Emočně nestabilní adolescenti představují rozsáhlou skupinu pacientů, kterými se v současnosti zabývají pedopsychiatrická pracoviště, jak ambulantního, tak lůžkového charakteru. Převážnou většinu tvoří adolescentní dívky, které přicházejí zejména pro úzkostně depresivní symptomatiku, sebepoškozování a suicidální chování. Emoční nestabilita v adolescenci představuje spektrum závažnosti, počínaje emoční labilitou obvyklou v dospívání, až po poruchy ve vývoji osobnosti, které mohou v nejzávažnějším případě vyústit do emočně nestabilní – hraniční poruchy osobnosti. Terapie vyžaduje integrovaný přístup, s důrazem na psychoterapii a rodinnou terapii, a také indikovanou farmakoterapii.
Emotionaly unstable adolescents represent a large group of patients currently dealt with pedopsychiatric facilities, both outpatient and inpatient. The vast majority are adolescent girl who come mainly for anxiety - depressive symptoms, self harm and suicidal behavior. Emotional instability in adolescence represents a spektrum of severity, starting with emotional lability common in adolescence, up to disturbances in personality development, which in the most serious case can reset in emotionally unstable - bordeline personality disorder. Therapy requires an integrated approach, with an emphasis on psychotherapy and family therapy, as well as indicated pharmacotherapy.
INTRODUCTION: Panic disorder (PD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD) are associated with various psychosocial factors that may influence their onset and psychopathology. Dissociation encompasses a wide range of manifestations, from benign experiences to severe mental health issues. Research comparing childhood trauma and dissociation, general psychopathology, and the onset of the disorder among patients with PD, OCD, and BPD has not yet been published. RESULTS: The severity of dissociative symptoms negatively correlated with the onset of the disorder, whereas it positively correlated with the disorder's overall severity and general symptomatology. Patients with more severe childhood trauma had an earlier onset of the disorder and more severe depressive and dissociative symptoms. They rated higher on the overall severity of the disorder. Physical abuse and neglect were associated with more severe PD, OCD, and BPD. Patients with BPD had higher levels of dissociation than those with PD or OCD. BPD was also connected with more severe childhood trauma than PD and OCD patients. Comorbidity exacerbated the severity of the psychiatric disorders. CONCLUSIONS: Childhood trauma and dissociation play a significant role in anxiety and depressive symptoms in patients with PD, OCD, and BPD.
- MeSH
- disociační poruchy * psychologie epidemiologie MeSH
- dítě MeSH
- dospělí MeSH
- hraniční porucha osobnosti * psychologie epidemiologie MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nepříznivé zkušenosti z dětství psychologie MeSH
- obsedantně kompulzivní porucha * psychologie epidemiologie MeSH
- panická porucha * psychologie epidemiologie MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: PAdverse Childhood Experiences (ACEs) are associated with an increased risk of mental health issues in general, but their relationship with panic disorder (PD) and obsessive-compulsive disorder (OCD) has received less attention compared to borderline personality disorder (BPD). Dissociative experiences are significant predictors of increased symptoms, reduced treatment adherence, and poor prognosis in several psychiatric conditions, including PD, OCD, and BPD; still, their impact remains underexplored. This part of the study focuses on the overall efficiency of psychotherapeutic programs on treatment-resistant patients diagnosed with PD, OCD, and BPD (or combined), as well as the relationship between ACEs, dissociation rates, and treatment results. METHOD: The study was conducted under standard conditions in an inpatient psychotherapy unit that specialized in anxiety, affective disorders, and personality disorders. Patients were hospitalized for 6 weeks and treated with a comprehensive CBT program and pharmacotherapy. The study included patients diagnosed with PD, OCD, or BPD (or combined). Two independent psychiatrists confirmed the inclusion and exclusion criteria. Patients were assessed using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Clinical Global Impression Scale - Severity (CGI-S), Dissociative Experience Scale (DES), and Childhood Trauma Questionnaire (CTQ-SF). RESULTS: A total of 349 out of 357 patients completed the study. The average age of patients was 33.33 ± 11.59 years. After the 6 week treatment, there was a statistically significant decrease in mean scores across all assessed scales. Changes in any scale during treatment did not correlate with the total CTQ-SF score or sub-scores. The relative change in CGI-S showed a statistically significant negative correlation with the total dissociation score on the DES scale at the beginning of treatment but not with pathological dissociation assessed by the DES-T questionnaire. Statistically significant decreases in mean CGI-S scores were observed in patients with a single diagnosis of PD, OCD, and BPD. Among comorbid groups, significant changes were observed only in patients with comorbid OCD and BPD. No statistically significant change in mean BDI-II scores was observed in patients with comorbid PD and OCD or comorbid OCD and BPD. CONCLUSIONS: Our analysis showed that treatment led to a significant decrease in the severity of depressive symptoms assessed by BDI-II and anxiety symptoms assessed by BAI in patients with PD, OCD, and BPD. This decrease was not statistically significant in patients with comorbid disorders, suggesting that the presence of multiple diagnoses may affect treatment efficacy. ACEs did not correlate to treatment results, but dissociation rates were linked with poorer treatment outcomes.
- MeSH
- disociační poruchy * terapie psychologie MeSH
- dospělí MeSH
- hospitalizovaní pacienti MeSH
- hraniční porucha osobnosti * terapie psychologie MeSH
- kognitivně behaviorální terapie * metody MeSH
- kombinovaná terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- obsedantně kompulzivní porucha * terapie psychologie MeSH
- panická porucha * terapie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Emočně nestabilní adolescenti představují rozsáhlou skupinu pacientů, kterými se v současnosti zabývají pedopsychiatrická pracoviště, jak ambulantního, tak lůžkového charakteru. Převážnou většinu tvoří adolescentní dívky, které přicházejí zejména pro úzkostně depresivní symptomatiku, sebepoškozování a suicidální chování. Emoční nestabilita v adolescenci představuje spektrum závažnosti, počínaje emoční labilitou obvyklou v dospívání, až po poruchy ve vývoji osobnosti, které mohou v nejzávažnějším případě vyústit do emočně nestabilní - hraniční poruchy osobnosti. Terapie vyžaduje integrovaný přístup, s důrazem na psychoterapii a rodinnou terapii, a také indikovanou farmakoterapii.
Emotionaly unstable adolescents represent a large group of patients currently dealt with pedopsychiatric facilities, both outpatient and inpatient. The vast majority are adolescent girl who come mainly for anxiety - depressive symptoms, self harm and suicidal behavior. Emotional instability in adolescence represents a spektrum of severity, starting with emotional lability common in adolescence, up to disturbances in personality development, which in the most serious case can reset in emotionally unstable - bordeline personality disorder. Therapy requires an integrated approach, with an emphasis on psychotherapy and family therapy, as well as indicated pharmacotherapy.
- Klíčová slova
- emoční labilita,
- MeSH
- chování mladistvých psychologie MeSH
- chování sebezraňující diagnóza etiologie patologie terapie MeSH
- dialektická behaviorální terapie metody MeSH
- emoce MeSH
- hraniční porucha osobnosti * diagnóza etiologie patologie terapie MeSH
- lidé MeSH
- mladiství MeSH
- psychoterapie klasifikace metody MeSH
- rodinné vztahy psychologie MeSH
- sebepoškozování diagnóza etiologie patologie terapie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
PURPOSE: Child abuse and trauma are significant risk factors in the etiology of borderline personality disorder (BPD). Apart from affecting the risk of developing BPD, adverse childhood experiences seem to increase its symptoms and related disability. Self-stigma presents another common issue with equally prominent consequences for mental health. Despite being theoretically linked, the connections among childhood trauma, self-stigma, and mental health have not been explored in patients with BPD. This study aimed to provide first insights into this understudied topic. PATIENTS AND METHODS: This cross-sectional study included 283 inpatients diagnosed with BPD participating in a residential transdiagnostic psychotherapeutic program. The patients completed several measurements - the Internalized Stigma of Mental Illness Scale, the Childhood Trauma Questionnaire - Short Form, the Clinical Global Impression - Severity, the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Dissociative Experiences Scale, the Sheehan Disability Scale, and a demographic questionnaire. The data was statistically analyzed using IBM SPSS and AMOS 26 programs, and bivariate correlation tests and structural equation modeling explored the hypotheses. RESULTS: Retrospectively reported childhood trauma positively correlated with current self-stigma. Both childhood trauma and self-stigma were also positively related to several indicators of general psychopathology and disability. The significance of these connections was subsequently confirmed by structural equation modeling, where self-stigma acted as a partial mediator of childhood trauma, general psychopathology, and disability. CONCLUSION: Self-stigma significantly mediates the relationship between childhood trauma and selected mental health symptoms among adult patients diagnosed with BPD. Longitudinal studies are necessary to explore the causality of the findings. Therapeutic and societal efforts to tackle childhood trauma or self-stigma might benefit from reflecting its broader psychosocial context.
- Publikační typ
- časopisecké články MeSH
Potíže spojené s emoční nestabilitou jsou v adolescenci časté a diagnostikování poruchy osobnosti už v tomto věku se stává běžnější. Jedná se o významnou skupinu pacientů, obzvlášť když uvážíme, že se tato porucha vyskytovala až u 76 % adolescentů, kteří vyhledali péči pro suicidální úvahy. Rodinné prostředí hraje roli při vzniku emočně nestabilní poruchy osobnosti a zároveň jsou blízcí těmito potížemi také významně zasaženi. Existuje několik terapeutických postupů, které byly adaptovány i pro emočně nestabilní adolescenty a vykazují efektivitu v jejich léčbě. Zapojení rodiny v léčbě je nezbytné. Tento článek se věnuje roli rodiny a možnostem zapojení rodinných příslušníků emočně nestabilních adolescentů v jejich léčbě
Difficulties associated with emotional instability are frequent in adolescence, and the diagnosis of personality disorders at this age is becoming common. The importance of this group of patients is evident, when we consider that this disorder was present in up to 76 % of adolescents who sought care for suicidal ideation. Family environment plays a role in the pathogenesis of emotionally unstable personality disorder, while on the other hand, relatives are also significantly affected by this disorder. There are several therapeutic procedures that have been adapted for emotionally unstable adolescents and show effectiveness in their treatment. Family involvement in the treatment is essential. This article explores the role of the family and the possibilities of involvement of family members of emotionally unstable adolescents in their treatment
Ethical reflection is a process that comes from the deeper attitudes and values of the therapist and supervisor. The capability to recognize one's perspectives and ethical dimensions and how they affect own practice is one of the crucial tasks of a responsible therapist. Attitudes and values of an individual or a group may significantly influence the therapeutic process and a choice of strategies and behaviour towards the patient, often working at an unconscious, unreflected levels. Ethics is closely connected with psychotherapeutic treatment. Basic principles, such as expediency, honesty, integrity, justice, and respect, apply to all people equally, including psychologists, psychiatrists, psychotherapists, and supervisors. The goal of supervision is to cultivate the therapeutic process in the client's best interest. The supervisor-supervisee relationship is then grounded on principles similar to those in the therapeutic relationship.
- MeSH
- Brassicaceae * MeSH
- kognitivně behaviorální terapie * metody MeSH
- lidé MeSH
- psychoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Individuals with borderline personality disorder (BPD) suffer from an excessive fear of abandonment, leading to tense moments in their intimate relationships. These struggles translate into lower marital satisfaction perceived by both intimate partners. However, this connection is bidirectional, since conflicts with a romantic partner are the most common precipitating factors of decompensation in BPD patients. METHOD: This narrative review was performed using PubMed, Web of Science, and Scopus databases with keywords "borderline personality disorder", "partnership", marital problems", and "marital conflicts". Articles, books, and book chapters published within January 1980 - December 2020 were extracted and analysed. Additional sources were found while reviewing references of relevant articles. The total of 131 papers met the inclusion criteria. RESULTS: Patients with BPD struggle with reaching marital satisfaction. They often find themselves in disharmonic and unfulfilling relationships. The association between the relationship issues and BPD may partly come from misunderstanding one or both partners' behaviour. Individuals with BPD tend to misinterpret their partner's behaviour, struggle with communication, and sometimes be verbally and physically aggressive. They often do not recognize that their intrapersonal processes influence their interpersonal struggles. Understanding the role of the maladaptive personality traits in the relationship and their management could be beneficial for both partners. CONCLUSION: Individuals with BPD often report dysfunctional romantic relationships characterized by insecure attachment, maladaptive communication, and lower relationship satisfaction. Future studies should focus on finding effective strategies of couples ́ therapy working with this population.
- MeSH
- hraniční porucha osobnosti * MeSH
- interpersonální vztahy MeSH
- konflikt v rodině MeSH
- lidé MeSH
- manželství MeSH
- sexuální chování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Self-awareness can be characterised as impartial, non-judgmental thoughtful attention towards the self. Self-reflection in therapy is when a therapist reviews their experiences, thoughts, and behaviours concerning therapy and changes them as needed to enhance the therapeutic process. Therapists with good quality self-reflection can make more effective and ethical decisions, differentiate their own needs from clients', understand transference and countertransference, and consider the optimal response during a session. Practising the CBT approach and reflecting on one's own experiences can be essential for successful therapeutic development. Furthermore, self-reflection forms the basis of a fruitful therapeutic relationship and the therapist's self-confidence and sense of competence.
