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Buhl-Nielsen B, Steele H, Steele M. Attachment and body representations in adolescents with personality disorder. J Clin Psychol 2024; 80:1981-1997. [PMID: 38822751 DOI: 10.1002/jclp.23705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/20/2024] [Accepted: 05/07/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Attachment theory has served as an influential framework for understanding psychopathology, partly due to reliable assessment methodology. The influence of insecure attachment on attitudes toward the body and the impact this might have for the development of psychopathology is however less well elucidated. METHOD A total of 123 adolescents (35 with borderline personality disorder or BPD, 25 with other personality disorders [OPD] and 63 comprising a normative control group) were interviewed with the Adult Attachment Interview (AAI) and the Mirror Interview (MI). The MI questions respondents about how they feel about their bodies, as they look in the mirror. RESULTS The AAIs from the Borderline group were predominantly insecure-preoccupied and unresolved. These adolescents had significantly lower levels of a positive and integrated sense of self and body than the other groups. Regression results revealed a high loving relationship with fathers, low involving anger with father, high coherence of mind, slight derogation of mother & low levels of unresolved loss uniquely and additively predicted 55% of variance in the summary score assigned to MI responses, that is, the summary score for a Positive and Integrated Body Representation (PIBR). CONCLUSION Unfavorable attachment experiences and current states of mind regarding attachment may give rise to problems with establishing PIBRs, and thus play a role in the development of psychopathology, especially BPD.
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Affiliation(s)
- Bernadette Buhl-Nielsen
- Department of Child and Adolescent Psychiatry, Region Sjaelland and University of Copenhagen, Copenhagen, Denmark
| | - Howard Steele
- Psychology Department, The New School for Social Research, New York, New York State, USA
| | - Miriam Steele
- Psychology Department, The New School for Social Research, New York, New York State, USA
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Gewirtz-Meydan A, Godbout N, Canivet C, Peleg-Sagy T, Lafortune D. The Complex Interplay between BDSM and Childhood Sexual Abuse: A Form of Repetition and Dissociation or a Path Toward Processing and Healing? JOURNAL OF SEX & MARITAL THERAPY 2024; 50:583-594. [PMID: 38544460 DOI: 10.1080/0092623x.2024.2332775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
In this theoretical paper the authors explore the connections between BDSM (i.e., practices involving bondage, discipline, dominance, submission, sadism, masochism) and CSA (childhood sexual abuse) in order to investigate the potential unconscious mechanisms at play and the therapeutic functions of BDSM practices among CSA victims. Drawing on the embodiment framework, the authors address how BDSM may serve as a form of unconscious repetition of traumatic experiences for certain CSA victims, with the aim of processing trauma and healing. A review of the empirical evidence regarding the links between BDSM and CSA trauma, along with the potential of BDSM to trigger trauma and elicit dissociation, guilt, or shame, is conducted. Finally, BDSM practices are reviewed through the concept of trauma-play, which involves deliberate rescripting. In short, the complex relationship between BDSM and CSA is highlighted, as well as its implications for understanding and potentially addressing trauma experiences in therapy.
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Affiliation(s)
- Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Natacha Godbout
- Department of Sexology, Université du Québec à Montréal, Montreal, Canada
| | - Cloé Canivet
- Department of Sexology, Université du Québec à Montréal, Montreal, Canada
| | - Tal Peleg-Sagy
- Department of Psychology, Ben Gurion University of the Negev, Beersheba, Israel
| | - David Lafortune
- Department of Sexology, Université du Québec à Montréal, Montreal, Canada
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Gewirtz-Meydan A, Godbout N. Between pleasure, guilt, and dissociation: How trauma unfolds in the sexuality of childhood sexual abuse survivors. CHILD ABUSE & NEGLECT 2023; 141:106195. [PMID: 37116448 DOI: 10.1016/j.chiabu.2023.106195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/02/2023] [Accepted: 04/07/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Childhood sexual abuse (CSA) is a significant risk factor for sexual difficulties in adulthood. OBJECTIVE In the current study we aimed to expand the understanding of the association between CSA and sexual difficulties by examining the moderating role of traumatic sexuality in the association between CSA and sexual difficulties among a sample of CSA survivors. PARTICIPANTS AND SETTING The hypothesized moderation model was examined among a sample of 393 CSA survivors. METHODS Significant interactions were probed using simple slopes tests using the interactions R package. RESULTS The results indicated main effects of traumatic sexuality on survivors' sexual difficulties: Greater severity of dissociation during sex was linked with greater sexual dysfunction and higher compulsive sexual behavior disorder (CSBD), and greater intrusiveness during sex and pleasing the other during sex were linked with higher CSBD. Experiencing higher sex-related guilt and/or shame and hypervigilance with regard to sex were associated with greater sexual dysfunction. As for the moderations, intrusiveness during sex and pleasing the other during sex moderated the association between CSA and sexual dysfunction. Intrusiveness during sex and sex-related guilt and/or shame moderated the association between CSA and CSBD. Intrusiveness during sex, pleasing the other during sex, and/or hypervigilance with regard to sex moderated the association between CSA and problematic pornography use. CONCLUSION This study points to the potential contribution of traumatic sexuality symptoms to sexual difficulties among survivors of CSA and lends support to the idea of offering trauma-focused therapy when treating the sexual difficulties of CSA survivors.
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Affiliation(s)
- Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, Israel. agewirtz-@univ.haifa.ac.il
| | - Natacha Godbout
- Sexology department, Université du Québec à Montréal (UQAM), Canada.
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Gewirtz-Meydan A, Lassri D. Sex in the Shadow of Child Sexual Abuse: The Development and Psychometric Evaluation of the Post-Traumatic Sexuality (PT-SEX) Scale. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4714-4741. [PMID: 36000712 DOI: 10.1177/08862605221118969] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sexual-related post-traumatic stress symptoms (sexual-related PTSS) refers to the traumatic reactions that are replicated during sexual activity among survivors of child sexual abuse (CSA). However, the construct of sexual-related PTSS have been adapted from clinical work with survivors, and research with limited examination of the scales themselves. Given this gap, the current study offers the development of a new measure (PT-SEX) that examines sexual-related PTSS. The study was conducted online, among two convenience samples of women survivors of CSA (study 1 included 451 women and study 2 included 330 women). Six reliable PT-SEX factors emerged from Study 1: Dissociation during sex, intrusiveness during sex, shame and guilt in regard to sexual aspects, pleasing the other during sex, interpersonal distress, and hypervigilance during sex. Study 2 revealed survivors of CSA had significantly higher sexual-related PTSS levels as compared to participants without such a history. Also, post-traumatic stress disorder and sexual-related PTSS made unique and unshared contributions to the observed data, including sexual self-esteem, sexual motives, relationship satisfaction, compulsive sexual behavior, and mental health. CSA significantly moderated the associations between sexual-related PTSS and sexual self-esteem, sexual motivations of self-affirmation and coping, and depression and anxiety. Findings from the current study show that over time, the trauma of CSA seems to be implicated in survivors' sexual experience. As sexual difficulties are accompanied by sexual-related PTSS, these symptoms are unlikely to resolve by trauma-focused therapy and must be actively targeted in therapy.
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Affiliation(s)
- Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, Israel
| | - Dana Lassri
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Israel
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Rudy JA, McKernan S, Kouri N, D'Andrea W. A meta-analysis of the association between shame and dissociation. J Trauma Stress 2022; 35:1318-1333. [PMID: 35749645 DOI: 10.1002/jts.22854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022]
Abstract
Shame and dissociation have been implicated theoretically and empirically in trauma exposure and its sequelae, with shame understood as an intense negative emotion and dissociation as a reaction to intense negative emotions. Understanding the connection between shame and dissociation is important for theory and practice; however, the strength of this association remains unclear. For example, in therapy, both shame and dissociation serve as a barrier to engaging with emotion. Theoretically, these two states should be distinct, as one (dissociation) confers low affective intensity and the other (shame) high intensity. The present meta-analysis focused on the magnitude of the association between these two phenomena and investigated the extent to which gender, trauma exposure, psychiatric comorbidities, and demographic characteristics influence this association given their independent links to shame and dissociation. An initial search of six databases identified 151,844 articles. Duplicates were removed, and additional articles were excluded based on abstract and title screening. After contacting authors for missing data, a full-text screen yielded 25 articles for the present analysis. The results indicate that shame and dissociation were moderately correlated (k = 33, n = 4,705), r = .42, 95% CI [.35, .48], p < .001, but no clear clinical moderators emerged. Despite this association, very few studies utilized experimental designs to examine the association between these constructs. Future research should focus on experimental study designs to investigate the extent to which shame induces dissociation or vice versa.
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Affiliation(s)
- Justine A Rudy
- Department of Psychology, The New School for Social Research, New York, New York, USA
| | - Scott McKernan
- Department of Psychology, The New School for Social Research, New York, New York, USA
| | - Nicole Kouri
- Department of Clinical Psychology, Wayne State University, Detroit, Michigan, USA
| | - Wendy D'Andrea
- Department of Psychology, The New School for Social Research, New York, New York, USA
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Katznelson H, Daniel SIF, Poulsen S, Lunn S, Buhl-Nielsen B, Sjögren JM. Disturbances in the experiences of embodiment related to attachment, mentalization and self-objectification in anorexia nervosa. J Eat Disord 2021; 9:137. [PMID: 34688309 PMCID: PMC8542305 DOI: 10.1186/s40337-021-00463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/19/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Body image disturbance is central to both the understanding and treatment of anorexia nervosa (AN); however, the underlying psychological processes involved are still not well understood. One way towards a better understanding of these mechanisms may be to explore the sense of embodiment in these patients in an attempt at integrating the role of the body in our understanding of the development of self in AN. It is hypothesized that difficulties in affective experiences of embodiment is related to insecure attachment, deficits in mentalization and self-objectification. METHODS Sixteen inpatients with AN were interviewed with the Mirror Interview (MI). In the interview, the individual is asked a set of questions related to thoughts and feelings about the body while standing in front of a full-length mirror. Furthermore, all patients were assessed with the Adult Attachment Interview, which was coded for both attachment and mentalization (operationalized by the Reflective Functioning scale; RF). Self-objectification was measured with the Objectified Body Consciousness Scale (OBCS). RESULTS Results from a multiple regression analysis showed that Global MI scores were significantly associated with Coherence of mind as an indicator of attachment, RF and scores on the OBCS. CONCLUSIONS The study suggests that affective experiences of embodiment in patients with AN are associated with negative attachment representations, mentalizing impairments and objectified body consciousness. Body image disturbance is a key diagnostic feature in anorexia nervosa but the underlying psychological processes are poorly understood. Recently, there has been a growing interest in how disturbances in the more psychological experience of the body (embodiment) in anorexia nervosa is related to both attachment, how individuals make sense of both themselves and others and the degree to which they tend to experience ourselves from the outside. In this pilot study, this was assessed with an innovative interview, the Mirror Interview, where the individual is asked a set of question while standing in front of a full length mirror. Results showed that difficulties in embodied experiences in patients with anorexia nervosa were related to more fundamental representations of self and self-objectification. This has potential implications for both the understanding and treatment of anorexia nervosa, as disturbances in body image may be seen as an underlying factor in the development of an eating disorder.
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Affiliation(s)
- Hannah Katznelson
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| | | | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Lunn
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Bernadette Buhl-Nielsen
- Psychotherapy Clinic, Department of Child and Adolescent Psychiatry, Region Zealand, Denmark
| | - Jan Magnus Sjögren
- Unit for Eating Disorders, Capital Region of Copenhagen, Psychiatric Centre Ballerup, Ballerup, Denmark
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Kedem D, Regev D, Guttmann J. Moving together: Assessing the effectiveness of group mother-child dance and movement therapy. ARTS IN PSYCHOTHERAPY 2021. [DOI: 10.1016/j.aip.2021.101803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vaillancourt-Morel MP, Bergeron S, Blais M, Hébert M. Longitudinal Associations Between Childhood Sexual Abuse, Silencing the Self, and Sexual Self-Efficacy in Adolescents. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:2125-2135. [PMID: 31300978 DOI: 10.1007/s10508-019-01494-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 06/10/2023]
Abstract
Sexual self-efficacy-the belief in one's ability to engage in desired and to refuse unwanted, sexual activities and behaviors-is an important feature in promoting adolescent sexual health and well-being. One factor that may affect the development of sexual self-efficacy is child sexual abuse. However, little is known about the processes underlying the relation between child sexual abuse and sexual self-efficacy. Using longitudinal data from a sample of 739 adolescent girls and boys aged between 14 and 18 years, we examined the mediational role of two "silencing the self" attitudes and behaviors in romantic relationships-self-silencing, i.e., inhibiting fulfilling one's own needs, and divided self, i.e., presenting an outer compliant self-in the associations between child sexual abuse severity and two dimensions of sexual self-efficacy: the ability to set clear sexual limits and the ability to use sexual protection. Results of path analysis showed that child sexual abuse severity was associated with more self-silencing and more divided self. In turn, self-silencing was associated with lower protection use self-efficacy, whereas divided self was associated with lower limit-setting and protection use self-efficacy. Thus, self-silencing strategies in romantic relationships mediated the associations between child sexual abuse severity and lower sexual self-efficacy. The overall findings may inform the development of prevention/intervention programs that target the enhancement of an integrated sense of self in intimate relationships to promote assertive strategies in sexual situations.
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Affiliation(s)
- Marie-Pier Vaillancourt-Morel
- Department of Psychology, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC, H3C 3J7, Canada.
| | - Sophie Bergeron
- Department of Psychology, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC, H3C 3J7, Canada
| | - Martin Blais
- Department of Sexology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Martine Hébert
- Department of Sexology, Université du Québec à Montréal, Montréal, QC, Canada
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Freysteinson WM, Mellott S, Celia T, Du J, Goff M, Plescher T, Allam Z. Body Image Perceptions of Women Veterans With Military Sexual Trauma. Issues Ment Health Nurs 2018; 39:623-632. [PMID: 29648911 DOI: 10.1080/01612840.2018.1445327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The researchers were invited to a transitional home for homeless women veterans to help veterans with body image issues. Convenience sampling was used to recruit 12 veterans who perceived they had a physical difference due to military service. Data were obtained in focus groups where the veterans were invited to share stories. Ricoeur's hermeneutic phenomenology guided the study. The research team learned early in the data collection stage that 11 of the 12 participants suffered military sexual trauma (MST). Three structures emerged in the data: (a) to speak up or not to speak, (b) from military pride to shameful anguish, and (c) invisible scars versus visible scars. A phenomenological interpretation of these invisible scars uncovered that viewing self in a mirror was depicted as viewing a stranger. Being with others, including family, was described as wearing a fake face. The phrase I am broken defined intimate relationships which were non-existent or strained. Shame permeated all body image structures. As the veterans listened to each other, they began to see themes in their stories. There was a shared sense of identity and a movement toward greater self-understanding and resolving. In addition to the recommendations the participants had regarding prevention of MST and recovery care of those with MST, implications for research and practice are provided.
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Affiliation(s)
- Wyona M Freysteinson
- a Nelda C. Stark College of Nursing , Texas Woman's University , Houston , Texas , USA
| | - Susan Mellott
- a Nelda C. Stark College of Nursing , Texas Woman's University , Houston , Texas , USA
| | - Tania Celia
- a Nelda C. Stark College of Nursing , Texas Woman's University , Houston , Texas , USA
| | - Jinlan Du
- b Office of Technology , Texas Woman's University , Houston , Texas , USA
| | - Marilyn Goff
- c Library, Texas Woman's University , Houston , Texas , USA
| | | | - Zoheb Allam
- e Research and Sponsored Programs , Texas Woman's University , Denton , Texas , USA
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Steele M, Steele H, Beebe B. Applying an attachment and microanalytic lens to “embodied mentalization”: Commentary on “Mentalizing homeostasis: the social origins of interoceptive inference” by Fotopoulou and Tsakiris. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/15294145.2017.1295218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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