Introduction 1986 1987 2000 1999 The possible influence of repression on disease development, health behavior and symptom reporting has been investigated in many studies. Summarizing the findings proves problematic, however, as authors use different labels for ‘repression-like’ concepts, such as repression, suppression, non-expression of negative emotions, emotional control, emotional inhibition, rationality, anti-emotionality, type C response style, defensiveness, restraint, concealment, type D personality, denial, alexithymia and blunting. It is unclear whether this array of terms actually refers to the same concept or altogether different concepts. For instance, is forgetting details of traumatic events (e.g., sexual abuse or war experiences) comparable to not wanting to show one’s emotions because of one’s preference to rationalize? Is the tendency to minimize one’s problems and to emphasize the positive aspects of experiences comparable to non-expression of negative emotions because one is afraid of personal confrontation? And yet in all these instances, the term repression is used. 2000 1999 2000 1979 1 Fig. 1 A conceptual diagram indicating which concepts fall under the headings of repression and anxious defensiveness, respectively, and which concepts are sometimes associated with, but theoretically different from defensiveness (voluntary suppression, repressed memories, denial and alexithymia)  Repression Repression is the general term that is used to describe the tendency to inhibit the experience and the expression of negative feelings or unpleasant cognitions in order to prevent one’s positive self-image from being threatened. A typical example of a person with repressive tendencies would be a sociable and cheerful man who rarely complains about any misfortune including disease, and whose self-image is one of a positive-minded person who is in control of his life. When he encounters someone who discusses an emotional problem, he is inclined to quickly change the subject in an attempt to avoid entering a world of anxiety, sadness or worry, which would imply that he has lost control. 2003 1992 1996 1987 2003 1979 1990 1990 Defensiveness 1990 1 1979 2 1990 Defensiveness, therefore, covers a broader category than repression. Defensiveness concerns different strategies to protect oneself against being hurt psychologically. One strategy is to behave—more or less anxiously—in a socially acceptable way, to be nice in order not to get hurt, and to avoid social confrontations. Another strategy is to inhibit thoughts about negative aspects of oneself, and to consider oneself as the social person one would rather be. The first condition, anxious defensiveness, includes the awareness of negative emotions, whereas the second condition, repression, denies these emotions. Weinberger’s division into two forms of defensiveness is highly useful. If high levels of anxiety or other forms of distress are implied in the definition of a repression-like concept, one should place this concept under the heading of anxious defensiveness, rather than under the heading repression. On an empirical level, a low level of distress reporting in repression would be expected (negative relationship between repression and distress), and a relatively high level in anxious defensiveness (positive relation). (Un)consciousness 1992 2001 1992 1979 1992 1992 1992 1996 1993 2001 1946 If any distinction is made between suppression and repression, the focus is usually placed on processes, i.e. on time-limited cognitive acts. The distinction between conscious and unconscious forms of inhibition does seem possible and it is perhaps useful when applying it to acts, but this distinction is more difficult to apply to traits. The discussion below is about repression as a trait (‘repressiveness’). One may on occasion be aware of one’s tendency to inhibit the experience and expression of negative feelings, but most of the time be vaguely aware, and more often totally unaware of them. 1987 Self-deception and Other-deception 1984 2002 1986 2003 1987 2003 1999 2002 1999 1992 1984 2002 2004 2004 1999 1992 1 Different Aspects of Repression 1990 1983 1988 2001 1983 Concepts Different from Repression Concepts that are in our view different from repression are: the act of emotional suppression, repressed memories, habitual suppression, concealment, type C coping pattern, type D personality, denial, alexithymia and blunting. The first concept refers to an ‘act,’ whereas repression is discussed in this paper as a tendency or coping style. Four of these concepts—habitual suppression, concealment, type C coping style and type D personality should, in our view, be interpreted as types of anxious defensiveness rather than forms of repression. Our motive for discussing these ‘non-repression’ concepts is that the literature may suggest that these concepts are related to repression. The Act of Voluntary Suppression of Emotionally Charged Material disclosure 1998 1988 1990 1992 1992 1993 expression non-expression 1993 2001 1993 Repressed Memories Repressing memories of traumatic events concerns a complex of cognitions and emotions that is mainly limited to a certain theme or event, such as sexual abuse in childhood. This is different from repression, which concerns the tendency not to express negative emotions in general. Repression of memories is initiated by traumatic events, whereas repression is a habitual style applied in a variety of situations. Although repressing memories of traumatic events could lead to an habitual style of repression, or magnify an existing tendency to repression that does not undo the conceptual difference. 1993 2001 Habitual Suppression 2004 2004 2003 2004 2000 Self-concealment 1990 1990 1990 How is this concept related to repression? There are three gradual differences with repression: (1) Self-concealment concerns specific distressing secrets, whereas repression concerns negative feelings in general, although it should be said that there is a rather thin line between these two elements; (2) Self-concealment is explicitly a tendency towards voluntary and conscious inhibition, whereas repression is conceptualized as incorporating both unconscious and conscious coping strategies; (3) Self-concealment implies the awareness of distressing thought contents, whereas repression implies the inhibition to become fully aware of such thought contents. Especially this last aspect implies that self-concealment could be better placed under the heading anxious defensiveness, rather than repression. 1990 1992 1992 1993 1997 2002 1990 1992 1992 1996 1996 1990 Type C Coping Style 1980 1984 1987 1990 Type D Personality 1997 2005 Denial 2007 1998 1979 1999 2000 2000 1987 2000 1979 1989 1990 1999 2000 Alexithymia 1976 1997 1997 1976 1967 1997 1992 1994 1995 1996 1997 1996 positively 1997 1998 negatively Based on psychometric comparisons, alexithymia shows some correspondence to the sensitizing style of high-anxious persons, rather than the avoidant style of repressors. Repressive individuals often report that they are not upset despite objective evidence to the contrary, whereas alexithymic individuals acknowledge that they are upset, but have difficulty in specifying the nature of their distress. Blunting 1987 Discussion The way in which most people use the term ‘repression’ in an everyday context indicates that they generally understand what it actually refers to. Whether science was right to introduce the current assortment of subtle differences thus exposing the gross simplicity of society’s everyday use of the term, or whether science has ultimately entangled the term in a maze of unclear terminology is debatable. It is undebatable, however, that there is a lack of consensus about what repression is. The impression is that the many terms used in this field—repression, suppression, non-expression of negative emotions, emotional control, emotional inhibition, rationality, anti-emotionality, defensiveness and restraint—denote something similar to repression, but there is no certainty whether they can be considered synonymous, indicate a subtle variation of repression, or indicate an associated, but essentially different concept. One reason for this confusion is that definitions are rarely given, and that hardly ever is indicated how a new term relates to regularly used terms. Repression has been defined as the tendency to inhibit—consciously or unconsciously—the experience and expression of negative emotions or unpleasant cognitions in order to prevent one’s positive self-image from being threatened. The term is used to describe an act, such as avoiding a specific memory, or a tendency or coping style (‘repressive coping style’). This paper deals with repression as a tendency or coping style. Terms whose definitions appear to agree with the definition of repression, which can therefore be considered synonyms of repression, are: non-expression of negative emotions, emotional inhibition, emotional control, anti-emotionality, rationality and self-restraint. Although these terms may all be subsumed under the heading repression, their definitions also suggest some differences concerning the motives for repression. 1 1990 1988 2001 By definition, repression implies (some degree of) self-deception, whereas repression may or may not include other-deception. Self-deception implies honestly believing one’s positive self-report. The overlap with repression is evident, given that “the inhibition of the experience of negative emotions or unpleasant cognitions in order to prevent one’s positive self-image from being threatened” implies self-deception. Other-deception is described as deliberately avoiding expression of negative emotions as part of the tendency to make a favorable impression on other people. Other-deception without self-deception, therefore, seems to be incoherent with the definition of repression. 1990 1990 We have also indicated which concepts, although sometimes associated with repression, are basically different from repression: voluntary suppression, repressed memories, habitual suppression, self-concealment, type C coping pattern, type D personality, denial, alexithymia and blunting. The first concept concerns an ‘act,’ whereas we have discussed repression as a tendency or coping style. Four of these concepts were placed under the heading anxious defensiveness, because their definitions imply experiencing high levels of negative emotions: Habitual suppression, self-concealment, type C coping style and type D personality. Our conceptual analysis has motivated us to propose the following recommendations for future research: (1) In studies on the character and the consequences of repression one should ideally include measures of personally related and socially related repression, and—as a contrast—a measure of anxious defensiveness. (2) An acute distinction should be made when summarizing literature findings between repression and concepts that are related to, but essentially different from repression (3) Future research will need to show whether relationships between questionnaires substantiate the similarities and differences between the concepts described in this paper. Our objective with this treatise on defensiveness-related concepts is to provide more clarity in this field. The next step in finding our way in the current maze of repression points to a review on defensiveness-related questionnaires.