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, Nykl? c? ek, 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 he 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 cancer patients, the first questionnaire was completed after the diagnosis of cancer. This does not answer the research question properly because whether the patients were repressors prior to diagnosis or not is still not known. A study conducted by Zachariae, Jensen, Pedersen, Jorgensen, Christensen, Lassesen and Lehbrink (2004), aimed to examine the same research question in Phipps et al. (2001)’s study.
Zachariae et al. (2004) measured RD before the diagnosis of breast cancer, 4 weeks after and 12 weeks after diagnosis. The results suggest that before diagnosis, women with breast cancer did not differ from women without cancer in RD as well as in the two components of the repression construct: defensiveness and trait anxiety. Four weeks after the examination, when the women were aware whether they had breast cancer or not, a significantly greater proportion of women with breast cancer were classified as repressive, compared to women without cancer.
Contrary to the studies suggesting that RD leads to adverse physical health outcomes, the study conducted by Zachariae et al. (2004) suggests that after the diagnosis of a health related problem, people can adopt a repressive defensive style. This again emphasises the fact that even if the relationship between RD and physical health is statistically significant, conclusions on the direction of the relationship should be made with care. Causality cannot be inferred from most of the correlational studies, therefore third variables such as social factors might moderate the relationship between RD and physical health outcomes.
A study conducted by Shirachi and Spirrison (2006), examined the relationship between substance abuse in college students and RD. Approximately 20% of alcohol dependents were repressors. Repressive alcohol dependents believed that they were less likely to be harmed by their own drinking than were non-repressive alcohol dependents, despite the fact that both groups engaged in problematic drinking behaviors. Thus, repressors are self-deceivers and usually in denial of negative health consequences.
These findings indicate that because repressors are in denial or unaware of the consequences of problematic drinking, not only are they at risk of adverse physical health outcomes such as high blood pressure and liver cancer, but also impaired in the ability to know that they are at risk in the first place. Therefore, third variables such as substance abuse moderate the relationship between RD and physical health outcomes. This also potentially explains why not all repressors have adverse health outcomes.
Also, preliminary studies indicate that repressors are better in situations when there is personal control. Repressors reported better self-care behaviour for dental hygiene but worse health-care behaviour when a dentist was perceived to be in control (Myers, 2010). Also, repressors with diabetes reported good metabolic control than non-repressors. This suggests that a third variable, personal control, might mediate the relationship between RD and physical health outcomes.
Furthermore, breast cancer patients who believed that they could exert control over their illness showed better short-term and long-term adjustment than did patients who did not hold those beliefs (Taylor, Lichtman & Wood, 1984). Those who believe that their health is controlled by chance are likely to experience increased anxiety and uncertainty about what will eventually happen to them. Also, expectations that compliance with medication will produce beneficial results should also have functional value for the patient, especially during the short-term adjustment period (Marks, Richardson, Graham & Levine, 1986).
Thus, if one believes they have control over their illness, they might be more likely to comply with medicine and seek help when necessary. However, those who believe that they do not have control over their situation might decide to not comply with the recommendations set by their doctor because they believe external expectancies (e. g. chance, fate) are in control of their illness. Serious illnesses such as cancer have high reoccurrence and mortality rates whereas less serious illnesses can usually be cured completely.
This might be the reason why repressors who have been diagnosed with a serious illness than a less serious illness are more likely to have adverse health outcomes as a result of adapting a repressive defensive style. In conclusion, research indicates that there are short term and long term effects of RD on physical health outcomes. However, most of the studies were correlational so causality cannot be inferred. That is, conclusions on the direction of the relationship between RD and physical health outcomes cannot be made.
As evident in the cancer literature (Zachariae et al. , 2004), it is possible that physical health consequences lead to RD. Furthermore, the relationship between RD and physical health consequences can be moderated by third variables such as substance abuse and personal control. A limitation of this paper is that it only examined a few third variables that might moderate the relationship between RD and physical health consequences. So the question why not all repressors have adverse health outcomes cannot be completely answered.
This is not a limitation that exists in this paper but generally in studies conducted on this area of interest. Therefore, future studies should look at examining other variables that might mediate or moderate the relationship between RD and physical health consequences rather than just identifying a correlational link between those two variables. Nevertheless, understanding the relationship between RD and physical health outcomes is important as it has many implications for treatment and rehabilitation of patients.