The Relationship Between Repressive Defensiveness and Physical Health Outcomes: Implications for Causality
The concept of repressive defensiveness (RD) has an extensive history in clinical and personality research (Bonanno, Davis, Singer & Schwartz, 1991). RD is the tendency to avoid negative emotions (Denollet, Martens, Nykĺıcˇek, Conraads & de Gelder, 2008). Repressors are characterised by their elevated levels of physiological and behavioural indicators of anxiety and low self-reported anxiety in stressful situations (Weinberger, Schwartz & Davidson 1979). They have limited self-awareness and an avoidant style of information processing, particularly in relation to negatively toned affective material (Bonanno et al., 1991). Furthermore, an increasing body of evidence suggests that although RD protects repressors against psychiatric disorders, they are at risk for serious health-related problems such as cancer, cardiovascular disease (CAD), asthma and much more (Myers, 2010).
Therefore, this paper aims to discuss existing evidence on RD leading to physical health outcomes. However, it is important to note that even if the relationship between RD and physical health outcomes is statistically significant, due to the correlational nature of most of the studies, no conclusion can be made about the direction of the relationship. Consequently, implications for causality exist. In light of this, this paper will further look at evidence that suggest physical health outcomes leads to RD. Finally, this paper will demonstrate that third variables such as substance abuse and personal control exist in the relationship between RD and physical health outcomes. Examining third variables might answer the question why not all repressors result in adverse physical health outcomes.
Firstly, research indicates that RD, in the short term, may be adaptive when people are faced with intensively stressful situations because it allows them function on a day-to-day basis and to adjust to a reality that they cannot control. This potentially enhances mental health (Gill, 2005). For example, a study conducted by Phipps, Steele, Hall and Leigh (2001) suggests that despite the considerable burden and numerous stressors associated with the experience of childhood cancer, the self-reports of children with cancer tend to reflect very positive mental states with low levels of affective distress, often significantly lower than those of healthy comparison groups.
However, in the long term, research on repressive cancer and CAD patients suggests that they are at a greater risk of death from cancer and CAD (Myers, 2010). In asthma patients, repressors had a significantly lower and impaired lung function (Cooke, Myers & Derakshan, 2003). The inhibiting, avoidant information processing style that characterises repressors might impair their ability to comply with medicine, seek important information about their health and implement necessary changes recommended by their doctor. Therefore, despite the large body of evidence which suggests that RD leads to adverse physical health outcomes, as mentioned earlier, most of these studies are only correlational. Causal conclusions about the direction of the relationship cannot be made. Furthermore, third variables that may potentially exist in this relationship is not identified and examined.
Contrary to the cross-sectional studies mentioned previously, Phipps et al. (2001) conducted a longitudinal study with children cancer patients in order to examine whether RD was premorbid or reactive. That is, whether the patient was a repressor before the onset of cancer or after the diagnosis of cancer. The results indicate that children with newly diagnosed cancer would show greater defensiveness and higher levels of repressive adaptation than would healthy children. This was stable over time within the cancer group. However, a limitation of this study is that although the study consisted of newly diagnosed...
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