Defense Mechanisms in Immune-Mediated Diseases: A Cross-Sectional Study Focusing on Severe Allergic Asthma and Hymenoptera Venom Anaphylaxis Patients

Gabriella Martino¹Mariagrazia Di Giuseppe^2*Orlando Silvestro³Carmelo Mario Vicario⁴Concetto Mario Giorgianni⁵Paolo Ruggeri¹Giorgio Sparacino⁶Maria Rosaria Juli³Peter Schwarz⁷Vittorio Lingiardi⁸Gianluca Lo Coco⁹Sebastiano Gangemi¹Luisa Ricciardi¹

• ¹Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
• ²Department of History, Humanities, and Society, University of Rome Tor vergata, Rome, Italy
• ³Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Calabria, Italy
• ⁴Department of Cognitive Sciences, Psychological, Educational and Cultural Studies, University of Messina, Messina, Italy
• ⁵Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
• ⁶Course Degree in Medicine and Surgery, University of Messina, Messina, Italy
• ⁷Department of Endocrinology, Centre for Cancer and Organ Diseases, Copenhagen University, Copenhagen, Denmark
• ⁸Department of Dynamic, Clinical Psychology and Health, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Lazio, Italy
• ⁹Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Sicily, Italy

Background: Chronic immune-mediated diseases, such as Severe Allergic Asthma (SAA) and Hymenoptera Venom Anaphylaxis (HVA), significantly impact quality of life. Defense mechanisms, as implicit emotion-regulation strategies, shape an individual's adaptation to chronic stressors. This cross-sectional study explored the relationship among defensive functioning, psychological symptoms, and perceived physical and mental health in patients with SAA and HVA.To explore the role of defensive functioning in perceived physical and mental health 34 patients with SAA and 32 with HVA were assessed with the Short-Form Health Survey, the Beck Depression Inventory, the Hamilton Anxiety Rating Scale, the Toronto Alexithymia Scale, and the Defense Mechanisms Rating Scales Self Report-30; between-group differences, and mediation analyses were performed. Results: Defensive functioning was positively associated with mental health and negatively related to depressive symptoms, anxiety and alexithymia. Males reported significantly higher physical and psychological health than females. Patients with SAA exhibited significantly higher defensive functioning but worse physical health than HVA patients. Mediation analysis revealed that defensive functioning correlated with disease type and physical health, accounting for 39% of the explained variances. Moreover, defensive functioning independently predicted mental health.This study highlights the influence of implicit emotional regulation on psychophysiological well-being in patients with chronic immune-mediated disorders. Despite reporting lower perceived physical health, patients with SAA exhibited higher defensive functioning, suggesting that chronic conditions may shape distinct psychological adaptation processes. These findings support the importance of defence mechanisms assessment to tailor psychological interventions promoting well-being in patients with chronic diseases.