Impasse de la rivalité maternelle et féminine chez les transsexuelles

Objectives

The projective protocols are due for analysing one type of gender dysphoria, a kind from transsexual females, looking for an anatomical sexual status to prove their one's identity. This psychogenesis feeling comes directly from their maternal imago. The female identity and these derived experiences, through transsexuals, are the fundamentals of this article.

Patients and methods

From five cases submitted to the multi-clinical exams protocol, we can observe three charts from Murray's Thematic Aperception Test (TAT). In chart 5, 7 GF, 9 GF, we can see the saturation level of the latent attraction from the maternal and female identity question. According to a psycho-dynamical clinical conception to intervene on the body, the deadlock in the conflict between the transsexual female and the mother lead to less fantasy. From the TAT results, one could notice a clash to the facts, a difference in perception, an unmarked or avoiding the reality (type C on the analysis rates, originated by Shentoub).

Results

The analysis of the observed individual indicates a shortage of the narrative ability as well as the inter-personal one. It comes to stories overstepping the external reality. The dramatic effect does not exist and the perception fulfils a non-significant internal reality. In that case the perception takes the place of the representation and the affect is therefore plaid down. At the end of the narration, it occurs that the psychodynamic test of personality of the candidates to a sexual reassignment is more important and reinforced.

Conclusion

Some questions are pending due to the non conflictual relationship from the transsexuals to their mothers and about the sexual post-reassignment. Once reconciled with her own look, how should the transsexual female deal with her own mother, and in the future how should her be in love or having sexual relations with other females?     

La jeune fille aux piercings: Revue de la littérature à partir d’un cas de piercings multiples

Background

Body piercing is on the rise in Western societies. Its high prevalence among psychiatric patients draws attention to the relationship between body piercing and psychopathology.

Method

A case study concerning a young patient with multiple body piercing followed by a review of the existing literature concerning the psychopathology of body piercing.

Results

In the case study described, body piercing is symptomatic of the patient's borderline personality disorder (BPD). Current research emphasizes its association with high risk and suicidal behaviours, violence and addictions. However, little data is available on the relationship with specific personality disorders.

Conclusion

The high prevalence of BPD symptoms among pierced populations suggests an association with this disorder. Further research, however, is necessary to confirm this hypothesis. When confronted with multiple piercings, practitioners should investigate associated symptoms and disorders.     

Being bullied in childhood: correlations with borderline personality in adulthood

Objective

This study was designed to explore correlations between a history of being bullied in childhood and borderline personality disorder (BPD) in adulthood, several externalizing behaviors, and mental health care utilization.

Method

Using a cross-sectional consecutive sample of internal medicine outpatients (N = 414), we examined the relationship between history of being bullied in childhood and 2 measures of BPD: the borderline personality scale of the Personality Diagnostic Questionnaire-4 and the Self-Harm Inventory. We also explored whether having ever been bullied was related to a number of externalizing behaviors (eg, rage reactions, road rage, excessive spending, alcohol and substance misuse, binge eating) as well as greater mental health care utilization.

Results

In this study, a history of being bullied in childhood demonstrated statistically significant correlations with both measures of BPD as well as a number of externalizing behaviors and the measures for mental health care utilization.

Conclusions

A history of being bullied in childhood demonstrates a positive correlation with BPD in adulthood, externalizing behaviors, and mental health care utilization. Although this does not necessarily imply causality, the nature of this relationship warrants further investigation.     

Utilization of primary care physicians in borderline personality

Objective

Individuals with borderline personality disorder (BPD) consistently demonstrate high patterns of utilization in both mental health and non-psychiatric settings. However, utilization of primary care physicians by these individuals has not been examined. In this study, we examined physician use patterns and hypothesized that primary care outpatients with BPD features would evidence higher numbers of primary care physicians seen, primary care treatment settings experienced, and specialists seen.

Method

Using a cross-sectional consecutive sample of 389 internal medicine outpatients and a self-report survey methodology, we examined the number of primary care physicians seen, primary care treatment settings experienced, and specialists seen by participants during the past 5 years in relationship to two self-report measures for BPD, the BPD scale of the Personality Diagnostic Questionnaire-4 and the Self-Harm Inventory.

Results

There were statistically significant between-group differences in the number of primary care physicians and specialists seen (not the number of primary care treatment settings) over 5 years, and BPD status according to both measures of BPD, with BPD patients reporting higher rates.

Conclusions

Patients with borderline personality symptomatology appear to see a greater number of primary care physicians and specialists than patients without these Axis II symptoms. These findings may reflect the underlying psychological processes of the disorder as well as a general pattern of over-utilization of healthcare services by these types of patients.     

Acceptabilité et faisabilité de la psychothérapie par les patients avec trouble de personnalité limite

Background

Borderline Personality Disorder (BPD) is a pervasive pattern of instability and impulsivity associated with serious psychosocial limitations and a significant risk of suicide (4-10 %). The prevalence of this disorder is around 1.8 % in the general population. In a public health perspective, the high financial cost arising from this disorder (around 17,000€ per year) requires optimizing their care utilization carefully. This medico-economic aspect converges with clinical observations of instability in the health network; BPD patients meet at least seven psychiatrists. Indeed, psychotherapy is less accessible, particularly in some geographic area.

Objective

Discuss strength and weakness of psychotherapy for BPD in the real world.

Method

Through a non systematic literature review, we present data on the availability and use of health services by people with BPD.

Results

The effectiveness and limitations of psychotherapeutic approaches, considered as the gold-standard therapy, are reviewed. All the psychotherapies assessed by Randomised Control Trials seem to be effective. However, not all the psychotherapies have the same level of evidence for core symptoms of BPD. Furthermore both the length of most of the psychotherapies suggested to these unstable patients and the number of participants (Dialectic Behavioral Therapy and Mentalization Based Treatment) needed to constitute the team for some of them are serious limitations. Moreover, even available, as shown by observational studies, high drop-out in studies they have a limited acceptability for BPD themselves. Some of them have less drop-out (Dialectic Behavioral Therapy) or a better therapeutic alliance (Schema Focused Psychotherapy) than other one. A presentation of alternatives to psychological approaches is proposed, particularly an example of a Quebec multidisciplinary care organization covering the range of service needs of people with BPD.

Conclusions

The heterogeneity of clinical situations grouped in the BPD is confronted with the limits of a dichotomous approach (structured psychotherapy or chaotic utilization of care), manifested by a reduced acceptability of care today. This encourages them to rethink the consistency of the service offer to these severe patients.     

Predictors of nonadherence among individuals with bipolar disorder receiving treatment in a community mental health clinic

Background

Subjective experience of illness is a critical component of treatment adherence in populations with bipolar disorder (BPD). This cross-sectional analysis examined clinical and subjective variables in relation to adherence in 140 individuals with BPD receiving treatment with mood-stabilizing medication.

Methods

Nonadherence was defined as missing 30% or more of medication on the Tablets Routine Questionnaire, a self-reported measure of medication treatment adherence. Adherent and nonadherent groups were compared on measures of attitudes toward illness and treatment including the Attitudes toward Mood Stabilizers Questionnaire, the Insight and Treatment Attitudes Questionnaire, the Rating of Medication Influences, and the Multidimensional Health Locus of Control Scale.

Results

Except for substance abuse comorbidity, adherent individuals (n = 113, 80.7%) did not differ from nonadherent individuals (n = 27, 19.3%) on clinical variables. However, nonadherent individuals had reduced insight into illness, more negative attitudes toward medications, fewer reasons for adherence, and more perceived reasons for nonadherence compared with adherent individuals. The strongest attitudinal predictors for nonadherence were difficulties with medication routines (odds ratio = 2.2) and negative attitudes toward drugs in general (odds ratio = 2.3).

Limitations

Results interpretation is limited by cross-sectional design, self-report methodology, and sample size.

Conclusions

Comorbid substance abuse, negative attitudes toward mood-stabilizing medication, and difficulty managing to take medication in the context of one's daily schedule are primary determinants of medication treatment adherence. A patient-centered collaborative model of care that addresses negative attitudes toward medication and difficulty coping with medication routines may be ideally suited to address individual adherence challenges.     

Hippocampal volume in borderline personality disorder with and without comorbid posttraumatic stress disorder: A meta-analysis

Background

Several studies have found a reduction in hippocampal volume in borderline personality disorder (BPD) patients.

Methods

In order to investigate the degree to which comorbid posttraumatic stress disorder (PTSD) could account for reduction in hippocampal volume in these patients, we conducted a systematic review and meta-analysis of studies that compared hippocampal volume in BPD patients with and without PTSD relative to healthy controls.

Results

Seven articles, involving 124 patients and 147 controls, were included. We found a statistically significant reduction for the left and right hippocampus. Data from the four studies that discriminated BPD patients with and without PTSD indicate that hippocampal volumes were reduced bilaterally in BPD patients with PTSD, relative to healthy controls, but that results were mixed for BPD patients without PTSD, relative to healthy controls.

Conclusions

Results from this meta-analysis suggest that hippocampal volumes are reduced in patients with BPD, relative to healthy controls, but particularly in cases in which patients are diagnosed with comorbid PTSD.     

Tryptophan-hydroxylase 2 haplotype association with borderline personality disorder and aggression in a sample of patients with personality disorders and healthy controls

Background

There is a decreased serotonergic function in impulsive aggression and borderline personality disorder (BPD), and genetic association studies suggest a role of serotonergic genes in impulsive aggression and BPD. Only one study has analyzed the association between the tryptophan-hydroxylase 2 (TPH2) gene and BPD. A TPH2 “risk” haplotype has been described that is associated with anxiety, depression and suicidal behavior.

Methods

We assessed the relationship between the previously identified “risk” haplotype at the TPH2 locus and BPD diagnosis, impulsive aggression, affective lability, and suicidal/parasuicidal behaviors, in a well-characterized clinical sample of 103 healthy controls (HCs) and 251 patients with personality disorders (109 with BPD). A logistic regression including measures of depression, affective lability and aggression scores in predicting “risk” haplotype was conducted.

Results

The prevalence of the “risk” haplotype was significantly higher in patients with BPD compared to HCs. Those with the “risk” haplotype have higher aggression and affect lability scores and more suicidal/parasuicidal behaviors than those without it. In the logistic regression model, affect lability was the only significant predictor and it correctly classified 83.1% of the subjects as “risk” or “non-risk” haplotype carriers.

Conclusions

We found an association between the previously described TPH2 “risk” haplotype and BPD diagnosis, affective lability, suicidal/parasuicidal behavior, and aggression scores.     

Multidimensional assessments of impulsivity in subjects with history of suicidal attempts

Objective

This study aimed to examine whether subjects with history of suicidal attempts had higher impulsivity as measured by neurocognitive tests and self-report questionnaires. The interrelationships among different impulsivity measures were also explored.

Methods

Fifty-four nonpsychotic psychiatric inpatients, including 24 subjects with previous history of suicidal attempts and 30 comparison subjects without previous suicidal attempts, completed the self-report Barratt Impulsiveness Scale-11-Chinese version (BIS-11-CH) and 2 neuropsychologic tests of impulsivity: the immediate memory task/delayed memory task (IMT/DMT) and the single key impulsivity paradigm (SKIP).

Results

The results indicated that subjects with previous suicidal attempts exhibited higher BIS-11-CH factor 2 (lack of self-control/attentional impulsivity) subscore (P = .02) and more commission errors in IMT (P = .03). However, BIS-11-CH scores and performance indices of IMT/DMT and of SKIP did not correlate with each other.

Conclusions

Our findings supported that subjects with previous suicidal attempts had higher impulsivity, which could be revealed by both self-report and neurocognitive measures. However, there is no correlation among self-report, IMT/DMT, and SKIP measures, indicating that they might be measuring different dimensions of impulsivity.     

The relationship between body image disturbance and distress in colorectal cancer patients with and without stomas

Objective

This study aimed to investigate the effect of having a stoma on body image in patients with colorectal cancer and to determine whether disturbances in body image predicted distress.

Methods

A prospective analysis of 79 colorectal cancer patients. Patients were assessed within 9 weeks of surgery and followed up at the end of adjuvant treatment. Body image disturbance, depressive symptoms, anxiety, and general distress were measured at baseline and follow-up.

Results

Patients who received stomas had poorer body image, which worsened over time. Although there were no differences between stoma groups on anxiety or depressive symptoms, those with a late stoma were most depressed. Body image was a strong predictor of initial levels of anxiety, depression, and distress and subsequent anxiety and distress.

Conclusions

These results confirm that stomas negatively impact on the body image of patients with colorectal cancer. Importantly, those whose body image is most disturbed are at risk for experiencing more anxiety and depression. These results underscore the importance of assessing and treating body image disturbance in colorectal patients who receive a stoma.     

Dysfunctional schema modes, childhood trauma and dissociation in borderline personality disorder

Objective

To examine the relationship between dysfunctional schema modes, childhood trauma and dissociation in borderline personality disorder (BPD).

Method

30 BPD patients completed the Wessex Dissociation Scale (WDS), Childhood Trauma Questionnaire (CTQ), General Health Questionnaire (GHQ), and Schema Mode Questionnaire (SMQ).

Results

The ‘Angry and Impulsive Child’ and ‘Abandoned and Abused Child’ modes uniquely predicted dissociation scores. Childhood trauma did not predict dissociation scores.

Conclusions

Findings support the schema mode model of BPD [Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioners guide. London: Guilford Press] and its emphasis on the role of dissociation. Clinically they support the emphasis on the identification and integration of dysfunctional parts of the personality in working with individuals diagnosed with BPD.     

Pregnancy affects appraisal of negative life events

Objective

It has been demonstrated that physiological responses to stress are diminished late in pregnancy. This study investigates whether emotional responding is diminished as well by measuring affective responses to specific life events during pregnancy.

Methods

A total of 292 pregnant women reported the occurrence of and affective responses to a range of major life events during gestation. Two analyses were conducted (across events and within events) on these responses to determine whether life events occurring in the first trimester were rated as more stressful than those that occurred in the third trimester.

Results

Both within-event and across-events analyses of responses to life events demonstrated that events occurring early in pregnancy were perceived as more stressful than events occurring later in pregnancy.

Conclusion

Responses to stress and affective state are progressively altered in pregnant women, suggesting that timing of stress exposure during gestation may be critical in determining its impact.     

The incidence of deep vein thrombosis in women undergoing cesarean delivery

Introduction

Venous thromboembolism (VTE) is one of the leading causes of maternal mortality in the United States. Cesarean delivery is a known risk factor. This study was to determine the incidence of deep vein thrombosis (DVT) post cesarean delivery.

Materials and Methods

This was a prospective cohort study where two patients having undergone cesarean delivery each day were randomly selected. A lower extremity compression ultrasound was performed prior to hospital discharge. If no DVT was detected, participants were asked to return for a second ultrasound two weeks postpartum. Participants were also telephone-interviewed at three months for reported VTE.

Results

Of the 194 patients who consented to study participation, only one participant developed DVT after cesarean delivery, giving an overall incidence of 0.5% (95% CI, 0.1 to 2.8%). There were no DVT identified on the second ultrasound nor VTE reported 3 months postpartum.

Conclusions

We found the DVT rate after cesarean delivery to be 0.5%.     

Headache sufferers' drawings reflect distress, disability and illness perceptions

Objective

Drawings have recently been used with patients with heart problems to assess their perceptions of their illness. This study aimed to investigate whether drawings could be a useful way to assess headache patients' perceptions of their headaches and their reactions.

Methods

In a cross-sectional study, 65 university students who experienced persistent headaches were asked to draw a picture of how their headaches usually affected them. Drawings were assessed in three ways: they were categorized based on content; their size was measured; and image analysis software assessed their darkness. Associations between drawings, illness perceptions, mood, and health outcomes were assessed.

Results

Twenty-seven people drew an external force to the head and these people had greater ratings of average pain and were more likely to attribute their headache to stress. Darker drawings were associated with greater emotional distress and lower vitality. Larger drawing size was associated with perceptions of worse consequences, worse symptoms, worse emotional representations, lower vitality, higher pain, and more days of restricted activity, lower happiness, and higher sadness.

Conclusion

Drawings offer an additional way to assess peoples' experience of their headaches and reflect illness perceptions and distress. People draw how they see themselves experiencing their headache and often include expressions and reactions. The inclusion of force to the head, darker drawings, and larger drawings are associated with worse perceptions of the headache and higher pain. Drawings may be a useful way for clinicians to understand patients' experience of pain.     

Symptom characteristics and psychiatric comorbidity among males with muscle dysmorphia

Objective

Muscle dysmorphia has been described as a disorder in which individuals are pathologically preoccupied with their muscularity. This study was designed to further investigate the symptom characteristics and psychiatric conditions associated with the disorder.

Method

Weight lifting males meeting current criteria for muscle dysmorphia (n = 15), past muscle dysmorphia (n = 8), and no history of muscle dysmorphia (n = 28) responded to advertisements placed in gymnasium and nutrition stores. Structured and semistructured interviews were administered, as well as survey measures.

Results

Relative to controls, males with current muscle dysmorphia experienced more aversive symptoms related to the appearance of their bodies, including more often thinking about their muscularity, dissatisfaction with appearance, appearance checking, bodybuilding dependence, and functional impairment. Higher rates of mood and anxiety disorders were found among individuals with a history of muscle dysmorphia relative to individuals with no history of muscle dysmorphia.

Conclusions

The findings suggest that muscle dysmorphia can be distinguished from normal weight lifting on a number of clinical dimensions. Muscle dysmorphia appears to be comorbid with other psychiatric conditions. Limitations of the current study and directions for future research are considered.     

Development of a computer-based behavioral assessment of checking behavior in obsessive-compulsive disorder

Objective

The goal of the current study was to develop and obtain preliminary psychometric data for a computer-based behavioral measure of compulsive checking behavior in a sample of patients with obsessive-compulsive disorder (OCD).

Method

We examined performance on a novel behavioral measure in 30 patients with OCD and 27 matched healthy controls. In the computerized assessment, participants navigated through two virtual environments (home and office) using a joystick and head-mounted display. The experiment consisted of three phases: training, distraction, and the main task. After the training and distraction phases, participants were instructed to check the virtual environments freely as if they were in their natural environment. Primary dependent variables in the current study included several indices of frequency and duration of checking behaviors. We examined construct validity for the task by comparing the novel behavioral measures with standardized self-report and interviewer-rated measures.

Results

Results indicated that (1) OCD patients demonstrated significantly greater problems with compulsive checking compared to controls, and (2) performance on the task was positively correlated with both self-reported symptoms and interviewer-rated measures associated with OCD.

Conclusions

This study provides preliminary data to support the use of this task as a new possible behavioral measure of compulsive checking behavior in OCD. If we merge the traditional behavioral research with this novel and ecologically valid method, it could improve the assessment of OCD in both clinical and research setting.     

The 5-HTTLPR Polymorphism modulates the association of serious life events (SLE) and impulsivity in patients with Borderline Personality Disorder

Background

Impulsivity belongs to the key features of Borderline Personality Disorder (BPD). It has been linked to altered serotoninergic neurotransmission and, genetically, to an over-representation of the short (S) allele of the serotonin transporter promoter-linked polymorphic region polymorphism (5-HTTLPR). On the other hand, serious life events (SLE) are of major importance in the development of BPD. However, the inter-relations between SLEs, impulsivity, and 5-HTTLPR are not understood.

Method

159 BPD patients from Germany were included in this study. Impulsivity was assessed by the Barratt Impulsiveness Scale (BIS). We analysed (1) the effects of SLEs on impulsivity; and (2) modulating effects of the 5-HTTLPR polymorphism on the effects of SLEs on impulsivity.

Results

Regression analyses confirmed a decreasing effect of childhood sexual abuse, the cumulative SLE-related reactions and the impairment by SLEs on BIS sum score. Regarding BIS sum score, all SLEs except for rape were associated with a decrease of impulsivity in SS/SL carriers and an increase of BIS sum score in LL carriers.

Conclusions

This study analyzing a specific gene x environment interaction in BPD patients suggests an interaction between SLEs and the 5-HTTLPR S/L polymorphism in the development of impulsivity in BPD patients. Clinical and research implications are discussed.     

Racial and ethnic differences in diabetes mellitus among people with and without psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Objective

This study examined racial/ethnic differences in the prevalence of diabetes mellitus in a nationally representative sample of adults with and without common psychiatric disorders.

Method

Data were drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N=34,653). Logistic regression models adjusting for sociodemographic variables and diabetes risk factors were used to examine racial/ethnic differences in 12-month prevalence rates of diabetes by psychiatric status.

Results

Among people without psychiatric disorders, African Americans, Hispanics and American Indians/Alaska Natives, but not Asians/Pacific Islanders, had significantly higher rates of diabetes than non-Hispanic whites even after adjusting for sociodemographic variables and diabetes risk factors. In the presence of psychiatric disorders, these health disparities persisted for African Americans and Hispanics, but not for American Indians/Alaska Natives. No significant interactions between race/ethnicity and psychiatric disorders in the odds of diabetes were found across any group.

Conclusion

Policies and services that support culturally appropriate prevention and treatment strategies are needed to reduce racial/ethnic disparities in diabetes among people with and without psychiatric disabilities.     

A pilot study of cognitive behavioral stress management effects on stress, quality of life, and symptoms in persons with chronic fatigue syndrome

Objective

The present pilot study was designed to test the effects of a 12-week group-based cognitive behavioral stress management (CBSM) intervention on stress, quality of life, and symptoms in chronic fatigue syndrome (CFS). We hypothesized that participants randomized to CBSM would report improvements in perceived stress, mood, quality of life, and CFS symptomatology from pre- to postintervention compared to those receiving a psychoeducational (PE) seminar control.

Method

We recruited 69 persons with a bona fide diagnosis of CFS and randomized 44 to CBSM and 25 to PE. Participants completed the Perceived Stress Scale (PSS), Profile of Mood States (POMS), Quality of Life Inventory (QOLI), and a Centers for Disease Control (CDC)-based CFS symptom checklist pre- and postintervention.

Results

Repeated measures analysis of variance revealed a significant Group×Time interaction for PSS, POMS-total mood disturbance (TMD), and QOLI scores, such that participants in CBSM evidenced greater improvements than those in PE. Participants in CBSM also reported decreases in severity of CFS symptoms vs. those in PE.

Conclusions

Results suggest that CBSM is beneficial for managing distress, improving quality of life, and alleviating CFS symptom severity.     

Eating disorder psychopathology as a marker of psychosocial distress and suicide risk in female and male adolescent psychiatric inpatients

Objective

The aim of this study was to examine psychosocial correlates of specific aspects of eating disorder (ED) psychopathology (ie, dietary restriction, body dissatisfaction, binge eating, and self-induced vomiting) in psychiatrically hospitalized adolescent girls and boys.

Method

A total of 492 psychiatric inpatients (286 adolescent girls and 206 adolescent boys), aged 12 to 19 years, completed self-report measures of psychosocial and behavioral functioning, including measures of suicide risk and ED psychopathology. Associations between ED psychopathology and psychosocial functioning were examined separately by sex and after controlling for depressive/negative affect using Beck Depression Inventory scores.

Results

Among the adolescent boys and girls, after controlling for depressive/negative affect, ED psychopathology was significantly associated with anxiety, low self-esteem, and current distress regarding childhood abuse. Among adolescent girls, after controlling for depressive/negative affect, ED psychopathology was significantly related to hopelessness and suicidality. Among adolescent boys, after controlling for depressive/negative affect, ED psychopathology was positively related to self-reported history of sexual abuse and various externalizing problems (drug abuse, violence, and impulsivity).

Conclusion

In psychiatrically hospitalized adolescents, ED psychopathology may be an important marker of broad psychosocial distress and behavioral problems among girls and boys, although the nature of the specific associations differs by sex.