A clínica da dor crônica como ninho de pacientes difíceis: o papel da identificação projetiva / Chronic pain clinic as a haven for difficult patients: the role of projective identification

Pacientes difíceis - ou de personalidade difícil - são frequentemente encontrados na clínica da dor crônica não-oncológica, impondo à relação médico-paciente sobrecargas que vão além das complexidades da doença e do tratamento. Esta revisão/relato de experiência discute o papel que o processo psicológico e comunicacional da identificação projetiva exerce sobre as relações entre pacientes e médicos (e outros profissionais) nas equipes de dor crônica. São revisados os conceitos de identificação projetiva, na sua forma benigna e maligna. Duas vinhetas clínicas são dadas como exemplos de cada uma. São apresentadas situações no cenário da comunicação médico-paciente em que a identificação projetiva opera complicando a relação terapêutica. Ao final, recomendações são dadas sobre o manejo do paciente difícil que se comunica maciçamente por identificação projetiva, assim como às equipes multiprofissionais que lidam com estes pacientes. Os pacientes difíceis de nossa clínica de dor crônica têm em comum o fato de se comunicarem pela forma maligna de identificação projetiva e terem organizações imaturas de personalidade. Nas equipes de dor crônica, as relações entre pacientes e profissionais (assim como as relações entre os profissionais), podem ser otimizadas se a equipe for capaz de identificar precocemente o fenômeno da identificação projetiva e manejá-lo de forma terapêutica. Para o paciente, a psicoterapia de longo prazo é o tratamento de eleição

Difficult patients - or those with difficult personalities - are frequently encountered in the treatment of chronic non-oncologic pain, overburdening the doctor-patient relationship far beyond the complexities of their illness and treatment. The present review/experiential report discusses the role that projective identification, as a psychological process of communication, puts the doctor-patient relationship in within the multi-professional chronic pain team. The concepts of projective identification are reviewed both in their benign and their malignant forms. Two clinical vignettes exemplify each of them. Some situations in the setting of doctor-patient communication are presented in which projective identification appears and complicates the therapeutic relationship. Some recommendations are offered regarding the handling of patients that communicate mainly by means of projective identification, and some ideas are offered to the multi-professional team. In our chronic pain clinic, difficult patients as a whole seem to prefer to communicate by means of a malignant form of projective identification and present with immature types of personality organizations. Within the chronic pain teams, doctor-patient relationships (as well as relations among the professionals) can be enriched if projective identification is detected early and appropriately handled. Long-term psychotherapy is the treatment that should be chosen for such patients

Interrelations Among Fast Food Intake, Food Behavior, and Personality in Adolescents / 대한지역사회영양학회지

Especially, the teenage period, an important lifetime to develop both physically and mentally, needs to be helpful to promote the growth of the body and to keep a well-balanced mind through a balanced and nourishing diet. It is well known that the western style fast food is the most liked meal by teenagers. Wrong recognition about fast food and its frequent intake by adolescents can lead to unbalanced diet and food behaviors which may also connect with a poor impact on their personalities as well as their physical health. In this study, therefore, relationships between fast food intake frequency and food behavior, sociability, and personality, such as anger expression, were surveyed from 1,295 adolescents (666 in Seoul, 316 in Changwon, and 313 in rural communities), and then analyzed using SPSS program. The results are shown as follows. The fast food preference score and the fast food intake frequency score showed no differences between male students (22.9/30, 14.4/30 respectively) and female students (23.0/30, 14.0/30 respectively). But, the fast food preference score correlated positively with the intake frequency score (r = 0.304) significantly (p < 0.001). The more frequently eating of fast food group showed significantly lower scores (r = -0.233, p < 0.001) in food behaviors. The frequency of fast food intake had no relationships with sociability, but it had a significantly effect on anger expression (r = 0.213, p < 0.001) and control (r =-0.147, p < 0.001). From these results, we could see the necessity of various nutrition education programs to build proper eating-out habits and also more studies are needed to find the relationships between fast food intake and growth and personality.