[The Hungarian adaptation of the Mental Health Quality of Life Questionnaire (MHQoL)]. / A Mentális Egészséggel Összefüggo Életminoség Kérdoív (MHQoL) magyar adaptációjának bemutatása.

Our study presents the Hungarian adaptation of the Mental Health Quality of Life Questionnaire (MHQoL). BACKGROUND: In recent decades, there has been a shift in the field of healthcare, with a notable change in the ultimate goal of health interventions. Rather than merely reducing symptoms and prolonging life, the objective of health interventions is now to improve quality of life. A number of measures of quality of life have been developed, but the majority of these focus exclusively on physical health and do not fully cover the dimensions that are relevant to the quality of life of people with mental health problems. Van Krugten et al. have developed the Mental Health Quality of Life (MHQoL) questionnaire, which covers the seven most important dimensions of mental health-related quality of life. OBJECTIVES: Our research had the following two main aims. Firstly, it aimed to develop and test a Hungarian adaptation of the Mental Health Quality of Life (MHQoL) questionnaire. Secondly, it aimed to compare the results of healthy individuals and those with diagnosed psychiatric disorders. METHODS: A total of 189 individuals participated in the survey, with 157 classified as psychiatrically healthy and 32 diagnosed with a mental disorder, of which 20 were in acute psychiatric care and 12 were in outpatient care. The data were analysed using confirmatory factor analysis, reliability analysis and independent samples t-test. RESULTS: Our confirmatoriy factor analysis indicated that all items show a good fit with the model. The factor weights for each item were observed to range from 0.45 to 0.79. The Cronbach's α index obtained in our reliability analysis of the MHQoL demonstrated exceptional internal reliability: an index value of 0.81, with individual item- specific reliability coefficients ranging from 0.7 to 0.81. Independent samples t-tests were conducted to assess the statistical significance of differences in mean scores between respondents with and without a psychiatric diagnosis. The results indicated that there were significant differences in the means of the two groups for items pertaining to future vision, mood, relationships and physical health, as well as when comparing the mean scores of the MHQoL total score and the mean scores of psychological well-being. The majority of variables exhibited statistically significant differences from each other, with medium effect sizes. CONCLUSIONS: The results thus far indicate that the Hungarian version of the MHQoL is an effective instrument for differentiating between individuals with and without mental illness, based on psychometric indicators. Furthermore, it provides valuable insights into the domains in which psychiatric illnesses have the greatest impact on patients' quality of life. The objective of our future research is to further validate the MHQoL questionnaire in order to contribute to the concept of healthcare that focuses not only on eliminating symptoms but also on improving quality of life.

Acute Musculoskeletal Complaints Vary According to the Perceived Stress Among Hungarian Professional Dancers.

Introduction: Studies showed that professional dance is often associated with a high degree of acute musculoskeletal injuries. These injuries' etiology predominantly describes their biomechanical or other extrinsic factors, but there is a limited number of scientific reports dealing with the perceived stress or mental health status concerning the physical complaints especially, among Hungarian professional dancers. Materials and Methods: In this study, we used validated questionnaires (RESTQ, SEFIP, Mental Health Test) filled out by Hungarian professional female dancers (N = 168) via an online platform anonymously and analyzed statistically. Results: Our findings showed a significantly positive relationship between musculoskeletal complaints and perceived stress, an elevated level of general stress, and a higher level of resilience in this population compared to the general population. Conclusion: Dancers demonstrate a heightened perception of stress; however, they exhibit elevated scores on resilience assessments, indicative of heightened functionality in their daily lives. Stress, per se, may not be directly regarded as a causative factor for acute musculoskeletal conditions, but it could potentially influence the severity of pain sensations and subjective pain levels in the context of existing injuries. Additional investigations are warranted to elucidate the precise mechanisms by which stress exacerbates the pain experience among dancers.

The role of stigma and depression in the reduced adherence among young breast cancer patients in Hungary.

BACKGROUND: The main aim of our study was to investigate the role of depression, stigmatization, body shame and self-compassion in the adherence of young Hungarian breast cancer patients aged between 18 and 45 years. METHODS: In a cross-sectional online survey, data were collected from 99 young breast cancer patients (BC). Participants completed self-report questionnaires on socio-demographic and cancer-specific parameters as well as psychological factors (adherence: 12-item Medication Adherence Scale; depression: Hospital Anxiety and Depression Scale; stigmatization: Stigma Scale for Chronic Illnesses; body shame: Experience of Shame Scale; self-compassion: Self-Compassion Scale). We tested the predictors and mediators of adherence using hierarchical regression, mediation and moderation analysis among BC patients. RESULTS: We found that adherence was significantly associated with body shame and stigmatization in our BC sample. In addition, stigmatization alone was a significant predictor of lower adherence. Finally, in mediation models, where body shame was a mediator, we found a significant direct effect between stigma and adherence, in other words body shame had a significant mediating effect between these variables. According to our moderation analysis, self-compassion as a significant moderator acts as a protective factor in the linear relationship between stigma and lower adherence. CONCLUSIONS: Our results highlight the importance of stigma and body shame in the development of adherence in oncological care among young Hungarian BC patients aged between 18 and 45 years. Assessment of stigma, body shame, self-compassion, and the improvement of the availability of evidence-based psychological interventions may increase the adherence of young Hungarian BC patients, leading to more favourable rates of survival.

Can Emotional or Physical Abuse Be a Risk Factor of Chronic Musculoskeletal Conditions in Professional Dance?

OBJECTIVE: In professional dance, the injury rate is extremely high and dancers have a great chance to experience at least one injury during their careers. Since the #metoo campaign, many abuse cases showed up in the dance industry, resulting in media coverage. Results indicate that dancers had a significantly higher distribution of post-traumatic stress disorder (PTSD) compared to the broad population. In this study, we investigate pathological dissociation, quantify chronic musculoskeletal conditions and evaluate abusive experiences. METHODS: Questionnaire-based dataset filled out online by Hungarian professional dancers (n = 168). The statistical analysis contains descriptive results, risk assessment, Kaplan Meier curve, and hazard ratios. RESULT: Dancers scored in the pathological dissociation values, reported several cases of emotional and physical abuse, and were represented by elevated chronic musculoskeletal conditions. We found a statistically significant relationship between abusive experiences and musculoskeletal conditions, so as with dissociation. CONCLUSION: We conclude that emotional abuse might be one of the factors in a multifactorial model that plays a role in the pathomechanism of chronic pain, inflammation, and tendinopathy. It is important to raise awareness about the importance of emotional factors of pedagogy and the working atmosphere among professional dancers since it might have a role in higher injury rates.

[A study on self-compassion and stigmatisation in female patients with breast cancer]. / Önegyüttérzés és stigmatizáció vizsgálata emlodaganatos nok körében.

Background: The number of patients with cancer is increasing rapidly: in only one year, in 2020 19.3 million new cases were registered and as many as 10 million deaths occurred due to tumours worldwide. Shame and self-blame for developing cancer deteriorate patients' quality of life and correlate significantly with poor adaptation and physical health, consequently may be risk factors in the final negative outcome. It is proven that stigmatisation may cause torturing emotional symptoms like shame leading to depressive symptoms, which, in turn, may deteriorate the patient's capacity to cope and her well-being, thus growing the risk of mortality. For all the above, a high level of self-compassion may be a potential solution. Numerous studies have already proven that self-compassion may significantly decrease the level of shame, depression, frustration as well as the perception of being stigmatised while resulting in a measurably better quality of life. The purpose of the investigation was to point out the relationship between shame, stigmatisation, depression on the one hand, and selfcompassion on the other while providing support for the effectiveness of self-compassionbased interventions among female breast cancer patients. Methods: The present study is part of the fi rst phase of a translational research, in other words it is part of a basic research already carried out. This cross-sectional study collected data using online questionnaires based on self-reports with female breast cancer patients aged between 18 and 45, who had been diagnosed in the past two years and did not present with distant metastases (n=79, mean age: 39.05 years, SD= 7.37). To measure constructs standardised scales were applied including the Experience of Shame Scale (ESS), the Stigma Scale for Chronic Illnesses 8-item version (SSCI8), the Hospital Anxiety and Depression Scale (HADS) and the Self-Compassion Scale (SCS). The research hypotheses were tested by hierarchic regression, correlation, and mediation analyses. Results: Stigmatisation shows a positive and strong (r = 0.56, p < 0.01) relationship with physical shame while self-compassion has a negative and strong relationship with the same (r = 0.71, p < 0.01). Hierarchical regression revealed that self-compassion was the only predictive factor in female breast cancer patients regarding physical shame (ß = - 0.09, p < 0.001) after controlling for age, marital status, exposure to operation, stigmatisation, and depression. According to mediation models a higher level of stigmatisation may result in a more expressed feeling of shame and depression through a lower level of self-compassion. We found a full mediation between shame and depression, which means that shame causes a higher level of depression entirely indirectly, through a decrease in self-compassion. Conclusions: The results of this work highlight the expected effectiveness of developing self-compassion in terms of alleviating shame, stigmatisation, and depression, thus contributing to a better quality of life among cancer patients. The main purpose of the translational research that was the basis of the present study was to develop a complex cognitive therapeutic programme that would, in a gap-filling way, offer oncological patients an effective psychological intervention supported by investigation. The results of the present study prove beyond doubt the rationale of the programme and involve the basic elaboration of a significant psycho-oncological practice.

Measuring post-traumatic stress disorder and complex post-traumatic stress disorder using the International Trauma Questionnaire: results from a Hungarian clinical and non-clinical sample.

Background: The 11th revision of the International Classification of Diseases (ICD-11) simplified the description of post-traumatic stress disorder (PTSD) and also introduced a new trauma-related diagnosis called complex post-traumatic stress disorder (CPTSD). CPTSD is linked to earlier, prolonged interpersonal trauma, and is characterized by a broader range of symptoms, in addition to the core PTSD symptoms. The International Trauma Questionnaire (ITQ) has been developed to assess the new diagnostic criteria.Objectives: The primary aim of our study was to test the factor structure of the ITQ in a clinical and a non-clinical Hungarian sample. We also examined whether the degree of traumatization or the type of trauma experienced was associated with meeting the criteria for PTSD or CPTSD, or with the severity of PTSD or disturbances in self-organization (DSO) symptoms, in both samples.Method: A trauma-exposed heterogeneous clinical sample (N = 176) and a non-clinical sample (N = 229) filled out the ITQ and a modified version of the Life Events Checklist (LEC-5). The factor structure of the ITQ was tested by examining the model fit of seven competing confirmatory factor analysis models.Results: A two-factor second-order model with a second-order PTSD factor (measured by three first-order factors) and a DSO factor (measured directly by six symptoms) had the best fit to the data in both samples if an error correlation was allowed between negative self-concept items. Those in the clinical group who reported more interpersonal and childhood trauma experienced more PTSD and DSO symptoms. Also, there were significant, positive, and weak associations between the total number of different traumas and PTSD and DSO factor scores in both samples.Conclusion: ITQ was found to be a reliable tool to differentiate between PTSD and CPTSD, two related but distinct constructs in a clinical and a non-clinical trauma-exposed sample in Hungary.

The distinction between PTSD and DSO as related but separate constructs was validated using the ITQ in a Hungarian clinical and non-clinical sample.CPTSD was more frequent than PTSD among general help-seeking clinical clients, while in the non-clinical sample PTSD had a higher prevalence rate.Interpersonal trauma in childhood and adulthood was associated with more PTSD and DSO symptoms.

Examining the mental health adversity among healthcare providers during the two waves of the COVID-19 pandemic: results from a cross-sectional, survey-based study.

OBJECTIVES: The current global health crisis of the COVID-19 pandemic has drastically affected the whole population, but healthcare workers are particularly exposed to high levels of physical and mental stress. This enormous burden requires both the continuous monitoring of their health conditions and research into various protective factors. DESIGN: Cross-sectional surveys. SETTING AND PARTICIPANTS: Self-administered questionnaires were constructed assessing COVID-19-related worries of health workers in Hungary. The surveys were conducted during two consecutive waves of the COVID-19 pandemic (N-first wave=376, N-second wave=406), between 17 July 2020 and 31 December 2020. PRIMARY AND SECONDARY OUTCOME MEASURES: COVID-19-related worry, well-being and distress levels of healthcare workers. We also tested whether psychological resilience mediates the association of worry with well-being and distress. Multiple linear regression analyses were performed. RESULTS: The results indicated that healthcare workers had high levels of worry and distress in both pandemic waves. When comparing the two waves, enhanced levels of worry (Wald's χ2=4.36, p=0.04) and distress (Wald's χ2=25.18, p<0.001), as well as compromised well-being (Wald's χ2=58.64, p<0.001), were found in the second wave. However, not all types of worries worsened to the same extent across the waves drawing attention to some specific COVID-19-sensitive concerns. Finally, the protective role of psychological resilience was shown by a mediator analysis suggesting the importance of increasing resilience as a key factor in maintaining the mental health of healthcare workers in the burden of the COVID-19 pandemic. CONCLUSIONS: Our results render the need for regular psychological surveillance in healthcare workers. REGISTRATION: Hungarian Scientific and Research Ethics Committee of the Medical Research Council (IV/5079-2/2020/EKU).

A case study of cognitive behavioral therapy for illness anxiety and depression caused COVID-19 in a breast cancer / A COVID-19-járvány miatt kialakult betegségszorongás és depresszió kezelése kognitív viselkedésterápiával egy emlorákos no esete kapcsán

Cancer and the various medical treatments and tests are a major physical and psychological challenge for patients, their relatives and for the medical staff as well. Adherence and compliance become critical factors during prolonged oncological therapies. The mental health of people with malignant cancer, untreated psychological symptoms can affect survival by increasing distress and suffering, weakening quality of life and reducing adherence. Furthermore, they have a particularly high comorbidity with psychiatric disorders. The aim of this study is to introduce the tools of cognitive behavioural therapy and the therapeutic indications in the context of mental disorders associated with chronic somatic illness. Our study presents the case of a 66-year-old woman with breast cancer. She was diagnosed with mild depressive episodes and hypochondriasis based on psychodiagnostic assessment. Instead of interpreting the patient's symptoms as a serious organic illness, the goal of psychotherapy is to develop new, more adaptive attitudes and more comforting perspective of the symptoms, and to reduce secondary depression. The elements of the 16 -session cognitive behavioural therapy included behavioural activation, analysis of symptomatic behaviour, diary management, development of new alternatives and behavioural experiments, conceptualisation, and summarising learned techniques and future planning.

Body-related shame or guilt? Dominant factors in maladaptive eating behaviors among Hungarian and Norwegian university students.

The main purpose of our study was to examine the psychometric properties of Conradts' Weight- and Body-Related Shame and Guilt Scale (WEB-SG) and associations of body shame and guilt with maladaptive eating behaviors and general chronic shame among Hungarian and Norwegian university students. Therefore, we collected data from 561 university students from both nations in a cross-sectional questionnaire study. Participants completed the following standardized self-report questionnaires in this online survey: WEB-SG, Eating Attitude Test-26 (EAT-26) and Experience of Shame Scale (ESS). We tested the measurement model of the WEB-SG with confirmatory factor analysis (CFA), and we performed CFA with covariates analysis to examine the association between WEB-guilt (WEB-G) and WEB-shame (WEB-S) and predictors. Our empirical model of WEB-SG has adequate fit with Conradts' theoretical model among both samples. The body-related guilt positively associated with dieting and negatively related to oral control in both groups. We found a significant positive relationship between WEB-S and BMI in Hungarian sample. According to our results, WEB-SG is an adequate questionnaire for assessing weight and body-related shame and guilt in Hungarian and Norwegian non-clinical samples. Maladaptive weight and body-related guilt could be a relevant factor in proneness to anorexia. Our results highlight WEB-G and WEB-S as two critical factors in the assessment and treatment of eating difficulties.

Shame mediates the relationship between stigma and quality of life among patients with coeliac disease. A 8 tételes Stigmatizáció Krónikus Betegségekben Kérdoív magyar adaptálása / A szégyen mediációs szerepe a stigma és az életminoség kapcsolatában coeliakiában szenvedo betegek körében. The Hungarian adaptation of the Stigma Scale for Chronic Illness-8

Összefoglaló. Bevezetés: A coeliakia és a kapcsolódó terhek befolyásolják az érintettek életminoségét. A krónikus betegségekkel járó stigmatizáció hozzájárul a fizikai tünetek és a lelki panaszok fokozódásához, valamint az egészségmagatartás csökkenéséhez. Mindez szükségessé teszi a krónikus megbetegedések kapcsán a stigmatizáció felismerését, felmérését és kezelését. Célkituzések: Fo célunk a 8 tételes Stigmatizáció Krónikus Betegségekben Kérdoív (SSCI-8) magyar adaptációja és pszichometriai vizsgálata volt coeliakiások körében. További célunk volt megvizsgálni a szégyen közvetíto szerepét a stigmatizáció és a jóllét között. Módszerek: A kutatás önbeszámolós, online kérdoíves, keresztmetszeti vizsgálatként zajlott (n = 85, átlagéletkor: 37,64, 91,8% no). Az SSCI-8 mellett felvételre kerültek a szégyenélményt, a coeliakiás életminoséget, a jóllétet méro kérdoívek. A kutatási célok tesztelése megerosíto faktorelemzéssel, korrelációs és mediációs elemzésekkel történt. Eredmények: Az SSCI-8 faktorelemzése során az egydimenziós modell megfelelo illeszkedést mutatott magas belso konzisztenciaértékek mellett. A mediációs modellek szerint a magasabb stigmatizáció a magasabb szégyenélményen keresztül járulhat hozzá a pszichés jóllét (coeliakiás életminoség, jóllét) csökkenéséhez. Megbeszélés: Az SSCI-8 rövid, átfogó kérdoívként megbízhatóan és érvényesen mérte a krónikus betegségben tapasztalt stigmatizációt a jelen coeliakiás mintán. Eredményeink alátámasztják, hogy a stigmatizáció és a szégyen fontos szerepet tölt be a jóllét csökkenésében. Következtetés: A nemzetközileg széles körben alkalmazott SSCI-8 adaptálására került sor, mely hazai kutatásokban és az egészségügyi ellátásban is hasznos méroeszköz lehet. Az eredmények rávilágítanak, hogy a stigmatizáció és a szégyenélmény további kutatása szükséges, különösen a hatékony pszichoszociális intervenciók kifejlesztését megcélozva. Hatékony pszichológiai segítség révén a szégyen és a stigmatizáltság mérséklésével javulhat a coeliakiával élok fizikai és lelki állapota, ami a gluténmentes diéta betartása révén hozzájárulhat a betegség okozta tünetek és szövodmények mérsékléséhez. Orv Hetil. 2021; 162(49): 1968-1976. INTRODUCTION: Coeliac disease can detrimentally affect well-being. Stigmatization related to a chronic disease can enhance physical and psychological symptoms and negatively influence health behaviour, hence, stigma in chronic diseases needs to be addressed. OBJECTIVES: Our main goal was to psychometrically evaluate the Hungarian adaptation of the Stigma Scale for Chronic Illness-8 (SSCI-8). Further aim was to examine the mediating role of shame on the relationship between stigmatization and well-being aspects among individuals with coeliac disease. METHODS: This cross-sectional study collected data using online questionnaires based on self-reports (n = 85, mean age: 37.64 years, 91.8% women). Instruments assessed levels of stigmatization, shame experience, quality of life in coeliac disease and well-being. Confirmatory factor, correlation and mediation analyses were used. RESULTS: Factor analysis showed adequate fit for a unidimensional model with high internal consistency. Mediation models showed that higher levels of stigmatization can contribute to decreased levels of quality of life in coeliac disease and well-being via increased levels of shame. DISCUSSION: The SSCI-8 is a short, valid, reliable instrument measuring stigmatization in the current sample of people with coeliac disease. The results highlight the role of stigma and shame in the decrease of well-being. CONCLUSION: The adapted version of the SSCI-8 can be a useful tool in Hungarian research and healthcare. The results suggest that stigmatization and shame need further attention to develop effective intervention which can reduce their effect and enhance adherence to gluten-free diet and improve physical and psychological well-being. Orv Hetil. 2021; 162(49): 1968-1976.

The motivational role of realistic and unrealistic weight targets in body-weight loss: Experiences with a cognitive behavioral body-weight loss program / A reális és irreális testsúlycélok motivációs szerepe a fogyásban: A kognitív viselkedésterápiás testsúlycsökkento programok tapasztalatai

Összefoglaló. Bevezetés: Az elhízás korunk egyik legnagyobb kihívása, hiszen a többletsúly számos krónikus betegség kockázati tényezoje, és fontos pszichés és szociális következményei vannak. A kezelésben bizonyítottan hatékony a kognitív viselkedésterápiás testsúlycsökkento program, amelynek során alapveto fontosságú a reális célsúly meghatározása, ugyanis az irreális elvárások megakadályozhatják a hosszú távú sikeres testsúlykontrollt. Célkituzés: Prospektív kutatásunk kérdése, hogy az elérheto fogyást milyen mértékben befolyásolják a testsúlycélok a kognitív viselkedésterápiás testsúlycsökkento program során. Feltételeztük, hogy a testsúlycsökkento csoport résztvevoi irreális fogyási elvárásokkal érkeznek, melyek azonban reálisabbá válnak a program végére, és megmaradnak az utánkövetés idejére. Emellett feltételeztük, hogy a testsúlycsökkento program során az evési magatartás pozitív irányban fog változni. Módszer: A 24 hetes testsúlycsökkento programban 63, az egyéves utánkövetésben pedig 49 felnott vett részt. A résztvevok antropometriai mutatói mellett (testtömeg, testmagasság) az evési magatartást és a testsúlycélokat a Háromfaktoros Evési Kérdoívvel, illetve a Célok és Relatív Testsúlyok Kérdoívvel mértük fel. Eredmények: A résztvevok közel 90%-a elérte a professzionális testsúlycsökkento módszerek esetében elvárható legalább 5-10%-os fogyást, az evési magatartás pozitív irányban változott, testsúlycéljaik reálisabbak lettek. A fogyás szignifikáns, fordított kapcsolatban volt az aktuális és az álomsúly, az aktuális és a vágyott, valamint az aktuális és az elfogadható testsúly közötti eltéréssel. Következtetés: A kognitív viselkedésterápia széles körben alkalmazható, hatékony testsúlycsökkento módszer, amelynek sikerében fontos szerepet játszanak a reálisan kituzött testsúlycélok. Orv Hetil. 2021; 162(28): 1119-1128. INTRODUCTION: Obesity has become one of the most challenging issues, as the excess body-weight is a risk factor for numerous chronic diseases and has serious psychological and social consequences. The cognitive behavioral approach to weight loss had been shown an effective treatment, in which realistic weight target setting is essential, because unrealistic expectations can hinder the effort for a successful long-term weight management. OBJECTIVE: The objective of our prospective study was to investigate as to how weight loss is influenced by realistic and unrealistic weight targets in a cognitive behavioral weight loss program. We hypothesized that the participants come with unrealistic weight loss expectations, which become more realistic by the end of the program and remain realistic for the follow-up. In addition, a positive change was expected in the eating behavior of the participants during the program. METHOD: The program was completed by 63 people, 49 subjects participated in the 1-year follow-up. Anthropometric data were obtained and the participants were asked to fill in the Three-Factor Eating Questionnaire - Revised 21 items and the Goals and Relative Weights Questionnaire. RESULTS: According to the results, the program is effective, since nearly 90% of the participants reached at least 5-10% weight loss as expected by professional weight loss methods. Besides weight loss there were positive changes in the participants' eating behavior; weight targets became more realistic. Weight loss was inversely related to the difference between actual and dream, actual and desired as well as between actual and acceptable weight. CONCLUSION: Our results in accordance with previous studies show that cognitive behavioral weight loss programs can be effective; however, setting up realistic weight targets can be crucial in successful weight loss. Orv Hetil. 2021; 162(28): 1119-1128.

Shame in Borderline Personality Disorder: Meta-Analysis.

Shame has been found to be a core feature of borderline personality disorder (BPD). To date, there is no existing systematic review or meta-analysis examining shame in individuals with BPD as compared to healthy controls (HCs). A meta-analysis of 10 studies comparing reported shame in BPD patients to HCs was carried out. Demographic and clinical moderator variables were included to see if they have a relationship with the effect size. Results showed that those with BPD had more reported shame than healthy controls. In addition, in BPD patients and HCs, higher education level was related to lower reported shame. In HCs, it was found that those who were younger reported a higher level of shame. Finally, among BPD patients, there was a relationship between levels of reported shame and elevated PTSD symptomatology. These findings emphasize the clinical relevance of shame in individuals with BPD and the need to formulate psychotherapeutic strategies that target and decrease shame.

[Borderline personality disorder in the light of developmental psychopathology]. / A borderline személyiségzavar a fejlodéspszichopatológia tükrében.

The incidence of borderline personality disorder (BPD) in psychiatric care has shown growing tendencies. Despite its frequency, it is an underdiagnosed disease. Profound knowledge of etiological factors of BPD is essential for the proper diagnosis and treatment. The present study aims to provide a developmental psychopathological analysis of borderline personality disorder, which includes a thorough review of genetic and environmental etiological factors, an introduction to the functionalist approach of evolutionary perspective, and an overview of age specific characteristics of borderline symptoms. Recent research suggests that in addition to neurobiological and psychosocial factors, genetic vulnerability may be responsible for the development of BPD. Psychosocial background includes childhood trauma, maternal mental illness, maladaptive parenting styles and dysfunctional parent-child relationship, all of which are recognized as contributing factors to the development of insecure or disorganized attachment styles in the infant. Regarding the neurobiological background, changes in the hypothalamic-pituitary-adrenal axis, neurotransmission, endogenous opioid system, and neuroplasticity play a prominent role, the development of which is also affected by childhood traumatic events. Brain imaging studies reveal differences in the limbic system (hippocampus, amygdala) and frontal cortex, which are also involved in stress response, cognition, memory function, and emotion regulation. Early developmental processes may also play an important role in the development of the disorder, as depression during pregnancy or increased stress affects the quality of maternal care and may also affect gene expression through epigenetic mechanisms. With respect to the gene-environment interaction, the interaction of the child's impulsive traits and the invalidating family environment can be highlighted, which can lead to disruption of emotion regulation. The persistence of BPD symptoms is supported by the evolutionary approach concerning several aspects. Fear of abandonment can be explained by the anticipation of exclusion and maladaptive attempts to avoid it. Developmental psychopathological analysis contributes to the development of effective prevention and intervention tools through a better understanding of the background of borderline personality disorder. In terms of prognosis, as a result of effective treatments, symptoms can be reduced, so improvement can be achieved in a large proportion of patients.

[Developmental psychopathological characteristics of obsessive-compulsive disorder]. / A kényszeres zavar fejlodéspszichopatológiai jellemzoi.

According to the currently available research data obsessive-compulsive disorder (OCD)is a disorder of multifactorial etiology, the causes of which include biological, genetic and environmental-social factors alike. Based on an etiology of that kind, it is justifiable to conduct a developmental psychopathological review of OCD, which may lead, through an exploration of the different factors involved, to a deeper understanding of the disorder's overall nature and specific characteristics, as well as to the development of the most efficient therapies possible. The main objective of the present comprehensive study is the developmental psychopathological analysis of the OCD, including the review of the evolutionary approaches and genetic and environmental factors, as well as an exploration of OCD's age-specific forms of manifestation, based on the recent research results and analyses available in the professional literature. According to our present knowledge, the genetic linkage of early-onset OCD is greater than that of the late-onset variant, as the onset of the syndrome can be attributed to genetic factors to the extent of 40-60%, coupled with the contribution of environmental factors like perinatal disorders, reproductive cycle, childhood infections, familial circumstances, age of the parents and traumatic life events. Evolutionary theories address OCD from a functional perspective. They strive to attribute it primarily to individual or group selection theories that a quite heterogeneous OCD syndrome, which is therapeutically difficult to change, remains to present itself with close to identical, invariably high prevalence in all cultures despite the difficulties. Obsessive-compulsive disorder is present in all ages, and it is often difficult to determine whether we are faced with a healthy or a pathological behavior, as certain obsessive phenomena may appear as part of normal development. The analysis of OCD's etiology, a better understanding of the respective function of specific symptoms, a thorough exploration of age-specific variants of the disorder, i.e. a developmental psychopathological analysis of OCD, is of key importance from diagnostic, therapeutic and vocational rehabilitation aspects alike.

[Bipolar aff ective disorder - Perspectives on Developmental Psychopathology]. / Bipoláris affektív zavar ­ fejlodéspszichopatológiai szempontok.

The prevalence of bipolar affective disorder is 3% in the general population, with a first occurrence around the age of 20-30. The first symptoms are usually rather mild, thus it is difficult to reach a decision about the diagnosis within the first years. In the past years bipolar affective disorder received increased attention because of the relatively high lifetime prevalence. Nowadays experts in the field try to reach a consensus in understanding the earlier phases of the syndrome, as earlier therapeutic interventions tend to have a better result. General developmental psychopathological factors, and gene-environment interactions or evolutionary theories can greatly contribute to early recognition and understanding of the syndrome. The main aim of our article is to explore the possible developmental psychopathological background of bipolar affective disorder through overview of the literature on general developmental psychopathology factors, gene-environment interaction, and the evolutionary approach, which can contribute to more effective methods of treatment.

[Possibilities of cognitive behavioral therapy in the oncological care]. / A kognitív viselkedésterápia lehetoségei az onkológiai ellátásban.

Cancer is a huge psychological difficulty both for the patient and the caregivers. Patients often suffer from hopelessness, helplessness, depression, anxiety or other psychological disturbances. Although the cognitive behavioral interventions (cognitive behavioral therapy, mindfulness) are evidence based, short, time-limited, focused treatments for patients with cancer, in Hungary there are only little evidence and experiences about application of cognitive behavioral methods in the oncological care. The main goal of this review to provide a survey about the cognitive behavioral theories and the international practical experiences in the field of oncological care, furthermore, to propose to apply these structured, directive, problem-focused interventions among patients with cancer to professionals which are able to decrease distress of patients or caregivers and these methods are able to treat the mental disorders, such as anxiety, depression, PTSD, which usually relate with cancer.

To see in a mirror dimly. The looking glass self is self-shaming in borderline personality disorder.

Symptoms of borderline personality disorder (BPD) can be conceptualized as the expression of and defenses against or response to the painful emotion of chronic shame, which may relate to early maladaptive schemas (EMS). The goal of this research is to examine levels of early maladaptive schemas, self-reported shame, and anxious or angry reactions to social put-downs as well as their associations. We also looked to assess the association of shame with BPD symptoms. Fifty-six patients with BPD completed self-report measures of EMSs, chronic shame, and reactions to put-downs. Comparison groups consisted of 24 patients without personality disorder (non-PD) and 80 healthy controls (HC). Those with BPD reported higher levels of EMSs, characterological, behavioral and bodily shame, and were more prone to react with anxiety and anger than non-PD patients and HC subjects. EMSs domains had specific associations with chronic shame and reaction types to social put-downs. Identity disturbances were associated with characterological, behavioral and bodily shame. Stormy relationships were associated with bodily shame. Chronic shame and anxious and angry reactions to social put-downs are prominent in patients with borderline personality disorder and are associated with specific EMS domains and with the symptoms of identity disturbance and stormy relationships.

Intact implicit statistical learning in borderline personality disorder.

Wide-spread neuropsychological deficits have been identified in borderline personality disorder (BPD). Previous research found impairments in decision making, declarative memory, working memory and executive functions; however, no studies have focused on implicit learning in BPD yet. The aim of our study was to investigate implicit statistical learning by comparing learning performance of 19 BPD patients and 19 healthy, age-, education- and gender-matched controls on a probabilistic sequence learning task. Moreover, we also tested whether participants retain the acquired knowledge after a delay period. To this end, participants were retested on a shorter version of the same task 24h after the learning phase. We found intact implicit statistical learning as well as retention of the acquired knowledge in this personality disorder. BPD patients seem to be able to extract and represent regularities implicitly, which is in line with the notion that implicit learning is less susceptible to illness compared to the more explicit processes.

Shame, trauma, temperament and psychopathology: Construct validity of the Experience of Shame Scale.

Although Experience of Shame Scale (ESS) is used in clinical research and it covers psychiatrically relevant dimensions of chronic shame, characterological (CS), behavioral (BS) and bodily (BoS) respectively, its factor structures were not confirmed on clinical sample. The goals of our research were to examine the factor structure of the Hungarian version of ESS, in addition, to analyze the associations between factors of ESS and different types of predictors, such as clinical status, gender, age, school years, early abuse history, general psychopathology (GSI), and temperament dimensions by using a series of confirmatory factor analyses (CFA) with covariates in a large clinical and matched healthy sample. Psychiatric inpatients (N=148) and healthy control subjects (N=148) participated in this cross-sectional questionnaire study. In both samples, the degree of fit was adequate. The final CFA with covariates model showed significant and positive associations between CS and clinical status and education respectively, between CS, BS, BoS and frequency of verbal abuse, between CS and BoS and GSI and between CS and BS and harm avoidance and in addition we found negative associations between each of the shame factors and age. Our results support the psychiatric validity of the ESS construct.

[The role of shame in development of the mental disorders II. Measurement of shame and relationship]. / A szégyen szerepe a mentalis zavarok kialakulásában II. A szégyen mérése és a szégyen kapcsolata a mentális zavarokkal.

Our review is an overview of research literature aimed at evaluating the differential association of shame with various mental disorders. In the first part of this review, we present questionnaire and experimental methods applied in clinical trials for measuring shame. In the second part of our review, we review research that investigated the association between shame, and shame induced behavioral and emotional reactions, as well as the following mental disorders: anxiety disorders (social phobia, PTSD, agoraphobia, generalized anxiety disorder, specific phobias, OCD), mood disorders (unipolar depression, bipolar disorder), suicide attempts, self-harm behavior, eating disorders, somatization, personality disorders, aggression, addictions, autism and paranoia. The results of the reviewed studies suggest that this excessive emotional state associated with negative self-esteem on global self plays a central role in mental disorders, although shame is very rarely applied as diagnostic criterion in DSM.