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1.
Psychodyn Psychiatry ; 51(3): 254-260, 2023 09.
Article in English | MEDLINE | ID: mdl-37712662

ABSTRACT

Psychoanalysis has long lost its historical influence on U.S. academic psychiatry. Psychoanalytic theory, however, provides us with a rich and remarkably comprehensive knowledge of human development, both normative and pathologic. This article describes a psychoanalytic concept that enriches our understanding of the mind and its disorders: Freud's structural hypothesis. This core concept provides a theoretical foundation for understanding the clinical features of both neurotic and personality disorders. It also informs a psychodynamic psychotherapy.


Subject(s)
Psychiatry , Psychoanalysis , Psychotherapy, Psychodynamic , Humans , Personality Disorders , Psychoanalytic Theory
2.
Omega (Westport) ; 85(3): 716-731, 2022 Aug.
Article in English | MEDLINE | ID: mdl-32867587

ABSTRACT

Some authors suggest the existence of links between the mechanisms of defense and attitude toward death, however, mechanisms underlying these relationships are not well understood. The objective of the present research was to investigate whether psychosocial ego development is a partial mediator in the association between mechanisms of defense and death attitude. The study included participants (N = 382) aged 19-85 (M = 47.02, SD = 16.19). Three measures were used: Defense Style Questionnaire-40, Psychosocial Inventory of Ego Strengths, and Death Attitude Profile-Revised. Findings partly confirmed the hypotheses. Psychosocial ego development is a partial mediator in positive relationships between maladaptive defenses and fear of death, death avoidance, and escape acceptance. Psychosocial ego development is also a partial mediator in the positive association between more adaptive defenses and approach acceptance. The study provides novel information on the mechanisms underlying the association between defense mechanisms and multidimensional death attitude.


Subject(s)
Defense Mechanisms , Ego , Humans , Phobic Disorders , Surveys and Questionnaires
3.
Omega (Westport) ; 84(3): 935-957, 2022 Feb.
Article in English | MEDLINE | ID: mdl-32336200

ABSTRACT

The aim of the article is to design a conceptual framework within the theory of psychosocial ego development that will allow for a better understanding and explanation of attitude toward death in the life cycle. The main weaknesses of previous studies on death attitude were examined; Erikson's concept may help exceed these limitations. The use of the model of hierarchy of defense mechanisms to study death attitude within Erikson's theory was proposed. The concept of the death complex was mentioned to better conceptualize the problem of attitude toward death as a part of the psychosocial theory. Finally, the evolution of attitude toward death in the consecutive phases of psychosocial development was discussed in the light of the concept of syntonic and dystonic ego features, as well as death complex, defense mechanisms, and psychosexual modes.


Subject(s)
Ego , Psychoanalytic Theory , Humans
4.
Tempo psicanál ; 53(1): 30-57, jan.-jun. 2021.
Article in Portuguese | LILACS-Express | LILACS, Index Psychology - journals | ID: biblio-1341711

ABSTRACT

A neurose obsessiva é uma das duas psiconeuroses de defesa descritas por Freud e sobre as quais se baseou fundamentalmente a construção e desenvolvimento de seu modelo de aparelho psíquico. No presente artigo, nos propomos promover um estudo sobre a neurose obsessiva, sua dinâmica e mecanismos de defesa. Para tal, desenvolveremos uma revisão de literatura sobre o tema tomando como ponto de partida a consideração angular de Castel (2011), segundo a qual teria sido a neurose obsessiva e não a histeria a responsável pelo surgimento das bases da psicanálise e da construção da ideia de um aparelho psíquico. A fim de circunscrever a ideia proposta por Castel, nos dedicaremos prioritariamente a um percurso sobre a construção da neurose obsessiva pautados nas proposições freudianas. Seguiremos a linha temporal buscando lançar luz sobre o desenvolvimento de uma forma de organização própria a essa neurose e sua dinâmica do desejo em pauta. Por fim, apresentaremos as considerações de Abraham a partir das quais desenvolveremos a ideia de um movimento de regressão libidinal posta em questão nesses casos, e não uma lógica de fixação a um estágio específico do desenvolvimento libidinal.


Obsessive neurosis is one of the two defense psychoneuroses described by Freud and on which the construction and development of his model of psychic apparatus was fundamentally based. In this article, we propose to promote a study on obsessional neurosis, its dynamics and defense mechanisms. To this end, we will develop a literature review on the subject taking Castel's (2011) angular consideration as a starting point, according to which it was obsessive neurosis and not hysteria that was responsible for the emergence of the bases of psychoanalysis and the construction of the idea of a psychic apparatus. In order to circumscribe the idea proposed by Castel, we will dedicate ourselves primarily to a journey on the construction of obsessional neurosis based on Freudian propositions. We will follow the timeline seeking to shed light on the development of a form of organization specific to this neurosis and its dynamics of desire on the agenda. Finally, we will present Abraham's considerations from which we will develop the idea of a libidinal regression movement in question in these cases and not a logic of fixation to a specific stage of libidinal development.


La névrose obsessionnelle est l'une des deux psychonévroses de défense décrites par Freud et sur lesquelles reposait fondamentalement la construction et le développement de son modèle d'appareil psychique. Dans cet article, nous proposons de promouvoir une étude sur la névrose obsessionnelle, sa dynamique et ses mécanismes de défense. Pour cela, nous développerons une revue de la littérature sur le sujet en prenant comme point de départ la considération angulaire de Castel (2011), selon laquelle c'est la névrose obsessionnelle et non l'hystérie qui a été responsable de l'émergence des bases de la psychanalyse et de la construction de l'idée d'un appareil psychique. Afin de circonscrire l'idée proposée par Castel, nous nous consacrerons principalement à un voyage sur la construction de la névrose obsessionnelle à partir de propositions freudiennes. Nous suivrons la chronologie cherchant à éclairer le développement d'une forme d'organisation propre à cette névrose et sa dynamique du désir à l'ordre du jour. Enfin, nous présenterons les considérations d'Abraham à partir desquelles nous développerons l'idée d'un mouvement de régression libidinale en question dans ces cas et non une logique de fixation à un stade spécifique du développement libidinal.

5.
Environ Sci Pollut Res Int ; 26(6): 6216-6222, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30628004

ABSTRACT

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental pollutants which exert detrimental effects on living beings. Considering the health risk associated with exposure to these pollutants, their presence in food increases efforts to establish early-warning indicators of pollution. We aimed to examine the effects of environmentally relevant concentrations of fluoranthene (0.2 ng and 18 ng/g dry weight of diet) on the activities of midgut antioxidant and detoxification enzymes in Blaptica dubia. Significant changes of superoxide dismutase and catalase activities, recorded at the higher fluoranthene concentration regardless of the exposure time, suggest that they may be used as biomarkers of PAH pollution. Increased GST activity and decreased total GSH content, detected upon acute exposure to the lower concentration, indicate processes of detoxification. Reorganization of B. dubia mechanisms of defense in response to oxidative stress caused by exposure to dietary PAH point to the necessity for further examination of fluoranthene actions.


Subject(s)
Cockroaches/drug effects , Dietary Exposure/adverse effects , Fluorenes/toxicity , Animals , Catalase/metabolism , Cockroaches/metabolism , Ecotoxicology/methods , Environmental Biomarkers/drug effects , Environmental Pollutants/toxicity , Glutathione/metabolism , Inactivation, Metabolic/drug effects , Oxidation-Reduction , Oxidative Stress/drug effects , Superoxide Dismutase/metabolism
6.
Dig Dis Sci ; 61(1): 273-82, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26289259

ABSTRACT

BACKGROUND: Sleep disturbances are common in cancer patients, but little is known about the complex interplay between the background psychological profile, coping with health stressors capacities and psychological distress in the formation of sleep difficulties in colorectal cancer. AIMS: To study the course and to identify psychological predictors of sleep difficulties in early non-metastatic colorectal cancer patients over a one-year period. METHODS: In this 1-year prospective study, we assessed in 84 early non-metastatic colorectal cancer patients the association of psychological distress (SCL-90-R), sense of coherence (SOC-29), and defense styles (Defense Style Questionnaire) with sleep difficulties (SCL-90-R) in multiple regression models. Eighty-two patients with breast cancer and 50 patients with cancer of unknown primary site served as disease controls, and 84 matched for age and sex alleged healthy individuals served as healthy controls. RESULTS: Colorectal cancer patients presented more sleep difficulties compared to healthy participants but fewer than patients with breast cancer and cancer of unknown primary site. Colorectal cancer patients' trouble falling asleep (p = 0.033) and wakening up early in the morning (p < 0.001) deteriorated over time. Sleep that was restless or disturbed was independently associated with low SOC (p = 0.046) and maladaptive defenses (p = 0.008). Anxiety symptoms (p < 0.001) predicted deterioration in trouble falling asleep, while depressive symptoms (p = 0.022) and self-sacrificing defense style (p = 0.049) predicted deterioration in wakening up early in the morning. CONCLUSIONS: Psychological parameters and coping with health stressors capacities are independently associated with sleep difficulties in colorectal cancer patients, indicating the need for psychological interventions aiming at improving adjustment to the disease.


Subject(s)
Colorectal Neoplasms/complications , Defense Mechanisms , Sense of Coherence , Sleep Wake Disorders/etiology , Sleep , Stress, Psychological/etiology , Aged , Case-Control Studies , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/physiopathology , Colorectal Neoplasms/psychology , Female , Health Status , Humans , Male , Mental Health , Middle Aged , Prospective Studies , Quality of Life , Risk Assessment , Risk Factors , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/physiopathology , Sleep Wake Disorders/psychology , Stress, Psychological/diagnosis , Stress, Psychological/physiopathology , Stress, Psychological/psychology , Surveys and Questionnaires , Time Factors
7.
Salud ment ; 33(6): 517-526, nov.-dic. 2010. ilus, tab
Article in English | LILACS-Express | LILACS | ID: lil-632811

ABSTRACT

Otto Kernberg states three types of personality organizations, also named psychological functional levels. They reflect the patient's predominant psychological characteristics: identity integration grade, defense mechanisms, and reality test. In mental disorders, the predominant defensive influences significantly in the severity and evolution of the suffering. Objectives The objective of the actual study was to determine the usage of defense mechanisms by patients with some mental disorder, grouping them according to personality organization levels or psychological functioning and the DSM-IV-TR Axis II diagnostic. Sample The sample included two groups: a) 1 02 hospitalized patients in the Instituto Nacional de Psiquiatría, 20 males and 82 females. b) A control group formed by 125 individuals, 48 males and 77 females; in all cases, they lived in Distrito Federal or Estado de México. Method The sample of this study was evaluated with the Defensive Questionnaire (DSQ-40) and the Personality Diagnostic Questionnaire (PDQ-4 + ); both instruments were applied as soon as patients were admitted to the hospital. The concepts of borderline psychological functioning and borderline personality disorder make reference to: The levels of personality organization or borderline psychological functioning characterized by an identity integration failure named identity diffusion, habitually reality judgment conserving and low level defenses supported on the splitting. b) The patients that were diagnosed with borderline personality disorder in agreement with the DSM-IV-TR. According to the personality organization, the psychotic disorders were grouped in the psychotic functioning level; the rest of the patients that suffered some anxiety or mood disorders were included in the borderline functioning level when they had also a diagnosis of borderline, narcissistic, antisocial, paranoid, schizoid, schizotypal, avoidant, dependent or histrionic personality disorder; in the neurotic functioning level those patients without personality disorder. The members of the control group were included in different academic level, labor and social scopes during the same period. Results The patients with a low level of personality organization (psychotic or borderline personality organization) used predominantly the immature or primitive defense mechanisms; patients with a high level of personality organization (neurotic level of psychological functioning) and members of the control group used predominantly mature or advanced defense mechanisms. Derived from the factorial analysis, three levels of defensive were determined: mature/advanced, neurotic and immature/primitive. In the mature/advanced defensive, the members of the control group were those that scored higher, followed by the psychotic patients and borderline. The scores of the neurotic defensive were higher in the borderline and psychotic groups than the control group. In the immature/primitive defensive, the borderline patients had higher scores than the psychotic and control group. The patients that were diagnosed through the PDQ-4+ with borderline personality disorder in agreement with the DSM-IV-TR had lower scores in the mature/advance defensive and higher than the control group in neurotic and immature/primitive defensive . The characteristics of personality of clusters A and B correlated positively with the following defensive s: immature/ primitive and neurotic and negatively with the mature/advanced defensive . The relation between the defensive s and the characteristics of personality of cluster C was negative in the defensive mature/advanced and positive in the neurotic and immature/ primitive. Conclusions: Through these findings a hierarchy between the levels of psychological functioning can be established, so that the lower the level of psychological functioning (borderline or psychotic), the higher is the use of immature mechanisms of defense and vice versa. The level of high psychological functioning (neurotic) used mature mechanisms of defense mainly; the borderline and psychotic levels of psychological functioning had major use of immature defenses, such as projection and autistic fantasy.


Los mecanismos de defensa son los elementos fundamentales de la organización de la personalidad, junto con la constancia objetal y el juicio de realidad. En los trastornos mentales, el estilo defensivo predominante influye significativamente en la gravedad y evolución del padecimiento. Objetivos El objetivo de este estudio fue determinar la relación existente entre los mecanismos de defensa, los trastornos de la personalidad y los niveles de funcionamiento psicológico (organización de la personalidad tipo neurótica, límite o psicótica) propuestos por Kernberg. Muestra La muestra del estudio estuvo constituida por dos grupos: a) Un grupo de 102 pacientes psiquiátricos hospitalizados, 20 del sexo masculino y 82 del femenino, provenientes del Instituto Nacional de Psiquiatría Ramón de la Fuente. b) Un grupo control, constituido por 1 25 sujetos, 48 hombres y 77 mujeres, en su mayoría residentes del Distrito Federal o del Estado de México. Método La población de este estudio fue evaluada con el Cuestionario de Estilos Defensivos (DSQ-40) y el Cuestionario Diagnóstico de la Personalidad (PDQ-4 + ) para determinar el uso de los mecanismos de defensa y detectar los trastornos de la personalidad, respectivamente. A los pacientes se les aplicaron ambos instrumentos al momento de su ingreso y se les agrupó en alguno de los tres niveles de funcionamiento psicológico de Kernberg. Los conceptos nivel de funcionamiento psicológico límite y trastorno límite de la personalidad hacen referencia a: a) La organización de la personalidad o nivel de funcionamiento límite caracterizada por la difusión de identidad, habitualmente conservación de la prueba de realidad y mecanismos de defensa basados en la escisión. b) El trastorno límite de la personalidad descrito por la Asociación Psiquiátrica Americana en el DSM-IV-TR. De acuerdo con la organización de la personalidad, los pacientes esquizofrénicos y con otras psicosis quedaron en el nivel de funcionamiento psicótico. Los pacientes que sufrían algún trastorno de ansiedad o del estado de ánimo se incluyeron en el nivel de funcionamiento límite o borderline cuando también tenían diagnóstico de trastornos de personalidad límite, narcisista, antisocial, paranoide, esquizoide, esquizotípico, evitativo, dependiente e histriónico; en el nivel de funcionamiento neurótico se incluyeron los pacientes con los trastornos mencionados, que no tenían trastorno de personalidad o bien cuyo diagnóstico fue de trastorno obsesivo-compulsivo de la personalidad. Los sujetos que sirvieron como controles fueron captados en distintos ámbitos escolares, laborales y sociales durante el mismo periodo. Resultados Los pacientes pertenecientes a los niveles de funcionamiento psicológico menores (psicótico o límite) usaron más los mecanismos de defensa inmaduros en comparación con los pertenecientes al nivel de funcionamiento psicológico de mayor nivel (neurótico) y que los sujetos controles. Se determinaron tres estilos defensivos: maduro/ avanzado, neurótico e inmaduro/primitivo. En el estilo maduro/ avanzado los sujetos del grupo control fueron los que puntuaron más alto, seguidos de los pacientes con nivel de funcionamiento psicológico psicótico y límite. Las puntuaciones del estilo defensivo neurótico fueron mayores en los grupos límite y psicótico que en el grupo control. En el estilo defensivo inmaduro/primitivo, los pacientes límites tuvieron puntuaciones mayores que los grupos psicótico y control. El grupo control puntuó más alto que el límite en sublimación, humor, anticipación y supresión, y que el psicótico en humor y supresión. El grupo de funcionamiento límite tuvo puntuaciones mayores que el grupo control en anulación, aislamiento, racionalización, proyección, agresión pasiva, exoactuación, fantasía autista, escisión y somatización. En cambio, puntuaron más alto que el grupo psicótico en supresión, agresión pasiva y somatización. El grupo psicótico tuvo puntuaciones mayores que el grupo límite en sublimación, anticipación y formación reactiva, y que el grupo control en anulación, desplazamiento, proyección y fantasía autista. Los pacientes diagnosticados a través del PDQ-4+ con trastorno límite de personalidad de acuerdo con el DSM-IV-TR tuvieron puntuaciones menores en el estilo defensivo maduro/avanzado que el grupo control pero mayores en los estilos defensivos neurótico e inmaduro/ primitivo. En el análisis individual de cada mecanismo de defensa se encontró que el grupo control tuvo mayores puntuaciones en sublimación, humor, anticipación, supresión y disociación que el grupo de pacientes con trastorno límite de la personalidad. Éstos puntuaron más alto en desplazamiento, racionalización, aislamiento, proyección, escisión, exoactuación, agresión pasiva, devaluación, fantasía autista, negación y somatización. Cuando se determinó el uso de las defensas de acuerdo con el diagnóstico de trastornos de la personalidad pertenecientes a los clusters A y B, se observó un mayor uso de los mecanismos de defensa basados en la escisión; de éstos, la fantasía autista fue la que tuvo mayor valor predictivo. Por el contrario, los trastornos de la personalidad del cluster C estuvieron asociados a los mecanismos de defensa de la esfera de la represión. Conclusiones Los resultados dan sustento empírico a la organización de la personalidad propuesta por Kernberg sobre los tres niveles de funcionamiento psicológico y a la vez demuestran la relación entre los trastornos de la personalidad y los mecanismos de defensa. El mecanismo de defensa denominado fantasía autista resultó ser un factor explicativo y predictivo de las características de la personalidad de los clusters A y B y del trastorno límite de la personalidad, en específico.

8.
Patient Prefer Adherence ; 4: 25-32, 2010 Mar 24.
Article in English | MEDLINE | ID: mdl-20361063

ABSTRACT

Several parameters mediate the selection of treatment modality in end-stage renal disease (ESRD). The nephrology community suggests that patient preference should be the prime determinant of modality choice. We aimed to test whether ego mechanisms of defense are associated with patients' treatment modality preferences, independent of psychological distress. In 58 eligible ESRD patients who had themselves chosen their treatment modality, we administered the Symptom Distress Checklist-90-R and the Defense Style Questionnaire. Thirty-seven patients (53.4%) had chosen hemodialysis and 21 (46.6%) peritoneal dialysis. Patients who preferred peritoneal dialysis were younger (odds ratio [OR], 0.89; 95% confidence interval [CI]: 0.804-0.988), had received more education (OR, 8.84; 95% CI: 1.301-60.161), and were twice as likely to adopt an adaptive defense style as compared to patients who preferred hemodialysis (57.1% vs 27.0%, respectively; P < 0.033). On the contrary, the latter were more likely to adopt an image-distorting defense style (35.1% vs 14.3%; P = 0.038) and passive-aggressive defenses (OR, 0.73: 95% CI: 0.504-1.006). These results were independent of psychological distress. Our findings indicate that the patient's personality should be taken into account, if we are to better define which modalities are best suited to which patients. Also, physicians should bear in mind passive-aggressive behaviors that warrant attention and intervention in patients who preferred hemodialysis.

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