Relationship between psychodynamic functioning, defensive mechanisms and trauma in patients with PTSD?

OBJECTIVE: Patients with Post-Traumatic Stress Disorder (PTSD) present a variety of symptoms, with different intensities, causing impairments in the individual, social and occupational functioning areas. The aim of this study was to understand the psychodynamic functioning of patients with PTSD, exploring the relationship between symptom severity, quality of life, subjective suffering, conflicts and psychic structure regarding sociodemographic characteristics, styles and defensive mechanisms. METHODS: This is a cross-sectional quantitative study with 60 participants. The following were used: sociodemographic questionnaire, the Operationalized Psychodynamic Diagnosis-2 (OPD-2) and the Defensive Style Questionnaire (DSQ-40). RESULTS: Participants had moderate to high symptom severity, with significant subjective suffering and isolation. The main conflict was Need for care x Self-sufficiency and the level of Total Structure was moderate/low. The use of immature, neurotic, and mature defensive styles was observed. More primitive personality structures, more rigid defenses and greater dependence were found in patients with history of past trauma. Other mental disorders were also associated. CONCLUSION: OPD-2 was effective to assess the psychodynamic functioning characteristics of patients with PTSD. Therapeutic treatment should focus on the psychic structure and not only on symptom control. Prevention strategies should target vulnerability factors and strengthening of protective factors.

Diagnóstico Psicodinâmico Operacionalizado (OPD-2) em pacientes com comportamento suicida prévio / Operationalized Psychodynamic Diagnosis (OPD-2) in patients with previous suicidal behavior

OBJETIVO: avaliar o funcionamento psicodinâmico de pacientes pós-tentativa de suicídio através do Diagnóstico Psicodinâmico Operacionalizado (OPD-2) e de outros instrumentos complementares. MÉTODOS: estudo de caso utilizando métodos mistos de análise (quali-quantitativa). Os pacientes foram avaliados em follow up 3 anos após a primeira entrevista (que ocorreu logo após a tentativa de suicídio), e dois deles concordaram em participar do follow up. RESULTADOS: observou-se nível moderado de funcionamento global nos pacientes. Os conflitos psíquicos com maior prevalência foram o de 'autoestima' e 'necessidade de ser cuidado' versus 'autossuficiência'. Em suas relações, mostraram-se dependentes, impulsivos e exigentes, o que ocasiona sensação constante de abandono. Nessa perspectiva, o medo de ser abandonado faz com que se distanciem e se isolem. Os fatores protetivos de tendências suicidas foram a qualidade da rede de apoio (MOS), a maior interação social, a maior estabilidade do self, o nível de defesas maduras e o tratamento em saúde mental posterior à alta hospitalar. CONCLUSÃO: o OPD-2 demonstrou-se um instrumento apropriado para uma ampla compreensão psicológica de pessoas que tiveram tentativas de suicídio.(AU)

OBJECTIVE: to evaluate the psychodynamic functioning of patients after suicide attempts through the Operationalization Psychodynamic Diagnosis (OPD-2) and other complementary instruments. METHODS: case study using mixed methods of analysis (quali-quantitative). Patients were evaluated in follow up 3 years after the first interview (which occurred shortly after the suicide attempt), and two of them has agreed in participating of the follow up. RESULTS: a moderate level of overall functioning was observed in the patients. The most prevalent psychic conflicts were 'self-esteem' and 'need to be cared for' versus 'self-sufficiency'. In their relationships, they have shown up to be dependent, impulsive and demanding, which causes a constant feeling of abandonment. In this perspective, the fear of being abandoned causes them to distance themselves and be isolated. The protective factors of suicidal tendencies were the quality of the support network (MOS), the greater social interaction, the greater stability of the self, the level of mature defenses and the mental health treatment after hospital discharge. CONCLUSION: OPD-2 proved to be an appropriate instrument for a broad psychological comprehension of people who had suicide attempts.(AU)

OBJETIVO: evaluar el funcionamiento psicodinámico de pacientes tras intentos de suicidio a través del Diagnóstico Psicodinámico Operacionalizado (OPD-2) y otros instrumentos complementarios. MÉTODOS: estudio de caso utilizando métodos mixtos de análisis (cuali-cuantitativo). Los pacientes fueron evaluados en el seguimiento 3 años después de la primera entrevista (que ocurrió poco después del intento de suicidio), y dos de ellos han aceptado participar del seguimiento. RESULTADOS: se observó un nivel moderado de funcionamiento general en los pacientes. Los conflictos psíquicos más prevalentes fueron la "autoestima" y la "necesidad de ser atendido" versus la "autosuficiencia". En sus relaciones se han mostrado dependientes, impulsivos y exigentes, lo que provoca un constante sentimiento de abandono. En esta perspectiva, el miedo al abandono hace que se distancien y se aíslen. Los factores protectores de las tendencias suicidas fueron la calidad de la red de apoyo (MOS), la mayor interacción social, la mayor estabilidad del yo, el nivel de defensas maduras y el tratamiento de salud mental tras el alta hospitalaria. CONCLUSIÓN: OPD-2 resultó ser un instrumento apropiado para una amplia comprensión psicológica de las personas que tuvieron intentos de suicidio.(AU)

Mental health outcomes in Syrian refugees: A systematic review.

BACKGROUND: Syria is the main country of origin for refugees in the world. The prevalence of mental disorders in this population is high, but there is a lack of more comprehensive data on mental health issues in this population. AIM: This study aims to review the literature for mental health outcomes in Syrian refugees. METHODS: We performed a systematic quantitative literature review of original observational studies indexed on the MEDLINE via PubMed, Embase, Web of Science, PsycINFO, LILACS, and SciELO databases with quantitative data reporting mental health outcomes in Syrian refugees. A descriptive analysis was conducted, and the quality of the included studies was assessed using an adaptation from The National Institutes of Health (NIH) quality assessment tool for observational studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS: A total of 64 studies were included. The majority were published between 2019 and 2020, and focused on the prevalence of post-traumatic stress disorder (PTSD), depression, and anxiety, with a wide range of variations. Other outcomes were difficulties in the post-migration period and promotive factors for mental health, such as resilience, positive coping strategies, and psychosocial well-being. CONCLUSIONS: High prevalence rates of mental disorders were observed, as well as risk factors for their occurrence. Studies showed a very high variability of prevalence rates and heterogeneity in methodologies. There is a need for research focusing on other determinants and specific necessities for mental health, especially in the post-resettlement period.

Understanding the psychodynamic functioning of patients with PTSD and CPTSD: qualitative analysis from the OPD 2 interview.

The traumatic event produces intolerable excitations to the psychic apparatus that searches to relief them through the production of symptoms. When established, patients with post-traumatic stress disorders (PTSD) and complex post-traumatic stress disorder (CPTSD) may experience flashbacks, somatizations, negative emotions about themselves, and difficulty in social contact. This work seeks to understand how the psychodynamic functioning of women victims of interpersonal and urban violence, diagnosed with these disorders, is organized, identifying traumatic experiences, ways of interpersonal relationships, conflicts and psychic structures and use of defense mechanisms, and for peculiarities that may differentiate these disorders. The qualitative transversal method was used through the content analysis of clinical interviews based on the Operationalized Psychodynamic Diagnosis (OPD-2). The sample of this study consisted of five women with PTSD and five with CPTSD. The following categories were created: reasons for seeking care, symptoms and desire for treatment, traumatic developmental events, and characteristics of the psychic functioning. Early trauma generates psychic organizations with greater disintegration. A new traumatic event destabilizes the psychic organization and intensifies symptoms. Relationships were marked by dependence and isolation. Participants with CPTSD presented tendency to disintegration related to the object relation regulation and the psychic conflict was of Individuation versus Dependence, with more primitive flaws in object representations, existential need for the other and direct discharge of impulses. Participants with PTSD had moderate to low level of object relation integration and the conflict was need to be care of versus self-sufficiency, with self-representations being fragile and with reduced capacity to manage impulses. Thus, it could be observed that OPD-2 is capable of assessing in a broad and deep way patients with traumatic disorders, in addition to identifying essential peculiarities to guide health professionals towards treatment in the search for better quality of life for patients.

Identifying posttraumatic stress disorder staging from clinical and sociodemographic features: a proof-of-concept study using a machine learning approach.

This proof-of-concept study aimed to investigate the viability of a predictive model to support posttraumatic stress disorder (PTSD) staging. We performed a naturalistic, cross-sectional study at two Brazilian centers: the Psychological Trauma Research and Treatment (NET-Trauma) Program at Universidade Federal of Rio Grande do Sul, and the Program for Research and Care on Violence and PTSD (PROVE), at Universidade Federal of São Paulo. Five supervised machine-learning algorithms were tested: Elastic Net, Gradient Boosting Machine, Random Forest, Support Vector Machine, and C5.0, using clinical (Clinician-Administered PTSD Scale version 5) and sociodemographic features. A hundred and twelve patients were enrolled (61 from NET-Trauma and 51 from PROVE). We found a model with four classes suitable for the PTSD staging, with best performance metrics using the C5.0 algorithm to CAPS-5 15-items plus sociodemographic features, with an accuracy of 65.6% for the train dataset and 52.9% for the test dataset (both significant). The number of symptoms, CAPS-5 total score, global severity score, and presence of current/previous trauma events appear as main features to predict PTSD staging. This is the first study to evaluate staging in PTSD with machine learning algorithms using accessible clinical and sociodemographic features, which may be used in future research.

Transculturalidade na psicoterapia de orientação analítica: estudo de um caso e revisão de literatura / Transculturality in analytically oriented psychotherapy: a case study and literature reviewc

A cultura representa os sistemas de valores e simbolismos presentes em um grupo social, e sua influência no psiquismo humano é mencionada na literatura psicanalítica desde a obra Totem e Tabu, de Sigmund Freud. Diferenças culturais podem determinar maneiras diversas de sentir e de expressar o sofrimento psíquico, e no que diz respeito à psicoterapia de orientação analítica considera-se fundamental que o terapeuta esteja sensível aos componentes culturais que influenciam a dinâmica psicológica do paciente. O modelo da psicoterapia transcultural propõe a adaptação de alguns elementos, a fim de cumprir esta finalidade. Este relato foi desenvolvido a partir do atendimento de um paciente de origem africana, admitido em uma internação psiquiátrica por uma síndrome psicótica. Procuramos relacionar os elementos transculturais presentes no caso, como particularidades no idioma e crenças culturais, à prática da psicoterapia de orientação analítica neste contexto. Elementos do conflito psíquico, da transferência e vinculação com o terapeuta foram analisados, tendo por base autores psicanalíticos clássicos e contemporâneos. A partir desta análise, discutimos a respeito de elementos teóricos e técnicos relacionados à transculturalidade em psicoterapia. Espera-se que este relato possa auxiliar psicoterapeutas a trabalhar neste contexto.(AU)

Culture represents value systems and symbolisms present in a social group, and its influence on human psyche has been mentioned in psychoanalytic literature since Sigmund Freud's Totem and Tabu. Cultural differences can determine different ways of feeling and expressing mental distress, and with regard to analytical orientation psychotherapy it is considered essential that the therapist be sensitive to cultural components that influence patient's psychic dynamics. The transcultural psychotherapy model proposes the flexibility of some elements in order to fulfill this purpose. This report was developed from the care of a patient of African origin, admitted to a psychiatric hospital for a psychotic syndrome. We sought to relate the cross-cultural elements present in the case, such as language peculiarities and cultural beliefs, to the practice of analytical-oriented psychotherapy in this context. Characteristics of psychic conflict, transference, and attachment to the therapist were analyzed based on classical and contemporary psychoanalytic authors. From this analysis, we discussed theoretical and technical elements related to transculturality in psychotherapy. It is expected that this report can help psychotherapists to work in this context.(AU)

La cultura representa sistemas de valores y simbolismos presentes en un grupo social, y su influencia en la psique humana ha sido mencionada en la literatura psicoanalítica desde Tótem y tabú de Sigmund Freud. Las diferencias culturales pueden determinar diferentes formas de sentir y expresar el malestar mental, y con respecto a la psicoterapia de orientación analítica se considera fundamental que el terapeuta sea sensible a los componentes culturales que influyen en la dinámica psíquica del paciente. El modelo de psicoterapia transcultural propone la flexibilidad de algunos elementos para cumplir con este propósito. Este relato se elaboró ??a partir de la atención de un paciente de origen africano, ingresado en un hospital psiquiátrico por un síndrome psicótico. Buscamos relacionar los elementos transculturales presentes en el caso, como las peculiaridades del lenguaje y las creencias culturales, con la práctica de la psicoterapia de orientación analítica en este contexto. Se analizaron las características del conflicto psíquico, la transferencia y el apego al terapeuta con base en autores psicoanalíticos clásicos y contemporáneos. A partir de este análisis, discutimos elementos teóricos y técnicos relacionados con la transculturalidad en psicoterapia. Se espera que este informe pueda ayudar a los psicoterapeutas a trabajar en este contexto.(AU)

Afetos, tormentos e desabafos: histórias em psicoterapia e psiquiatria / Affections, torments and outbursts: stories in psychotherapy and psychiatry

Resenha do livro "Afetos, Tormentos e Desabafos: histórias em psicoterapia e psiquiatria"¹, de autoria do Dr. Fernando Lejderman, publicado pela Editora ARTMED em 2022, apresenta a trajetória médico-profissional de vários anos do autor, assim como algumas das vivências que ele experimentou com seus pacientes.

Understanding the psychodynamic functioning of patients with PTSD and CPTSD: qualitative analysis from the OPD 2 interview

Abstract The traumatic event produces intolerable excitations to the psychic apparatus that searches to relief them through the production of symptoms. When established, patients with post-traumatic stress disorders (PTSD) and complex post-traumatic stress disorder (CPTSD) may experience flashbacks, somatizations, negative emotions about themselves, and difficulty in social contact. This work seeks to understand how the psychodynamic functioning of women victims of interpersonal and urban violence, diagnosed with these disorders, is organized, identifying traumatic experiences, ways of interpersonal relationships, conflicts and psychic structures and use of defense mechanisms, and for peculiarities that may differentiate these disorders. The qualitative transversal method was used through the content analysis of clinical interviews based on the Operationalized Psychodynamic Diagnosis (OPD-2). The sample of this study consisted of five women with PTSD and five with CPTSD. The following categories were created: reasons for seeking care, symptoms and desire for treatment, traumatic developmental events, and characteristics of the psychic functioning. Early trauma generates psychic organizations with greater disintegration. A new traumatic event destabilizes the psychic organization and intensifies symptoms. Relationships were marked by dependence and isolation. Participants with CPTSD presented tendency to disintegration related to the object relation regulation and the psychic conflict was of Individuation versus Dependence, with more primitive flaws in object representations, existential need for the other and direct discharge of impulses. Participants with PTSD had moderate to low level of object relation integration and the conflict was need to be care of versus self-sufficiency, with self-representations being fragile and with reduced capacity to manage impulses. Thus, it could be observed that OPD-2 is capable of assessing in a broad and deep way patients with traumatic disorders, in addition to identifying essential peculiarities to guide health professionals towards treatment in the search for better quality of life for patients.

Relationship between childhood trauma, parental bonding, and defensive styles and psychiatric symptoms in adult life.

INTRODUCTION: A relationship between different types of childhood trauma, parental care, and defensive styles and development of psychiatric symptoms in adulthood is proposed in this study. Understanding the nature of this association is essential to assist psychotherapists who treat patients with a history of past trauma. This study aims to examine the associations between childhood trauma, parental bonding, and defensive styles and current symptoms in adult patients who sought care at an analytical psychotherapy clinic. METHODS: The sample comprised 197 patients from an analytically oriented psychotherapy clinic. Participants responded to four self-report instruments that assessed, respectively, presence and frequency of several types of early trauma, type of parental attachment, styles of defenses, and current symptoms encompassing a wide variety of psychopathological syndromes. RESULTS: Only 5% of patients reported not having experienced any traumatic experience in childhood. Several traumas such as emotional and physical abuse, emotional neglect, and physical neglect showed positive and significant associations with several dimensions of current symptoms, and also with parental bonding and defensive styles. When analyzed together with the other variables, defensive styles explained the level of psychological suffering caused by the symptoms. CONCLUSIONS: This study offers additional support for understanding the associations between childhood trauma, parental bonding styles, and defense styles and the psychiatric symptoms of patients in analytically oriented psychotherapy.

Relationship between childhood trauma, parental bonding, and defensive styles and psychiatric symptoms in adult life

Abstract Introduction A relationship between different types of childhood trauma, parental care, and defensive styles and development of psychiatric symptoms in adulthood is proposed in this study. Understanding the nature of this association is essential to assist psychotherapists who treat patients with a history of past trauma. This study aims to examine the associations between childhood trauma, parental bonding, and defensive styles and current symptoms in adult patients who sought care at an analytical psychotherapy clinic. Methods The sample comprised 197 patients from an analytically oriented psychotherapy clinic. Participants responded to four self-report instruments that assessed, respectively, presence and frequency of several types of early trauma, type of parental attachment, styles of defenses, and current symptoms encompassing a wide variety of psychopathological syndromes. Results Only 5% of patients reported not having experienced any traumatic experience in childhood. Several traumas such as emotional and physical abuse, emotional neglect, and physical neglect showed positive and significant associations with several dimensions of current symptoms, and also with parental bonding and defensive styles. When analyzed together with the other variables, defensive styles explained the level of psychological suffering caused by the symptoms. Conclusions This study offers additional support for understanding the associations between childhood trauma, parental bonding styles, and defense styles and the psychiatric symptoms of patients in analytically oriented psychotherapy.

Validation of the Brazilian-Portuguese Version of the Clinician Administered Post Traumatic Stress Disorder Scale-5.

Objectives: The aim of this study was to validate CAPS-5 for the Brazilian-Portuguese language on a sample of 128 individuals from two centers (from the cities of São Paulo and Porto Alegre) who have been recently exposed to a traumatic event. Methods: We performed a reliability analysis between interviewers (with a subset of 32 individuals), an internal consistency analysis, and a confirmatory factorial analysis for the validation study. Results: The inter-rater reliability of the total PTSD symptom severity score was high [intraclass correlation coefficient =0.994, 95% CI (0.987-0.997), p < 0.001]. Cohen's Kappa for individual items ranged between 0.759 and 1. Cronbach's alpha coefficients indicated high internal consistency for the CAPS-5 full scale (α = 0.826) and an acceptable level of internal consistency for the four symptom clusters. The confirmatory factorial analysis for the 20-item original CAPS-5 did not fit the data well. A 15-item model with better results was then established by excluding the following CAPS-5 items: dissociative amnesia, recklessness, distorted cognitions, irritability, and hypervigilance. Conclusion: Despite the limitation of the predominance of female victims, and the high number of sexually assaulted women in our sample, the model with only 15 items provided a good fit to the data with high internal consistency (α = 0.835).

COVID-19 pandemic and social distancing: economic, psychological, family, and technological effects

Abstract Introduction The concept of social isolation is currently understood as a measure of epidemiological containment that aims to reduce the speed of spread of the disease, enabling health services to prepare their resources to cope with the likely increase in demand, while also seeking to provide additional protection to groups considered to be at higher risk. Objective The present narrative review aims to compile and synthesize the literature related to social isolation produced during the COVID-19 pandemic in 2020. Method This study is a narrative review of the literature on social isolation in the context of the COVID-19 pandemic. Results 73 publications were included for full-text reading and were classified into the following categories: levels of social isolation, economic effects, family relationships, health system, mental health of the population, and use of technology. Conclusions It is necessary to plan an escalation of responses to the consequences of the pandemic, especially in view of the increased demand on the health sector and social services. The negative effects of social isolation can be prevented by public policies that offer a response to the economic recession, maintenance of social work, encouragement of quality care in mental health services, and community support for vulnerable families.

COVID-19 pandemic and social distancing: economic, psychological, family, and technological effects.

INTRODUCTION: The concept of social isolation is currently understood as a measure of epidemiological containment that aims to reduce the speed of spread of the disease, enabling health services to prepare their resources to cope with the likely increase in demand, while also seeking to provide additional protection to groups considered to be at higher risk. OBJECTIVE: The present narrative review aims to compile and synthesize the literature related to social isolation produced during the COVID-19 pandemic in 2020. METHOD: This study is a narrative review of the literature on social isolation in the context of the COVID- 19 pandemic. RESULTS: 73 publications were included for full-text reading and were classified into the following categories: levels of social isolation, economic effects, family relationships, health system, mental health of the population, and use of technology. CONCLUSIONS: It is necessary to plan an escalation of responses to the consequences of the pandemic, especially in view of the increased demand on the health sector and social services. The negative effects of social isolation can be prevented by public policies that offer a response to the economic recession, maintenance of social work, encouragement of quality care in mental health services, and community support for vulnerable families.

Violent situations during the COVID-19 pandemic

INTRODUCTION: The pandemic caused by the novel coronavirus (SARS-CoV-2) has changed the lifestyle of the general population, mainly due to the distancing and isolation measures adopted to contain the spread of the disease. These measures generated a series of stressors, including an increase in domestic violence. OBJECTIVE: To identify the occurrence of domestic violence during isolation resulting from the COVID-19 pandemic in Brazil, its association with issues related to mental health and poorly adaptive personality traits. METHOD: Non-probabilistic study, composed of a sample of 3625 participants who were assessed using the PCL-5, DASS-21, PID-5-BF and AUDIT-C. Instruments were administered on-line from April 22, 2020 to May 8, 2020. RESULTS: 379 (13%) of respondents experienced some type of adverse situation during social distancing. Participants who experienced violence had higher alcohol consumption (p=0.004), greater severity of symptoms related to a diagnosis of PTSD (p <0.001), and greater prevalence of anxiety (p<0.001) and depression (p<0.001) symptoms in relation to those who had no such experiences. They also demonstrated higher PID-5 scores of maladaptive personality traits, such as negative affectivity (p<0.001), distance (p<0.001), antagonism (p<0.001), disinhibition (p<0.001) and psychoticism (p<0.001). CONCLUSION: Isolation due to the pandemic is having a great impact on people's mental health, specifically on those who have experienced violence. Together with public agencies and the private sector, strategies should be created aimed at scaling up interventions to mitigate this impact of the pandemic, especially by providing expanded listening spaces in the health and social care sectors.(AU)

INTRODUÇÃO: A pandemia causada pelo novo coronavírus (SARS-CoV-2) alterou o estilo de vida da população em geral, principalmente através das medidas de distanciamento e isolamento adotadas para contenção do avanço da doença. Estas medidas geraram uma série de estressores, dentre eles o aumento da violência doméstica. OBJETIVO: Identificar a ocorrência de violência doméstica durante o isolamento decorrente da pandemia de COVID-19 no Brasil, a sua associação com questões relacionadas à saúde mental e traços mal adaptativos de personalidade. MÉTODO: Estudo não probabilístico, composto por uma amostra de 3625 participantes que foram avaliados através do PCL-5, DASS-21, PID-5-BF e AUDIT-C. Instrumentos aplicados on-line no período entre 22 de abril de 2020 a 08 de maio de 2020. RESULTADOS: 379 (13%) dos respondedores sofreu algum tipo de situação adversa durante o distanciamento social. Os participantes que vivenciaram violência possuem maior consumo de álcool (p=0,004), maior gravidade dos sintomas relacionada ao diagnóstico de TEPT (p<0,01), maior presença de sintomas de ansiedade (p<0,001), depressão (p<0,001), em relação àquelas que não sofreram. Demonstraram ainda possuir, de acordo com o PID-5, escores mais elevados de traços mal adaptativos de personalidade, como afetividade negativa (p<0.001), distanciamento (p<0.001), antagonismo (p<0.001), desinibição (p < 0.001) e psicoticismo (p<0.001). CONCLUSÃO: O isolamento devido a pandemia está causando grande impacto na saúde mental das pessoas, especificamente naquelas que sofreram violência. É necessário, junto ao órgão públicos e privados, criar estratégias visando uma escalada de intervenções relacionadas ao impacto da pandemia, sobretudo ampliando espaços de escuta no setor de saúde e na assistência social.(AU)

INTRODUCCIÓN: La pandemia provocada por el nuevo coronavirus (SARS-CoV-2) ha cambiado el estilo de vida de la población en general, principalmente a través de las medidas de distancia y aislamiento adoptadas para contener el avance de la enfermedad. Estas medidas generaron una serie de factores estresantes, entre ellos el aumento de la violencia intrafamiliar. OBJETIVO: Identificar la ocurrencia de violencia doméstica durante el aislamiento resultante de la pandemia COVID-19 en Brasil, su asociación con problemas relacionados con la salud mental y rasgos de personalidad poco adaptables. MÉTODO: Estudio no probabilístico, compuesto por una muestra de 3625 participantes que fueron evaluados mediante la PCL-5, DASS-21, PID-5-BF y AUDIT-C. Instrumentos aplicados on-line en el período comprendido entre el 22 de abril de 2020 y el 8 de mayo de 2020. RESULTADOS: 379 (13%) de los encuestados sufrieron algún tipo de situación adversa durante la distancia social. Los participantes que experimentaron violencia tienen mayor consumo de alcohol (p=0,004), mayor gravedad de los síntomas relacionados con el diagnóstico de TEPT (p<0,01), mayor presencia de síntomas de ansiedad (p<0,001), depresión (p<0,001), en relación con los que no sufrieron. También demostraron tener, según PID-5, puntuaciones más altas de rasgos de personalidad poco adaptativos, como afectividad negativa (p<0.001), distancia (p<0.001), antagonismo (p<0.001), desinhibición (p<0.001) y psicoticismo (p<0.001). CONCLUSIÓN: El aislamiento debido a la pandemia está teniendo un gran impacto en la salud mental de las personas, específicamente en quienes han sufrido violencia. Es necesario, junto con los organismos públicos y privados, crear estrategias orientadas a ampliar las intervenciones relacionadas con el impacto de la pandemia, especialmente ampliando los espacios de escucha en el sector salud y la asistencia social.(AU)

Association between anger expression and attempted suicide at a general emergency hospital in the south of Brazil.

INTRODUCTION: Suicide is one of the leading causes of death in the world. For every person who commits suicide, twenty or more have attempted to take their own lives. The emotional state of anger is often associated with suicidal behavior. However, this association needs to be further clarified. OBJECTIVES: This study sought to investigate the profiles of traits and expressions of anger in inpatients admitted to a general emergency hospital after surviving a suicide attempt. METHODS: In this case-control study, a sample of 28 suicide survivors was matched for sex, age, and educational level with 56 controls. The State-Trait Anger Expression Inventory-2 was used to measure anger traits and expression. RESULTS: Suicide survivors scored higher for anger traits and expression and lower for anger control than the control group. They also had lower levels of state anger and willingness to express anger verbally than the control group. CONCLUSIONS: Patients who attempted suicide and had high scores for anger expression (in and out) are inclined to have extreme difficulty in interpersonal relationships and rigidity towards change and are at higher risk of developing psychopathologies.

Trauma infantil e manifestações histéricas na atualidade: uma revisão da literatura / Child trauma and hysterical manifestations today: a literature review

As reações corporais e emocionais sentidas pelos pacientes com manifestações histéricas podem atingir tamanha intensidade, a ponto de prejudicar sua vida social, familiar e laboral. O trabalho parte dos seguintes questionamentos: como são as manifestações histéricas na atualidade? Qual a compreensão sobre a histeria na literatura da área ao longo do tempo? O objetivo é descrever aspectos teóricos sobre a histeria e o trauma infantil, articulando-os com a clínica atual. Foi desenvolvida uma revisão da literatura por meio do método narrativo. Os resultados encontrados foram 106 estudos nos últimos 6 anos (Bireme e Dialnet), sendo que, de 2017 em diante, houve um decréscimo nas publicações científicas sobre o tema. Apesar de a categoria psicopatológica da histeria ter desaparecido dos manuais de transtornos mentais, na clínica atual as manifestações histéricas são facilmente confundidas com outros transtornos (depressivos, dissociativos e distúrbio borderline). As manifestações somáticas aparecem no corpo para comunicar eventos traumáticos não contidos pelo aparelho psíquico. Conclui-se que as manifestações histéricas seguem presentes nos dias de hoje, e o corpo tende a ser uma via de expressão somática. No contexto da relação entre sintomas histéricos e traumas vivenciados na infância, a psicoterapia ocupa lugar de destaque, promovendo ressignificações para tais eventos traumáticos.(AU)

The bodily and emotional reactions felt by patients with hysterical manifestations can reach such intensity as to harm their social, family and work life, causing several losses for the individual. The study starts from the following questions: how are the hysterical manifestations today? What about understanding hysteria in the literature of the area over time? The objective is to describe theoretical aspects of hysteria and childhood trauma, in conjunction with the current clinic. A literature review using the narrative method was developed. The results found were 106 studies in the last 6 years (Bireme and Dialnet), and as of 2017 there is a decrease in scientific publications on the topic. Although the psychopathological category of hysteria has disappeared from the manuals of mental disorders, nowadays in the clinic the hysterical manifestations are easily confused with other disorders (depressive, dissociative and borderline). Somatic manifestations appear in the body to communicate traumatic events not contained by the psychic apparatus. It is concluded that the hysterical manifestations are still present today, and the body tends to be an important way of expressing symptoms through the somatic path. In the context of the relationship between hysterical symptoms and childhood trauma, psychotherapy occupies a prominent place, promoting reframing for such traumatic events.(AU)

Las reacciones corporales y emocionales que sienten los pacientes con manifestaciones histéricas pueden alcanzar tal intensidad como para dañar su vida social, familiar y laboral, causando varias pérdidas para el individuo. El estudio parte de las siguientes preguntas: ¿Cómo son hoy las manifestaciones histéricas? ¿Cuál es la comprensión de la histeria en la literatura de la zona a lo largo del tiempo? El objetivo es describir aspectos teóricos de la histeria y el trauma infantil, en conjunto con la clínica actual. Se ha elaborado una revisión de la literatura utilizando el método narrativo. Los resultados encontrados fueron 106 estudios en los últimos 6 años (Bireme y Dialnet), y a partir de 2017 hubo una disminución en las publicaciones científicas sobre el tema. Aunque la categoría psicopatológica de histeria ha desaparecido de los manuales de trastornos mentales, hoy en día en la clínica las manifestaciones histéricas se confunden fácilmente con otros trastornos (depresivo, disociativo y borderline). Las manifestaciones somáticas aparecen en el cuerpo para comunicar eventos traumáticos no contenidos por el aparato psíquico. Se concluye que las manifestaciones histéricas todavía están presentes hoy en día, y el cuerpo tiende a ser una forma importante de expresar los síntomas a través de las vías somáticas. En el contexto de la relación entre los síntomas histéricos y el trauma vivido en la infancia, la psicoterapia ocupa un lugar destacado, promoviendo replanteamiento para tales eventos traumáticos.(AU)

Translation and cultural adaptation of the DSM-5 Personality Inventory - Brief Form (PID-5-BF)

Abstract Introduction The Personality Inventory for the DSM-5 - Brief Form (PID-5-BF) - is an instrument for assessment of the five pathological personality traits from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) alternative model of personality disorders. Objectives To determine the psychometric properties of the version of the PID-5-BF translated and adapted to Brazilian Portuguese. Methods The process of translating and cross-culturally adapting the text was carried out by independent translators and the resulting version was administered to 176 patients in two hospitals in Rio Grande do Sul. The internal structure was tested by means of confirmatory factor analysis. Evidence of reliability was tested by examining the internal consistency of the scales and their convergent and concurrent validity with other methods of psychopathology. Results The five factors were replicated in the present sample with adequate indicators of fit of the data to the model. Appropriate reliability coefficients for the scales and evidence of validity were observed, indicating the clinical usefulness of the PID-5-BF in the Brazilian context. Conclusion The psychometric properties of PID-5-BF proved satisfactory in an initial sample of Brazilians.

Intimate partner violence against women: Operationalized Psychodynamic Diagnosis (OPD-2).

INTRODUCTION: Intimate partner violence against women is one of the most common forms of violence. Different research fields are trying to understand the cycle of violence, such as the psychological field, to understand how these women's relational patterns and intrapsychic conflict function in the cycle of violence. OBJECTIVE: To investigate the operationalized psychodynamic diagnosis of women victims of domestic violence, exploring the severity and experience of violence, structural functions, dysfunctional interpersonal patterns, and intrapsychic conflicts. METHOD: We conducted a cross-sectional quantitative study using the OPD-2 Clinical Interviews, which were recorded and transcribed. The sample was composed by 56 women victims of domestic violence, mean age 30.07 (SD = ±9.65). Reliability was satisfactory for judges interviews(k>0,6). RESULTS: According to the OPD-2 evaluation, we found that the severity of the violence was associated with the intensity of women's subjective suffering. In the relational pattern, they stay in the relationship, leaving themselves vulnerable; perceive the partner as controlling, aggressive, offensive, and fear abandonment. As a defensive mechanism to relational discomfort and suffering victims anticipate the aggressor's desire, resulting in submissive behavior. The main psychic conflict was the "need for care versus self-sufficiency" (78.6%). And medium was the predominant structure level, in which they presented insecure internal objects, presenting difficulties in emotional regulation and perceiving reality in a distorted way. Hence, they do not recognize their limitations and needs. We found that 78.6% of the cases had some psychiatric disorder: MDD, PTSD. CONCLUSION: This study provides empirical evidence on clinical observations on the psychological functioning of this population and the issues that make up the maintenance of domestic violence against women. The understanding of internalized patterns, structural functions, and motivational tensions are fundamental for the prevention of re-victimization and improving coping mechanisms, as well as promoting greater adherence to treatment.

Translation and cultural adaptation of the DSM-5 Personality Inventory - Brief Form (PID-5-BF).

INTRODUCTION: The Personality Inventory for the DSM-5 - Brief Form (PID-5-BF) - is an instrument for assessment of the five pathological personality traits from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) alternative model of personality disorders. OBJECTIVES: To determine the psychometric properties of the version of the PID-5-BF translated and adapted to Brazilian Portuguese. METHODS: The process of translating and cross-culturally adapting the text was carried out by independent translators and the resulting version was administered to 176 patients in two hospitals in Rio Grande do Sul. The internal structure was tested by means of confirmatory factor analysis. Evidence of reliability was tested by examining the internal consistency of the scales and their convergent and concurrent validity with other methods of psychopathology. RESULTS: The five factors were replicated in the present sample with adequate indicators of fit of the data to the model. Appropriate reliability coefficients for the scales and evidence of validity were observed, indicating the clinical usefulness of the PID-5-BF in the Brazilian context. CONCLUSION: The psychometric properties of PID-5-BF proved satisfactory in an initial sample of Brazilians.

The association between traumatic experiences and suicide attempt in patients treated at the Hospital de Pronto Socorro in Porto Alegre, Brazil.

OBJECTIVE: To analyze associations between attempted suicide and childhood trauma. METHODS: A seven month comparative case-control study (28 subjects - patients with suicide attempt; 56 controls - patients without suicide attempt). The following instruments were used: Childhood Trauma Questionnaire (CTQ), Mini International Neuropsychiatric Interview (MINI), and Medical Outcomes Study (MOS). RESULTS: The group with suicide attempt had significantly higher scores for some variables: emotional abuse (p < 0.001), physical abuse (p < 0.001), emotional neglect (p < 0.001), and physical neglect (p < 0.001). CONCLUSIONS: The results suggest that variables related to previous trauma may influence future suicide attempts. The adoption of preventive and therapeutic actions related to mistreatments during child development is a crucial factor in reduction of suicide risk.