Trouble de personnalité borderline et temps vécu

Objectives

Starting from the semiological heterogeneousness of borderline patients, we try to understand the everyday life of such subjects, and to determine the psychopathological structure of Borderline Personality Disorder.

Délire paranoïaque de revendication et passages à l’acte justiciers

Objectives

The present clinical research explores the underlying logic of litigious paranoid delusion, more specifically in its querulous and pseudo-altruistic forms. This research examines both the causality and the psychic functions fulfilled by episodes of vengeful acting out and in some cases murder.

Le regard paranoïaque à l’épreuve du visage neutre

Objectives

For paranoid patients, the confrontation with a neutral face is a perceptual and interpretative challenge. Since birth, faces seem to be the favorite visual stimulus of humans, and unexpressive faces tend to provoke discomfort (according to the still face paradigm). Considering their symptoms, this discomfort might be particularly strong for paranoid adult patients. Images of neutral faces are often used in eye-tracking studies to mesure scanpath impairments, but almost only draw a comparison with expressive faces. A short review of eye-tracking studies, in which neutral faces are presented to paranoid patients, could allow a first interpretation of visual exploration impairments and their relational consequences, through the prism of the paranoid symptoms revealed by the unexpressivity of the face.

La paranoïa au travers de la procédure pénale

One clinical case. Three steps of a criminal proceeding. The opportunity to approach clinical data and legal issues through three essential questions. Pre-sentence responsibility; paranoid position at the time of trial; post-sentence dangerousness. From marginal, « simple » personality reorganization, normal psychic functioning, to characterized delusion. Is there a continuum? Some mentioned it. Are we facing distinctive psychic states? Some think there are. In front of a situation involving emotion, mood, and passion, clinicians regularly face a dead end. This case shows both legal system and psychiatry limits addressing paranoia.     

Délires paranoïaques,dangerosités et homicides

“Are you threatening to kill me?”, asks the psychiatrist. “It's not a threat, it's a promise!”, replies the paranoiac patient. In just a few short words, this exchange raises the issue of a dangerous, potentially homicidal nature linked to paranoia. This mental disorder is such that it severely complicates interpersonal relationships. Its mechanisms and delusional themes often cause paranoiac individuals – male or female – to have difficult, tense, conflictual and even violent relationships both inside and outside of the family. These difficult relationships can sometimes lead to serious non-lethal attacks or, more exceptionally, single or multiple homicides that have frequent precursory warning signs. The motives for homicides committed by paranoiacs are linked to the themes of their delusions: persecution, prejudice, jealousy, filiation, erotomania, betrayal, etc. The therapeutic alliance, frequently difficult to set up and maintain, makes healthcare treatment difficult for dangerous paranoiac individuals. Ideally, this treatment is based on two key approaches: medicinal treatment and psychotherapy. When these people are not considered to be criminally responsible for the acts that they have committed they are forced to receive care.     

Thérapie basée sur la mentalisation et le trouble de personnalité limite

Theoretical background

The borderline personality disorder is a complex psychiatric disorder that represents a high number of patients in a psychiatric adult service. Even if some therapies have shown to be effective in the therapeutic care of the borderline personality disorder they only target certain symptoms (e.g. anxiety, sadness, self-mutilation). The aim of this paper is to introduce a therapeutic model little known in France: the mentalization based therapy (MBT) developed in 2004 by Bateman and Fonagy. This therapeutic model apprehends the borderline personality disorder in all its complexity and is based on two main concepts: Bowlby's attachment theory and the concept of mentalization. The MBT is based on the hypothesis that a deficit of mentalization leads to the development of borderline disorder. The capacity of mentalization, also known as reflexive function, is acquired in infancy through interpersonal relationships, in particular those of attachment, and is the ability to understand the mental state (emotions, needs, thoughts, etc.) of oneself and others which underlies explicit behaviour. This reflexive capacity is of a better quality when the person has a secure attachment style. Indeed, borderline patients have, mainly, a deficit of mentalization capacity associated with an insecure attachment style. Thus, the main objective of the Bateman and Fonagy approach is to develop and reinforce the mentalization capacity through a therapeutic relationship as a secure base, a group therapy and the concept of insight.

Dimensions de personnalité et facteurs de stress chez les policiers

ObjectivesPolice officers are exposed to chronic and cumulative potentially traumatic events in their careers. The personality influences the development of pathological stress. Literature highlights that positive valence personalities (conscientiousness, extraversion, and openness) are less susceptible to the development of pathological stress than neuroticism. The aim of this study is to assess the influence of personality dimensions on the development of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) among police officers.Patients or materials and methodsWe presented the research project to several police department heads and police officers in Belgium. We were contacted by volunteer police officers. Then, we organized interviews lasting nearly 2 hours. First, we conducted an anamnesis during which police officers identified the most traumatic events experienced in their career. Secondly, we administered diagnostic instruments evaluating ASD (SASRQ), PTSP (TraumaQ) and personality dimensions (BFI-fr). The population includes 83 police officers.ResultsMultiple linear regression analyzes show that neuroticism is the personality dimension influencing the development of acute stress disorder and post-traumatic stress disorder. It is positively associated with most of their symptoms. Moreover, extraversion appears as the most protective personality dimension against pathological stress symptoms.ConclusionsThe assessment of trauma and personality is therefore important in the selection process of police officers’ candidates and throughout the career. It can be useful in identifying signs of anxiety, or even acute or post-traumatic stress and risk factors related to their development.     

Délire de jalousie et syndrome de Capgras : à propos d’un cas de paranoïa

Capgras syndrome or Capgras delusion is part of the psychiatric classification of delusional misidentification syndromes. The patient is able to identify the facial features of his close relations but is maintaining that they have been replaced by double (identical substitutes) that are absolutely identical. This syndrome associates, as Capgras and Reboul-Lachaux stressed it, a feeling of strangeness and a feeling of familiarity. The patient perceives the similarity with his close relation but cannot recognize the identity. Using a clinical case of paranoia, which associates jealousy delusion and Capgras syndrome, and a study of the concept of double, we will underline the relevance of psychodynamic theories.     

Trouble de stress post-traumatique en milieu pénitentiaire

PTSD is frequent in prison, with a lifetime prevalence of 17.8% among male inmates, and of 40.1% among female inmates. Despite those high rates, only a limited number of studies have been published about this disorder in the prison population, and PTSD is still widely underdiagnosed in jail. We conducted a review of the literature to identify the PTSD sociodemographic characteristics and specificities among incarcerated populations. Some epidemiological characteristics of PTSD are identical in both the general and the prison populations, with a higher prevalence among women than men, high rates of comorbidity with depression and anxiety disorders, and high suicide rates. PTSD after committing a violent crime seems to be common but is greatly underdiagnosed, mostly because of a lack of knowledge about this entity. The occurrence is especially high when the offender suffers from a severe mental illness at the time of the offence. Homicidal crimes are the most at risk to lead to PTSD. Every inmate should be screened for this diagnosis by psychiatrists practicing in prisons. Inmates are exposed to many traumatic events during their time in detention. Yet, little is known about the mental health consequences of imprisonment. PTSD after exposure to a traumatic event while in detention should be systematically explored, and future studies need to consider this matter. The high levels of PTSD among imprisoned people could be explained by the exposition of prisoners to repetitive traumatic events, especially during childhood, and by the multiple risk factors for PTSD found in this population. In France, screening for and treatment of PTSD in prison are insufficient. Strategies must be elaborated by the institutions created in 2019 (Centre National de Ressource et de Résilience et Centre Régionaux de Psychotraumatismes) to improve the health of inmates suffering from PTSD. Complex PTSD should also be studied in the prison population.     

Utilisation problématique d’Internet,temps passé en ligne et traits de personnalité

BackgroundInternet addiction or problematic Internet use is a recent and increasingly recognized disorder which has been consistently associated with many psychiatric disorders, adding to the documented negative consequences of problematic Internet use. However, very few studies have examined the relationship between problematic Internet use and personality traits and none in a French sample. Moreover, those which have evaluated this relationship have mainly been conducted on small samples.ObjectiveThe main goal of our study was to explore the relationship between problematic Internet use, time spent online and personality traits in a French sample, taking into account the presence of depressive symptoms, and gender.MethodsA sample of 276 participants aged from 18 to 50 (M = 28; SD = 8.9) completed a questionnaire assessing problematic Internet use, time spent online, the presence of ten personality traits and depressive symptoms.ResultsOur results revealed significant differences between genders. Among men, problematic Internet use was associated with personality clusters A and B while in women no cluster or personality traits were associated. Time spent online was predicted by schizoid personality traits among men and avoidant personality traits among women.DiscussionOur results indicate that cluster A (schizoid and schizotypal) and cluster B traits (borderline and antisocial) play a more important role in problematic Internet use than cluster C traits among men. Differences between men and women regarding the relationships between personality traits, time online and problematic Internet use may be related to differences in the activities engaged in by men and women online. We observed that communication websites use was more prevalent among women while erotic, gambling and shopping websites use was more prevalent among men suggesting that the characteristics of problematic Internet use may vary according to gender.ConclusionFew studies have examined the relationship between problematic Internet use, time spent online and personality traits, and none among a French sample. These results suggest the importance of assessing the impact of personality traits on Internet use, particularly on time spent online, by differentiating results in terms of gender and online activities.     

Traits de personnalité, insertion socio-professionnelle et employabilité chez les jeunes en mesure d’insertion

Inactive young adults (neither employed nor in training) are at risk of long lasting precariousness and bad health.

Hyperphagie boulimique : liens avec la personnalité et l’émotionnalité

Objectives

Our two objectives were: (1) to investigate the relationship between binge eating disorder, dimensions of personality (according to the Big Five model of Costa and McCrae) and those of emotionality in the “tripartite” model of emotions of Watson and Clark; (2) to evaluate the correspondence between the Binge Eating Scale (BES) and the Eating Disorder Inventory (EDI-2) scores.

Dimensions affectives et impulsives dans le trouble bipolaire et le trouble de la personnalité borderline

Background

Studies have shown that patients with borderline personality disorder are often misdiagnosed to have bipolar disorder and conversely. Indeed, a number of characteristics common to both disorders could explain this problem: emotional instability as well as impulsivity represent confounding factors and contribute to the risk of misdiagnosis. However, it appears that these characteristics manifest themselves in different ways according to the pathology. The aim of the study is to show differences between affective lability, emotional intensity and impulsivity dimensions. The clinical aim is to refine bipolar disorder and borderline personality disorder diagnosis, to improve psychological care for these patients in the long-term.

Irresponsabilité et responsabilité pénales : faut-il réformer l’article 122-1 du Code pénal français ?

Determining whether perpetrators of offences have penal responsibility or not with regard to a penal offence is one of the most significant pre-sentencing issues. Article 122-1 of the French penal code – in force since 1st March 1994 – is the deciding factor in this issue. In order to better take into account the mental diversity and the situations of perpetrators that commit notably criminal offences, the text could be reformed in these three ways: by taking into account the potential plurality of psychic and/or neuropsychic disorder(s) at the moment when the act is committed; by removing the blurred concepts of “abolition” or “alteration of discernment” and “abolition of” or “obstruction to control of their acts”, sources of diverging interpretations and concepts and not necessarily relevant to every single person affected by psychic and/or neuropsychic disorder(s) when the act is committed, which could warrant a verdict of penal irresponsibility or a reduction in their sentence; by refocusing the text of the two paragraphs that deal with the subject of the exclusive or non-exclusive causality which can exist between potential psychic and/or neuropsychic disorder(s) and the committal of penal offences. If this proposal to reform article 122-1 of the French penal code were to be accepted, it could improve the validity of any responses to issues that bear upon a perpetrator's penal responsibility or absence thereof with regard to their mental state at the moment when they commit the act that they are charged with.     

Lecture des troubles de personnalité limite à travers la théorie de l’attachement

Borderline personality disorders concern clinicians and caregivers because of the violent and impulsive nature of their behavioral and affective reactions, which often confronts them to a feeling of helplessness and incomprehension. Indeed, it may be difficult to deal with self-harm, massive anxiety, intense affects and interpersonal ruptures, which are often present in the life course of the borderline patients. Their distress is particularly difficult to accept as it takes place in the therapeutic link, which reveals the core of the patient's attachment problematic. This paper aims to draw up an overview of borderline personality disorders, in light of attachment theory, which could help to clarify the involved mechanisms and gather the described behaviors in a coherent unit. Many studies relating to borderline personality disorder and attachment theory highlight what constitutes the specificity of these disorders through an integrative approach. Thus, the combination of an insecure attachment style, biological vulnerabilities and environmental stressors like traumatisms may induce the establishment of many defensive mechanisms, such as attachment system hyperactivation, emotional dysregulation or mentalization's failure. People suffering of borderline personality disorder activate these mechanisms as soon as they have to deal with real or imagined abandonments related to one of their attachment figures. However, in view of the massive anxiety and the severe disruption, those inefficient mechanisms cannot enable a good resolution of stressful situations. Consequently, borderline patients are likely to resort to new kind of emotional regulation such as suicidal, destructive and impulsive behaviors. Attachment based theories focus on these defensive mechanisms and inadequate attempts of emotional regulation, in order to propose an appropriate treatment for borderline personality disorder.     

La classification de la paranoïa dans la psychiatrie américaine contemporaine : une revue de la littérature

Objective

The main objective of this paper is to undertake a literature review on the classification of the paranoia in contemporary American psychiatry.

La théorie de la dissociation structurelle de la personnalité pour conceptualiser et traiter la psychose dissociative : deux études de cas

ObjectivesWe present the theory of the structural dissociation of the personality as a way to conceptualize dissociative psychosis and illustrate this with two case studies. This theory was developed to help understand trauma related disorders, i.e. dissociative disorders. In line with Janet's work, this theory states that a traumatic event can lead to a division (dissociation) of the personality in two or more parts: an apparently normal part of the personality deals with daily life activities and avoids the traumatic memories, and one or more emotional parts of the personality stay fixated on the traumatic experience and can reach a certain autonomy as in dissociative identity disorder. Dissociative psychosis is understood as the intrusion of emotional parts into the apparently normal part, which gets overwhelmed, with psychotic-like intrusions. In the most severe cases, an emotional part takes over the executive role over a long period of time.Patients/methodsThe first case study is a male patient suffering from repetitive (at least once a year) psychotic episodes with a normal nonpsychotic functioning between episodes. Main psychotic symptoms are mystic delusions, verbal auditory hallucinations and disorganized thinking. Hypnotherapeutic interventions allowed an evaluation of a possible structural dissociation, which then led to the diagnostic of dissociative psychosis. A psychotherapy based on the theory of structural dissociation was then engaged. The second case study is a female patient with depersonalization disorder and a dissociative psychosis several weeks after the traumatic birth of her twin children. Psychotic symptoms were mystic, referential and persecutory delusions.ResultsIn the first case, after three years of adapted psychotherapy, the patient showed no relapse of dissociative psychosis and did not need any hospitalization. A single risk of relapse was avoided with one session of adapted hypno-imaginative interventions. In the second case, after three sessions of hypnotherapeutic treatment based on the theory of the structural dissociation of the personality, the patient was symptom free, also at two and half years follow up.ConclusionsThe theory of the structural dissociation of the personality is useful in conceptualizing dissociative psychosis. Hypnotherapeutic and hypno-imaginative interventions with a light trance and adapted to this theory can be useful in the treatment of such a disorder. Such interventions can help clinicians enter the patient's inner world to better understand the meaning of the symptoms and then suggest a resolution for the trauma related emotional parts involved in the expression of the psychotic-like symptoms. We discuss the necessity of an official diagnostic for this disorder that could be better named reactive dissociative psychosis or reactive dissociative disorder with psychotic features. Clinicians need to be aware of this specific diagnostic that may benefit from specific psychotherapeutic interventions, probably better adapted than those needed for real psychotic disorders.