raw impulses with the immature defenses, to preoccupation
with all-important others with the neurotic defenses, and then to creative expression of
one’s self with the mature defenses (Bond, 1986; Freud, 1936).
Immature defenses can usually be seen in healthy individuals before the age of 15.
These defenses are used to relieve stress due to the threat of interpersonal intimacy, or the
threat of the loss of interpersonal intimacy. These defenses should change as the person
matures, or as interpersonal relationships improve. The immature defenses typically
include: projection, passive-aggression, acting out, isolation, devaluation, autistic fantasy,
denial, displacement, dissociation, splitting, rationalization, and somatization (Vaillant,
1986).
Neurotic defenses are common in healthy individuals between the ages of three
and 90, in neurotic disorders, and in the mastery of acute stress. These defenses are used
to change private feelings, or the expression of instincts. The neurotic defenses include:
undoing, pseudoaltruism, idealization, and reaction formation (Vaillant, 1986).
Mature defenses are found in individuals who are between the ages of 12 to 90.
These defenses allow the individual to integrate reality, interpersonal relationships, and
private feelings. Under stress, though, users of mature defenses may revert back to a less
mature form. The mature defenses include: sublimation, humor, anticipation, and
suppression (Vaillant, 1986). Table 1 provides a description of the different defense
mechanisms in relation to how people use them to deal with emotional conflicts, or
internal and external stressors.
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In the short run, defenses may be successful in ameliorating incapacitating anxiety
and providing the highest level of adaptation possible. In the long run, especially if they
interfere with problem-focused coping, defenses are likely to hinder successful
adaptation. Use of immature defenses is found to be related to high symptom scores on
the Global Severity Index of the SCL-90 (Cramer, 2000). Defense scores based on
clinicians’ ratings have been found to predict adequacy of interpersonal and global
functioning, with immature defenses being a negative indicator (Cramer, 2000).
Table 1 – Descriptions of Defense Mechanisms [adapted from Glossary of Defense Mechanims for DSMIIIR by the Advisory Committee on Defense Mechanisms, in (Vaillant, 1986)]
Defense Mechanism
Immature Defenses
Projection
Passive-Aggression
Acting Out
Isolation
Devaluation
Autistic Fantasy
Denial
Displacement
Dissociation
Splitting
Rationalization
Somatization
Neurotic Defenses
Undoing
Psuedo-Altruism
Idealization
Reaction Formation
Mature Defenses
Sublimation
Humor
Anticipation
Suppression
Description
Falsely attributes unacknowledged feelings, impulses, or thoughts to others
Indirectly and unassertively expresses aggression towards others
Acting without reflection or apparent regard for negative consequences
Unable to simultaneously experience the cognitive and affective components
of an experience (the affect is kept from the consciousness)
Attributes exaggerated negative qualities to self or others
Uses excessive daydreaming as a substituted for human relationships, more
direct and effective action, or problem solving
Refuses to acknowledge some aspect of external reality that would be
apparent to others
Redirects a feeling about, or response to, an object onto another less
threatening object
Temporarily alters the integrative functions of consciousness or identity
Fails to integrate the positive and negative qualities of self and others into
cohesive images (either all-good, or all-bad)
Devises reassuring/self-serving but incorrect explanations for behavior
Becomes preoccupied with physical symptoms disproportionate to any actual
physical disturbance
Utilizes behavior designed to symbolically make amends for or negate
previous thoughts, feelings, or actions
Becomes dedicated to fulfilling the needs of others, in part as a way to fulfill
his/her own needs
Attributes exaggerated positive qualities to self or others
Substitutes behavior, thoughts, or feelings that are diametrically opposed to
his/her unacceptable thoughts or feelings
Channels personally unacceptable feelings or impulses to socially desirable
behavior
Emphasizes the amusing or ironic aspects of the conflict or stressor
Attempts to predict possible outcomes and changes behavior accordingly
Intentionally avoids thinking about disturbing problems, wishes, or feelings,
or experiences
The study of defensive styles in alcoholics and individuals with social anxiety
has been given little attention over the years. One study found that alcoholics employed
adaptive defense strategies significantly less often when compared to controls, and that
9
that lack of adaptive defenses led to greater perceived psychological benefits from
drinking (Ojehagen & Smith, 1993). Kennedy, Schwab, and Hyde (2001) found that
patients with social phobia had the highest defense style 1 (maladaptive) scores when
compared to other Axis 1 anxiety disorders and controls, and they had the highest mean
scores for defense style 2 (image distorting) as well. The maladaptive defenses of
defense style 1, and the image distorting defenses of defense style 2 are examples of
immature defense styles. Pollock and Andrews (1989) found that, when compared to
controls, patients with social phobia were more likely to use displacement and
devaluation and less likely to use humor as a defense. Again, this shows the tendency of
an individual with social phobia to endorse immature defenses over mature defenses.
Some gender differences, though slight, have been found with respect to the use of
defense mechanisms. Males tend to use isolation and suppression to a greater extent than
do females, who use pseudo-altruism to a greater extent than do males (Watson & Sinha,
1998).
Purpose
Social anxiety is likely to put an individual at risk of developing alcohol abuse
problems. The use of immature and inadequate defense mechanisms also puts
individuals at higher risks for abusing alcohol. Therefore, the use of immature defense
mechanisms in individuals with social anxiety may have some predictive value in
determining risk factors for alcohol abuse problems, especially in college-age students
who are experiencing new situations and anxieties.
Though this is an exploratory study, it is hypothesized that the use of immature
defenses will prove to be a significant risk factor for alcohol abuse in individuals with
social anxiety. It is hypothesized that both genders will use immature defenses, but may
employ different ones. I expect to find some use, overall, of neurotic defenses, and no
use of mature defenses, in individuals with social anxiety who are abusing alcohol.
Method
Participants
Two-hundred eighty six students were recruited from the Psychology
Department’s subject pool at Miami University. The majority of these students were
from an Introduction to Psychology course, and were mostly Freshman and Sophomores.
10
This is the ideal time-frame to find students who are beginning to cope with the transition
to college, or who are close to the time they dealt with the transition. Basic information
about the sample is presented in Table 2:
Table 2 – Description of Sample
Age
Response
Gender
#
%
Response
Year in School
#
%
Response
#
Ethnicity
%
Response
#
%
17
1
0.3
Female
179
62.2
Freshman
161
56.3
Caucasian
254
88.8
18
114
39.9
Male
104
36.7
Sophomore
86
30.1
Black/African-American
6
2.1
19
73
25.5
Blank
3
0.1
Junior
21
7.3
Hispanic/Latino
5
1.7
20
31
10.8
Senior
13
4.5
Asian-American
4
1.4
21
15
5.2
5+
3
1
Native-American
2
0.7
22
0
0
Blank
2
0.7
Biracial/Multi-racial
8
2.8
23
1
0.3
Other
4
1.4
24
0
0
Blank
3
1
25
1
0.3
Blank
50
17.5
After informed consent was obtained, participants completed measures dealing
with drinking, social anxiety, and defense mechanisms. The measures were numbered
and placed in random order to minimize order effects. The participants were allowed one
hour to complete all the measures, and were compensated with one hour of credit to use
towards the requirements in their Introductory Psychology course. Upon completion of
the measures, the participants were provided with a paper which debriefed them as to the
purpose of the study, and provided contact information for psychological services as well
as updates on the results of the study.
Measures
Participants were first asked to give demographic information including age,
gender, ethnicity, and year in school. Then, they filled out the following measures:
Michigan Alcoholism Screening Test
The Michigan Alcoholism Screening Test (MAST) is a 25 item, yes-no format
instrument designed to be administered rapidly and effectively by professionals and nonprofessionals (Selzer, 1971). Scores range from zero to fifty-three, and a score of 0-3 is
considered to indicate normal social drinking, 4 is a borderline score, and 5 or above
indicates alcoholism (Brady, Foulks, Childress, & Pertschuk, 1982). It has been shown to
11
have high internal consistency, with reported alpha coefficients between .83 and .95. It
also has high test-retest reliability, ranging from .90-.96 (Hedlung & Vieweg, 1984).
Additional questions were added to the MAST to assess for binge-drinking behaviors as
defined by Weschler, et al., (2000).
Bond’s Defense Style Questionnaire (short version – DSQ 40)
The Defense Style Questionnaire (DSQ), one of the oldest and most widely used
self-report measures of defense functioning, divides defense mechanisms into immature,
neurotic, and mature (Wastell, 1999). The original DSQ consists of 88 questions, and
was shown to demonstrate construct validity (Andrews, Singh, & Bond, 1993). Later, it
was broken down into a less lengthy form, the DSQ-40, which has proven to be internally
reliable, but differentially for each type of defense. Mature defenses have an alpha of
.68, neurotic defenses have an alpha of .58, and immature defenses have a reported alpha
of .80 (Andrews et al., 1993). Test-retest correlations range from .75 to .85 depending on
the type of defense (Andrews et al., 1993). The short version looks at 20 defenses, still
subsumed under the original three sub-types. The defenses on the DSQ-40 are presented
in Table 3:
Table 3 – Defense Mechanisms measured by DSQ-40
Mature
Neurotic
Immature
Anticipation
Pseudo-altruism
Acting-out, Denial, Devaluation, Displacement,
Humor
Idealization
Dissociation, Autistic Fantasy,
Suppression
Reaction-Formation
Isolation, Passive Aggression,
Sublimation
Undoing
Projection, Rationalization, Somatization,
Splitting
Social Anxiety Measures
To assess social anxiety, four scales were used: The Fear of Negative Evaluation
(FNE), the Social Avoidance and Distress Scale (SADS), the Liebowitz Social Anxiety
Scale (LSAS), and the Brief Social Phobia Scale (BSPS). Each measure takes only a few
minutes to administer, and highlights different aspects of the overall disorder, providing a
clearer picture, and a more accurate description of someone as having social anxiety.
The FNE is a 30-item true-false scale that is used to measure expectation and
distress related to perceived negative evaluation from others. A higher score reflects
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more anxiety, with certain items getting one point for a true answer, and other items
getting one point for a false answer. It has been shown to have high internal consistency,
ranging from .94 to .96, and good test-retest reliability from .78 to .94 (Orsillo, 2001).
The SADS is a 28-item, true-false scale that is used to measure distress during
and avoidance of social situations. Once again, a higher score reflects more anxiety. It
has been shown to have excellent internal consistency, with one study yielding a
correlation of .94. Test-retest over a one-month period in a college student sample
ranged from .68-.79. The FNE and SADS were developed together, and are moderately
correlated with each other (Orsillo, 2001).
The Liebowitz Social Anxiety Scale is a 24-item interview that looks at the
constructs of fear and avoidance of social situations. Though the measure is designed to
be an interview, it can also be used as a self-report. Fear and avoidance are measured
with respect to difficulties with social interactions and performance. Fear is rated using a
four point Likert scale ranging from 0 (none) to 3 (severe), and avoidance is also rated on
a four point Likert scale ranging from 0 (never) to 3 (usually). Fear and avoidance scores
were obtained which were summed for a total score (Orsillo, 2001). In one major study
(Heimberg et al., 1999), Cronbach’s alpha for the total score was .96. The LSAS total
score has been shown to be related to other self-report measures for social anxiety
(Orsillo, 2001).
The BSPS is an 18-item scale used to determine the amount of fear, avoidance,
and physiological arousal related to social phobia. It is divided into two parts, the first of
which assesses fear and avoidance of seven social situations. Fear is assessed on a five
point Likert scale ranging from 0 (none) to 4 (extreme). Avoidance is also assessed on a
five point Likert scale ranging from 0 (never – 0%) to 4 (always – 100%). The second
part assessed the physiological response to social situations based on four symptoms one
might experience. Arousal is also scored on a five point Likert scale, ranging from 0
(none) to 4 (extreme). The BSPS has been shown to have a high internal consistency of
.81, with Cronbach’s alphas for the subscales being: .60 (arousal), .70 (fear), and .78
(avoidance). Test-retest has been shown to be as high as .91 (Orsillo, 2001).
Results
13
First, participants were divided into two groups using their scores from the social
anxiety measures; one group included those with high levels of social anxiety, and the
other group included the low levels of social anxiety. In order to divide the participants
into these groups, the scores from each of the measures of social anxiety were
standardized. Then, each individual’s scores on the measures were added together to
create one social anxiety score. Finally, a median split was performed on the
participant’s scores, and the final result was a division of the participants into high and
low social anxiety. Next, participants’ scores on the DSQ-40 were coded into which
group of defense mechanisms described them best: immature, neurotic, or mature.
Defense mechanisms and social anxiety became the independent variables for further
analyses. These variables were compared with two dependant variables: alcohol abuse
and binge drinking. Scores from the MAST were used as a continuous variable of
alcohol abuse, and these scores were also used to divide individuals into the categories of
non-alcoholic, borderline alcoholic, and alcoholic. Finally, individuals were divided into
the categories of binge-drinker and non-binge-drinker based on their responses to alcohol
use questions. The division of participants into these categories is summarized in Table
4:
Table 4 – Categorical Variables
Category
MAST
Defense Mechanisms
Social Anxiety
Binge Drinking
N
%
Non-alcoholic
22
7.8
Borderline Alcoholic
34
12.1
Alcoholic
226
80.1
Immature
17
6.0
Neurotic
59
20.9
Mature
206
73.0
Low
142
50.4
High
140
49.6
Non-Binge Drinker
122
43.3
Binge Drinker
160
56.7
First, a two-way ANOVA was completed to look at the relationship between
alcoholism, as measured by the MAST, and social anxiety and defense mechanisms. The
ANOVA was 2(social anxiety: high, low) X 3 (defense mechanisms: immature, neurotic,
mature). The median split of social anxiety approached significance, F(1, 276) = 2.795, p
14
= .096, with individuals who are lower in social anxiety scoring higher on the MAST
(though the means of both high and low social anxiety were in the alcoholic range). The
interaction of social anxiety and defense was also marginally significant, F(2, 276) =
2.448, p = .088. Follow-up simple effects tests show that individuals who employ
immature defense mechanisms, and are low in social anxiety score significantly higher on
the MAST than those who employ immature defense mechanism and are high in social
anxiety, F(1, 276) = 4.869, p = .028. No differences were found for individuals
employing mature defenses, F(1, 276) = .016, p = .901, of for individuals who employ
neurotic defenses, F(1, 276) = .103, p = .749 Defense mechanisms alone were not
significant, F(2, 276) = 1.866, p = .157.
The relationship between the independent variables was examined further in
relation to binge drinking. A binomial logistic regression was performed, and the overall
model was significant, Wald χ2 = (2, N=282) = 8.349, p = .015, though social anxiety
accounted for more of the ability to predict the probability of being a binge drinker, Wald
χ2 = (1, N=282) = 6.867, p = .009, than did the defense mechanisms, which did not add
significantly to the model, Wald χ2 = (1, N=282) = .762, p = .383.
Additional Chi Square analyses were performed to determine the individual
relationships between defense mechanisms and binge drinking, social anxiety and binge
drinking, defense mechanisms and alcoholism, and social anxiety and alcoholism. In
these analyses, alcoholism was treated as a categorical variable, where the score on the
MAST divided individuals into three groups: non-alcoholic, borderline alcoholic, and
alcoholic. Defense mechanisms were significantly related to binge drinking, χ2 = (2,
N=282) = 6.402, p = .041. Individuals using immature and mature defense mechanisms
were both more likely to be binge drinkers. Neurotic defense users were the only
individuals who were unlikely to be binge drinkers. Social anxiety was also significantly
related to binge drinking, χ2 = (1, N=286) = 8.201, p = .004. High social anxiety was
overrepresented among non-binge drinkers, and low social anxiety was overrepresented
among binge drinkers. Though defense mechanisms were related to binge drinking when
examined alone, there is no individual variance offered by defense mechanisms that isn’t
encompassed by the measures of social anxiety, as can be seen in the results of the
binomial logistic regression. Defense mechanisms were not related to alcoholism, χ2 =
15
(4, N=282) = 2.728, p = .604, nor was social anxiety related to alcoholism, χ2 = (2,
N=282) = .797, p = .671, when each was measured alone. This is consistent with the
observation that only marginally significant results were obtained in the two-way
ANOVA.
Gender differences were analyzed with respect to each variable: binge drinking,
alcoholism, defense mechanisms, and social anxiety. Among binge drinkers, there was a
significant sex difference, χ2 = (1, N=283) = 9.210, p = .002. Men were overrepresented
as binge drinkers, and women were underrepresented. These number and percentage of
participants of each gender that fell into each category are summarized in table 5 below.
Table 5 – Binge Drinking and Gender
Gender
Non-Binge Drinker
Binge Drinker
N
% of Gender
% of Sample
N
% of Gender
% of Sample
Male
33
31.7
11.7
71
68.3
25.1
Female
90
50.3
31.8
89
49.7
31.4
Gender was not significantly related, though, to classification of alcoholism as
measured by the MAST, χ2 = (2, N=283) = 4.227, p = .121. Gender was also not
significantly related to any differences in use of defense mechanisms, χ2 = (2, N=279) =
1.093, p = .579, or social anxiety scores, χ2 = (1, N=286) = .886, p = .347.
Whether a person was considered alcoholic, borderline alcoholic, or non-alcoholic
was significantly related to their status as either a non-binge drinker or a binge drinker, χ2
= (2, N=286) = 23.717, p = .000. Non-binge drinkers were more likely to be considered
non-alcoholic, or borderline alcoholic. Binge drinkers were likely to be coded as
alcoholic.
Defense mechanisms were related to level of social anxiety, χ2 = (2, N=282) =
9.869, p = .007. Mature defenses were overrepresented in individuals low in social
anxiety; neurotic defenses were overrepresented in individuals with high social anxiety;
immature defenses were near expected counts. This provides further validation for the
DSQ-40.
Means and standard deviations for each measure used are provided in Table 6. It
is interesting that the mean score for the MAST was in the range that would be labeled
“alcoholic.” Scores on the DSQ corresponded closely with scores reported in a previous
16
study using a college student populations (Watson, 2002). Scores on all measures of
social anxiety were near what would be expected from previous research as well, with the
exception of the mean SADS score (Orsillo, 2001). Additional analysis was completed to
determine whether or not the final scores on the measures of social anxiety were
correlated with each other. All were correlated with p = .000. The correlation matrix is
provided in Table 7.
Table 6 – Means and Standard Deviations of Individual Measures
Measure
Mean
SD
MAST
8.44
6.261
DSQ - Mature
5.70
13.405
DSQ - Neurotic
4.84
1.07
DSQ - Immature
4.10
0.91
FNE
14.70
8
SADS
6.29
6.15
LSAS
37.41
21.23
LSAS Fear
19.62
11.37
LSAS Avoidance
17.76
10.86
BSPS
19.93
10.837
BSPS Fear
8.49
4.72
BSPS Avoidance
8.07
4.49
BSPS Physiological
3.49
3.27
Table 7 – Correlation Matrix of Final Scores on Measures of Social Anxiety
FNE
FNE
SADS
LSAS
BSPS
.414
.507
.536
.514
.599
SADS
.414
LSAS
.507
.514
BSPS
.536
.599
.799
.799
All correlations are significant at the .000 level (2-tailed).
Discussion
As hypothesized, social anxiety and defense mechanisms predicted binge
drinking. Contrary to hypotheses, though, individuals who were high in social anxiety,
and employed immature defense mechanisms were not more likely to binge drink.
Instead, individuals considered low in social anxiety, who used mature and immature
defense mechanisms were more likely to binge drink. With marginally significant results,
17
individuals considered low in social anxiety, and who used immature defense
mechanisms were more likely to score higher on a measure of alcoholism. It was
hypothesized that individuals high in social anxiety would be more likely to binge drink
or be considered alcoholic. According to the literature review, this would be expected,
but the current study had different results. There are possible explanations as to why the
results from this particular study would be discrepant from what would be expected based
on the literature.
The culture of a college campus often permits, and even promotes, binge drinking
and other forms of alcohol abuse (Hartzler & Fromme, 2003; Turner et al., 2000;
Wechsler et al., 1995; Wolburg & Treise, 2004). Individuals low in social anxiety may
be more likely to take part in such group activities that would lead to situations where
alcohol use is common, as opposed to individuals high in social anxiety, who may keep
to themselves more while at college. The individuals high in social anxiety may be less
likely to join such activities or groups that would lead to drinking behavior. Further
studies need to be done to determine whether individuals who are high in social anxiety
are more or less likely to join in activities and/or groups on campus where they may be
led to drink.
The results of the current study did not support the self-medication (McKeehan &
Martin, 2002) or the tension-reduction (Hartman, 1986) theories of alcohol abuse. If
those theories were to have been supported, it would have been expected that individuals
high in social anxiety would be more likely to abuse alcohol. Since the current study
found that, in a college population, individuals low in social anxiety were more likely to
abuse alcohol and/or binge drink, it is unlikely that the drinking was caused by an
underlying desire to reduce anxiety.
The hypothesis that there would be no use of mature defenses in individuals with
social anxiety who are abusing alcohol was not supported. For individuals who binge
drink, it was likely that they could employ mature or immature defenses. In those who
scored highly on the alcoholism measure, all levels of defense mechanisms were
represented, though immature defense mechanisms were represented to a greater degree.
The only gender difference that was found was in regard to binge drinking, where
men were found to be more likely to binge drink whereas women were not at a higher
18
risk for binge drinking than expected. This is consistent with the literature, though the
lack of support for gender differences in alcoholism was inconsistent with the literature
(Hartzler & Fromme, 2003; Wechsler et al., 1995). No gender differences in use of
defense mechanisms was found, which is not surprising since only slight differences have
been found in the past (Watson & Sinha, 1998). There was also no gender difference
with respect to level of social anxiety, which was inconsistent with past research findings
that indicate that women are as much as twice as likely than men to have social anxiety
(Lepine & Pelissolo, 2000; Lydiard, 2001).
The current study sheds much light on the topic of college binge drinking, and
factors that may affect it. Unfortunately, little could be discovered with regards to
college alcoholism using the current study. It is interesting that a person’s categorization
into non-alcoholic, borderline alcoholic or alcoholic was related to their status as a bingedrinker or non-binge drinker, but many tests that were significant for binge drinking were
not significant for MAST categorization. Even though there is a relationship between the
two factors, it is useful to look at them separately, and they should not be assumed to be
synonymous. In a study by Epstein, et al., (1995), different classification systems of
alcoholism were examined. It seems that while all binge drinkers may be considered
alcoholics, not all alcoholics are binge drinkers. There are many other classifications of
alcoholism beyond that of binge drinking, including: episodic, sporadic, and steady.
There is much debate over the operational definitions of these terms, but there seems to
be little debate that there are multiple ways to classify an alcoholic. It might be useful to
complete further studies which examine the many drinking patterns that may be present
on a college campus.
Limitations
The results of this steady, specifically with respect to the fact that low social
anxiety appeared to put individuals at a higher risk of binge drinking and alcohol abuse,
are counter-intuitive when compared to previous research results. These results could be
due to measurement error. It is possible that using a median split to categorize
individuals into high or low social anxiety was too conservative, and did not accurately
portray the variability in social anxiety scores. The results in the correlational analysis of
the measures of social anxiety add some validity to the scores, though. The fact that the
19
measures all correlated with one another at the .000 level indicates that they are accessing
similar constructs. It may be useful, in the future, to create a new measure of social
anxiety that encompasses the different aspects of each of these measures.
It is troubling that the mean scores of the FNE and SADS were not as closely
related as expected. These measures have been co-normed (Orsillo, 2001), and there
should not be as large of a discrepancy between the means of each measure as this study
found. It is likely that this is due to the fact that individuals in this sample may have
more feelings of social anxiety, which would be measured by the FNE, but they may
exhibit fewer behaviors related to these feelings of social anxiety, causing the
discrepancy. The low scores on the SADS are likely to have had an impact on the overall
standardized social anxiety score, and it will likely be beneficial to look at each measure
separately in future analysis.
An additional limitation in the study may relate to the difference between actually
having a diagnosable disorder, or having characteristics that relate to that disorder. Much
of the literature that was examined was based on research done on clinical populations of
individuals with social anxiety, and may not relate to a non-clinical population. Also,
much of the research done relating social anxiety to alcohol use was done using
populations of individuals with the comorbid diagnosis of social anxiety disorder and
alcoholism. Again, the findings from this population may not be generalizable to a
college population, or to individuals who do not have a clinical diagnosis.
A final limitation is considered in relation to the use of categorical variables,
especially in relation to the median split of social anxiety, and categories of alcohol abuse
as measured by the MAST. The results of the logistic regression had marginally
significant results when looking at the main effect of social anxiety on MAST score,
using the MAST score as a continuous variable. An additional chi square analysis was
performed to examine the relationship between social anxiety and MAST category, and
this analysis was not significant. This is likely due to the fact that the categorical variable
is not as accurate of a reflection of the variability within the subjects as is the continuous
variable. There is a great deal of variability in MAST scores within the alcoholic range
alone that is lost when all people in that range are grouped into one single category. The
same problem arises with respect to performing a median split on the social anxiety
20
scores. It may have been more useful to use each individual measure as a continuous
variable that could be examined separately, instead of using all the measures to form a
standardized score, which was divided into high and low social anxiety. It is likely that
people labeled as high in social anxiety may have actually scored within the normal range
on the individual measures, but were placed in the high category simply due to the
procedure of performing a median split. It may be beneficial to perform future analyses
using a quartile split, or to perform analyses using the individual measures and the cut off
scores that they recommend.
21
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