Defensive avoidance of disapproval: The relationship of a defensive style to physical and mental health

This article presents an exploration of a clinically meaningful interpersonal style labeled here as defensive avoidance of disapproval (DAD), which involves a motivated inattention to physiological, affective, or cognitive reactions arising from stressful social transactions, thereby safeguarding a self-image of social competence. First, we discuss conceptual antecedents of DAD derived from post-Freudian theories of twentieth-century psychodynamic and interpersonally oriented clinicians. Second, we highlight measurement issues as they relate to DAD. Third, we review research on the association of DAD with psychophysiological stress reactivity and diminished health. Finally, DAD-related clinical implications are considered. Our discussion of DAD invites the (1) assessment of phenomenological "blind spots" regarding the physiological, affective, and cognitive components of disapproval-induced stress, (2) development of strategies to decrease premature therapy termination that may result from a defensive avoidance of social disapproval, and (3) cultivation of interventions to increase the high DAD patient's acknowledgement, rather than rejection, of the signs of social stress.