Psychodynamic Factors Research Articles

Understanding Adolescent Mental Health in the COVID-19 Era: A Psychodynamic Approach.

This cross-sectional, case-control study aimed to explore the psychodynamic characteristics that influenced adolescents' mental health during the COVID-19 pandemic. Personality structure impairments, psychodynamic conflicts, defense styles, and mental health issues were examined using the OPD-Structure- and Conflict-Questionnaires, the Defense Style Questionnaire, and the Patient Health Questionnaire in adolescents before (n = 288) and after (n = 451) the COVID-19 pandemic in Germany. Adolescents with mental health issues exhibited greater impairments in personality structure, more immature defense styles, and higher levels of psychodynamic conflicts both before and after the pandemic onset. Comparisons between pre-pandemic and pandemic samples indicated a lower level of the conflict of taking care of oneself versus being cared for in passive mode among adolescents during the pandemic. In-depth analysis of adolescents with mental health issues from the pandemic group revealed significant associations between personality structure impairments and a maladaptive defense style with somatoform, depressive, anxiety, eating, and alcohol use disorders. The findings provide clinically relevant insights into the psychodynamic factors that contributed to the psychological vulnerability of adolescents during the COVID-19 pandemic. These insights can guide the development of targeted psychodynamic interventions to support adolescents' mental health in similar future crises.

Understanding the psychodynamics of the pathway to suicide

This paper describes the current understanding of the psychodynamics of the pathway to suicide and argues that the limitations of current epidemiological and observational approaches often overlook crucial psychodynamic factors. It describes how an underlying vulnerability in the capacity to process emotions can lead to unbearable pain, where death is perceived as the only escape. The intense emotional states following life’s losses can then precipitate a profound division within the self. This internal split is characterised by a detached, destructive ‘perpetrator’ aspect and a vulnerable ‘victim’ aspect, with the former often overpowering the latter in the lead-up to suicide through suicidal fantasies of life after death. Drawing on data from various sources, including case studies, mental health audits, and coroner’s reports, the paper assesses the practical efficacy of understanding suicide through a psychodynamic lens. This approach aims to provide more effective intervention strategies, not just by preventing suicide but also by addressing the needs of those left bereaved, who often suffer from complex grief and an elevated risk of suicide themselves. By shifting focus from solely preventive measures to a deeper understanding of the underlying psychological mechanisms, this research advocates for a more holistic approach to suicide prevention. It calls for a shared philosophical inquiry into the nature of human existence and the existential conflict between the will to live and the impulse to die, suggesting that a more nuanced comprehension of these dynamics could lead to better support systems both for those at risk and those bereaved.

Insight to the psychosocial factors of survivors of suicidal hanging.

The incidence of hanging has increased over the last ten years and is the most common method of suicide. Because of its multifactorial causation, the reason behind hanging remains unfolded unless the victims leave a suicidal note. In the present study, the psychodynamic factors of hanging were assessed among the survivors of suicidal hanging. The cross-sectional study was conducted at S.C.B Medical College and Hospital, Cuttack, India, over a period of three years. Eighty-two individuals admitted in medicine ward of this tertiary care hospital to receive treatment for the complications as a sequel of hanging and willing to participate in study were included after obtaining informed consent. The information was recorded in a pre-designed pro forma. Subjects from rural areas (87.8%) and low socio-economic backgrounds (67.1%) attempted suicide more often. Most of the victims were in the age group of 21-30 years, followed by less than 20 years. The most common cause of attempted suicide by hanging was family-related issues, and mainly by immediately available materials like dupattas, saree, lungi, and other fabrics. Females in rural areas and males from urban areas attempted suicide by hanging in significantly higher proportions (P = 0.041). Most people commit suicide at a younger age due to failure to cope with the different stressful situations. The most common reason for attempted suicide by hanging was family-related issues. Early intervention in family disputes in developing countries, especially in younger individuals, may help to curb suicide.

Evaluation Criteria for Psychosomatic Practice

To diagnose and treat somatic disorders while considering psychosocial factors, medical and psychological practices require a comprehensive and operationalized list of criteria. The Evaluation Criteria for Psychosomatic Practice (ECPP) has been developed to address this need. It builds upon the updated version of the Diagnostic Criteria for Psychosomatic Research (DCPR) by incorporating significant psychodynamic factors and restructuring its framework to better cater to the practical demands of clinical assessment, diagnosis, treatment planning, and outcome monitoring. It offers four axes for clinical evaluation that can be used together or separately, depending on the needs of diagnostic process, treatment, informing the patient, or research: psychosomatic symptoms and complaints, risk factors related to personality structure, triggers, and secondary risk factors. By utilizing the ECPP’s four axes, clinicians can gain a deeper understanding of how psychosocial factors impact the clinical picture and dynamics of somatic disorders and then effectively communicate this knowledge to patients, improving compliance and collaboration in treatment. Additionally, the ECPP’s framework allows for a balance of psychological, physical, and social treatment interventions that can be tailored to the specific needs of the patient, ultimately leading to better treatment outcomes.

A COVID-19 Patient's Request to Die and Ensuing Conflict: Psychodynamic Considerations.

The role of psychodynamic theory in consultation-liaison (C-L) work, and particularly the importance of countertransference, has been well established. The psychological impact of the COVID-19 pandemic on healthcare workers is a new factor that must now be taken into account as C-L psychiatrists traverse a changed healthcare landscape. In this article, we highlight the case of a critically ill COVID-19 patient who endorsed a desire for hastened death. This request generated significant conflict between the physicians and nurses caring for him, and it became challenging for the C-L team to perform our typical liaison function. We briefly review the existing literature on the psychological impact of the pandemic on healthcare workers, and examine how psychodynamic factors within this context impacted the events that unfolded. Themes under consideration include the effect of mass trauma on clinician defense mechanisms, and specifically the impact on countertransference toward patients who express a desire for hastened death. C-L psychiatrists themselves are not immune to such reactions and must be particularly attentive to emergent conflict in such cases. Interdisciplinary meetings to discuss and process these disagreements may be effective in repairing staff ruptures.

Broadening the perspective on the polarized mind: Commentary on van Baar and Feldmanhall (2022).

The article "The Polarized Mind in Context: Interdisciplinary Approaches to the Psychology of Political Polarization" (van Baar & FeldmanHall, 2022) explores a crucial challenge to contemporary U.S. society. The article focuses on two aspects of the polarized mind: cognitive inflexibility and (exogenous) environmental factors, such as "media filter bubbles" and "biased social networks." However, there are also underlying existential-humanistic and psychodynamic factors that have been identified as elucidating the polarized mind. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Special Report: How to Work With Patients Using Problem-Focused Psychodynamic Psychotherapies

Special Report: How to Work With Patients Using Problem-Focused Psychodynamic Psychotherapies

Abstract- Poster

Abstract- Poster

Studies on the psychodynamics of Chronic Orofacial Pain Disorder

Studies on the psychodynamics of Chronic Orofacial Pain Disorder Objectives: Psychodynamic factors play an important role in its emergence and development of Chronic Orofacial Pain Disorder (COP), which is also known as Chronic Primary Orofacial Pain. This factors form the basis for differentiated psychotherapy. Methods: Seven female and two male patients with COP who had visited the Dental School, University Hospital, Ludwig Maximilian University of Munich, and the dental surgery of a practising dentist over the year were included in the study. Following a detailed dental examination, a psychodynamic interview was videotaped, reconstructing the connections between the life history and the development of the illness. Psychosomatic data were assessed by 3 psychotherapists based on a consensus model with regard to symptom trigger mechanisms such as conflicts and pressure, the development of symptoms, and the personality structure. Pathogenetically, we differentiated among conversion, somatization and projection. Results: The patients had a mean age of 57 years (range: 44-67) and an average illness duration of three (1-5) years. The average age where the illness had manifested was 54 (43-64). All patients showed clear psychodynamic factors in the development and course of the illness. The symptoms developed mainly during transitional situations during the life history, predominately in midlife. During this phase, dental treatment undertaken for whatever reason could trigger the chronic symptoms, which could then be further exacerbated by further dental interventions. The mode of symptom development by equal number of patients related to a somatoform disorder, such as a somatization of affect, a conversion with conflict symbolism and a projective-hypochondriac disorder. In the remaining patients, COP was an accompanying symptom of depressive disorder or the consequence of a posttraumatic stress disorder with self-mutilating tendencies. Conclusion: The consideration of psychosomatic connections and pathogenetic differentiation is helpful for the understanding and management of COP. This diagnostic differentiation could serve as a basis for prognosis and for specific therapeutic indications. Despite numerous general researches about chronic pain syndromes, there is a lack of intervention studies which take into account the specific conditions of COP on a larger sample.

Psychodynamic factors in tinnitus aurium

Tinnitus aurium is the conscious perception of an acoustic sensation in the absence of a corresponding external stimulus. Besides other psychological factors, psychodynamic factors play an important role in the disease. This study evaluated patients with tinnitus who attended the tinnitus outpatient clinic at the ENT Department of LMU Munich. In addition to a physical examination, in a psychodynamic interview the trigger situations, parents’ parenting style, relation to hearing personality, and individual conflict dynamics associated with the onset and course of tinnitus were examined. We included 99 patients diagnosed with tinnitus. Besides organ-related triggers, we identified conflict-laden stresses as trigger situations. 53% of the patients described themselves as sensitive to noise before the start of the tinnitus. Compared with the general population, patients with tinnitus showed less overt aggressiveness (P < .001) and more social orientation (P < .001) and state and trait anxiety (P < .001). Inhibition of aggression was a major psychodynamic factor in the development of tinnitus. A conflict of autonomy was found in the majority of cases. The results underline the importance of psychodynamic factors in tinnitus. We were able to put the individual psychological factors into a meaningful overall context.

Psychodynamics of imagination failures: Reflections on the 20th anniversary of 9/11

This article aims to advance the psychodynamic understanding of imagination failures by studying lessons learned in the US government’s public inquiry into September 11th, 2001 (9/11). Analyzing the findings of The 9/11 Report, I theorize that two forms of macro-level hubris—America’s “hubris of empire-building” and Al Qaeda’s “hubris-nemesis complex”—amalgamated in a uniquely generative manner leading to events on 9/11. Previous studies of public inquiries often demonstrate that inquiry reports are monological story-telling performances used to create sense-making narratives that function hegemonically to impose a simplified version of reality to assign blame and depoliticize events in order to facilitate closure after shocking events. In contrast, findings here suggest that by constructing a critical narrative, The 9/11 Report may serve as a new type of public inquiry report that invites learning about the complex factors that underpin crisis. The article concludes by identifying fruitful areas of future research and ways to theorize further about the collective psychodynamics of macro-level hubris and the psychodynamic factors that hinder learning and contribute to imagination failures.

Heterosexism and the self: A systematic review informing LGBQ-affirmative research and psychotherapy

Heterosexism negatively impacts the mental health of sexual minorities, although the degree to which people are impacted and the nature of how they respond to minority stressors varies. In this systematic review, the authors synthesize literature on heterosexism and three psychodynamic personality factors—attachment style, defense style, and ego identity—and reconceptualize heterosexist stigma as something that not only impairs mental health but also influences personality development. The authors present a theoretical framework that outlines the bidirectional influences between sociocultural contexts and the self, which can inform future research and clinical work with sexual minority clients.

The feasibility of training general practitioners to do cognitive behavioural therapy in routine practice—A qualitative study

AbstractObjectiveIn a collaborative care model in Denmark, general practitioners (GPs) were trained in cognitive behavioural therapy (CBT) of their patients with common mental disorders through supervision by psychiatric nurses and a psychiatrist. We explored the feasibility of implementing CBT as a treatment into routine general practice through this supervision.DesignA qualitative interview study as part of a larger implementation study of collaborative care between general practice and psychiatry in Denmark.MethodInterviews with all three professional groups involved in the intervention were analysed using interpretative phenomenological analysis.ResultsThe participants experienced several cultural and organizational challenges with implementing CBT in general practice. The GPs were used to carrying out talking therapy with methods integrated into the treatment culture in general practice, and it was difficult for them to supplant existing therapeutic skills and approaches. The specific CBT approach was not compatible with the work conditions and work culture in general practice regarding patient relations, time frames and workload; and the inter‐professional training relations between GPs and psychiatric nurses were often challenging. There was an overall agreement among the professionals that general practice of talking therapy could not be changed in the image of psychiatry.ConclusionThe results suggest that wide‐scale implementation of CBT delivered by GPs to patients with common mental disorders is not feasible. Nevertheless, there are many psychotherapeutic elements in routine consultations in general practice, and GPs could possibly gain from improving their ways of questioning, and their use of non‐specific therapeutic, relational and psychodynamic factors.

Mimetic desire and mirror neurons: the consciousness of workplace bullying

Workplace bullying is important to business and government, because it has a real impact on unfortunate casualties’ wellbeing and organizations’ benefits. Studies into the causes and outcomes of workplace bullying with a focus on the key psychodynamic factors underlying harassment and the subsequent results are rare. This paper applies Rene Girard’s mimetic desire theory to clarify the elements and non-cognizant components associated with “interdividual” connections prompting aggression for the victim by the harasser. The disclosure of mirror neurons affirms that mimetic desire grows unwittingly through a mediator of the mimetic brain. Mimetic desire theory helps to recognize and understand that the destructive patterns of behavior and emotional responses to situations leading to moral harassment is a direct consequence of the mimetic rivalry between the bully and the victim. The unconscious mechanism is then brought up to the consciousness. The bully and the victim can avoid becoming entrapped within dysfunctional and toxic relationships such as bullying. The use of the mimetic desire concepts also enables human resources managers, bystanders, and practitioners to better deal with protagonists. This can help minimize or eliminate workplace bullying.

Autism, 75 years of history: From psychoanalysis to neurobiology

In this article we evaluated the lengthy seventy-five year history of Autism Spectrum Disorder beginning with the first diagnosis in 1943 and the first etiological orientations (psychodynamic factors) until today, in which the approach to behavioral problems has increasingly become neurobiological in nature. Abnormal relationships, verbal communication impairments and stereotyped behaviors, are no longer considered the cause of the problem, but rather the manifestation of this problem. Additionally, these factors must not be considered a “problem” and should be viewed as an “adaptation”. In other words, a way through which individuals with different anatomical and functional nervous system give “meanings” to their own bodies and the external world. Subjects with autism have a different connectome. Their neuronal network, under life experiences (learning), has undergone an abnormal selection. In modern words, talking about connectome, could mean direct our attention and studies on the body-brain relationship and chronic inflammation.

Ain’t no love in the heart of the city: Compensatory quasi-adaptive coping among African American males

ABSTRACTThe social and developmental challenges associated with the normative transition from adolescence to young adulthood for young African American males is quite difficult. These challenges are often further complicated when social, environmental, and even psycho-dynamic factors impinge on these developmental processes. Neighborhood disorder along with chronic exposure to urban stressors represent a quiet danger for this population that entrenches them in a milieu characterized by angst, hopelessness, fear, and nihilism. For many young African American males, this creates a seemingly intractable chasm that often relegates them to truncated life course trajectories. The current article explores these areas and the implications for research and practice with this vulnerable population.

Personality, Psychopathology, and Health Through the Lens of Interpersonal Relatedness and Self-Definition.

Sidney Blatt's seminal contributions in the domain of personality development, psychopathology, and health rank among the best researched and most empirically supported theories in psychoanalysis. Blatt is known primarily for his two-polarities model of personality development, which he viewed as evolving through a dialectical, synergistic interaction between two fundamental processes across the lifespan: the development of interpersonal relatedness on the one hand, and of self-definition on the other. In this model, psychopathology is viewed as an attempt to find a balance, however distorted, between relatedness and self-definition. Neurobiological research has confirmed the intrinsic dialectical relationship between these two processes in the development of the neural circuits subserving these capacities, a finding with important implications for physical health. Research relevant to these ideas is reviewed, and the influence that Blatt's approach has had in reintroducing psychodynamic factors into contemporary psychology and psychiatry, as reflected in DSM-5, is discussed.

Erotomania: A psychodynamic overview

IntroductionErotomania is a delusional disorder in which one believes to be loved by someone else. Even though its etiology is not known, psychodynamic factors have been proposed as a possible explanation.ObjectivesTo review the psychodynamic etiology of erotomania.MethodsA search of the Medline/Pubmed database was conducted using the terms “erotomania” and “psychodynamic”.ResultsSeveral authors wrote about the psychodynamic etiology of erotomania. Kraepelin describes it as a “compensation for the disappointments of life”. De Clérambault highlights the idea of “sexual pride”: stimulated by the absence of affective and sexual approval, erotomania flourishes as a way of satisfying the individual's pride. Hollender and Callahan explain the disorder as a result of an ego deficit of not feeling attractive enough. According to Segal, the erotomanic delusion meets the patient's need for love and it is related to the idea of it as the ultimate way of approval. Taylor highlights the patients’ isolation, loneliness and extreme dependence on others.ConclusionsAbout every author agrees with the idea that the erotomanic delusion acts as a gratification to the individual's narcissistic needs, when personal experience has failed to do so. Wanting to be loved is the core of human motivation and the delusion most commonly appears in people who feel rejected by society; facing that perceived rejection, it emerges as the fantasy that other human being is in love with them. This is a relevant overview of this disorder with implications in patients’ treatment, since psychotherapy could be important along with drug treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psicopatia: influências ambientais, interações biossociais e questões éticas

The causality behind psychiatric disorders lies on a still poorly understood interaction between genetic, biological, environmental, social, and psychodynamic factors. The classical biopsychosocial model hypothesizes that psychopathy develops when genetic and neurobiological components are associated with personality traits such as impulsivity, increasing the risk when these individuals are exposed to a dysfunctional family, and worsening when the surrounding social environment fails to provide basic protection. Notwithstanding, other models have been studied. For instance, brain structure and function, neurotransmitters, and hormones are traditionally categorized as biological risk factors; however, they may have either a genetic or an environmental origin, or they may reflect an interaction between both, characterizing the so-called biosocial interaction. Acting on gene expression, environmental factors may modify the brain, changing psychopathic traits and increasing the risk of developing the disorder or, on the contrary (i.e., in a positive way), protecting the individual. Regarding environmental influences, family dysfunction is the most important psychological factor involved, covering paternal antisocial behavior or alcoholism, lack of boundaries and supervision as a child, and parental separation or loss. Childhood trauma may have a dramatic impact on the child’s mental health and is also related to psychopathy. Finally, ethical issues are discussed: Does the presence of psychopathy affectcriminal responsibility in these individuals? If yes, in what way? Should psychopaths committi ng crimes be sent to prison or to forensic hospitals? Is it correct to subject psychopaths to research and scienti fi c investi gati on? These and other questi ons are addressed in the light of current knowledge and controversies.

A case report of a Capgras’ syndrome in elderly

IntroductionCapgras syndrome is the most frequent delusional misidentification syndrome (DMS) which was first described in 1923 by Capgras and Reboul-Lachaux as ‘L’illusion des sosies’. Consists of believe that close relatives have been replaced by nearly identical impostors. It can occur in the context of psychiatric disorders (schizophrenia, major depression) such organic, in which onset of delirium is usually later coinciding with neurological damage or neurodegenerative disease.Case reportWoman 73-year-old diagnosed of schizophrenia since more than thirty years ago. Her family talk about general impairment of the patient in the last two years. She needed a couple of psychiatric hospitalizations because of her psychiatric disease, and probably onset of cognitive impairment. In this context, we objectified the presence of a Capgras syndrome.ObjectivesTo review the literature available about Capgras syndrome in elderly and illustrate it with a clinical case.MethodsReview of literature about Capgras syndrome in elderly by searching of articles in the PubMed database of the last five years to illustrate the exposure of a single case report.ResultsThe etiology of this syndrome is not yet well understood. Advanced age is frequently found Capgras syndrome with or without the concomitant presence of an obvious cognitive impairment.ConclusionsSince it is a complex process an etiological model that combines cognitive and perceptual deficits, organic impairment and psychodynamic factors should be proposed. And it is important to make a correct differential diagnosis that allows us to carry out the best possible treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.