Contents:
Psychiatric aspects of impulsivity. What dimensions underlie cluster B personality disorders? Factor structure of borderline personality disorder criteria. Br J Addict ; Quality of depressive experience in borderline personality disorder and major depression: J Personal Disord ;6: Genetics in borderline conditions. Psychopathological and nosological characteristics in subtypes of self-injurers. Affective instability and impulsivity in personality disorder.
Results of an experimental study. The fate of borderline patients. The longitudinal pattern of suicidal behaviour in borderline personality disorder: A prospective follow-up study. Borderline Personality Disorder as an impulse spectrum disorder. Serotonergic studies in patients with affective and personality disorders. Correlates with suicidal and impulsive aggressive behavior.
Prospective studies of outcome. Understanding mechanism of change in patients with borderline personality disorder.
Psychiatr Clin North Am ; D-L fenfluramine response in impulsive personality disorder assessed with [18F] fluorodeoxyglucose positron emission tomography. Heritability of irritable impulsiveness: Clinical outcome of psychopharmacologic treatment of borderline and schizotypal personality disordered subjects. J Clin Psychiatry ;59 Suppl 1: Extraversion in pathological gamblers correlates with indexes of noradrenergic function. Growth hormon responses to intravenous clonidine challenge correlate with behavioral irritability in psychiatric patients and in healthy volunteers.
Aggression, suicide, and serotonin: Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region. Tryptophan hydroxylase genotype is associated with impulsive-aggression measures: Am J Med Genet ; Ital J Psychopathol ; Pharmacotherapy or borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine and tranylcypromine.
Continuation pharrnacotherapy of borderline personality disorder with haloperidol and phenelzine. Efficacy of phenelzine and haloperidol in borderline personality disorder. A preliminary double-blind, placebo-controlled trial of divalproex sodium in borderline personality disorder. Divalproex sodium for impulsive aggressive behavior in patients with personality disorder.
An open trial of valproate in borderline personality disorder. Divalproex sodium as a treatment for borderline personality disorder. Ann CIin Psychiatry ;7: A trial of carbamazepine in borderline personality disorder. The effect of lithium on impulsive aggressive behavior in man. The long-term use of lithium in aggressive prisoners. Fluoxetine in borderline personality disorder.
Prog Neuropsycho-pharmacol Biol Psychiatry ; Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatry ; Suppl An open trial of sertraline in personality disordered patients with impulsive aggression. Fluoxetine in the treatment of borderline and schizotypal personality disorders. Fluoxetine trial in borderline personality disorder. Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder.
J Clin Psychopharmacol ; Fluoxetine and impulsive aggressive behavior in personality disordered subjects. Pharmacotherapy of impulsivity, aggression, and related disorders. Hollander E, Stein DJ, eds. John Wiley and Sons , pp. Amitriptyline versus haloperidol in borderlines: J Clin Psychopharmacol ;9: Progress in pharmacotherapy of borderline disorders. A double-blind study of amitriptyline, haloperidol, and placebo. Response of borderline and schizotypal patients to small doses of thiothixene and haloperidol.
Clozapine treatment of borderline patients: The successful use of clozapine in ameliorating severe self mutilation in a patient with borderline personality disorder. J Personal Disord ;9: Low-dose clozapine in acute and continuation treatment of severe borderline personality disorder. Olanzapine treatment of female borderline personality disorder patients: Olanzapine safety and efficacy in patients with borderline personality disorder and comorbid dysthymia. Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder. Risperidone in comorbid borderline personality disorder and dysthymia.
Remission of self-mutilation in a patient with borderline personality during risperidone therapy. Effective treatment of aggression and impulsivity in antisocial personality disorder with risperidone. Psychiatry Clin Neurosci ; Treatment of borderline personality disorder with risperidone. Toward a psychobiological theory of borderline personality disorder: The Diagnostic Interview for Borderline Patients.
Quetiapine in the treatment of borderline personality disorder. World J Biol Psychiatry ;4: Antiaggressive effect of quetiapine in a patient with schizoaffective disorder. Impulsivity in self-mutilative behaviour: J Psych Res ; Pharmacotherapy of borderline personality disorder: International Society for the Study of Personality disorders. The occurrence of borderline personality disorder in the families of borderline patients. J Personality Disord ;2: Relationship between borderline personality disorder and Axis I diagnosis in severity of depression and anxiety.
Axis I diagnostic comorbidity and borderline personality disorder. Nizzoli U, Pissacroia G, eds. Trattato completo degli abusi e delle dipendenze. This web site uses technical cookie in order to enhance user experience and to provide services to users. Profiling and third party cookies may be used too when content from third party sites like YouTube, Google Maps, etc To accept use of all cookies, please click Accept. Home Archive Issue Pinto Dipartimento Salute Mentale, A. In particolare, risulta che: Farmacoterapia del comportamento impulsivo nel paziente borderline Gli interventi terapeutici possono condizionare positivamente il decorso del DBP, riducendo il rischio di comportamenti potenzialmente dannosi o letali.
Website developed by Archimede Informatica. Furthermore - and this seems to me a critical point - whatever the level of one's constitutional or historically endowed degree of ego strength or self-cohesiveness, unresolved conflict and accompanying anxiety weaken the personality, and the resolution of conflict and decreases in anxiety strengthen the personality. I share Gedo's skepticism toward talk about resumption of developmental growth and the claim that psychotherapy somehow directly repairs developmental impairments and structural defects - whether through "transmuting internalizations" or any other hypothetical process.
Rather, as Gedo points out, the effects of such impairments and defects are more likely to be ameliorated through "new functions learned in the context of a satisfying and age-appropriate human relationship" Gedo, , p. For some patients the new learning consists in such things as more efficient tension regulation, the prudent avoidance of understimulation or disruptive over-excitement, and raising unrecognized biologically based needs e. For many patients, as noted earlier, the experience of the therapist as a supportive symbiotic partner sufficiently reduces anxiety to permit the learning of new functions.
But I strongly suspect that for all patients help in the recognition and resolution of conflicts is a primary means of promoting increased feelings of intactness and self-cohesiveness. As adults, we are not simply frozen at "arrested" points in childhood. Hence, it is not at all clear as to what is meant by permitting arrested configurations to unfold as they would have in the normal course of development.
No process, physiological or psychological, unfolds in an adult as it would have when we were 1, 2, or 3 years of age. What can such talk mean or refer to? After all, as Loewald reminds us,. That we do not, as adults, simply resume a developmental growth that was arrested at an earlier period does not mean that growth in adulthood is not possible. As adults, we can experience a deepening and increase in self-understanding and self-knowledge; we can alter our attitudes and our irrational and grim unconscious beliefs; we can become more self-confident and less plagued with anxiety; we can become more forgiving and self-accepting and less self-castigating; and so on.
Furthermore, many of these outcomes may follow a renewed struggle with developmental issues which were left unresolved. However, all these changes are age-appropriate ones that occur in the lives of adults. They do not, nor could they, constitute the resumption of a developmental growth process that is characteristic of a 2- or 3-year-old.
As for the "transformation" of archaic configurations We are merely told generally that the analyst's empathic mirroring and understanding, his permitting the archaic configuration to unfold, and his availability as a self object all work to heal self-defects, promote structuralization and resumption of developmental growth, facilitate separation-individuation, and transform archaic self and object configurations into more mature ones.
Given the remarkableness of these claims, it would be important to go beyond these vague generalizations and to learn something about the specific psychological processes which bring about all these changes. The point I raise here only briefly is the one more fully discussed in dealing with the work of the Mt.
Zion group, applicable to all psychoanalytic psychotherapy. According to the Mt. Zion group , the assumption that patients seek to repeat or obtain in the transference the gratification of infantile wishes is simply not an accurate description of what goes on in treatment with any patient. Instead, they suggest and present impressive evidence for the idea that all patients seek "conditions of safety," one critical aspect of which is the assurance that the therapist or perhaps more accurately, the patient-therapist interaction will not repeat earlier traumata.
Zion group highlights as an essential ingredient of all psychotherapy. Theory, Clinical Observation,and Empirical Research. Guilford, ; Weiss J. Scientific American , , , 3 March: I want to note some additional difficulties that characterize current discussion of developmental arrests and defects. The emphasis on early periods of development has led to unbridled speculations regarding supposed events and processes in infancy and childhood.
Such speculations are often of an etiological nature or may simply refer to what presumably goes on in early development. What they all have in common is that, remarkably enough, they are entirely based on clinical work with adult patients and make no reference to empirical studies with infants and children, let alone long-term longitudinal evidence.
Consider, for example, the extraordinary fact that all the evidence Kohut and his followers adduce to support their etiological notions regarding defects in the self are derived from the production of adults in treatment. It is worth noting in passing that to the extent that there is reliable evidence available regarding the young infant's cognitive capacities, it indicates that he or she has a far greater integrative and synthesizing capacity than is suggested by all the recent speculations regarding early splitting and other related characteristics e.
As for the second example, in discussing traumatic deficiencies in early care having to do with absence of empathic responsiveness, extreme inconsistencies, and "frequent exposure of the child to affectively unbearable sexual and aggressive scenes," Stolorow and Lachmann conclude that. To the extent that one can decipher the jargon, what is being proposed here is a causal proposition regarding the effects of early experiences upon subsequent development without a shred of evidence.
The question that arises in all these instances is the nature of the evidence regarding these supposed actual events, let alone their purported effects on subsequent development. One finds in the current literature all sorts of descriptions of early deprivations, parental pathology, etc. But, as Rubinfine cautions,.
As for the adult patients' memories about purported early events, I remind the reader of Freud's warning, after noting that certain memories may have been falsified, that. Our childhood memories show us our earliest years not as they were but as they appeared at the latter period of arousal. The first above example from Stolorow and Lachmann also illustrates another difficulty of much current writing, which is characterized by the tendency to conceptualize adult pathology in terms of presumably normal stages in infant and child development.
Thus, in the above example, an adult's difficulty with positive and negative affective evaluations is taken to represent an arrest at a similar normal stage in infant development. One finds that this sort of thinking completely underlies Kernberg's discussion of splitting.
Splitting, Kernberg tells us, is the infant's normal manner of coping with positive and negative affects, given his limited integrative capacity. It is the continued defensive use of such splitting, Kernberg goes on, which then characterizes the borderline adult. However, as Peterfreund so cogently points out in referring to those fallacies as the "adultomorphization" of infancy and the "tendency to characterize early states of normal development in terms of Or, to state it in reverse fashion, infant behavior is not the same nor even essentially similar to adult pathological behavior.
The normal infant is not an arrested or defective version of the completed adult, but an organism whose responses are highly adaptive, given its capacity and level of organization. This is perhaps the most basic and most serious problem with the conceptualization of adult pathology in terms of arrested development. It perpetuates the fallacious idea that certain adult pathology is essentially a "freezing" of, or regression to, a particular normal stage of development.
It draws on vague analogies between purported infant states and adult pathology without shedding light on either. Consider as a case in point the frequent analogy drawn between adult narcissistic behavior and feelings e. To link the two represents superficial analogizing and "a confusing adultomorphization of infancy" Peterfreund, , p. Other examples of both adultomorphization and what can be called "pathormorphization" Milton Klein, of infancy, cited by Peterfreund, include Mahler's characterization of early infancy as "normal autism" and Melanie Klein's , positing of the "paranoid-schizoid" and "depressive" positions of infancy.
Similar superficial anagogic and confused thinking often enter discussions of regression. While a man who has suffered a cerebrovascular accident and is therefore unable to speak may be said to be suffering from aphasia, one would not want to say that he is in "the same state as an infant of two months who cannot speak. What is clearly suggested in recent discussions of developmental arrest is that the functioning of individuals so afflicted either remains at or, under appropriate precipitating conditions, regresses to states and stages of functioning which were normal at earlier periods of development.
This state of affairs is a highly unlikely one. The very concepts of developmental arrest and development defect, if they are to be theoretically coherent and meaningful, must be clarified and elucidated in their own right e. I want to note my conviction, however, that even when that is accomplished one will still find that not only are considerations of dynamic conflict and structural defects not incompatible, but that they are simply different perspectives on the same general phenomenon.
I come to one final way in this discussion in which current formulations of developmental arrests do not represent accurate accounts of the nature of development. The implication in many clinical and theoretical descriptions is that problems and issues associated with later stages of development do not make their appearance until earlier stages are successfully negotiated.
This is most frequently presented in terms of pre-Oedipal and Oedipal issues. For example, Kohut writes that Oedipal issues and "structural conflicts" do not surface until earlier pre-Oedipal concerns having to do with self-cohesiveness have been resolved. I believe that this is an inaccurate conception of how development proceeds and I also believe that it is contradicted by clinical evidence. With regard to the latter point, it is a common clinical experience to observe in patients with a predominance of pre-Oedipal constellations - whether these are described as self defects or schizoid or even schizophrenic - the presence of typical Oedipal conflicts and anxieties e.
In such patients, Oedipal conflicts often trigger and are but they saturated with unresolved pre-Oedipal issues and concerns, nevertheless remain characteristically Oedipal in nature. It should be noted that in typically neurotic patients, too, pre-Oedipal issues are re-aroused and re-intensified at late-Oedipal and post-Oedipal periods - such as adolescence - albeit in less intense degree and although dealt with in a less pathological way. The point is that even in instances of developmental defects or arrests, it is not the case that psychological development on all fronts comes to a standstill as is implied in Kohut's descriptions and formulations.
This is an inaccurate model of how development proceeds. Rather, what is more typical for people with developmental defects in certain areas is that they are more poorly equipped to deal with later developmental challenges that is, challenges characteristic of later developmental stages and later developmental issues are more soffused with earlier unresolved issues.
But, and again this is the critical point, all of development in all areas is not held in abeyance awaiting the correction of the defect or arrest. For example, among severely disturbed adolescent whether described as borderline, schizoid, or narcissistic disorders issues and problems having to do with sexual gratification, reawakening of Oedipal conflicts, intimacy, heterosexual and homosexual fears, independence, vocational choices, and so on, make their appearance and become prominent.
After all, rapid physical growth, endocrinological and other physiological changes, altered social demands and pressures, and other radical changes are as characteristic of adolescents with self disorders as they are of normal adolescents. I recently treated a very disturbed young man who reacted with thinly disguised castration anxiety whenever he engaged in behavior which could be seen as adult and as supplanting father e.
Now, despite his severe pathology and developmental arrests, these above reactions are not unlike patterns one commonly sees in neurotic patients. That is not where the basic differences lie. What is distinctive about my patient is the way he reacted to his ambivalence toward and conflicts surrounding his relationship with his girlfriend, which included dissociation and feelings of depersonalization i.
I also recall a hospitalized, actively schizophrenic patient I treated suddenly announcing in a group therapy session that he would volunteer for castration surgery if that was necessary to cure his illness. He then went on to make clear his belief that his incestuous wishes were the source and cause of his "craziness," that he experienced his craziness as a castration anyway, and that if he went directly to the heart of the matter by getting castrated he might get better and recover. Now, a good deal of this material is obviously Oedipal in nature.
The patient is not unique in this regard. What is striking, of course, is the blatant conscious and untamed appearance of incestuous wishes and the direct, undisguised link between such wishes and actual not displaced or symbolic castration expectations. To return to the basic point, whether or not clinical accounts or pathology in terms of "structural defect" are correct, such a point of view is not incompatible with dynamic considerations.
Introduzione al narcisismo (Italian Edition) - Kindle edition by Sigmund Freud, R. Colorni, Renata Colorni. Download it once and read it on your Kindle device. Introduzione al narcisismo e Inibizione sintomo e angoscia (Italian Edition) - Kindle edition by Sigmund Freud, Renata Colorni, Mario Rossi. Download it once .
Recent emphasis on developmental arrests, self-defects, borderline conditions, and so on have highlighted certain considerations and certain dimensions of personality and of psychopathology which have tended to be ignored in traditional theory. Thus we are much more likely now to be aware of the overriding importance of separation-individuation and "narcissistic" dimensions, including differentiation between self and other, degree of self-integrity and self-cohesiveness, ability to relate to the other as a separate other, and regulation of self-esteem.
And this, I believe, is a real contribution. However, these dimensions are likely to be important for all people, in varying degrees and in different ways. There are likely to be, for example, different forms of separation-individuation challenges at different periods in one's life. In short, it is not the case that one group of people is governed by a psychology of aims, impulses, and inner conflict, while another group is governed by a psychology of self and the pursuit of self-cohesiveness[ Footnote 3 ].
As I have argued, such pursuit cannot be divorced from issuesof gratification of basic instinctual drives and needs, and for all people the integrity of self-organization is a superordinate aim and is pursued at different levels. Mitchell argues that this division of areas of applicability represents, at least in part, an attempt of escaping the accusation of heresy within the psychoanalytic community through the "strategy consisting in keeping the metapsychological frame of reference of drive theory, while creating orthodox concepts at the diagnostic level" p. This kind of "psychodynamic ecumenism" is declared through "strategies of complementarity, in Kohut, the attempt of hierarchically integrating the various concepts, in Kernberg, and the designation, by both, of a new form of psychopathology to which now it possible to apply "the formally heretical theoretical lines p.
Further, whatever defects one has, whether constitutionally given or the result of early traumas, what further weakens the personality is the existence of excessively intense and pervasive conflicts and other incompatibilities which, through their failure to be resolved, threaten one's sense of self-coherence and self-integrity.
This idea has been central to psychoanalysis from Freud's earliest writings to G. Klein's recent "exploration of essentials. That is, the resolution and integration of unresolved schisms in the personality is the major therapeutic means through which one strengthens the self and ameliorates so-called self-defects. There is no need for a dichotomy, certainly not a radical one, between a psychology of developmental arrests and one of dynamic or structural conflict.
Rather, at each developmental stage one is challenged by the need to resolve and integrate various kinds of incompatibilities, including the incompatibilities among adaptational modes appropriate to different stages. How well one faces these tasks as well as how successfully one integrates one's various needs and aims both reflects and determines the subsequent quality and integrity of one's self-organization. Of course, one's success in resolving incompatibilities reflects one's integrative capacity which, in turn, is undoubtedly influenced by, as noted earlier, constitutional predispositions and early experiences.
But it is unlikely that a particular set of early experiences - whether consisting of failures of empathic experiences or opportunities for idealization - would have a determinative and decisive influence on something as complex as integrative capacity. In any case, issues of conflict, self-organization, and ego functions, including integrative capacity, are all inextricably linked. Essaysin Honor of Edith Jacobson. Review of Psychoanalytic Books , 1, 4: The concepts of need and wish in self psychology. Psychoanalytic Psychology , 7 Supplement: Psychoanalytic Studies of the Personality.
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