The Inventory of Personality Organization: A valid instrument to detect the severity of personality dysfunction

Background and aims In the eleventh revision of the International Classification of Diseases (ICD-11), the severity of personality dysfunction became the central dimension of personality disorder’s (PDs) definition, besides the trait domain qualifiers. Personality functioning, also known as personality organization (PO), is becoming an increasingly important concept in administering, predicting, and measuring severity and nature of personality disturbance. Otto Kernberg and his team developed several tools to measure personality impairment. The Inventory of Personality Organization (IPO) is a self-report rating scale for the measurement of PO. Aim of this study was to identify severity groups according to the level of PO and to explore their validity. Materials and methods A clinical sample of 118 patients was recruited from a 4-weeks in-patient cognitive psychotherapy program. Beside the IPO, Structured Clinical Interview for the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV.) Axis I and II, Symptom Check List-90 (SCL-90), State-Trait Anger Expression Inventory and Dissociative Experience scale (DES). Two types of analyses were conducted: a person-centered (latent profile) analysis and various variable-centered tests to confirm the factor structure of IPO and calculate group differences. Results The three-factor (CFI = 0.990, TLI = 0.990, RMSEA = 0.022, SRMR = 0.089) and the five-factor (CFI = 0.995, TLI = 0.995, RMSEA = 0.014, SRMR = 0.090) models of the IPO was supported. Latent class analysis identified three subgroups of PO: “Well-integrated,” “Moderately integrated,” and “Disintegrated” classes. There were no significant differences between the three classes in the number of Axis 1 diagnoses (p = 0.354; η2 = 0.01). Group differences in the number of PDs, the number of PD symptoms as well as in the presence of borderline and depressive PD were significant (all p < 0.001; V = 0.35–0.42; η2 = 0.15–0.26). Persons with more severe PO problem level had higher rates of psychopathological symptoms, state and trait anger, and dissociative characteristics (all p < 0.001; η2 = 0.13–0.36). Conclusion The IPO can be an appropriate instrument to measure the severity of personality disorganization and to classify participants along a continuum of severity in this regard. Our results present further evidence that the severity of personality dysfunction, the central dimension of the ICD-11 and the Alternative Model for PDs is detectable with an instrument, the IPO, that was initially developed to detect the disturbances in PO.Peer Reviewe

A kognitív sémák és a társkapcsolatok fejlődésének különböző útjai gyermekkori daganatos betegségből felgyógyult felnőtteknél = Different process of development in cognitive schemata and social relations in cancer survivals whose illness onset dated from early or late childhood

Elméleti háttér: Az egyre javuló orvosi ellátás, a gyerekkori onkológiai betegek túlélési arányának növekedése ellenére a trauma következményei a kezelések befejezését követően is még éveken keresztül fennmaradhatnak, befolyásolva a mindennapi adaptációt, szociális kapcsolatok alakulását. A megterhelő életeseményre adott reakciókat, a hosszabb távú pszichoszociális alkalmazkodást a támogató társas környezeten túl nagymértékben befolyásolja a gyermek életkora és a kognitív érettsége. Cél: Vizsgálatunk célja a nyolcéves kor alatt és nyolcéves kor feletti életkorban elszenvedett onkológiai betegség felnőttkori társas kapcsolatokra és értelmező sémákra gyakorolt hatásainak elemzése. Vizsgálati mintánk gyermekkori onkológiai betegséget túlélő felnőttekből (N = 59), míg a kontrollcsoport (N = 53) gyermekkori krónikus betegségben nem szenvedő, a túlélőkhöz hasonló életkorú felnőttekből állt. Módszerek: A vizsgált személyek kognitív séma, megküzdési mód, társkapcsolati, szorongás, depresszió, valamint traumatizációs jellemzőinek felmérése az alábbi eszközökkel történt: Young-féle Séma Kérdőív, EMBU (Neveltetésem Emlékei Kérdőív), Közvetlen Kapcsolatok Élményei Kérdőív, COPE (Megküzdés Kérdőív), Kórházi Szorongás és Depresszió Skála, Poszttraumás Stressz Skála. Eredmények: Eredményeink szerint a nyolcévesnél idősebb korban diagnosztizált felnőtt túlélők és egészséges kontrollszemélyek között sem a nők, sem a férfiak vonatkozásában nincs a vizsgált paraméterekben különbség. A nyolcévesnél fiatalabb korban kezelt felnőtt nők gyakrabban folyamodnak passzív megküzdési stratégiához, továbbá olyan különféle maladaptív sémák alkalmazásához, mint a fokozott szeparációs érzés, korlátozott autonómia, függőség és aggodalmaskodás. Következtetések: Eredményeink hangsúlyozzák a kora gyermekkorban onkológiai betegségben szenvedő lányok esetén a pszichoszociális ellátás fontosságát, különösen a felnőttkori kapcsolati problémák megelőzésére való tekintettel. A későbbi gondozás során fokozott figyelmet kell fordítani a problémamegoldás aktív formáinak támogatására, az elszakítottságérzés csillapítására, az autonómia erősítésére, a független motivációkból származó cselekedetek támogatására és az aggodalmaskodás enyhítésére. | Background: Despite the improving medical care and increasing survival rate, the consequences of pediatric cancer may persist for many years after the end of treatment, which can influence everyday adaptation and social relationships. Perception of the stressful life events and the long term psychosocial adaptation are influenced by social support and cognitive appraisal determined by many factors including cognitive maturity and age. Aim: The aim of this study is to investigate the effects of social relationships and cognitive schemata in childhood cancer survivors. The patient group consisted of persons suffered from cancer before and after eight years of age (N = 59) and a matched control group without chronic childhood illness (N = 53). Methods: The participant’s cognitive schemata system, coping capacity, close relationships, anxiety, depression, and trauma-related data were measured by a test battery involving Young Schema Questionnaire, COPE (Coping questionnaire), Experience of Close Relationships, My Memories of Upbringing (Egna Minnen Beträffande Uppfostran), Hospital Anxiety and Depression Scale, and Impact of Event Scale-R. Results: No differences were found in test parameters of survivors diagnosed after eight years of age and healthy control participants, among males and females. However, women with cancer diagnosed before eight years of age reported more passive coping style and different kind of maladaptive schemata including feelings of separation, limited autonomy, dependency, and apprehensiveness. Conclusion: Our data underline the importance of psychosocial care of early childhood cancer which might have significant influences on adult interpersonal problems, first of all among females. During follow-up, psychosocial interventions — focusing on active problem-solving, decreasing feelings of separation, strengthening autonomy, reducing dependency — are highly recommended

Emotion regulation, mindfulness, and self-compassion among patients with borderline personality disorder, compared to healthy control subjects

ObjectivesEmotion regulation difficulties are a major characteristic of personality disorders. Our study investigated emotion regulation difficulties that are characteristic of borderline personality disorder (BPD), compared to a healthy control group.MethodsPatients with BPD (N = 59) and healthy participants (N = 70) filled out four self-report questionnaires (Cognitive Emotion Regulation Questionnaire, Difficulties in Emotion Regulation Scale, Five Facet Mindfulness Questionnaire, Self-Compassion Scale) that measured the presence or lack of different emotion-regulation strategies. Differences between the BPD and the healthy control group were investigated by Multivariate Analysis of Variance (MANOVA) and univariate post-hoc F-test statistics.ResultsPeople suffering from BPD had statistically significantly (pConclusionIn comparison to a healthy control group, BPD patients show deficits in the following areas: mindfulness, self-compassion and adaptive emotion-regulation strategies. Based on these results, we suggest that teaching emotion-regulation, mindfulness, and self-compassion skills to patients can be crucial in the treatment of borderline personality disorder

Disturbed body schema, perceptual body image, and attitudinal body image in patients with borderline personality disorder

BackgroundBorderline personality disorder (BPD) is a severe mental disorder that affects attitudes toward the body. However, whether this condition also affects body schema and perceptual body image remains unclear. Previous questionnaire-based studies found dissatisfaction with one's body in patients with BPD. In addition to attitudinal body image, our study investigates whether body schema and perceptual body image are disturbed in patients with BPD.MethodOur study included 31 patients diagnosed with BPD (25 women) and 30 healthy individuals (19 women) (Mage = 29 for both groups). The SCID-5-PD interview was used to determine personality disorder. Attitudinal body image was measured using the Body Attitude Test (BAT) factors. Body schema and perceptual body image were measured by two conditions of a body representation task, the body portraying method (BPM).ResultsBPD patients achieved higher scores in all three BAT factors and were more susceptible to misinformation in both conditions of BPM. Based on the results, BPD patients appear to have more negative attitudes toward their bodies and worse perceptual body image and body schema.ConclusionThe novel finding of our study is that, besides the previously found attitudinal dissatisfaction with the body, individuals with BPD also show disturbances at the levels of body schema and perceptual body image. Our findings concerning disturbances in body schema and perceptual body need further research into their etiological factors and provide new therapeutic targets for the treatment of BPD

Reliability and validity of the Hungarian version of the Personality Inventory for DSM-5 (PID-5)

Objectives and methodsIn order to assess the internal consistency, fit indexes, test-retest reliability, and validity of the Personality Inventory for the DSM-5 (PID-5) and its associations with age, gender, and education, 471 non-clinical (69,6% female; mean age: 37,63) and 314 clinical participants (69,7% female, mean age: 37,41) were administered the Hungarian translation of the PID-5, as well as the SCL-90-R and the SCID-II Personality Questionnaire.ResultsWe found that; (a) temporal consistency of the Hungarian PID-5 was confirmed by one-month test-retest reliability analysis, (b) validity of the PID-5 instrument is acceptable in the clinical and the non-clinical sample as well, based on significant correlations with SCID-II and SCL-90-R, (c) PID-5 facets' and domains' associations with gender, age, and level of education are in accordance with previous findings.ConclusionThese findings support that the Hungarian PID-5 is a reliable and valid instrument for both clinical and non-clinical populations

A Method to Compare the Delivery of Psychiatric Care for People with Treatment-Resistant Schizophrenia

Abstract Introduction: Community services are gaining ground when it comes to attention to patients with psychiatric diseases. Regarding patients with treatment-resistant schizophrenia (TRS), the use of information and communication technology (ICT) could help to shift the focus from hospital-centered attention to community services. This study compares the differences in mental health services provided for patients with TRS in Budapest (Hungary), Tel-Aviv (Israel) and Catalonia (Spain) by means of a method for the quick appraisal of gaps among the three places, for a potential implementation of the same ICT tool in these regions. Methods: An adapted version of the Description and Standardised Evaluation of Services and Directories in Europe for Long Term Care (DESDE-LTC) instrument was made by researchers in Semmelweis University (Budapest, Hungary), Gertner Institute (Tel-Aviv, Israel) and Hospital de la Santa Creu I Sant Pau and Parc Sanitari Sant Joan de Déu (Catalonia, Spain). Results: Two types of outpatient care services were available in the three regions. Only one type of day-care facility was common in the whole study area. Two residential care services, one for acute and the other for non-acute patients were available in every region. Finally, two self-care and volunteer-care facilities were available in the three places. Conclusion: Although the availability of services was different in each region, most of the services provided were sufficiently similar to allow the implementation of the same ICT solution in the three places.The m-RESIST Group is composed of: Francisco Alcalde Enrico d’Amico Caritat Almazán Anna Alonso-Solís Jesús Berdún István Bitter Walter Baccinelli Chiara Bonizzi María Bulgheroni Johanna Caro Mendivelso Asaf Caspi Tanguy Coenen Anat Cohen Xavier Constant Iluminada Corripio Marisol Escobar Kinga Farkas Kata Fazekas Yoram Feldman Emmanuel Gimenez Shenja van der Graaf Eva Grasa Levente Herman Margarita Hospedales Elena Huerta-Ramos Matti Isohanni Erika Jääskeläinen Charlotte Jewel Teija Juola Timo Jämsä Rachelle Kaye Panagiotis Kokkinakis Hannu J. Koponen Silvia Marcó Gregoris Mentzas Jouko Miettunen Jani Moilanen Susana Ochoa Ilias Papas Fotis Paraskevopoulos Elisabeth Reixach Alexandra Roldán Katya Rubinstein Elena Rubio-Abadal Garifalia Sebú Annika Seppälä Jussi Seppälä Valentina Simonetti Matthias Stevens Vittorio Tauro Anna Triantafillou Zsolt Szabolcs Unoka Judith Usall Vincenzo Vella David Vermeir Ilaria de Vit

Regional Grey Matter Structure Differences between Transsexuals and Healthy Controls-A Voxel Based Morphometry Study.

Gender identity disorder (GID) refers to transsexual individuals who feel that their assigned biological gender is incongruent with their gender identity and this cannot be explained by any physical intersex condition. There is growing scientific interest in the last decades in studying the neuroanatomy and brain functions of transsexual individuals to better understand both the neuroanatomical features of transsexualism and the background of gender identity. So far, results are inconclusive but in general, transsexualism has been associated with a distinct neuroanatomical pattern. Studies mainly focused on male to female (MTF) transsexuals and there is scarcity of data acquired on female to male (FTM) transsexuals. Thus, our aim was to analyze structural MRI data with voxel based morphometry (VBM) obtained from both FTM and MTF transsexuals (n = 17) and compare them to the data of 18 age matched healthy control subjects (both males and females). We found differences in the regional grey matter (GM) structure of transsexual compared with control subjects, independent from their biological gender, in the cerebellum, the left angular gyrus and in the left inferior parietal lobule. Additionally, our findings showed that in several brain areas, regarding their GM volume, transsexual subjects did not differ significantly from controls sharing their gender identity but were different from those sharing their biological gender (areas in the left and right precentral gyri, the left postcentral gyrus, the left posterior cingulate, precuneus and calcarinus, the right cuneus, the right fusiform, lingual, middle and inferior occipital, and inferior temporal gyri). These results support the notion that structural brain differences exist between transsexual and healthy control subjects and that majority of these structural differences are dependent on the biological gender

Mobile therapeutic attention for treatment-resistant schizophrenia (m-RESIST): a prospective multicentre feasibility study protocol in patients and their caregivers

INTRODUCTION: Treatment-resistant schizophrenia (TRS) is a severe form of schizophrenia. In the European Union, approximately 40% of people with schizophrenia have TRS. Factors such as the persistence of positive symptoms or higher risk of comorbidities leave clinicians with a complex scenario when treating these patients.Intervention strategies based on mHealth have demonstrated their ability to support and promote self-management-based strategies. Mobile therapeutic attention for treatment-resistant schizophrenia (m-RESIST), an innovative mHealth solution based on novel technology and offering high modular and flexible functioning, has been developed specifically for patients with TRS and their caregivers. As intervention in TRS is a challenge, it is necessary to perform a feasibility study before the cost-effectiveness testing stage. METHODS AND ANALYSIS: This manuscript describes the protocol for a prospective multicentre feasibility study in 45 patients with TRS and their caregivers who will be attended in the public health system of three localities: Hospital Santa Creu Sant Pau (Spain), Semmelweis University (Hungary) and Gertner Institute & Sheba Medical Center (Israel). The primary aim is to investigate the feasibility and acceptability of the m-RESIST solution, configured by three mHealth tools: an app, wearable and a web-based platform. The solution collects data about acceptability, usability and satisfaction, together with preliminary data on perceived quality of life, symptoms and economic variables. The secondary aim is to collect preliminary data on perceived quality of life, symptoms and economic variables. ETHICS AND DISSEMINATION: This study protocol, funded by the Horizon 2020 Programme of the European Union, has the approval of the ethics committees of the participating institutions. Participants will be fully informed of the purpose and procedures of the study, and signed inform consents will be obtained. The results will be published in peer-reviewed journals and presented in scientific conferences to ensure widespread dissemination. TRIAL REGISTRATION NUMBER: NCT03064776; Pre-results

Sématerápia = Schema therapy

Elméleti összefoglalómban a kognitív terápiás irányzaton belül kialakult terápiás irányzat, a sématerápia bemutatására vállalkozom. A sématerápia súlyos kapcsolati problémákkal küzdő, személyiségzavarban vagy krónikus első tengely zavarban szenvedő páciensek számára kidolgozott hosszú (heti két alkalom, két éven át) egyéni vagy csoportos terápia. Először bemutatom a sématerápia kognitív, viselkedésterápiás, tárgykapcsolati és kötődéselméletet, Gestalt-terápiás elemeket integráló elméletét. A tanulmány második felében áttekintem a sématerápia hatékonyságára és a korai maladaptív sémaelmélet egyes elemeit alátámasztó kutatási eredményeket. Végül összefoglalom a sématerápia főbb szakaszait és specifikus terápiás technikáit: kognitív, viselkedésmintákat megtörő, élményalapú és a terápiás kapcsolatra fókuszáló technikákat. | In this theoretical review schema therapy, a recently developed approach within the cognitive-behavioral tradition will be introduced. Schema therapy approach is a long-term (twice a week, two years), individual or group therapy for patients suffering from severe interpersonal problems, personality disorders, or chronic first axis disorders. In the first part of the paper the theoretical background of this highly integrative therapeutic approach is introduced, including its roots in cognitive behavior therapy, object relational and attachment theory, Gestalt therapy. In the second part, this review investigates the empirical evidences of schema therapy and early maladaptive schema theory. In the third part, the structure of schema therapy is summarized, and its specific techniques: cognitive, behavioral pattern breaking, experiential techniques and techniques focusing on the therapeutic relationship