Relato de experiência da perda ambígua diante de um filho adolescente desaparecido / Case study of ambiguous loss front of a missing teenager son

A Teoria da Perda Ambígua (P.A) coloca que tal perda é uma das mais inquietantes, estressante e traumatizante diante das demais, não há confirmação, fechamento ou rituais de apoio e, portanto, não há uma resolução verdadeira. Este estudo objetivou verificar características da perda ambígua (de primeiro tipo) vivido por uma mãe de um adolescente desaparecido, caracterizada pela ausência física, mas sem comprovação de morte, e com uma presença psíquica permanente. Também investigou interligações das falas da genitora com resultados do Inventário de Percepção de Suporte Familiar. Foi possível identificar baixo nível quanto ao suporte familiar em todos os fatores (afetivo-consistente, autonomia e adaptação familiar), bem como diversos fatores desta perda ambígua, concentrando-se em questões como a esperança e desesperança, presença e ausência, sendo estes, fatores essenciais para novos focos de intervenções transformadoras.(AU)

The Theory of Ambiguous Loss (AL) to put that is one of the most disturbing, stressful and traumatizing, in front of the others, aren`t confirmation, closing or supporting rituals, therefore, isn`t a true resolution, this study aimed to verify characteristics of ambiguous loss, (the first kind) Lived by a mother of a missing teenager, characterized by physical absence, but without comprovation of death, and with psychic presence continuous. Also investigated interrelationships between the speaker's giver and the results of the family Support Perception Inventory. was possible to identify low level of family support in all factors (affective-consistent, autonomy and family adaptation), as well as several factors of this ambiguous loss, focusing on issues such as hope and hopelessness, presence and absence, factors for new focuses of transformative interventions.(AU)

A arte da fuga: sobre a personalidade reativa e o tratamento psicanalí­tico de um adolescente em crise / The art of escape: on reactive personality and psychoanalytic treatment of an adolescent in crisis / El arte de la fuga: sobre la personalidad reactiva y el tratamiento psicoanalí­tico de un adolescente en crisis

Este trabalho apresenta uma discussão acerca de um caso clínico que interroga a ação do psicanalista perante o processo de crise de um adolescente em condição de abrigamento. O desdobramento do caso pôde, somente a posteriori, levar-nos ao estudo do funcionamento daquilo que Jacques Lacan, em seu seminário A Angústia (1962-1963), chamou de "personalidade reativa". Trata-se, segundo Lacan, não de uma espécie de sujeito, mas sim de uma zona de relação definida por ele como a do acting-out. William recorria exatamente a essa zona como único recurso diante do "não se pode dizer".

This paper presents a discussion about a clinical case that questions the psychoanalyst's action in the crisis process of an adolescent in shelter condition. Only later the case's development was able to lead us to the study of the functioning of what Jacques Lacan called "reactive personality" in his seminar Anxiety (1962-1963). According to Lacan, it is not a kind of subject, but a zone of relation defined by him as acting-out. That zone was the only resource that William had before the "cannot be said".

Este trabajo presenta una discusión acerca de un caso clínico que cuestiona la acción del psicoanalista ante el proceso de crisis de un adolescente en condición de refugio. El despliegue del caso pudo llevarnos, sólo a posteriori, al estudio del funcionamiento de lo que Jacques Lacan, en su seminario La angustia (1962-1963), llamó "personalidad reactiva". Según Lacan, no se trata de una especie de sujeto, sino de una zona de relación definida por él como acting-out. Esa zona era exactamente el único recurso que William poseía ante el "no se puede decir."

Trauma and homelessness in youth: Psychopathology and intervention.

Youth runaway behavior and homelessness (RHY) in the U.S. is increasingly common, with prevalence estimated at 1-1.7 million youth. RHY have multiple, overlapping problems often including poor physical and mental health, frequent street victimization, and histories of physical and sexual abuse. Further, current street victimization interacts with childhood abuse to produce complex, unique presentations of traumatic symptoms and related disorders in runaway and homeless youth. This review paper explores (1) the role of childhood trauma in the genesis of runaway and homeless behavior, and (2) how childhood trauma interacts with street victimization to create vulnerability to psychopathology. In response to the trauma needs of RHY, we conducted a systematic review of the state of the current literature on trauma-informed interventions for RHY. We conclude that the field currently lacks empirically validated trauma interventions in RHY. However, theoretically plausible frameworks do exist and could be the basis for future research and intervention development.

Nonlinear dynamics of runaways among children and adolescents: disruptive disorder or step toward a suicide attempt?

The aim of this study is to analyze the decision-making process whereby susceptible adolescents end up choosing the option to run away or attempt suicide. Our basic hypothesis is that this transition is largely based on cooperative mechanisms. The runaway state is regarded as a potential precursor of the suicidal one. A mathematical model incorporating these processes is developed from which the time evolution and the values of the susceptible, runaway and suicidal populations are evaluated in terms of a number of key parameters. It is shown that for appropriate ranges of parameter values the interactions present in the system eventually end up counteracting both runaway and suicidal attempts. Quantitatively this is shown by the existence of stable solutions of the model equations in which the populations of both suicidal and runaway individuals end up being zero, although in some cases a significant temporary enhancement can take place. But as the parameters are varied beyond these ranges the system starts sustaining non-trivial stable states, in which the populations of suicidals or runaways are maintained at non-zero levels. This hints at prevention strategies and crisis management such as separation from the environment and specific treatment different from those dispending traditional adolescent psychiatric units.

Two-year predictors of runaway and homeless episodes following shelter services among substance abusing adolescents.

Given high levels of health and psychological costs associated with the family disruption of homelessness, identifying predictors of runaway and homeless episodes is an important goal. The current study followed 179 substance abusing, shelter-recruited adolescents who participated in a randomized clinical trial. Predictors of runaway and homeless episodes were examined over a two year period. Results from the hierarchical linear modeling analysis showed that family cohesion and substance use, but not family conflict or depressive symptoms, delinquency, or school enrollment predicted future runaway and homeless episodes. Findings suggest that increasing family support, care and connection and reducing substance use are important targets of intervention efforts in preventing future runaway and homeless episodes amongst a high risk sample of adolescents.

It's called "Going out to play": a video diary study of Hmong girls' perspectives on running away.

How do Hmong immigrant adolescent girls decide to run away, return home, leave again, or stay home? Video diaries by 11 sexually exploited runaway Hmong girls, ages 13-16, revealed four themes: "fighting restrictions," or resisting family and cultural expectations and desires to be like other American teens; "not running away, going out to play," which captured impulsive decision making; "unrestrained partying," which described runaway experiences but minimized the dangers faced; and "trying to change," or returning home because of family bonds and wanting to "be someone good." Given their limited ability to anticipate risks, interventions should focus on runaway prevention initiatives for Hmong families and teens.

The relationship between victimization and substance use among homeless and runaway female adolescents.

Each year, thousands of female adolescents run away from home due to sexual abuse, yet they continue to be victims of sexual assault once on the street. To date, few studies have examined how various forms of victimization are related to different types of substance use. The purpose of this article is to investigate the relationship between street exposure, childhood abuse, and different forms of street victimization with alcohol and marijuana use among 137 homeless and runaway female adolescents. Results from path analysis revealed that child sexual abuse was positively linked to trading sex and sexual and physical victimization. In addition, those who have traded sex experienced greater physical victimization, and who have spent more time away from home, used alcohol more frequently. Moreover, trading sex and experiencing more types of sexual victimization were positively linked to more frequent marijuana usage. Age, age at first run, longest time away from home, sexual abuse, and trading sex had significant indirect effects on alcohol and/or marijuana use. Together, these factors accounted for 27% of the variance in alcohol use and 37% of the variance in marijuana use.

The impact of running away on teen girls' sexual health.

This article reviews three recent studies investigating the impact of running away on adolescent females' sexual health. There are between 500,000 and 2.8 million runaway and homeless youth in the U.S. at any point in time, and adolescent females are at increased risk as compared to males. All three studies analyzed data from The National Longitudinal Study of Adolescent Health and each examined a different health risk related to runaways including sexual debut, sexual assault and pregnancy. These studies show how health risks are persistent even after adolescents return home to their primary residence.

The effects of conducting a functional analysis on problem behavior in other settings.

It has been suggested that reinforcing problem behavior during functional analyses (FAs) may be unethical (e.g., Carr, 1977), the implication being that doing so may result in an increase in problem behavior outside of FA sessions. The current study assessed whether conducting a FA resulted in increases in problem behavior outside of the FA setting for 4 participants. The rate of problem behavior was measured outside the FA setting prior to and during a FA. Idiosyncratic results suggest that problem behavior outside of the FA setting may increase, decrease, or be unaffected by conducting a FA.

Protective factors associated with fewer multiple problem behaviors among homeless/runaway youth.

Although homeless youth exhibit numerous problem behaviors, protective factors that can be targeted and modified by prevention programs to decrease the likelihood of involvement in risky behaviors are less apparent. The current study tested a model of protective factors for multiple problem behavior in a sample of 474 homeless youth (42% girls; 83% minority) ages 12 to 24 years. Higher levels of problem solving and planning skills were strongly related to lower levels of multiple problem behaviors in homeless youth, suggesting both the positive impact of preexisting personal assets of these youth and important programmatic targets for further building their resilience and decreasing problem behaviors. Indirect relationships between the background factors of self-esteem and social support and multiple problem behaviors were significantly mediated through protective skills. The model suggests that helping youth enhance their skills in goal setting, decision making, and self-reliant coping could lessen a variety of problem behaviors commonly found among homeless youth.

An exploratory model of girls' vulnerability to commercial sexual exploitation in prostitution.

Due to inaccessibility of child victims of commercial sexual exploitation, the majority of emergent research on the problem lacks theoretical framing or sufficient data for quantitative analysis. Drawing from Agnew's general strain theory, this study utilized structural equation modeling to explore: whether caregiver strain is linked to child maltreatment, if experiencing maltreatment is associated with risk-inflating behaviors or sexual denigration of self/others, and if these behavioral and psychosocial dysfunctions are related to vulnerability to commercial sexual exploitation. The proposed model was tested with data from 174 predominately African American women, 12% of whom indicated involvement in prostitution while a minor. Findings revealed child maltreatment worsened with increased caregiver strain. Experiencing child maltreatment was linked to running away, initiating substance use at earlier ages, and higher levels of sexual denigration of self/others. Sexual denigration of self/others was significantly related to the likelihood of prostitution as a minor. The network of variables in the model accounted for 34% of the variance in prostitution as a minor.

The influence of running away on the risk of female sexual assault in the subsequent year.

This study explores the sexual risk trajectories of female youths and sheds light on the long-term effects of running away. It evaluates whether running away increases the risk of sexual assault in the following year, which is after runaways return home. The sample consists of 5,387 heterosexual females between the ages of 11 and 18 years from the Longitudinal Study of Adolescent Health. Nearly one quarter (23%) of runaways report a previous sexual assault in contrast to 5% of nonrunaways. In a logistic regression model, childhood neglect increases the risk of sexual assault between Waves 1 and 2 by nearly two times. Poor mental health is statistically significant. Alcohol use doubles the odds of sexual assault. The risk of sexual assault is approximately three-fold for girls with a history of sexual onset and sexual touching in a romantic relationship. Running away increases the risk by nearly two and a half times. There is evidence that alcohol use and sexual onset partially mediates the relationship between running away and sexual assault.

The effect of early maltreatment, victimization, and partner violence on HIV risk behavior among homeless young adults.

PURPOSE: The purpose of our study was to examine the relationship between child maltreatment, physical and sexual victimization, and partner violence victimization with human immunodeficiency virus (HIV) risk behaviors among a sample of homeless young adults from the midwestern United States. METHODS: Data are from the Homeless Young Adult Project. A total of 199 young adults aged 19-26 years were interviewed over 14 months using a systematic sampling strategy. The final sample included 172 young adults who were homeless or had a history of running away and being homeless. RESULTS: Results from the path analysis revealed that sexual abuse is directly linked with street sexual victimization which was positively associated with a greater number of HIV risk behaviors. Experiencing more types of physical abuse and neglect were positively correlated with partner violence victimization, which was, in turn, associated with more HIV risk behaviors. Those who suffered from more types of neglect also experienced more forms of sexual and physical victimization. CONCLUSIONS: These findings have implications for service providers. Clinicians who serve homeless youth should recognize the potential effect that experiencing a variety of forms of victimization may have on health risk behaviors.

That which does not kill you makes you stronger: runaway youth's resilience to depression in the family context.

The present study sought to uncover the relationship between risk and protective factors for depressive symptomatology among runaway youth. To that aim, 3 models of resiliency-the compensatory, risk-protective, and challenge models-were tested separately on girls and boys. The data came from a cross-sectional survey on a sample of 140 runaway adolescents between the ages of 12 and 17 years who were recruited from the only runaway crisis shelter in a large Midwestern city. Risk factors in the proposed model included primary caretaker's depressive symptoms, family conflict, and adolescent's and primary caretaker's verbal aggression; protective factors included adolescent's report of task-oriented coping and family cohesion. Findings supported the challenge model for predicting adolescent depressive symptoms, suggesting that moderate levels of risk can be beneficial for these runaway adolescents. In addition, risk and protective factors differed by adolescent gender. Implications for preventive interventions and future research are discussed.

The high-risk environment of homeless young adults: consequences for physical and sexual victimization.

Little is known about how the social environment of homeless youth contributes to their risk and how it varies for different types of victimization. As such, the current study examines the constructs of victimization theories in order to investigate the potential risk for physical and sexual victimization among homeless young adults. Results revealed that running at an earlier age, running more often, sleeping on the street, panhandling, deviant peers associations, and not having a family member in one's network are associated with more physical victimization. Being female, a sexual minority, having an unkempt physical appearance, panhandling, and having friends who traded sex are associated with more sexual victimization. Overall, we find that the constructs differed in their ability to explain sexual versus physical victimization.

Running away experience and psychoactive substance use among adolescents in Taiwan: multi-city street outreach survey.

BACKGROUND: This study aimed to examine: 1) the relationship between being a runaway and the time since the first absconding event and adolescent substance use; 2) whether different kinds of psychoactive substances have a different temporal relationship to the first absconding event; and 3) whether the various reasons for the first absconding event are associated with different risks of substance use. METHODS: Participants were drawn from the 2004-2006 nationwide outreach programs across 26 cities/towns in Taiwan. A total of 17,133 participants, age 12-18 years, who completed an anonymous questionnaire on their experience of running away and substances use and who were now living with their families, were included in the analysis. RESULTS: The lifetime risk of tobacco, alcohol, betel nut, and illegal drug/inhalant use increased steadily from adolescents who had experienced a trial runaway episode (one time lasting or= 2 times or lasting > 1 day), when compared to those who had never ran away. Adolescents who had their first running away experience > 6 months previously had a greater risk of betel nut or illegal drug/inhalant use over the past 6-months than those with a similar experience within the last 6 months. Both alcohol and tobacco use were most frequently initiated before the first running away, whereas both betel nut and illegal drug/inhalant use were most frequently initiated after this event. When adolescents who were fleeing an unsatisfactory home life were compared to those who ran away for excitement, the risk of alcohol use was similar but the former tended to have a higher risk of tobacco, betel nut, and illegal drug/inhalant use. CONCLUSIONS: More significant running away and a longer time since the first absconding experience were associated with more advanced substance involvement among adolescents now living in a family setting. Once adolescents had left home, they developed additional psychoactive substance problems, regardless of their reasons for running away. These findings have implications for caregivers, teachers, and healthcare workers when trying to prevent and/or intervening in adolescent substance use.

The relationship between frequency of family dinner and adolescent problem behaviors after adjusting for other family characteristics.

OBJECTIVE: To examine the association between frequency of family dinners (FFD) and selected problem behaviors for adolescents after adjusting for family connectedness, parental awareness, other family activities, and other potentially confounding factors. METHODS: Data are drawn from the National Longitudinal Survey of Youth, 1997. The primary variable of interest is self-reported FFD in a typical week. Problem behaviors studied are substance-use, physical violence, property-destruction, stealing, running away from home, andgang membership. Multivariate logistic models are estimated for each behaviors. Linear regression models are estimated for behavior-frequency for the sub-samples engaging in them. Analysis is done separately by gender. RESULTS: FFD is negatively associated with substance-use and running away for females; drinking, physical violence, property-destruction, stealing and running away for males. CONCLUSION: Family meals are negatively associated to certain problem behaviors for adolescents even after controlling rigorously for potentially confounding factors. Thus, programs that promote family meals are beneficial.

The meaning of running away for girls.

OBJECTIVE: The aim of this qualitative research was to understand how runaway girls perceive the processes involved in leaving home and the meaning they attribute to it. METHOD: Findings are based on in-depth interviews with 10 Israeli girls aged 13-17 with a history of running away from home. RESULTS: The meaning of running away as it emerged from the girls' descriptions of their lives prior to leaving home was that of survival - both psychological and physical. The girls' stories centered on their evolving experiences of alienation, loneliness and detachment, and the failure of significant relationships at home and outside of home to provide them with the support they needed. These experiences laid the ground for the "final moments" before leaving, when a feeling of "no alternative," a hope for a better future, and various particular triggers led the girls to the decision to leave home. CONCLUSION: Participants' insights about the dynamics leading to running-away center on the meaning of family relationships, particularly those with the mother, as constituting the girl's psychological home. The girls seemed to perceive running away as an inevitability, rather than a choice, and even portrayed the running away as "living suicide." Yet, their stories clearly demonstrate their ability to cope and the possession of strengths and skills that enabled them to survive in extremely difficult home situations. PRACTICE IMPLICATIONS: The findings of this research highlight the importance of improving services for reaching out and supporting girls who are on the verge of running away from home. Such services should be tailored to the needs of girls who experience extreme but often silenced distress at home, and should facilitate alternative solutions to the girls' plight other than running away. An understanding of the dynamics leading to running away from the girls' perspective has the potential to improve the efficacy of services provided by contributing to the creation of a caring, empowering, understanding and trustful professional relationship.

Exposure to violence in adolescence and precocious role exits.

Exposure to violence is a serious public health concern that compromises adolescents by affecting their behavior and psychological well-being. The current study advances knowledge about the consequences of exposure to violence in adolescence by applying a life course perspective to evaluate the developmental implications of adolescents' exposure to violence. In particular, drawing on a sample of 11,949 school-aged adolescents in the U.S., we examine whether exposure to violence in adolescence is associated with precocious role exits that some adolescents experience. Exposure to violence is conceptualized as including both direct (i.e., experiencing physical victimization) and indirect exposure (i.e., witnessing others' victimization). Three types of direct exposure to violence are examined: street, intimate partner, and family victimization, as well as four types of indirect exposure including: street, peer, and school violence as well as exposure to family/friend suicide. Using three waves of longitudinal data from the Add Health Study, we find that exposure to violence is associated with greater risks of running away from home, dropping out of high school, having a child, attempting suicide, and coming into contact with the criminal justice system in later adolescence. In addition, risks depend upon the relational context in which the exposure to violence occurred, risks increase with greater exposure to violence, and risks are, for the most part, highest for those youth exposed to both indirect and direct violence in adolescence.

Onset of conduct disorder, use of delinquent subsistence strategies, and street victimization among homeless and runaway adolescents in the Midwest.

This study examines the effects of childhood-onset conduct disorder on later antisocial behavior and street victimization among a group of homeless and runaway adolescents. Four hundred twenty-eight homeless and runaway youth were interviewed directly on the streets and in shelters from four Midwestern states. Key findings include the following. First, compared with those who exhibit adolescent-onset conduct disorder, youth with childhood onset are more likely to engage in a series of antisocial behaviors such as use of sexual and nonsexual survival strategies. Second, youth with childhood-onset conduct disorder are more likely to experience violent victimization; this association, however, is mostly through an intervening process such as engagement in deviant survival strategies.