Betrayal Trauma and Histrionic Personality Pathology.

Histrionic personality disorder is among the most common forms of personality pathology, and recent research on it has focused on its associations with trauma. This research has focused primarily on the types of traumatic experiences people endure, highlighting the role of sexual trauma in particular. However, recent research on the association between traumatic events and histrionic personality characteristics has not taken into account the role of traumatic experiences characterized by interpersonal betrayal, which research suggests is associated with personality pathology in general. In this study, we examine this, evaluating the association between traumatic experiences with varying degrees of betrayal on histrionic personality characteristics in a sample of men and women recruited online (N = 364). Results suggested that interpersonal trauma without a high degree of betrayal as well as non-interpersonal trauma had positive associations with histrionic personality characteristics, but interpersonal trauma with a high degree of betrayal did not. Further analysis indicated that sexual trauma both with and without a component of betrayal was associated with histrionic personality characteristics for women but not men. Study findings add to the research on the potential traumatogenic origins of histrionic personality characteristics and provide numerous directions for future research.

Change processes in psychotherapy for patients presenting with histrionic personality disorder.

OBJECTIVE: Histrionic personality disorder (HPD) with a lifetime prevalence rate of 1.8% is an under-researched psychiatric diagnosis. The present study therefore aimed to investigate both the processes and outcomes of psychotherapy for HPD in a non-controlled study. METHODS: A total of 159 patients diagnosed with HPD were recruited and received clarification-oriented psychotherapy. Sessions 15, 20, and 25 were video-recorded and analysed using the Process-Content-Relationship Scale. Therapy outcome was assessed with symptom measures at intake and discharge. Hierarchical linear modelling was applied to estimate the changes in the psychotherapeutic outcome and associations with patient and therapist process developments. RESULTS: Improvements in relationship processes of patients and therapists were systematically related to outcome while only partial relationships were found on the levels of process and content. CONCLUSION: The present study represents the first systematic insight into core changes in patients with HPD undergoing psychotherapy.

[Hysteria: history of a concept and its clinical reality]. / L'hystérie : histoire d'un concept et de sa réalité clinique.

Hysteria is one of the oldest and best known clinical terms. Its history reveals the extent to which pathological entities, some more than others, are the fruit of successive conceptions of experts, themselves undoubtedly influenced by the prevailing currents of thought of their time. From its uterine origin to its psychogenic etiology, here is the history of hysteria and its controversies. A history that belongs to that of medicine, neurology, psychiatry, psychology and psychoanalysis.

Development of two psychological experience questionnaires for screening violence-related mental health disorders of non-psychiatric inpatients.

BACKGROUND: Increased violent events happen in the general hospitals in China and yet non-psychiatric departments do not have tools for violence-tendency screening. METHODS: The current study developed and evaluated two Inpatient Psychological Experience Questionnaires (IPEQs) for the screening of violence-related six mental health disorders: (Inpatient Psychological Experience Questionnaire-1 (IPEQ-1): anxiety, depression and suicidality; Inpatient Psychological Experience Questionnaire-2 (IPEQ-2): paranoid personality disorder, emotionally unstable personality disorder and histrionic personality disorder). Two initial IPEQs (IPEQ-1: 37 items and IPEQ-2: 30 items) were developed and assessed by domain experts. Then 1210 inpatients were recruited and divided into three groups (160, 450 and 600 samples, respectively) for IPEQs item selection and evaluation. During the two-stage item selection, three statistical methods including Pearson's correlation coefficient, exploratory factor analysis and item response theory were applied. For the item evaluation, Cronbach's alpha coefficient, test-retest reliability, criterion-related validity and construct validity of the final questionnaires were measured. RESULTS: Twelve items were selected for each IPEQs. Cronbach's alpha coefficients were 0.91 and 0.78 for IPEQ-1 and IPEQ-2, respectively. Test-retest replication ratios were 0.95 and 0.87 for IPEQ-1 and IPEQ-2, respectively. Correlation coefficients between different disorders and their related-tools scores were [0.51, 0.44] and [0.40, 0.44] for IPEQ-1 and IPEQ-2, respectively and were significant (P < 0.01). Confirmatory factor analysis supported the validity of the final IPEQs (P < 0.05), and the model fit index met the criterion generally. CONCLUSION: The IPEQs developed in this study could be effective and easy-to-use tools for screening inpatients with violence-intendancy in non-psychosomatic departments.

Psychobiological Correlates of Vaginismus: An Exploratory Analysis.

BACKGROUND: Evidence concerning the determinants of vaginismus (V), in particular medical conditions, is inconclusive. AIM: To investigate, in a cohort of subjects consulting for female sexual dysfunction, whether there is a difference in medical and psychosocial parameters between women with V and women with other sexual complaints. METHODS: A series of 255 women attending our clinic for female sexual dysfunction was consecutively recruited. V was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Lifelong and acquired V cases were included. OUTCOMES: Patients underwent a structured interview and physical, gynecologic, laboratory, and clitoral ultrasound examinations; they completed the Female Sexual Function Index (FSFI), the Middlesex Hospital Questionnaire, the Female Sexual Distress Scale-Revised (FSDS), and the Body Uneasiness Test. RESULTS: V was diagnosed in 20 patients (7.8%). Women with V were significantly younger than the rest of the sample (P < .05). No differences were found for traditional risk factors such as a history of sexual abuse, relational parameters, or gynecologic diseases or for newly investigated parameters (ie, neurologic, hormonal, and metabolic alterations). Women with V showed significantly higher histrionic-hysterical symptoms and traits (as detected by MHQ-H score; P < .05) compared with subjects with other sexual complaints. When the scores of all MHQ subscales were simultaneously introduced in a logistic model, the association between V and MHQ-H score was confirmed (P = .013). Women with V also showed higher FSFI pain and FSDS total scores, even after adjusting for age (P < .05). In an age-adjusted model, FSDS total score increased as a function of the years of duration of V (P = .032) but not as a function of its severity. All observations were confirmed in a case-control study (ratio = 1:3). CLINICAL IMPLICATIONS: Our data demonstrate that some novel contributors of V should be investigated, namely histrionic-hysterical traits. This psychological comorbidity could offer valuable insights for intervention and managing complications. STRENGTHS AND LIMITATIONS: This is the first study to assess the role of many metabolic and hormonal parameters as potential determinants of V. The main limitation is its exploratory and cross-sectional nature; our data need to be confirmed in larger, more systematic analyses. CONCLUSION: V was associated with histrionic-hysterical traits, FSFI pain domain, and sex-related distress. A history of abuse, relational parameters, gynecologic diseases, and hormonal and metabolic alterations do not seem to play a role in the development of V. Maseroli E, Scavello I, Cipriani S, et al. Psychobiological Correlates of Vaginismus: An Exploratory Analysis. J Sex Med 2017;14:1392-1402.

Psychotropic medication use pre and post-diagnosis of cluster B personality disorder: a Quebec's health services register cohort.

Background: Cluster B personality disorders (PDs) are considered some of the most severe mental health conditions. Scarce evidence exists about the real-world utilization of psychotropics for cluster B PD individuals. Objective: We aimed to uncover trends and patterns of psychotropic medication use among individuals diagnosed with cluster B PD in the year before and after their diagnosis and to identify factors associated with medication use in a large cohort of individuals newly diagnosed with cluster B PDs. Methods: We conducted a population-based observational study using Quebec's health services register. We identified Quebec residents aged ≥14 years and insured with the provincial drug plan with a first diagnosis of cluster B PD recorded between April 1, 2002, and March 31, 2019. Cluster B PD was defined with ICD-9/10 diagnostic codes. We retrieved all claims for the main psychotropic medication classes: antipsychotics, antidepressants, anxiolytics, mood stabilizers, and attention-deficit/hyperactivity disorder (ADHD) medications. We calculated the proportion of individuals exposed to these medication classes and analyzed trends over the years using robust Poisson regression models, adjusting for potential confounders. We used robust Poisson regression to identify factors associated with medication class use. Results: We identified 87,778 new cases of cluster B PD, with a mean age of 44.5 years; 57.5% were women. Most frequent psychiatric comorbidities in the five years before cluster B PD diagnosis were depression (50.9%), anxiety (49.7%), and psychotic disorders (37.5%). Most individuals (71.0%) received at least one psychotropic during the year before cluster B PD diagnosis, and 78.5% received at least one of these medications in the subsequent year. The proportion of users increased after the diagnosis for antidepressants (51.6-54.7%), antipsychotics (35.9-45.2%), mood stabilizers (14.8-17.0%), and ADHD medications (5.1-5.9%), and remained relatively stable for anxiolytics (41.4-41.7%). Trends over time showed statistically significant increased use of antipsychotics and ADHD medications, decreased use of anxiolytics and mood stabilizers, and a stable use of antidepressants. Conclusion: Psychotropic medication use is highly prevalent among cluster B PD individuals. We observed an increase in medication use in the months following the diagnosis, particularly for antipsychotics, antidepressants, and mood stabilizers.

How to Deal with the Issues of Fertility, Malignancies, and the Postfinasteride Syndrome while Prescribing Finasteride for Male Pattern Hair Loss.

Oral finasteride represented a breakthrough for treatment of male pattern hair loss (MPHL), with clinical studies having demonstrated high efficacy of treatment and a favorable safety profile. And yet, fertility issues, malignancy, and postfinasteride syndrome have been concerns of users and prescribers of the drug. Pre-existing mental health disorder may put patients at an increased risk of nocebo, while the prevalence of personality disorders in subjects with MPHL is known to be higher than in the general population, specifically histrionic personality disorder. We devised a system for patient selection and risk assessment, including fertility issues, regular PSA determinations, and specific mental health assessment. For those who choose regular prostate cancer screening, the use of finasteride meaningfully reduces the risk of prostate cancer. While gynecomastia is a known, rare adverse effect of finasteride, so far, studies support the view that exposure to finasteride is not associated with male breast cancer risk. Patient understanding and involvement are central to optimal treatment selection and active patient role in treatment.

Post-Finasteride Syndrome: An Induced Delusional Disorder with the Potential of a Mass Psychogenic Illness?

Post-finasteride syndrome (PFS) has been claimed to occur in men who have taken oral finasteride to treat either hair loss or benign prostatic hyperplasia, independent of age, dosage, or indication. By definition, the condition is characterized by sexual dysfunction, somatic symptoms, and psychological disorders that persist after cessation of finasteride treatment. As yet, the condition is not recognized by the medical community, although individuals who suffer from PFS present with relatively homogenous symptoms. The concept of PFS has emerged from reports of non-dermatologists, neuroendocrinological research and reflections, and uncontrolled studies of low quality and with a strong bias selection, while a significant nocebo effect among patients informed about possible side effects of finasteride is recognized. There are no predictive factors for the risk of development of PFS. Nevertheless, it has been suggested that a patient history of preexisting mental health disorder, particularly depression, may put patients at an increased risk. We report the first case of PFS in a long-standing (over 20 years) dermatotrichological practice with frequent finasteride prescription observed in a 25-year-old male following dutasteride treatment for male androgenetic alopecia. There was circumstantial evidence that PFS may represent a delusional disorder of the somatic type, possibly on a background of a histrionic personality disorder, which would explain the refractoriness of the condition and a high degree of suggestibility.

Enfermedad psicógena masiva. Reporte de tres episodios no recientes / Massive Psychogenic Disease. A report of three not recent episodes

Episodios de enfermedad psicógena masiva han ocurrido en entornos sociales diferentes, en todo el mundo, a lo largo de la historia de la humanidad. Cada vez los profesionales de la salud participan más en su atención y solución. Este trabajo presenta tres "casos" catalogados como tales, que el autor tuvo la oportunidad de asistir. Se realizan comentarios en cada uno de ellos y se actualizan conceptos sobre esta condición, que se expresa por los más variados síntomas en un grupo de personas ante un estrés intenso por supuestas amenazas, aunque no exista una razón física o ambiental para que se enfermen. Genera marcada tensión tanto en pacientes como en facultativos y en el público. Los médicos, y el personal sanitario en general, deben estar preparados para su adecuado diagnóstico y conducta a seguir.

Episodes of massive psychogenic disease have occurred in different social contexts, worldwide, throughout history. Every time health professionals participate more in their attention and solution. This work presents three ¨cases¨ classified as such, which the author had the opportunity to attend. There are, in this work comments, about each of them and concepts about this condition are updated; which is expressed by the most varied symptoms in a group of people facing intense stress due to supposed threatening even though there is no physical or environmental reason to get sick. It generates a marked tension in patients and doctors so as in the general public. Doctors and sanitary personnel should be prepared for its adequate diagnosis and conduct to follow.

Cocaine users with comorbid Cluster B personality disorders show dysfunctional brain activation and connectivity in the emotional regulation networks during negative emotion maintenance and reappraisal.

Cocaine dependence often co-occurs with Cluster B personality disorders. Since both disorders are characterized by emotion regulation deficits, we predicted that cocaine comorbid patients would exhibit dysfunctional patterns of brain activation and connectivity during reappraisal of negative emotions. We recruited 18 cocaine users with comorbid Cluster B personality disorders, 17 cocaine users without comorbidities and 21 controls to be scanned using functional magnetic resonance imaging (fMRI) during performance on a reappraisal task in which they had to maintain or suppress the emotions induced by negative affective stimuli. We followed region of interest (ROI) and whole-brain approaches to investigate brain activations and connectivity associated with negative emotion experience and reappraisal. Results showed that cocaine users with comorbid personality disorders had reduced activation of the subgenual anterior cingulate cortex during negative emotion maintenance and increased activation of the lateral orbitofrontal cortex and the amygdala during reappraisal. Amygdala activation correlated with impulsivity and antisocial beliefs in the comorbid group. Connectivity analyses showed that in the cocaine comorbid group the subgenual cingulate was less efficiently connected with the amygdala and the fusiform gyri and more efficiently connected with the anterior insula during maintenance, whereas during reappraisal the left orbitofrontal cortex was more efficiently connected with the amygdala and the right orbitofrontal cortex was less efficiently connected with the dorsal striatum. We conclude that cocaine users with comorbid Cluster B personality disorders have distinctive patterns of brain activation and connectivity during maintenance and reappraisal of negative emotions, which correlate with impulsivity and dysfunctional beliefs.