Men don't cry: The supporting role as necessary for women's well-being after termination of pregnancy.

OBJECTIVES: The present study investigated similarities and differences of grief between men and women as part of the parental couple 1 year after termination of pregnancy (TOP) following a diagnosis of fetal anomaly. METHODS: We applied a method triangulation approach. We assessed several aspects of perinatal grief, depressive symptoms, posttraumatic stress, and anxiety as well as health-related quality of life. In addition, we conducted qualitative interviews with the men to explore the fathers' roles in the partnership during pregnancy, the time of the diagnosis, TOP, and afterwards. RESULTS: Women showed a more elevated grief response compared with men. Qualitative data revealed that men in our sample were mainly concerned with their partners' well-being and concentrated on supporting their partners rather than on their own emotions. In addition, the supportive role of the male partner plays a central role in the well-being of women and the man's coping with the situation. CONCLUSION: In clinical work, but also when developing new questionnaires, the specific role of the male partners needs to be considered more thoroughly. Particular attention should be paid to identify the men who find it difficult to assume the supporting role.

Personality functioning and self-disorders in individuals at ultra-high risk for psychosis, with first-episode psychosis and with borderline personality disorder.

BACKGROUND: Assessment of personality functioning in different stages of psychotic disorders could provide valuable information on psychopathology, course of illness and treatment planning, but empirical data are sparse. AIMS: To investigate personality functioning and sense of self in individuals at ultra-high risk (UHR) for psychosis and with first-episode psychosis (FEP) in comparison with a clinical control group of individuals with borderline personality disorder (BPD) and healthy controls. METHOD: In a cross-sectional design, we investigated personality functioning (Structured Interview of Personality Organization, STIPO; Level of Personality Functioning Scale, LPFS) and disturbances of the basic self (Examination of Anomalous Self-Experience, EASE) in 107 participants, comprising 24 individuals at UHR, 29 individuals with FEP, 27 individuals with BPD and 27 healthy controls. RESULTS: The UHR, FEP and BPD groups had moderate to severe deficits in personality organisation (STIPO) compared with the healthy control group. Self-functioning with its subdomain (facet) 'self-direction' (LPFS) was significantly worse in participants with manifest psychosis (FEP) compared with those at-risk for psychosis (UHR). The FEP group showed significantly worse overall personality functioning than the UHR group and significantly higher levels of self-disturbance (EASE) than the BPD group, with the UHR group lying between these diagnostic groups. Hierarchical cluster analysis based on the seven STIPO domains yielded three clusters differing in level of personality functioning and self-disturbances. CONCLUSIONS: Our data demonstrate that psychotic disorders are associated with impaired personality functioning and self-disturbances. Assessment of personality functioning can inform treatment planning for patients at different stages of psychotic disorder.

Termination of pregnancy for fetal malformation: A traumatic event? A qualitative analysis of women's perception.

Objective: To investigate women's experience of termination of pregnancy (TOP) for severe fetal malformation.We focus on women's individual perception of psychological counselling on decision making, experiencing the birth process, seeing and holding the baby as well as emotional processing. Methods: An explorative study was conducted with 42 women (the age range was between 21 and 45 years [mean 36.17; SD±6.66]) on average twelve months after TOP using semi-structured qualitative interviews. All women received psychological counselling before, during and after the time of TOP (mean 5.2; range 2-11), at the initial counselling session all partners were present. Data were analysed by means of qualitative content analysis by Mayring; the main research question focused on women's perception of psychological counselling on experiencing TOP and coping with this incisive life event. Results: After receiving psychological counselling most of the women felt sufficiently prepared to make a decision, to experience the birth process and to bid farewell to their child. Seeing and holding the baby were perceived as helpful for emotional processing. At the time of the interview, despite the emotional distress,most women reported having positivememories and felt they had coped with the loss. Conclusions: Long-term psychological care from the time of diagnosis through TOP and follow up impacts positively on experiencing TOP, saying farewell to the child and integrating the loss into life. Further studies to detect women at risk for prolonged mourning-reactions are needed.

Personality functioning in anxiety disorders.

BACKGROUND: The Alternative DSM-5 Model for Personality Disorders as well as the upcoming IDC-11 have established a new focus on diagnosing personality disorders (PD): personality functioning. An impairment of self and interpersonal functioning in these models represents a general diagnostic criterion for a personality disorder. Little is known so far about the impairment of personality functioning in patients with other mental disorders than PD. This study aims to assess personality functioning in patients with anxiety disorders. METHODS: Ninety-seven patients with the diagnosis of generalized anxiety disorder, panic disorder, or phobia, and 16 healthy control persons were diagnosed using the Structured Clinical Interview for DSM-IV (SCID-I and -II) and were assessed by means of the Structured Interview for Personality Organization (STIPO) to determine the level of personality functioning. RESULTS: While all three patient groups showed significant impairment in personality functioning compared to the control group, no significant differences were observed between the different patient groups. In all three groups of anxiety disorders patients with comorbid PD showed significantly worse personality functioning than patients without. Patients without comorbid PD also yielded a significant impairment in their personality functioning when compared to the control group. CONCLUSIONS: Anxiety disorders are associated with a significant impairment in personality functioning, which is significantly increased by comorbid PD. There are no differences in terms of personality functioning between patients with different anxiety disorders.