ABSTRACT
INTRODUCCIÓN: El Psicodiagnóstico interventivo, basado en las Consultas Terapéuticas propuestas por Winnicott, involucra, desde la primera sesión, intervenciones clínicas. Dado su empleo en diferentes contextos y poblaciones, instrumentos proyectivos como el Test de Apercepción Temática Infantil con Figuras Humanas son utilizados con la finalidad de explorar y comprender el mundo vivencial, y aspectos relevantes de la personalidad de niños y adolescentes, apoyando el trabajo clínico con adolescentes. OBJETIVO: Introducir, por medio del análisis del Psicodiagnóstico interventivo con la ayuda del CAT-H, la ilustración clínica de una adolescente con comportamiento de autolesión no suicida. MÉTODO: Se trata de un estudio clínico-teórico, con delineamiento de estudio de caso. Los datos fueron analizados a partir de la libre inspección del material y a la luz del abordaje psicoanalítico winnicottiana. RESULTADOS: Se evidenció el principal conflicto interno experimentado por el participante: sumisión frente al deseo de hacer lo que es propio de la época, así como la autoimagen vulnerable y el empleo de mecanismos de defensa primitivos dada la intensa sensación de impotencia. CONCLUSIÓN: El material clínico descrito presenta el uso del test más allá de su posibilidad diagnóstica, en calidad de mediador terapéutico, colaborando para la profundización en la queja y ofreciendo una experiencia de acogida y reflexión a la paciente, de manera similar la oferta del juego del garabato de Winnicott, es decir estableciendo contacto el campo emocional.
INTRODUÇÃO: O psicodiagnóstico interventivo, baseado nas Consultas Terapêuticas propostas por Winnicott, envolve, desde a primeira sessão, intervenções clínicas. Devido ao seu emprego em diferentes contextos e populações, instrumentos projetivos como o Teste de Apercepção Infantil com Figuras Humanas são utilizados para explorar e compreender o mundo vivencial, e aspectos relevantes da personalidade do público infanto-juvenil, subsidiando a atuação clínica com adolescentes. OBJETIVO: Apresentar a análise do psico diagnóstico interventivo com o auxílio do teste por meio da ilustração clínica de um adolescente com comportamento de autolesão não suicida. MÉTODO: Trata-se de um estudo teórico-clínico, com delineamento de estudo de caso. Os dados foram analisados a partir da livre inspeção do material e à luz da abordagem psicanalítica winnicottiana. RESULTADOS: Evidenciou-se o principal conflito interno vivenciado pelo participante: submissão versus desejo de fazer o que é próprio para a idade, assim como autoimagem vulnerável e emprego de mecanismos primitivos de defesa diante do intenso sentimento de desamparo. CONCLUSÃO: O material clínico descrito apresenta a utilização do teste além de sua possibilidade diagnóstica, como mediador terapêutico, colaborando para aprofundar a queixa e oferecendo uma experiência de acolhimento e reflexão ao paciente, à semelhança da proposta do jogo de rabiscos de Winnicott, ou seja, estabelecendo contato com o campo emocional.
INTRODUCTION: The interventive psychodiagnosis, based on the Therapeutic Consultations proposed by Winnicott, involves, from the first session, clinical interventions. Given its use in different contexts and populations, projective instruments such as the Children's Apperception Test with Human Figures are used in order to explore and understand the living world, and relevant aspects of the personality of children and adolescents, supporting clinical work with adolescents. OBJECTIVE: To present the analysis of the interventive psychodiagnosis with the help of the test through the clinical illustration of an adolescent with non-suicidal self-injury behavior. METHOD: This is a clinical-theoretical study, with a case study design. Data were analyzed from the free inspection of the material and in the light of the Winnicottian psychoanalytic approach. RESULTS: The main internal conflict experienced by the participant was evidenced: submission versus the desire to do what is proper for the age, as well as vulnerable self-image and employment of primitive defense mechanisms given the intense feeling of helplessness. CONCLUSION: The clinical material described presents the use of the test in addition to its diagnostic possibility, as a therapeutic mediator, collaborating to deepen the complaint and offering an experience of welcoming and reflection to the patient, similarly to the proposal of Winnicott's scribble game, which is, establishing contact with the emotional field.
Subject(s)
Humans , Male , Female , Child , Thematic Apperception Test , Child Behavior/psychology , Self-Injurious Behavior/diagnosis , Self-Injurious Behavior/psychology , Qualitative ResearchABSTRACT
Abstract Background Skin picking disorder is a prevalent disorder frequently comorbid with depression and anxiety, which is underdiagnosed mainly by dermatologists. Assessment of skin picking disorder is based on instruments influenced by the awareness about skin picking disorder and comorbid symptoms. To date, there is no validated instrument for Brazilian individuals nor an instrument to evaluate the severity of skin lesions in an objective way. Objectives Validate the Skin Picking Impact Scale for Brazilian Portuguese and create a photographic measurement to assess skin lesions. Methods The sample was assessed through the Skin Picking Impact Scale translated into Brazilian Portuguese, the Hamilton Anxiety Scale, the Beck Depression Inventory, and the Clinical Global Impression Scale. The patients' skin lesions were photographed. Photos were evaluated regarding active excoriation, crust/bleeding, exulceration, and linear lesions. Results There were 63 patients included. The Skin Picking Impact Scale translated into Brazilian Portuguese had good internal consistency (Cronbach's alpha = 0.88), which tests of goodness-of-fit, showing a suitable model. The reliability of photographic measurement was 0.66, with a high internal consistency (Cronbach's alpha = 0.87). Photographic measurement was not correlated with the Skin Picking Impact Scale, the Clinical Global Impression Scale, or comorbid symptoms. Study limitations Lack of a previously validated instrument to evaluate dermatillomania in the Brazilian population for comparison. Conclusion The Skin Picking Impact Scale validated in Brazilian Portuguese is a good instrument to evaluate skin picking disorder. Photographic measurement is a consistent way of assessing skin lesions, but it does not reflect the impact of skin picking disorder on the individual's life.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Skin/injuries , Photography/trends , Self-Injurious Behavior/diagnosis , Self-Injurious Behavior/psychology , Sickness Impact Profile , Psychiatric Status Rating Scales/standards , Socioeconomic Factors , Translations , Severity of Illness Index , Brazil , Reproducibility of Results , Statistics, Nonparametric , Obsessive-Compulsive DisorderABSTRACT
Objective: To investigate the clinical differences between intermittent explosive disorder (IED) (disorder of aggression primarily directed towards others) and nonsuicidal self-injury (NSSI) (disorder of aggression predominantly directed towards the self) in order to better understand the different clinical subtypes of aggression. Methods: We used treatment-seeking samples to compare demographic and clinical correlates between 82 participants with IED and 55 participants with NSSI. Results: The IED group was older, more likely to be male, in a relationship, and employed than the NSSI group. With respect to clinical variables, the NSSI group had more severe depressive symptoms and more social adjustment difficulties. Regarding psychiatric co-morbidities, the IED group had higher rates of generalized anxiety disorder. On the other hand, the NSSI group had higher rates of major depressive disorder, agoraphobia, substance use disorder, and bulimia nervosa. Conclusions: Individuals with NSSI may benefit from better management of psychiatric comorbidities, specifically depressive symptoms and social adjustment difficulties. Conversely, the treatment of individuals with IED may be improved by targeting comorbid generalized anxiety disorder. Our results provide important insight for the development of tailored interventions for specific subtypes of aggression.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Self-Injurious Behavior/psychology , Disruptive, Impulse Control, and Conduct Disorders/psychology , Anxiety Disorders , Socioeconomic Factors , Comorbidity , Sex Factors , Age Factors , Self-Injurious Behavior/diagnosis , Self-Injurious Behavior/therapy , Aggression/psychology , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Disruptive, Impulse Control, and Conduct Disorders/therapy , Impulsive Behavior , AngerABSTRACT
According to current proposals for ICD-11, stereotyped movement disorder will be classified in the grouping of neurodevelopmental disorders, with a qualifier to indicate whether self-injury is present, similar to the classification of stereotypic movement disorder in DSM-5. At the same time, the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders has proposed a grouping of body-focused repetitive behavior disorders within the obsessive-compulsive and related disorders (OCRD) cluster to include trichotillomania and skin-picking disorder. DSM-5 has taken a slightly different approach: trichotillomania and excoriation (skin picking) disorder are included in the OCRD grouping, while body-focused repetitive behavior disorder is listed under other specified forms of OCRD. DSM-5 also includes a separate category of nonsuicidal self-injury in the section on “conditions for further study.” There are a number of unresolved nosological questions regarding the relationships among stereotyped movement disorder, body-focused repetitive behavior disorders, and nonsuicidal self-injury. In this article, we attempt to provide preliminary answers to some of these questions as they relate to the ICD-11 classification of mental and behavioral disorders.
Subject(s)
Humans , Trichotillomania/diagnosis , International Classification of Diseases , Self-Injurious Behavior/diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Movement Disorders/diagnosis , Obsessive-Compulsive Disorder/diagnosis , Stereotyping , Diagnosis, Differential , Movement Disorders/classificationABSTRACT
Self-injurious acts are understood as transnosologic behaviors, which by their vital risk and psychopathological complexity require a specific medical diagnosis and treatment. Their management should be known by psychiatrists and other medical specialties. There are varied reasons that can trigger these maladaptive behaviors which are coming from the specific difficulties arising from the patient's mental state. It is essential to identify the presence of triggering or concomitant psychiatric disorders for the appropriate guiding of clinical management...
Las conductas autoagresivas pueden comprenderse como comportamientos transnosológicos que, por su riesgo vital y complejidad psicopatológica, requieren de un diagnóstico y manejo médico específicos. Este manejo debe ser conocido tanto por el médico psiquiatra como por facultativos de otras especialidades. Existen variadas motivaciones que pueden desencadenar conductas autolesivas, las que tienen su origen en dificultades específicas relacionadas con el estado mental del paciente. Resulta imperativo identificar la presencia de patologías psiquiátricas desencadenantes, o concomitantes, para orientar el apropiado manejo clínico...