**4. Psychodynamics and quality of life**

What kind of relationship is there between Psychodynamics and Quality of Life? Considering that perceptions and relationships are core elements of the concept of QoL, one might assume that ego defense mechanisms and object relations are associated with a person's quality of life. Vaillant [10] states that ego defense mechanisms can change an individual's perception of both internal and external realities, which can compromise QoL, which, according to the WHO, is the individual's perception of their position in life [1]. Similarly, Bell points out that the standard profile of object relations (an indicator of psychological maturity) reveals the ability to sustain healthy relationships. At the same time, the pathological one indicates a failure of this capacity [26].

Both psychodynamic concepts (E.D.M. and OR) are interconnected, although they are different.

E.D.Ms are characterized by trying to avoid (or reduce) the psychic discomfort caused by anxiety, while OR are how the subject relates to their world.

Defense mechanisms mediate the individual's reaction to emotional conflicts and external stressors [13]. To American Psychiatric Association, E.D.M. is an automatic psychological process that protects individuals from anxiety and awareness of internal or external stressors or dangers. In other words, E.D.M. mediates how individuals relate to internal and external objects (OR).

Both concepts are indicators of psychological maturity. E.D.Ms range from the most immature (splitting) to the most mature (sublimation) [17], and OR are within a spectrum that begins with pathological relations and ends with normal relations [26].

Since pathological relations occur through immature ego mechanisms (in an adult) and healthy relations occur through mature mechanisms, the parallelism between such concepts becomes apparent, even though one cannot speak of a complete theoretical equivalence between them. Again, both formulations are indicators of psychological maturity.

What is the relation between psychological maturity and quality of life? Psychological maturity is directly proportional to the quality of life.

A study in Brazil demonstrated this conclusion.

The first hypothesis was a relationship between the physician's QoL and their monthly income, working hours, and workplace. The authors designed a cross-sectional survey to test this hypothesis. They also investigated a relationship between a physician's QoL

(Whoqol-bref) and their psychodynamics (DSQ-40 and BORRTI Form O) (**Figure 1**). The authors concluded there were:


#### **Figure 1.**

*Diagram representing the relationship between the independent and dependent variables.*

#### **Figure 2.**

*Comparison of quality of life scores, assessed by the Whoqol-Bref, between participants with normal and pathological object relations profiles.*

#### **Figure 3.**

*Relationship between mature factor scores (DSQ-40) and quality of life scores (psychological health) (A) and Relationship between immature factor scores (DSQ-40) and quality of life scores (psychological health) (B).*

Another study in Germany demonstrated the same conclusion.

The authors intended to demonstrate long-term psychodynamic psychotherapy's effectiveness in treating children and adolescents with different psychiatric disorders.

They compared two groups of patients (treatment and control) and evaluated the level of symptoms and quality of life before and after treatment.

The authors concluded:


It is possible to say that "solving inner conflicts" means changing from pathological object relations to normal ones. Or even to change from immature defense mechanisms to mature ones. Or it is even getting more considerable psychological maturity.

In conclusion, improving the quality of life is related to enhancing the psychodynamics of the patients.

Another study carried out in the U.S.A. showed similar results.

The objective was to explore whether object relations (OR) functioning improves throughout psychodynamic psychotherapy and whether this improvement is related to decreased symptoms.

After psychodynamic therapy, the authors concluded that:

1.The overall functioning of object relations, including interpersonal relationships, significantly improved with a large effect size.

Although this study does not mention the quality of life, it showed that psychodynamic psychotherapy improves the object relations profile.

Since the previous study showed that normal object relations are associated with better quality of life, one might think the same thing occurred with these patients [29].

Another Brazilian study assessed chronic obstructive pulmonary disorder patients' defensive profiles and compared them with healthy participants to test whether specific ego defense mechanisms are associated with health-related quality of life and self-reported dyspnea severity.

The researchers point out two topics:


Once again, the relationship between psychological maturity and quality of life is present.

A Canadian study evaluates whether disturbed relatedness accounts for the negative association between narcissistic pathology and quality of life.

The results showed that:


Quality of life is related to the quality of object relations. In other words, quality of life is related to psychological maturity.

A Brazilian naturalistic study evaluated psychodynamic and neurobiological factors in psychoanalytic psychotherapy.

The author studied the relationship between the pattern of object relations, defensive style, and quality of life.

The results demonstrated:

1.An association between mature ego defenses and healthy object relations.

2.An association between pathological object relations and low quality of life [32].

Once again, quality of life is associated with psychological maturity.
