Funcionamento psíquico de sujeitos com transtorno de estresse pós-traumático (TEPT) na perspectiva do diagnóstico psicodinâmico operacionalizado (OPD-2)

Introdução: O desenvolvimento de sintomas e o diagnóstico de Transtorno de Estresse Pós-Traumático (TEPT) tem sido evidenciado de forma elevada na população exposta a eventos traumáticos produzindo sentimentos intensos de medo, ansiedade e angústia. Tais sintomas acabam por afetar consideravelmente o funcionamento global dos sujeitos, o que torna a compreensão do transtorno e como manifesta-se, frente a organização psíquica daqueles que sofrem bem como, formas de intervenções precoces e eficazes, fundamentais. De tal modo, o Diagnóstico Operacionalizado Psicodinâmico 2 (OPD-2) destaca-se como um instrumento diferencial no diagnóstico psicodinâmico avaliativo, de planejamento e acompanhamento terapêutico. Objetivo: Investigar as características do funcionamento psicodinâmico em pacientes com TEPT, sob uma perspectiva dimensional operacionalizada, identificando associações com mecanismos e estilos defensivos, bem como avaliando possíveis alterações após três meses de tratamento. Método: Artigo1: Estudo de caso único de paciente com TEPT-Complexo; Artigo 2: análise qualitativa e transversal cujo foco foi a análise de conteúdo de entrevistas; Artigo 3: Estudo exploratório, quantitativo e transversal; Artigo 4: Estudo exploratório, quantitativo e transversal; Artigo 5: Estudo exploratório, quantitativo e comparativo. Os estudos basearam-se na amostra de 60 participantes vítimas de violência sexual, física, emocional, urbana e perda trágica de um familiar com proximidade afetiva, com idade média de 39.05 anos (DP=14.41). Foram incluídos participantes de 18 a 60 anos que procuraram atendimentos e foram diagnosticados com TEPT e TEPT-Complexo em um serviço especializado de tratamento do trauma durante os anos de 2019 e 2020. Utilizou-se a Entrevista Clínica do Diagnóstico Psicodinâmico Operacionalizado (OPD-2), gravadas e transcritas. Essas entrevistas foram codificadas e analisadas por dois juízes independentes e com treinamento específico no instrumento. Também foi utilizado a Entrevista clínica para avaliação do TEPT- CAPS-5, o Defensive Style Questionnaire (DSQ-40) e o Self-Report Questionnaire (SRQ-20). Resultados: Artigo 1: Observa-se traumas no desenvolvimento e dificuldades em regular o estresse diante de traumas na vida adulta, causando intenso sofrimento subjetivo, dependência, outros transtornos mentais, isolamento e uso de defesas mais rígidas. Após tratamento ocorre uma leve diminuição dos sintomas, com mudança no Conflito e Estrutura psíquica. Artigo 2: Identificou-se que traumas precoces geram organizações psíquicas com maior desintegração. O evento traumático índice desestabiliza a organização psíquica e intensifica os sintomas. As relações eram marcadas pela dependência e isolamento. Os participantes com TEPT-Complexo apresentaram tendência à desintegração relacionada à regulação da relação objetal e o Conflito psíquico era de Individuação x Dependência, com falhas mais primitivas nas representações objetais, necessidade existencial do outro e descarga direta de impulsos. Os participantes com TEPT apresentaram nível Estrutural de moderado a baixo de integração objetal e o Conflito foi Necessidade de cuidado x Autossuficiência, com autorrepresentações frágeis e com capacidade reduzida de gerenciar impulsos. Artigo 3: Levantou-se que o nível de Estrutura da personalidade foi médio a baixo, com Conflito Necessidade de cuidado x Autossuficiência, relacionamento interpessoal permeado por dependência-isolamento e presença de outros transtornos mentais. Pacientes com estruturas de personalidade mais integradas tiveram melhor funcionamento global, melhor qualidade de vida e menos sintomas. A escolaridade mostrou-se um possível fator protetor. Artigo 4: Avaliou-se Funcionamento Global moderado, com significativo sofrimento subjetivo e isolamento. O principal Conflito foi Necessidade de cuidado x Autossuficiência e o nível de Estrutura Total foi moderado/baixo. Observou-se o uso de estilos defensivos imaturos, neuróticos e maduros. Estruturas de personalidade mais primitivas, defesas mais rígidas e maior dependência foram encontradas em pacientes com história de trauma passado. Outros transtornos mentais foram associados. Artigo 5: História pregressa de traumas e doenças psiquiátricas. Abandono terapêutico de cerca de 50% em três meses. Houve diminuição significativa dos sintomas quando comparados Tempo 0 e Tempo 1. Estrutura, com nível moderado de integração, Conflito Necessidade de cuidado x Autossuficiência e Relações Interpessoais baseadas na necessidade de cuidado/isolamento, mantiveram-se nos dois tempos. Uso variado de Mecanismos Defensivos em nível maduro, neurótico e imaturo. Conclusão: Este estudo fornece evidências empíricas sobre características psicodinâmicas de pacientes com TEPT e TEPT-Complexo. O OPD-2 demosntrou-se um instrumento capaz de avaliar especificidades na organização psíquica dos participantes e desenvolvimento dos transtornos. A compreensão de padrões internalizados, funções estruturais e forma com que se estabelecem as relações interpessoais são fundamentais para o direcionamento do tratamento visando o desenvolvimento de modos de enfrentamento mais adaptativos e melhorando a qualidade de vida.Introduction: The development of symptoms and the diagnosis of Posttraumatic Stress Disorder (PTSD) have been highly evidenced in the population exposed to traumatic events, producing intense feelings of fear, anxiety and anguish. Such symptoms end up by considerably affecting the overall functioning of patients, which emphasizes the importance of understanding how the disorder is perceived regarding the psychic organization of patients and forms of early and effective interventions. In this way, the Operationalized Psychodynamic Diagnosis 2 (OPD-2) stands out as a differential instrument in the evaluative psychodynamic diagnosis, planning and therapeutic follow-up. Objective: To investigate the characteristics of the psychodynamic functioning of patients with PTSD from the operationalized dimensional perspective, identifying associations with defensive mechanisms and styles, as well as to evaluate possible changes after three months of treatment. Method: Article 1: Single case study of a patient with Complex PTSD; Article 2: qualitative and cross-sectional analysis whose focus was the content analysis of interviews; Article 3: Exploratory, quantitative and cross-sectional study; Article 4: Exploratory, quantitative and cross-sectional study; Article 5: Exploratory, quantitative and comparative study. Studies were based on a sample of 60 participants who were victims of sexual, physical, emotional, and urban violence and tragic loss of a close family member, with mean age of 39.05 years (SD=14.41). Participants aged 18-60 years who sought care and were diagnosed with PTSD and C-PTSD in a specialized trauma treatment service during the years 2019 and 2020 were included. Clinical interviews of the Operationalized Psychodynamic Diagnosis 2 (OPD-2) were used, which were recorded and transcribed. These interviews were coded and analyzed by two independent judges with specific training on the instrument. The clinical interview was also used to evaluate the PTSD-CAPS-5, the Defensive Style Questionnaire (DSQ-40) and the Self-Report Questionnaire (SRQ-20). Results: Article 1: Trauma in development and difficulties in regulating stress in the face of trauma in the adult life are observed, causing intense subjective suffering, dependence, other mental disorders, isolation and use of more rigid defenses. After treatment, there is a slight decrease in symptoms, with change in Conflict and Psychic Structure. Article 2: It was identified that early trauma generates psychic organizations with greater disintegration. The index traumatic event destabilizes the psychic organization and intensifies symptoms. Relationships were marked by dependence and isolation. Participants with Complex PTSD showed tendency to disintegration related to the regulation of the relationship between object and the psychic conflict was Individuation x Dependence, with more primitive failures in object representations, existential need for the other and direct discharge of impulses. Participants with PTSD had moderate to low Structural level of object integration and the Conflict was Need for care x Self-sufficiency, with fragile self-representations and reduced ability to manage impulses. Article 3: It was found that the level of personality Structure was medium to low, which Conflict was Need for care x Self-sufficiency, interpersonal relationships permeated by approach-isolation and presence of other mental disorders. Patients with more integrated personality structures had better global functioning, better quality of life and fewer symptoms. Schooling proved to be a possible protective factor. Article 4: Psychic global functioning was from moderate, with significant subjective suffering and isolation. The main Conflict was Need for care x Self-sufficiency and the Total Structure level was moderate/low. The use of immature, neurotic and mature defensive styles was observed. More primitive personality structures, more rigid defenses and greater dependency were observed in patients with history of past trauma. Other mental disorders were also associated. Article 5: Past history of trauma and psychiatric diseases. Therapeutic dropout of about 50% in three months was observed. Significant decrease in symptoms was observed when comparing Time 0 and Time 1. Structure, with moderate level of integration, Conflict Need for Care x Self-sufficiency and Interpersonal Relationships based on the need for care/isolation, were maintained in both times. Varied use of mature, neurotic and immature defensive styles was observed. Conclusion: This study provides empirical evidence on the psychodynamic characteristics of patients with PTSD and C-PTSD. OPD-2 was able to assess specificities in the psychic organization of participants and the development of disorders. Understanding internalized patterns, structural functions and the way in which interpersonal relationships are established are fundamental for directing treatment aimed at developing more adaptive ways of coping with the disease and improving quality of life

Cycle of violence in women victims of domestic violence : qualitative analysis of OPD 2 interview

Introduction: Domestic violence places woman as the victim and man as the aggres‐sor in the family environment. There is limited consistent and clear information based on empirical evidence on the dynamic functioning of the victims.Objective: To further understand the psychodynamics of women in the cycle of vio‐lence taking into account the aspects of psychological trauma. It is transversal re‐search design. The sample was composed of ten women victim of domestic violence. Data collection was based on the OPD‐2 Clinical Interview. Content analysis was performed from categories created by a posteriori: (a) Previous history; (b) Behavioral aspects; (c) Emotional aspects; (d) Reason for being in the relationship; (e) Type of violence and explanation for the reason of violence; (f) Support network and daily activities; and (g) Clinical and legal referral.Results: Constant violence causes changes in the structural functioning and psycho‐logical conflict of the victims: difficulties in mentalization, instability in relationships, emotional dependence, abandonment of her own life for her partners, difficulty in having a sense of identity. Victims presented difficulties in making significant changes in daily life to break the cycle of violence.Conclusion: The research sought to collaborate with more evidence on the subject, suggesting a reformulation on forms of encounter to break the cycle of violence

Adaptação transcultural do Módulo de Avaliação da Violência Doméstica do Diagnóstico Psicodinâmico Operacionalizado (OPD-2) em mulheres brasileiras vítimas de violência doméstica

Introduction: Intimate partner domestic violence against women causes physical and psychological harm to victims. The relevance of this topic is indisputable and there is a need to identify in greater detail how these women experience violence, since these factors have considerable clinical implications. Objective: To develop a Portuguese version of the Module for Assessment of Domestic Violence, adapted from Axis I of the Operationalized Psychodynamic Diagnosis (OPD-2), considering content validity and psychometric characteristics. Method: Cross-cultural adaptation was based on guidelines for the process of cross-cultural adaptation of self-report measures. OPD clinical interviews were recorded and transcribed. These interviews were analyzed by two independent judges trained in the OPD-2. Results: The sample comprised 56 women who had been victims of domestic violence, with a mean age of 30.07 years (standard deviation = 9.65). The adapted version has content validity and good psychometric characteristics. Evaluation of semantic equivalence took into account the psychodynamic references, using the same ideas as the original instrument. Interexaminer reliability between the judges was substantial (k = 0.63) and Cronbach’s alpha for the new version indicates good reliability. Conclusion: The OPD-2 offers a psychodynamic diagnosis of the victim that complements traditional nosological diagnosis, particularly in the context of domestic violence with the adaptation of Axis I. Certain biases could have been detrimental to aspects of this study, but they were controlled. The study objective was achieved and the Module was successfully adapted to Brazilian Portuguese. The results are in line with those of the original study.Introdução: A violência doméstica por parceiro íntimo contra as mulheres causa danos físicos e psicológicos às vítimas. A relevância deste tópico é indiscutível, e é necessário identificar em mais detalhe como essas mulheres sofrem violência, uma vez que esses fatores têm implicações clínicas consideráveis. Objetivo: Desenvolver uma versão em português do Módulo de Avaliação da Violência Doméstica, adaptado do Eixo I do Diagnóstico Psicodinâmico Operacionalizado (Operationalized Psychodynamic Diagnosis – OPD-2), considerando a validade de conteúdo e as características psicométricas. Método: A adaptação transcultural foi baseada nas diretrizes para o processo de adaptação transcultural de medidas de autorrelato. As entrevistas clínicas do OPD foram gravadas e transcritas. Essas entrevistas foram analisadas por dois juízes independentes treinados no OPD-2. Resultados: A amostra foi composta por 56 mulheres vítimas de violência doméstica, com idade média de 30,07 anos (desvio padrão = 9,65). A versão adaptada demonstrou validade de conteúdo e boas características psicométricas. A avaliação da equivalência semântica levou em consideração as referências psicodinâmicas, utilizando as mesmas ideias do instrumento original. A confiabilidade entre os juízes foi substancial (k = 0,63), e o alfa de Cronbach para a nova versão indica boa confiabilidade. Conclusão: O OPD-2 oferece um diagnóstico psicodinâmico da vítima que complementa o diagnóstico nosológico tradicional, particularmente no contexto de violência doméstica com a adaptação do Eixo I. Certos vieses poderiam ter sido prejudiciais aos aspectos deste estudo, mas foram controlados. O objetivo do estudo foi alcançado e o Módulo foi adaptado com sucesso para o português do Brasil. Os resultados estão alinhados com os do estudo original

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 fashbacks, somatizations, negative emotions about themselves, and difculty 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, conficts and psychic structures and use of defense mechanisms, and for peculiarities that may diferentiate 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 fve women with PTSD and fve 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 intensifes symptoms. Relationships were marked by dependence and isolation. Participants with CPTSD presented tendency to disintegration related to the object relation regulation and the psychic confict was of Individuation versus Dependence, with more primitive faws 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 confict was need to be care of versus self-sufciency, 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

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

Situaciones violentas durante la pandemia COVID-19

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: Nonprobabilistic 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.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.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

A função reflexiva em adolescentes em conflito com a lei e em adolescentes escolares = The reflexive function in adolescents in conflict with the law and school adolescents = La función reflexiva en adolescentes en conflicto con la ley y en adolescentes escolares

A função reflexiva (FR) é identificada como um constructo importante à compreensão psicopatológica e para a prática clínica. Sendo assim, neste artigo, busca-se ampliar o conhecimento sobre a função reflexiva em dois grupos de adolescentes com diferentes trajetórias, um em conflito com a lei (G1=91, M idade 16,57 anos, DP=0,77) e outro de escolares (G2=64, M de idade 15,89 anos, DP=0,75). Os instrumentos utilizados foram dados sociodemográficos, Questionário sobre Função Reflexiva para Jovens e Questionário de Capacidade e Dificuldades. Da amostra, identificou-se que 119 adolescentes eram não clínicos e 95 clínicos. A análise univariada demonstrou diferenças significativas na função reflexiva considerando a interação entre a variável G1 e G2 e as categorias clínico e não clínico. Assim, o G2 não clínico apresentou maior função reflexiva (M=8,60; DP=0,68; F=4,66; p<0,05), seguido pelo G1 clínico (M=8,29; DP=0,68). Tal característica no grupo clínico de adolescentes em conflito com a lei assinala hipermentalização. Aponta-se, portanto, a necessidade de avaliação e desenvolvimento da função reflexiva como prevenção em saúde menta

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

IntroductionIntimate 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.ObjectiveTo 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.MethodWe 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).ResultsAccording 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.ConclusionThis 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