The Affective Charge of Sulphur and Salt in Working with Compulsion.

The author presents a long analysis of a patient, Giulia, whose obstinate will to achieve evokes the workings of alchemical sulphur at its fieriest and a dread of its coniunctio with alchemical salt. Jung's description of these symbols in Mysterium Coniunctionis offers a useful imaginal perspective to clinical work in the area of compulsion and its possible transformations. Right from the start, the analytic relationship appeared to be mirrored and affected by this alchemical perspective. However, it was only after much time, uncertainty and emotional endurance that a fuller psychological experience of sulphur and salt could be accessed, allowing the analysis to take a more imaginative and mercurial turn. In the course of his work with Giulia the author has witnessed and experienced a range of intense affects-the many colours that the combustion of sulphur can generate-whether on the verge of unstoppable creation or ruthless destruction, often of archetypal intensity. This experience has been lived through and has undergone a transformative relation with salt, which until then had lived a dissociated existence in the fixed trauma of the compulsion and in a nocturnal underworld of tears.

L'auteur présente la longue analyse d'une patiente, Giulia, dont la volonté obstinée de réussir fait penser à l'activité du soufre alchimique à son point le plus ardent et à la crainte terrible de son coniunctio avec le sel alchimique. La description que fait Jung de ces symboles dans Mysterium Coniunctionis fournit une perspective imaginale qui est utile pour le travail clinique dans le domaine de la compulsion et de ses transformations possibles. Dès le début, la relation analytique semblait être reflétée et affectée par cette perspective alchimique. Cependant, ce fut seulement après beaucoup de temps, d'incertitude et d'endurance émotionnelle qu'une expérience psychologique plus complète du soufre et du sel a pu être atteinte, ce qui a permis à l'analyse de prendre une tournure plus imaginative et plus mercurienne. Durant son travail avec Giulia l'auteur a été témoin et a éprouvé un éventail d'affects intenses ­ les multiples couleurs que la combustion du souffre peut générer ­ que ce soit au bord d'une création irrésistible ou d'une destruction impitoyable, souvent d'une intensité archétypale. Cette expérience a été traversée et a subi une relation transformative avec le sel, qui jusqu'alors avait vécu une existence dissociée dans le traumatisme figé de la compulsion et dans les enfers nocturnes des larmes.

El autor presenta un largo análisis de una paciente, Giulia, cuya obstinada voluntad de logro evoca el funcionamiento del azufre alquímico en su forma más ardiente y el temor a su coniunctio con la sal alquímica. La descripción que Jung hace de estos símbolos en Mysterium Coniunctionis ofrece una perspectiva imaginal útil para el trabajo clínico en el ámbito de la compulsión y sus posibles transformaciones. Desde el principio, la relación analítica pareció reflejarse y verse afectada por esta perspectiva alquímica. Sin embargo, fue sólo después de mucho tiempo, incertidumbre y resistencia emocional que pudo accederse a una más plena experiencia psicológica de azufre y sal, lo cual permitió que el análisis tomara un giro más imaginativo y mercurial. En el transcurso de su trabajo con Giulia, el autor ha sido testigo y ha experimentado una gama de intensas emociones ­los múltiples colores que puede generar la combustión del azufre­, ya sea al borde de una creación imparable o de una destrucción despiadada, a menudo de intensidad arquetípica. Esta experiencia pudo ser atravesada y ha experimentado una relación transformadora con la sal, la cual hasta entonces había vivido una existencia disociada en la fijeza compulsiva del trauma y en un submundo nocturno de lágrimas.

The relationship between childhood maltreatment and self-harm: the mediating roles of alexithymia, dissociation, internalizing and posttraumatic symptoms.

Background: Although childhood maltreatment is associated with later self-harm, the mechanism through which it might lead to self-harm is not completely understood. The purpose of this study was to examine the roles of alexithymia, dissociation, internalizing and posttraumatic symptoms in the association between exposure to childhood maltreatment and subsequent self-harm.Methods: A total of 360 adolescents were asked to complete the Childhood Trauma Questionnaire, the Toronto Alexithymia Scale, the Dissociative Experience Scale, the Somatoform Dissociation Questionnaire-20, the Posttraumatic Stress Checklist for DSM-5, and the Deliberate Self-Harm Inventory.Results: Results of structural equation modelling analysis revealed the significant mediation effects of alexithymia and dissociative symptoms in the relationship between childhood maltreatment and self-harm, while internalizing and posttraumatic symptoms did not significantly mediate.Conclusion: The findings indicate that alexithymia and dissociative symptoms may be proximal mechanisms linking maltreatment exposure and adolescence self-harm.

Self-harm can be used as a maladaptive coping strategy in response to both hyper- and hypo-arousal symptoms.Alexithymia and dissociative symptoms may be proximal mechanisms linking maltreatment exposure and adolescent self-harm.Posttraumatic symptoms did not mediate the relationship between a history of childhood maltreatment and self-harm.

Trauma-related mental health problems among mothers in Taiwan and their relationship with children's emotional and behavioral problems.

ABSTRACTBackground: Trauma can give rise to mental health problems and emotional and interpersonal difficulties, which in turn can perpetuate the cycle of trauma and adversity for future generations. However, little is known about the prevalence and potential effects of trauma and trauma-related mental health problems among parents.Objective: The primary goal of this study was to examine childhood and adulthood trauma and trauma-related symptoms among mothers of children aged between 6 and 18. We also conducted exploratory analyses of their potential relationship with children's emotional and behavioural problems.Method: A total of 817 mothers living with a child aged between 6 and 18 in Taiwan completed standardized self-report assessments of trauma exposure, trauma-related symptoms, and children's emotional and behavioural problems. A subsample (n = 256) also provided follow-up data after six months.Results: Most surveyed mothers reported at least one childhood traumatic event (74.79%) and one adulthood traumatic event (78.70%); 4.4% met the ICD-11 criteria for PTSD, and 12.1% for complex PTSD; 11.4% reported clinically significant dissociative symptoms. Mothers' complex PTSD and dissociative symptoms were cross-sectionally correlated with children's emotional and behavioural problem (rs = .186 to .239, p < .001). After controlling for possible confounding variables and baseline scores, mothers' childhood non-betrayal trauma reported at baseline was found to be a predictor of children's emotional and behavioural problems reported at follow up.Conclusion: This study is the first to provide data regarding childhood and adulthood trauma and trauma-related disorders, including ICD-11 complex PTSD, among mothers in the community. It calls for more studies to understand the potential effects of intergenerational trauma.

Trauma-related symptoms are common among mothers.Mothers' childhood non-betrayal trauma predicted children's problems.Intergenerational trauma warrants recognition as a public health concern.

Complex posttraumatic stress disorder and dissociation in trauma-exposed Chinese adolescents: a latent class analysis.

Background: Preliminary evidence provides support for the proposition that there is a dissociative subtype of Complex posttraumatic stress disorder (CPTSD). Research on this proposition would extend our knowledge on the association between CPTSD and dissociation, guide contemporary thinking regarding placement of dissociation in the nosology of CPTSD, and inform clinically useful assessment and intervention.Objectives: The present study aimed to investigate the co-occurring patterns of CPTSD and dissociative symptoms in a large sample of trauma exposed adolescents from China, and specify clinical features covariates of such patterns including childhood trauma, comorbidities with major depressive disorder (MDD) and generalized anxiety disorder (GAD), and functional impairment.Methods: Participants included 57,984 high school students exposed to the coronavirus disease 2019 (COVID-19) pandemic. CPTSD and dissociative symptoms, childhood traumatic experience, and functional impairment were measured with the Global Psychotrauma Screen for Teenagers (GPS-T). Major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Latent class analysis (LCA) was employed to test the co-occurring patterns of CPTSD and dissociative symptoms. Analysis of covariance (ANCOVA) and chi-square tests were respectively used to examine between-class differences in continuous and categorical clinical covariates.Results: A 5-class model emerged as the best-fitting model, including resilience, predominantly PTSD symptoms, predominantly disturbances in self-organization (DSO)symptoms, predominantly CPTSD symptoms, and CPTSD dissociative subtype classes. The CPTSD dissociative subtype class showed the lowest level of functioning and the highest rates of MDD, GAD and childhood trauma.Conclusions: Our findings provide initial empirical evidence supporting the existence of a dissociative subtype of CPTSD, and inform for further research and clinical practice on traumatized individuals.

The present study identified a dissociative subtype of ICD-11 CPTSD among trauma exposed youth.The dissociative subtype of ICD-11 CPTSD was associated with poorer mental health outcomes.Findings of this study provide initial empirical evidence supporting the existence of a dissociative subtype of CPTSD.

Differential constellations of dissociative symptoms and their association with childhood trauma - a latent profile analysis.

Background: While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific dissociative symptoms cluster together among individuals with childhood trauma histories ranging from none to severe.Objective: We aimed to explore symptom constellations across the whole spectrum of dissociative processing from patients with severe dissociative disorders to healthy controls and relate these to maltreatment severity and sociodemographic characteristics.Methods: We employed latent profile analysis to explore symptom profiles based on five subscales, measuring absorption, depersonalization, derealization, somatoform and identity alteration, based on the 20 items of the German short version of the Dissociative Experiences Scale-II (Fragebogen zu Dissoziativen Symptomen-20) in a large aggregate sample (n = 3,128) overrepresenting patients with trauma-related disorders. We then related these profiles to maltreatment severity as measured by the five subscales of the Childhood Trauma Questionnaire as well as sociodemographic characteristics.Results: Based on the five FDS subscales, six clusters differentiated by symptom severity, but not symptom constellations, were identified. Somatoform dissociation varied in accordance with the remaining symptom clusters. The cluster with the highest overall symptom severity entailed nearly all subjects diagnosed with Dissociative Identity Disorder and was characterized by extreme levels of childhood maltreatment. Both abuse and neglect were predictive of cluster membership throughout.Conclusions: The higher the severity of dissociative processing in a cluster, the more subjects reported high severity and multiplicity of childhood maltreatment. However, some subjects remain resilient to the development of dissociative processing although they experience extreme childhood maltreatment.

Dissociative symptoms, including identity alterations, are closely related to the severity of experienced childhood abuse.Somatoform dissociation occurs on all levels of overall dissociation severity.Some subjects with a history extreme childhood maltreatment do not develop dissociative symptoms, while some subjects with extreme dissociative symptoms do not report any childhood maltreatment.

Peritraumatic dissociation and posttraumatic stress symptoms: the moderating role of perceived threat.

Background: Although peritraumatic dissociation (PD) is viewed as a risk factor for posttraumatic stress disorder (PTSD), prospective studies taking into account other well-known risk factors for PTSD have been scarce, and the exploration of potential moderators within the relations between PD and PTSD has been lacking.Objective: Filling this gap, this prospective study explored the moderating role of perceived threat within the relations between PD and PTSD, above and beyond age, gender, education, and early trauma-related symptoms.Method: A convenience sample of 200 Israeli civilians filled out self-report questionnaires during the peritraumatic phase (T1) and one to two months after the posttraumatic phase (T2) of being exposed to rocket attacks.Results: The results showed that perceived threat and PD were associated with early trauma-related symptoms and PTSD symptoms. Moreover, perceived threat moderated the relationship between PD and all PTSD symptom clusters apart from avoidance.Conclusions: The present results suggest that the implications of PD are shaped by levels of perceived threat, so that detriments of PD are evident when the trauma is appraised as being highly threatening. Therefore, early interventions that aim to decrease PD may be beneficial in preventing PTSD symptoms of intrusion, hyper arousal, and negative alterations in mood and cognition, for individuals who perceive traumatic events as highly threatening.

Perceived threat was related to early trauma-related symptoms and PTSD symptoms.Peritraumatic dissociation was related to early trauma-related symptoms and PTSD symptoms.Perceived threat moderated the link between peritraumatic dissociation and PTSD symptoms.

[Translated article] Spinopelvic dissociation: Current concepts.

INTRODUCTION: Spinopelvic dissociation is an uncommon injury, but, at the same time, very serious, since it can associate important complications with high morbidity and mortality. Its low frequency means that the experience of the specialists who have to deal with it is often very limited. OBJECTIVE: To analyze the treatment indications based in classifications and surgery techniques. METHOD: A search for scientific articles from high-impact journals was performed through international databases, such as Pubmed, Cochrane Library, Scopus, Science Direct and OVID. CONCLUSIONS: The management of the injury we are analyzing represents a challenge. The diagnosis is carried out through a meticulous anamnesis and physical examination, supported by imaging tests, where tomography acquires special relevance. The treatment is fundamentally surgical, reserved the conservative option for a few cases. Triangular fixation is nowadays considered the treatment of choice.

Dissociative symptoms among community health service users in Hong Kong: a longitudinal study of clinical course and consequences.

Background: Previous studies have demonstrated the high prevalence of dissociative symptoms and their association with considerable healthcare costs. However, there is a lack of studies that describe whether dissociative symptoms persist and lead to other clinical outcomes over time in the community.Objectives: This study investigated the persistence, predictors, and consequences of dissociative symptoms in the community.Methods: We analyzed longitudinal data in a sample of community health service users in Hong Kong (N = 173).Results: A relatively high proportion (63.6%) of participants with baseline dissociative symptoms continued to exhibit dissociative symptoms after approximately 9 months. Baseline non-betrayal trauma predicted subsequent dissociative symptoms (ß = .141, p = .024). Participants with baseline dissociative symptoms were more likely to have received subsequent emergency mental health services (9.1% vs 0.7%, p = .005). Baseline dissociative symptoms significantly predicted subsequent post-traumatic symptoms (ß = .165 to .191, p < .05) and difficulty in social and occupational participation (ß = -.152 to -.182, p < .05) even after controlling for baseline scores, trauma exposure, and use of professional support. The predictive role of dissociative symptoms on subsequent disturbances in self-organization symptoms and social participation difficulty remained significant after applying the Bonferroni correction.Conclusions: This is one of the very few studies showing that dissociative symptoms are persistent to a certain degree and could predict other symptoms and subsequent impairments even in community settings. Factors that affect the trajectory of dissociative symptoms should be further investigated. Regular screening for dissociative symptoms is recommended. Considering its prevalence, persistence, and clinical and social consequences, dissociation should be given greater public health attention.

Dissociative symptoms have been linked to considerable healthcare costs.The persistence and consequences of dissociation in the community had not been previously reported.This study showed that dissociative symptoms persisted to a certain degree and predicted subsequent impairments after approximately 9 months.Dissociation should be given greater public health attention.

Persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms: a one-year follow-up study.

BACKGROUND: Recent studies found that post-traumatic and dissociative symptoms are common in people with depressive symptoms. Although a trauma-related subtype of depression has been proposed, little is known about the persistence and clinical consequences of these symptoms. OBJECTIVE: This one-year follow-up study investigated the persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms. METHODS: We analyzed longitudinal data from an international sample of people self-reporting depressive emotions (N = 152) (mean Patient Health Questionnaire-9 score = 17.27; SD = 6.31). RESULTS: More than half (58.4%) of participants with baseline post-traumatic stress disorder (PTSD) still met the criteria for PTSD after one year. Participants with dissociative symptoms at baseline were significantly more likely to report lifetime psychiatric hospitalization (31.2% vs 14.7%), past-year use of psychiatric hospitalization (10.4% vs 0%) and emergency services (16.9% vs 4%) than those without dissociative symptoms. All post-traumatic and dissociative symptom clusters were cross-sectionally (r = .286 to .528, p < .001) and longitudinally (r = .181 to .462, p < .001) correlated with depressive symptoms. A sense of current threat (ß = .146, p < .05) and negative self-concept (ß = .173, p < .05) at baseline significantly predicted depressive symptoms after one year. CONCLUSIONS: These findings contribute to the increasing body of knowledge regarding the PTSD/dissociation-depression comorbidity. Given their persistence and clinical consequences, we recommend that post-traumatic and dissociative symptoms be regularly screened for in clinical settings. The existence of a possible trauma-related subtype of depression should receive more attention in both research and clinical practice.

Post-traumatic and dissociative symptoms are common in people with depressive symptoms.These symptoms generally persist over one year and predict more depressive symptoms at follow-up.Trauma-related symptoms should be regularly screened for in clinical settings.

Treatment of dissociative symptoms with opioid antagonists: a systematic review.

BACKGROUND: The clinical guidelines for the treatment of dissociation focus primarily on psychotherapy. However, different psychoactive drugs are used in clinical practice. The use of opioid antagonists has been proposed as a therapeutic option based on the theory that dissociation might be a phenomenon mediated by dysregulation of the endogenous opioid system. OBJECTIVE: To review and meta-analyse the available evidence on the efficacy of the opioid antagonists naltrexone, naloxone, and nalmefene as treatments for dissociative symptoms and disorders. METHOD: The PRISMA guidelines were followed, and this review was registered in Prospero with reference number CRD42021280976. The search was performed in the PubMed, Scopus, Web of Science, EMBASE, PsycINFO, and PubPsych databases. RESULTS: 1,798 citations were obtained. After removing duplicates and applying inclusion and exclusion criteria, we included 5 comparative studies with 9 dissociation measures that had included a total of 154 participants, of whom 134 had been treated with an opioid antagonist. The results of the meta-analysis showed a treatment effect for dissociation when using opioid antagonists [pooled d = 1.46 (95% CI: 0.62-2.31)]. However, the studies we included were very heterogeneous [Q = 66.89 (p < .001)] and there may have been publication bias. CONCLUSIONS: Although more research is needed and the results must be interpreted with caution because of the limited amount of data and heterogeneity in the studies and their methodological qualities, opioid antagonists (particularly naltrexone) are promising candidates for the treatment of dissociative symptoms and showed a moderate - large effect size in reducing these symptoms.

The results of the meta-analysis showed a treatment effect for dissociation when using opioid antagonists [pooled d = 1.46 (95% CI: 0.62­2.31)].The results must be interpreted with caution because of the limited amount of data and heterogeneity in the studies and their methodological qualities.Opioid antagonists (particularly naltrexone) are promising candidates for the treatment of dissociative symptoms and showed a moderate ­ large effect size in reducing these symptoms.

The role of dissociation-related beliefs about memory in trauma-focused treatment.

OBJECTIVE: Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms. METHOD: Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (n = 111) or the dissociative subtype of PTSD (n = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated. RESULTS: Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome. CONCLUSION: The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.

This study investigated the role of dissociation-related beliefs about memory on trauma-focused treatment.Dissociation-related beliefs were related to post-traumatic and dissociative symptoms, and were especially prominent in patients with the dissociative subtype of post-traumatic stress disorder.Dissociation-related beliefs about memory do not impact the effectiveness of trauma-focused treatment. In fact, trauma-focused treatment effectively decreased these beliefs, suggesting that dissociation-related beliefs about memory should not be a determining factor in withholding patients from receiving trauma-focused therapy.

Self-stigma predicts post-traumatic and depressive symptoms in traumatized individuals seeking interventions for dissociative symptoms: a preliminary investigation.

Background: Previous studies showed that self-stigma is associated with poor clinical outcomes in people with serious mental illness, and is associated with post-traumatic stress disorder (PTSD). However, less is known about self-stigma in people with dissociative symptoms, which are often related to psychological trauma. This study examined whether baseline self-stigma would be associated with dissociative, PTSD and depressive symptoms at post-intervention, after controlling for treatment usage and baseline symptom severity, in a sample of traumatized Chinese adults undertaking a psychoeducation intervention for dissociative symptoms.Methods: We conducted a secondary analysis of data from a 60-day web-based psychoeducation programme. A total of 58 participants who provided data before and after the intervention were included for analysis. Hierarchical regression analyses were conducted.Results: In this highly traumatized, dissociative, and symptomatic help-seeking sample, baseline self-stigma was associated with PTSD (ß = .203, p = .032) and depressive (ß = .264, p = .025) symptoms at post-intervention, even after controlling for baseline symptom severity, age, location, number of sessions attended in the web-based psychoeducation programme, and use of psychological treatments for PTSD/dissociative symptoms. However, self-stigma was not associated with dissociative symptoms (p = .108).Conclusions: This is the first study showing that self-stigma is a significant predictor of comorbid symptoms (i.e. PTSD and depressive symptoms) in people seeking interventions for dissociative symptoms. The findings that post-traumatic and dissociative symptoms have different relationships to self-stigma also highlight the possibility dissociation might be an independent psychological construct closely associated with trauma, but not merely a PTSD symptom, although further studies are necessary. The preliminary findings call for more efforts to understand, prevent, and address self-stigma in people with trauma-related mental health issues such as dissociative symptoms.

Little is known about the clinical impacts of self-stigma in people with trauma and dissociation.Self-stigma predicted post-traumatic and depressive symptoms in people seeking interventions for dissociative symptoms.More efforts to understand and prevent self-stigma in people with trauma-related symptoms are needed.

Spinopelvic dissociation: Current concepts. / Disociación espinopélvica, revisión de conceptos actuales.

INTRODUCTION: Spinopelvic dissociation is an uncommon injury, but, at the same time, very serious, since it can associate important complications with high morbidity and mortality. Its low frequency means that the experience of the specialists who have to deal with it is often very limited. OBJECTIVE: To analyze the treatment indications based in classifications and surgery techniques. METHOD: A search for scientific articles from high-impact journals was performed through international databases, such as Pubmed, Cochrane Library, Scopus, Science Direct and OVID. CONCLUSIONS: The management of the injury we are analyzing represents a challenge. The diagnosis is carried out through a meticulous anamnesis and physical examination, supported by imaging tests, where tomography acquires special relevance. The treatment is fundamentally surgical, reserved the conservative option for a few cases. Triangular fixation is nowadays considered the treatment of choice.

Seeing in the Dark: A View into Dissociation and Healing.

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched's (2013) recommendation for a "binocular stance" to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client's unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.

Dans cet article, j'explorerai le rôle de la création artistique, l'expérience du traumatisme et de la dissociation, et le processus de travail avec les états liés au soi, ceci à partir d'un cadre analytique et créatif. La littérature se rapportant à la dissociation, au traumatisme et à l'utilisation de l'art sera étudiée. Un cas concernant mon travail avec une adolescente qui a été victime d'abus sexuels par une personne de sa famille sera partagé, en mettant l'accent sur le rôle significatif que les images ont joué au cours du processus thérapeutique. Les modèles jungiens et psychanalytiques de conceptualisation et de travail avec la dissociation sont pris en compte, suivant la recommandation de Donald Kalsched (2013) pour une « position binoculaire ¼ dans le traitement - mettre l'accent à la fois sur le monde intérieur et intrapsychique et sur le domaine relationnel interpersonnel - et comment les images issues de l'art ont à la fois éclairé et exprimé ces domaines. Dans le processus thérapeutique, les images artistiques ont donné au thérapeute un accès au processus inconscient du client et ont créé un terrain de rencontre pour que les barrières dissociatives soient progressivement vues, ressenties et connues par le thérapeute et le client. L'expérience de la dissociation, en images et en séance, a fourni un point de référence pour mon client, « Taylor ¼, et pour moi-même afin de développer une compréhension commune et un cadre de travail pour la croissance.

En este artículo, exploraré el rol de la creación artística, la experiencia del trauma y la disociación, y el proceso de trabajar con los estados del self desde un marco analítico y creativo. Se discutirá la literatura relevante sobre disociación, trauma y el uso del arte. Se compartirá un caso de mi trabajo con una adolescente que había sufrido abusos sexuales por parte de un familiar, haciendo hincapié en el papel significativo que desempeñaron las imágenes durante el proceso terapéutico. Se incluyen modelos tanto junguianos como psicoanalíticos de conceptualizar y trabajar con la disociación, siguiendo la recomendación de Donald Kalsched (2013) de una "postura binocular" para el tratamiento, incluyendo tanto un enfoque en el mundo interno, intrapsíquico, como en la dimensión interpersonal, relacional, y en cómo las imágenes de arte iluminaron y expresaron estas áreas. Dentro del proceso terapéutico, las imágenes artísticas permitieron al terapeuta una visión del proceso inconsciente del cliente y crearon un punto de encuentro para que las barreras disociativas fueran vistas, sentidas y conocidas gradualmente, tanto por el terapeuta como por el cliente. La experiencia de la disociación, en imágenes y en sesión, proporcionó un punto de referencia para mí y para mi cliente, "Taylor", para desarrollar una comprensión compartida, y un marco de referencia para el crecimiento.

PTSD Symptom dynamics after the great east japan earthquake: mapping the temporal structure using Dynamic Time Warping.

Background: After the Great East Japan Earthquake [GEJE], approximately 70,000 Japan Ground Self Defense Force [JGSDF] personnel were deployed, risking Post-Traumatic Stress Disorder [PTSD]. The network approach to psychopathology suggests that symptoms may cause and exacerbate each other, resulting in the emergence and maintenance of disorders, including PTSD. It is therefore important to further explore the temporal interplay between symptoms. Most studies assessing the factor structure of the Impact of Event Scale-Revised [IES-R] have used cross-sectional designs. In this study, the structure of the IES-R was re-evaluated while incorporating the temporal interplay between symptoms.Methods: Using Dynamic Time Warping [DTW] the distances between PTSD symptoms on the IES-R were modelled in 1120 JGSDF personnel. Highly correlated symptoms were clustered at the group level using Distatis three-way principal component analyses of the distance matrices. The resulting clusters were compared to the original three subscales of the IES-R using a Confirmatory Factor Analysis (CFA).Results: The DTW analysis yielded four symptom clusters: Intrusion (five items), Hyperarousal (six items), Avoidance (six items), and Dissociation (five items). CFA yielded better fit estimates for this four-factor solution (RMSEA = 0.084, CFI = 0.918, TLI = 0.906), compared to the original three subscales of the IES-R (RMSEA = 0.103, CFI = 0.873, TLI = 0.858).Conclusions: DTW offers a new method of modelling the temporal relationships between symptoms. It yielded four IES-R symptom clusters, which may facilitate understanding of PTSD as a complex dynamic system.

Personnel from the Japan Ground Self-Defense Force responded to the aftermath of the 2011 Great East Japan Earthquake, putting them at increased risk of developing symptoms of Post-Traumatic Stress Disorder.In recent years, psychological research has focused increasingly on methods to map the ways in which symptoms of psychopathology cause and exacerbate each other.The Dynamic Time Warping algorithm seems to be an appropriate and useful tool to analyse the interaction between post-traumatic stress symptoms over time, especially if these are not instantaneous or linear. This can improve our understanding of psychopathology and help move towards personalized medicine.

Psychometric properties of the dissociative subtype of posttraumatic stress disorder scale: replication and extension in two German-speaking samples.

Background: The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced the dissociative subtype of posttraumatic stress disorder (D-PTSD). To assess this subtype, the Dissociative Subtype of PTSD Scale (DSPS), a 15-item self-report measure to identify lifetime and current dissociative symptoms of D-PTSD, was developed. However, so far, the scale has only been validated in war veterans. Moreover, criterion validity and diagnostic utility have not been examined yet.Objective: We aimed to validate the DSPS in two samples of civilian trauma-exposed German-speaking participants.Methods: In Study 1, a pre-registered online study, participants with and without PTSD symptoms (N = 558) answered questionnaires about traumatic experiences, dissociation, PTSD, depression, generalized anxiety disorder, somatic symptom disorder, alcohol use disorder, absorption, and dissociative responding to trauma-related questionnaires. In Study 2, which used secondary data of a pre-registered clinical study, participants with a PTSD diagnosis (N = 71) answered questionnaires about traumatic experiences, dissociation, PTSD, depression, generalized anxiety disorder, somatic symptom disorder, and dissociative responding to standardized trauma exposure. Moreover, PTSD, D-PTSD, and other diagnoses were assessed with structured clinical interviews.Results: Analyses confirmed a three-factor structure as well as high internal consistency, and high convergent, discriminant, and criterion validity of the DSPS. Moreover, the scale was able to identify a latent D-PTSD group and individuals with D-PTSD diagnosis.Conclusions: The DSPS constitutes a reliable and valid tool to assess D-PTSD symptoms in clinical practice and research and thereby may contribute to a better understanding of these debilitating symptoms.

Many individuals with posttraumatic stress disorder (PTSD) suffer from dissociative symptoms which can be assessed with the Dissociative Subtype of PTSD Scale (DSPS; Wolf et al., 2017).The DSPS demonstrated good psychometric properties in two German-speaking trauma-exposed samples and hence might be used to assess D-PTSD symptoms in research and clinical practice.Complementing the original English version, a German version of the DSPS is provided in the Supplements.

Una alternativa esperanzadora “la terapia con esketamina intranasal en una paciente con depresión resistente”. A propósito de un caso / A hopeful alternative is "intranasal esketamine therapy in a patient with resistant depression". About a case

El Trastorno Depresivo Mayor es la causaprincipal de discapacidad a nivel mundial. La depresión resistente al tratamiento ocurre en un subgrupo de pacientes con trastorno depresivo mayor, y consiste en una falta de respuesta a dos o más antidepresivos diferentes en dosis y duración adecuadas, con una adherencia óptima al tratamiento. En 2019 tanto la FDA como la EMA aprobaron la indicación de esketamina intranasal (esketamina in-) en el Trastorno Depresivo Mayor, cuyo mecanismo de acción se basa en el antagonismo del receptor NMDA. En este artículo exponemos el caso de una paciente con Trastorno Depresivo Mayor, que fue tratada con esketamina en uso compasivo, los efectos secundarios presentados y el manejo de los mismos. Los resultados fueron espectaculares, ya que, a partir de la tercera administración, se observó una respuesta clínica muy favorable, evidenciándose la remisión completa a las 5 semanas. El uso de esketamina intranasal ha demostrado ser muy efectivo y con una gran rapidez de acción, siendo el único antidepresivo capaz de lograr la remisión completa en esta paciente tan compleja y grave, además de conseguir ajustar a la baja la medicación concomitante. Los efectos secundarios fueron de fácil manejo, transitorios y autolimitados al momento de la administración. Tal y como se describe en la ficha técnica y en el informe de posicionamiento terapeútico de esketamina intranasal, el tratamiento debe ser administrado en un entorno clínico adecuado, que podría ser bien el hospital o el ambulatorio, ya que ambos contienen los recursos necesarios para la sesión de administración y posterior periodo de observación del paciente. (AU)

Mayor depressive disorder is the main cause of disability in the world. Treatment resistant depression occurs in a subgroup of patients with mayor depressive disorder and consists of a lack of response to two or more different antidepressants in adequate doses and duration, with optimal adherence to treatment. In 2019, both the FDA and the EMA approved the indication of intranasal esketamine in Major Depressive Disorder, whose mechanism of action is based on NMDA receptor antagonism. In this article we present the case of a patient with Major Depressive Disorder, who was treated with esketamine in compassionate use, secondary effects presented and their management. The results were dramatic, since from the third administration a very favorable clinical response was observed, showing complete remission at five weeks. The use of intranasal esketamine has proved to be very effective and rapid over time, being the only antidepressant able of achieving complete remission in this very complex and severe patient, in addition to achieving downward adjustment of the concomitant medication. The treatment may be administered in a suitable clinical environment, so both hospital and outpatient resources may be suitable places for administration. (AU)

Peritraumatic physical symptoms and the clinical trajectory of PTSD after a terrorist attack: a network model approach.

Introduction: Following a mass casualty event, such as the Paris terrorist attacks of 13 November 2015, first responders need to identify individuals at risk of PTSD. Physical peritraumatic symptoms involving the autonomic nervous system may be useful in this task.Objective: We sought to determine the trajectory of physical response intensity in individuals exposed to the Paris terrorist attacks using repeated measures, and to examine its associations with PTSD. Using network modelling, we examined whether peritraumatic physical symptom associations differed by PTSD status.Methods: Physical reactions were assessed using the Subjective Physical Reactions Scale at three time points: peritraumatic by retrospective recall, then current at one year (8-18 months) and three years (30-42 months) after the attacks. Interaction networks between peritraumatic physical reactions were compared according to PTSD status.Results: On the one hand, the reported intensity of physical reactions was significantly higher in the PTSD group at all time points. On the other hand, using the dynamic approach, more robust positive interactions between peritraumatic physical reactions were found in the PTSD group one and three years after the attacks. Negative interactions were found in the no-PTSD group at one year. Peritraumatic physical numbness was found to be the most central network symptom in the PTSD group, whereas it was least central in the no-PTSD group.Discussion: Network analysis of the interaction between peritraumatic physical subjective responses, particularly physical numbness, may provide insight into the clinical course of PTSD. Our knowledge of the brain regions involved in dissociation supports the hypothesis that the periaqueductal grey may contribute to the process leading to physical numbing.Conclusions: Our findings highlight the role of peritraumatic somatic symptoms in the course of PTSD. Peritraumatic physical numbness appears to be a key marker of PTSD and its identification may help to improve early triage.

Physical numbness was found to be a central symptom in people developing PTSD in our study examining peritraumatic physical symptoms related to the 2015 Paris terrorist attacks.

La fragmentación de la identidad en la disociación y en las psicosis / Identity fragmentation in dissociation and psychoses

En la psiquiatría actual tenemos mucho interés en dilucidar las semejanzas y las diferencias existentes entre las experiencias psicóticas y las experiencias disociativas, y en especial las dinámicas patogénicas que dan lugar a unas y a otras, y los abordajes terapéuticos más eficaces en cada caso. Desde el punto de vista de la identidad plural, estas dos experiencias constituyen las dos grandes crisis biográficas funcionales que dan lugar a la fragmentación de la identidad, con la pérdida de su unidad y continuidad, además de su autonomía y autoestima. Ambas se diferencian por los mecanismos de represión y disociación que están en el origen de las mismas. Ahora bien, cualquier enfoque o hipótesis con la que tratemos de entender estos dos tipos de experiencias no debe limitarse a comprenderlas en sus representaciones actuales y en las claves que hoy llamaríamos “científicas”, porque experiencias de este tipo han existido a lo largo de la historia de la humanidad reconceptualizadas de forma distinta, en otras claves culturales, espirituales, religiosas o morales. (AU)

In current psychiatry, there is a great interest in elucidating the existing similarities and differences between psychotic experiences and dissociative ones; especially, the pathogenic dynamics that give rise to both of them, as well as the most effective therapeutic approaches in each case. From the point of view of plural identity, these two experiences make up the two great functional biographic crises that give rise to identity fragmentation, with the loss of their unity and continuity, in addition to the loss of their autonomy and self-esteem. Both of them are differentiated by the repression and dissociation mechanisms that exist in their origin. That said, any approach or hypothesis that we may use to try to understand these two types of experiences should not be limited to understanding them in their current representations and with the keys that we currently call “scientific”, because experiences of this type have existed throughout the history of humanity, reconceptualized differently in other cultural, spiritual, religious or moral keys. (AU)

The Unreal Child.

Unrepresented mental states lead to an impaired ability to feel emotions and trust in oneself, one's history and in the world. The article explores the question of how representations of oneself and the relevant other, the mother, become possible in the course of therapy when dissociative processes previously made this impossible, and what role unconscious communication plays in the analytic realm. This question will be explored by examining the theories of André Green, Philip Bromberg, and Howard Levine.

Les états mentaux non-représentés résultent en une capacité réduite à ressentir les émotions et la confiance en soi, en son histoire et dans le monde. Cet article explore la question de comment les représentations de soi et de l'autre - la mère - deviennent possible durant une thérapie alors que les processus de dissociation rendaient cela impossible auparavant. L'article explore également la question du rôle de la communication inconsciente dans le domaine analytique. Cette question sera explorée à travers les théories d'André Green, de Philip Bromberg, et de Howard Levine.

Los estados mentales no representados conducen a un deterioro de la capacidad para sentir emociones y confiar en uno mismo, en la propia historia y en el mundo. El artículo explora la cuestión de cómo las representaciones de uno mismo y del otro relevante, la madre, se vuelven posibles en el curso de la terapia cuando previamente los procesos disociativos lo hacían imposible, y qué papel juega la comunicación inconsciente en el ámbito analítico. Esta cuestión se explorará examinando las teorías de André Green, Philip Bromberg y Howard Levine.