[Personality disorders in a nonclinical sample of adolescents]. / Troubles de la personnalité dans un échantillon non clinique d'adolescents.

OBJECTIVE: To examine the comorbidity of borderline personality disorder and other personality disorders in a nonclinical sample of high-school students. METHOD: 311 high-school students who completed the French version of the CES-D (Center for Epidemiological Studies-Depression Scale), were asked to participate to interviews evaluating personality functioning: 60 subjects (19%) accepted to participate in the study. The mean CES-D score of these 60 subjects (16 boys, 44 girls, mean age=17.7 1.7) was significantly higher than the mean score of the whole sample (23.9 10.4 versus 16.7 9.8). Thus the interviewed sample was not representative of the population of high-school students. Subjects were assessed using the major depressive episode module of the MINI (Mini International Neuropsychiatric Interview) and the SIDP IV (Structured Interview for DSM IV Personality). Inter-rater reliability was determined by comparing the independent ratings of interviewers and an experienced clinician on a random sample of 20 interviews. For DSM IV borderline personality disorder diagnosis, the Cohen's kappa coefficient was 0.85. For personality disorder criteria, kappa ranged from 0.6 to 1.0 (average kappa=0.79). RESULTS: Sixteen of these subjects (26,7%, 4 males, 12 females) received a diagnosis of borderline personality disorder according to DSM IV criteria. The mean CES-D score of borderline subjects (30.6 10.2) was significantly higher than the mean score of nonborderline subjects (21.6 10.5). Of the 16 borderline subjects, 11 (75%) received a diagnosis of major depressive disorder versus 14 (31%) of the non borderline subjects. None of the other personality disorders approached the frequency of borderline personality disorder. The next most frequent diagnoses were depressive and dependent personality disorders which occurred in respectively in 16.6% and 10% of the 60 subjects. All the personality-disorders occurred at higher rates in the group with borderline personality disorder with the exception of obsessive-compulsive personality disorder which was diagnosed only in nonborderline subjects. Of the 16 borderline subjects, 11 (68.7%) met the criteria for another personality disorder which were depressive personality disorder (N=5), paranoid personality disorder (N=4), dependent personality disorder (N=3), antisocial personality disorder (N=2), histrionic personality disorder (N=2), avoidant personality disorder (N=2), negativistic personality disorder (N=2), schizotypal personality disorder (N=1), narcissistic personality disorder (N=1), self-defeating personality disorder (N=1). The optional diagnoses (self-defeating, depressive and negati-vistic personality disorders) accounted for 8 of 23 (34.7%) cases of personality disorders diagnosed among borderline subjects. Among these 11 adolescents, 5 received 2 diagnoses of personality disorders (borderline and paranoid personality disorders, N=1; borderline and dependent personality disorders, N=1; borderline and depressive personality disorders, N=3), 3 received 3 diagnoses (borderline, antisocial and histrionic personality disorders, N=1; borderline, avoidant and negativistic personality disorders, N=1; borderline, depressive and negativistic personality disorders, N=1), 3 received 5 diagnoses (borderline, paranoid, histrionic, narcissistic and dependent personality disorders, N=1; borderline, paranoid, dependent, avoidant and depressive personality disorders, N=1; borderline, paranoid, schizotypal, antisocial and self-defeating personality disorders, N=1). Among the 44 adolescents (12 boys, 32 girls) without borderline personality disorder, 10 (22.7%) (3 boys, 7 girls) met the criteria for another personality disorder which were depressive personality disorder (N=5) or cluster C disorders -obsessive-compulsive personality disorder (N=4), dependent personality disorder (N=2), avoidant personality disorder (N=1) - with the exception of one diagnosis of histrionic personality disorder. Two subjects received 2 diagnoses (obsessive-compulsive and depressive personality disorder). The internal consistency of personality disorders criteria was assessed with Cronbach's alpha coefficient. Borderline personality disorder criteria had high internal consistency (0.82). The factor structure of borderline personality disorder criteria was studied with an exploratory factorial analysis which extracted three factors. The eigenvalues were 3.70, 1.06, and 1.01. Confirmatory factorial analyses were conducted. The correlated two-factor model and the three-factor model fit the data well but the correlation between factors was, however, judged too high, ranging from 0.70 to 0.78. The one-factor model proved to have a good fit (Goodness of Fit Index=0.89, Comparative Fit Index=0.90, Root Mean Square Residual=0.07). As a previous study showed the frequency of two schizotypal personality disorder criteria (odd beliefs/magical thinking experiences and unusual perceptual experiences), an exploratory factorial analysis was performed on the combined set of criteria of borderline and schizotypal personality disorders. It yielded 2 factors: the first factor consisted of all the borderline personality disorder criteria, odd beliefs/magical thinking, and unusual perceptual experiences and could be called the borderline factor; the second factor consisted of the paranoid and the social avoidance criteria and could be called the interpersonal hypersensitivity factor. A confirmatory factor analysis showed that this two-factor model provided a good fit to the data (GFI=0.82, CFI=0,91, RMSR=0.10). The correlation between factors was weak (0.25). These results suggest that odd beliefs/magical thinking and unusual perceptual experiences are a component of borderline symptomatology in adolescents. DISCUSSION: The high frequency of major depressive disorder and personality disorders in the interviewed sample may be due to the possibility that adolescents with psychological problems have used the interview as a way to obtain attention and support from a psychologist. The interviewed sample, which was characterized by a high intensity of depressive symptomatology and by a high frequency of borderline personality disorder, could thus be seen as intermediate between a clinical and a community sample. Our results may be more generalizable to an outpatients population of adolescents. This study found conflicting results about the construct validity of borderline personality disorder in adolescent. The high internal consistency and the one-factor structure of the borderline personality disorder criteria argue for their validity in adolescents. However, the high rates of comorbidity of borderline personality disorder with depression and other personality disorders, extended to clusters A, B and C and to optional diagnoses, suggest the lack of construct validity of either borderline personality or cluster B disorders in adolescents. CONCLUSION: Borderline symptomatology in adolescents appears more in adequacy with a dimensional model than with a typological classification. More studies are needed to assess and improve the construct validity of borderline personality disorder in adolescents.

[Validation of the French version of of the Telic Dominance Scale (TDS)]. / Validation française de la Telic Dominance Scale (TDS)--echelle de dominance télique.

There are connections between sensation seeking, difficulties to plan the future and to work towards aims, in relation with fails of mentalisation and addictions. Those characteristics have been described by M.J. Apter as a paratelic dominance of the person, in opposition with the telic dominance. That dimension of the personality has been formalizing as a part of the Reversal Theory. After a presentation of the foundations of this theory, and the validity's studies of the English version of the Telic Dominance Scale, the article explains the proceedings of validation of the TDS French version (Echelle de dominance télique). The population is 72 subjects: 38 addicts--ASI criteria--and 34 control. The component analysis with varimax rotation doesn't allow to find the three factors of construction, but there is a good inter-correlation between the factors. Alpha's Cronbach coefficient is correct, underlining the intern consistency of the scale. At the comparison between groups, the scale has a good sensitivity. There is no correlation between the variables of population (age, sex, employment) and TDS. Lastly, there is a correct correlation between self esteem, anxiety, depression and TDS. The results make TDS a scale with an imperfect validity in its French version, but this scale has sufficient qualities to be used in the case of short studies about addicted population. In association with others instruments, this scale can assess a stable component of the personality giving a measure of the addictive risk.

Addiction as a function of action system properties.

Generalising from some previous analyses of addiction and introducing the concept of an action system which governs all actions which are focused on what Brown (1988) calls "hedonic management," we argue that addictions of every kind involve an action system that displays high salience, low variety, and low vicariance. Addictions also involve what Apter (1982) calls the "paratelic state." A study was carried out comparing 31 drug addicts with 29 control subjects in terms of action system variables. To measure these variables, we constructed a new instrument, the Activity-System Drawing Test, and also used the Telic Dominance Scale to measure frequency of paratelic states. Dysphoria was measured by means of the BATE (anxiety), IDA-13 (depression), SEI (self-esteem), and TAS-20 (alexithymia) instruments. Strong significant differences were found between groups for both action system variables and dysphoria. This supports the idea that addictions emerge from systemic properties of the action system.

[Defense mechanisms and the prediction of PTSD]. / Mécanismes de défense et prédiction des états de stress post-traumatiques.

The purpose of this study was to assess mental defense mechanisms, characteristics of trauma and life events predicting the development of posttraumatic stress disorder. Victims of traumatic events were recruited from a general university hospital. 23 participants were examined with a semi structured clinical interview, according to DSM IV criteria. All of them were assessed with the Social Readjustment Scale (Holmes et al., 1967), with the Traumatic Disorder Inventory Scale (Steinitz et al., 1992) and completed the Impact of Event Scale of Horowitz. All the subjects completed the Defense Style Questionnaire-40 (DSQ-40). The different mechanisms were ranked in three categories: mature, neurotic, and immature. Finally, we compared defense scores, trauma scores and life events scores between PTSD subjects and non PTSD subjects. 8 subjects were diagnosed as having PTSD compared to 15 not considered to have PTSD. Being alone during exposure significantly enhances the risk for the development of PTSD. Among PTSD subjects only reaction formation, a neurotic defense, was employed significantly more often than in those without PTSD. These findings suggest that mental defense mechanisms may be indicative of a risk for the development of PTSD after event exposure. Using DSQ-40, mature and immature defenses didn't differ, although reaction formation played a role, particularly in regard to traumatic memories and perseverative thoughts.

[Dependence disorders in psychopathology]. / La dépendance en psychopathologie.

Research concerning the psychopathological aspects of dependence implicates a wide range of behaviors reassembled under the term of "dependence behaviors": sexual, medical, alcoholic and tobacco dependencies. Speech samples of dependent subjects show that encountering the object of dependence (product, element, ...) introduces a particular form of organized psychological processes. According to several authors, psychopathological dependence can be attributed to: early personality development; failures in the separation-individuation processes; disorders in mother-infant interactions; and a deficit in the psychological functioning of the subjects. For psychopathology, the dependence cannot be reduced to physiological dependence on the product but is understood rather in terms of a complex process indicative of either specific or non-specific suffering which is addressed by abused substance that represents a solution--the effects of which constitute the addictive process. Understanding this process requires an analysis of the psychopathological dependence from a triple meta-psychological viewpoint (topographical, dynamic, economic). Such analysis allows for a psychoanalytical theoretical interpretation of dependence based on three models: pleasure, narcissism and stress reduction. At the same time, the analysis extends the examination of psychopathological dependence towards issues concerning the body. Such body issues are critically placed between the biological and the psychological processes.

[Is the functioning of our brain of an addictive nature?]. / Le fonctionnement de notre cerveau serait-il de nature addictive?

The concept of addiction is increasingly bound to a general model of heterogeneous and polymorphous dependences. In this paper we examine upstream what could found this universal addictive principle, asking the question of the neurobiological root of addictivity. In other words, is the root of our brain working in an addictive way? To answer affirmatively to this question we gather two sets of datas: firstly, the conditions of the brain addictivity and secondly, the brain mechanisms that suggest this kind of addictive working. These datas are common if we consider them one by one, but their synthesis in a bundle of heuristic clues could be interesting to examine and to submit to thought. The model we suggest proposes that the architecture of our brain and the type of functioning of our neurones, imply the presence of a natural addictive set of problems in all human beings, between a fight against cerebral background noise--a dysphoric source--and a stimulation need. Finally, considering some neurobiological data in the last five years, we propose a triangular model of the addict brain, that involves three associated systems: "arousal" system, "liking" system and "wanting" system. This model, supported by the sensation seeking one, will allow us to suggest an explanation of the processes that lead to pathological addictions, according to the principles of a natural and universal addictivity.

Splitting and the psychodynamics of adolescent and young adult suicide attempts.

The authors point to a link between the contradictory meanings and functions of adolescent and young adult suicide attempts and splitting mechanisms that may explain the normal coexistence of opposite tendencies. They argue that suicide attempts of young people reveal a deadlock in development, in which individuation and the need for dependence are equally intolerable because of the arousal of anxiety linked to persecution or abandonment. The sexualisation of the body and of intimate relationships engenders a risk of psychic decompensation, which is temporarily set aside through the reinforcement of splitting and denial; the suicide attempt, however, is precipitated by conditions that provoke a traumatic return of that which has been split-off and denied. Suicide attempts thus represent an act of compromise, the object of which is to avoid psychic disorganisation through the re-establishment of a precarious equilibrium between antithetical tendencies that splitting can simultaneously address. In particular, suicide may represent an attempt at individuation and flight from incest while at that same time satisfying fusion needs and the realisation of oedipal fantasies. Clinical examples are presented to illustrate the manifestation and the function of splitting in young people's suicide attempts.

[Cognitive therapy and psychoanalytical therapy of limited personalities: a critical consideration]. / Thérapie cognitive et psychothérapie analytique des personnalités limites: une réflexion critique.

Comparative studies of psychoanalytical and cognitive approaches to psychotherapy for borderline personalities reveal not only convergences of opinion, particularly concerning the importance of the relationship with the therapist, but also noteworthy differences. Different types of cognitive therapy are to be distinguished by their highly structural nature and by the learning of cognitive capacity with a view to reducing the severity of emotional and behavioral disorders. The different types of analytical therapy attempt a reorganisation of the personality by referring to a complex psychopathological model, allowing an overview of mental functions and of transferral interaction, and attempt to modify them.

[A metapsychological reading of questioning by police and during criminal investigations]. / Une lecture métapsychologique de l'interrogatoire de police et de l'interrogatoire d'instruction.

The pursuit and reception of a confession during police interrogation and cross examination lead to a dynamic interaction between interrogator and interrogated which can be examined under the light of psychoanalytical concepts. This reference framework enables a reading of the different positions occupied by the interrogator with regard to the interrogated, and allows to understand certain mechanisms in the arrival of a confession as well as some of its effects.