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Ducasse D, Brand-Arpon V, Tralbaut F, Ollivier V, Courtet P, Olié E, Jørgensen CR. How to target disturbed identity in borderline patients? Self-identification program: A case study. L'ENCEPHALE 2023; 49:596-605. [PMID: 36253170 DOI: 10.1016/j.encep.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/05/2022]
Abstract
Borderline personality disorder (BPD) is a severe and relatively prevalent psychiatric disorder, responsible for high rates of suicidal behaviors. Disturbed identity appears as at the very core of this disorder, being inter-related with all other BPD features. Notably, from a dimensional perspective on mental disorders, one should realize that it is from our usual self-representation that we live all our daily experiences. Then, if the understanding of self-concept (or identity) is impaired, all the interventions implemented to decrease the self's suffering will subsequently be impaired. The purpose of the present case study was to illustrate the nine identity diffusion categories described by Jørgensen & Bøye (2022) and how the level of identity function can be improved in a third-wave cognitive and behavioral therapy targeting progressive correct self-identification.
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Affiliation(s)
- D Ducasse
- Department of Emergency Psychiatry and Post Acute Care, CHRU de Montpellier, Montpellier, France; IGF, Université Montpellier, CNRS-Inserm, Montpellier, France; Therapy Center for Mood and Emotional Disorders, Department of adult psychiatry, La Colombière, CHU de Montpellier, Montpellier, France.
| | - V Brand-Arpon
- Therapy Center for Mood and Emotional Disorders, Department of adult psychiatry, La Colombière, CHU de Montpellier, Montpellier, France
| | - F Tralbaut
- Therapy Center for Mood and Emotional Disorders, Department of adult psychiatry, La Colombière, CHU de Montpellier, Montpellier, France
| | - V Ollivier
- Centre médico-psychologique, Carcassonne, USSAP Aude, France
| | - P Courtet
- Department of Emergency Psychiatry and Post Acute Care, CHRU de Montpellier, Montpellier, France; IGF, Université Montpellier, CNRS-Inserm, Montpellier, France
| | - E Olié
- Department of Emergency Psychiatry and Post Acute Care, CHRU de Montpellier, Montpellier, France; IGF, Université Montpellier, CNRS-Inserm, Montpellier, France
| | - C R Jørgensen
- Department of Psychology, Aarhus University, Aarhus, Denmark
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Bogaerts A, Luyckx K, Bastiaens T, Sleuwaegen E, Berens A, Claes L. The Self-Concept and Identity Measure in Patients with Personality Disorders: A Psychometric Evaluation and Associations With Identity Processes, Core Domains of Self-Functioning, and Personality Disorder Symptoms. Assessment 2023; 30:2184-2197. [PMID: 36594676 DOI: 10.1177/10731911221140313] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
As developmental and clinical research on identity has largely developed in disconnect, scholars recommend adopting a developmental psychopathology perspective on identity, which considers adaptive and pathological identity functioning. Such a perspective has also been introduced in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Alternative Model for Personality Disorders (AMPD), which suggests that all personality disorders (PDs) are marked by moderate to extreme deficits in self-functioning (i.e., identity and self-direction). The present study aims to validate the Dutch Self-Concept and Identity Measure (SCIM), a 27-item self-report questionnaire that assesses consolidated identity, disturbed identity, and lack of identity, in 153 psychiatric inpatients with PDs (75.2% female; Mage = 31.73). We investigated the factor structure and reliability of the SCIM, and examined associations of SCIM scales with typical identity processes, AMPD domains of self-functioning, and symptoms of all PDs. Results indicated that a 23-item Dutch SCIM produced valid and reliable scores among patients with PDs. Furthermore, SCIM scales were significantly and differentially related to identity commitment processes, ruminative identity exploration, domains of self-functioning, and symptoms of all PDs. Moreover, findings indicated that PDs varied regarding the severity of identity impairment.
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Affiliation(s)
- Annabel Bogaerts
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Tim Bastiaens
- University Psychiatric Centre, KU Leuven, Kortenberg, Belgium
| | - Ellen Sleuwaegen
- University Psychiatric Centre, UZA, Duffel, Belgium
- Faculty of Medicine and Health Sciences, University Antwerp, Belgium
| | - Ann Berens
- University Psychiatric Centre, UZA, Duffel, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University Antwerp, Belgium
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Lind M, Kiel L, Hansen SB, Jørgensen MS, Simonsen E. Narrative Identity within Mentalization-Based Group Therapy for Adolescents: A Feasibility Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050854. [PMID: 37238402 DOI: 10.3390/children10050854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Borderline personality disorder (BPD) is characterized by severe disturbances related to understanding oneself and other people and can be reliably detected and treated in adolescence. In this feasibility study, we aimed to focus on the features of, and changes in, narrative identity throughout the course of Mentalization-Based Treatment in Groups (MBT-G) for adolescents with BPD. Six female patients (M = 15.2, SD = 0.75) joined between 16 and 31 (M = 23.83) MBT g sessions. The narrated events within each session across sessions were coded for themes of agency and communion and the narrated reactions were coded for personality functioning. The patients and their parents also completed several self-report measures before and after therapy. Themes of diminished agency and communion were identified, with communion as the dominating theme. When comparing the patients' first five sessions with their last five sessions, there was an increase in themes related to agency and decreased in communion. The narrated reactions were dominated by themes related to thwarted self-functioning and primarily identity, although intimacy was also present. Patients improved in terms of self-reported functioning and internalizing and externalizing behavior before and after end of treatment. The importance of narration in BPD (group) therapy is discussed alongside clinical implications.
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Affiliation(s)
- Majse Lind
- Department of Communication and Psychology, Aalborg University, Nordkraft, Teglgårds Plads 1, 9000 Aalborg, Denmark
| | - Lennart Kiel
- Department of Psychology, Aarhus University, 8000 Aarhus, Denmark
| | - Sune Bo Hansen
- Department of Psychology, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Mie Sedoc Jørgensen
- Psychiatric Research Unit, Mental Health Services of Region Zealand, Region Zealand, 4200 Slagelse, Denmark
| | - Erik Simonsen
- Psychiatry East, Mental Health Services of Region Zealand, 4000 Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Stanghellini G. Homo dissipans: Excess and Expenditure as Keys for Understanding the Borderline Condition? Psychopathology 2023; 56:478-491. [PMID: 36889295 DOI: 10.1159/000529130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/09/2023] [Indexed: 03/10/2023]
Abstract
This paper sheds light on some aspects of what contemporary clinical theory calls "borderline" condition providing a description of a key figure of late-modern culture that I will call Homo dissipans (from Latin dissipatio, -onis = scattering, dispersion). Homo dissipans is the opposite of Homo œconomicus, the form that "narcissism" takes on in contemporary "achievement society," solely concerned with rational action aimed to utility and production. In order to define Homo dissipans, I follow French philosopher, anthropologist, and novelist Georges Bataille's descriptions of two core phenomena: "excess" and "expenditure." The former can be defined as a surplus of energy that according to Bataille characterizes human existence, animated by a general movement of exudation and dilapidation and an inexhaustible drive to "pour out" of oneself, especially outside the limits of composure and reasonableness. The latter is an ethical attitude which gives its approval to excess and to its metamorphic and destructive power. The Homo dissipans' credo is to profitlessly dissipate the surplus of energy, escape into a world of pure intensities in which all forms - including identity - dissolve and surrender themselves to transformation. I argue that Bataille's ideas about "dissipation" can help us reconsider two features attributed to borderline personality disorder which have been extensively described and sometimes stigmatized - "identity diffusion" and "stable instability" - and to better recognize, understand, and make sense of their phenomenology in the clinical context.
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Affiliation(s)
- Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Centro de Estudios de Fenomenologìa y Psiquiatrìa, 'Diego Portales' University, Santiago, Chile
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Brewin CR. Identity - A critical but neglected construct in cognitive-behaviour therapy. J Behav Ther Exp Psychiatry 2023; 78:101808. [PMID: 36435550 DOI: 10.1016/j.jbtep.2022.101808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/26/2022] [Accepted: 11/12/2022] [Indexed: 11/24/2022]
Abstract
In cognitive-behaviour therapy attention paid to the self and identity has primarily involved self-representations (the Me-Self) rather than how the self is experienced (the I-Self). Within the I-Self experiences vary on a continuum from pre-reflective consciousness (raw experienced perceptions and states of being) to self-awareness (permitting reflection on and evaluation of subjective experience). There is considerable evidence that the I-Self is affected in many if not all disorders, and I review illustrative studies of OCD, eating disorders, body dysmorphic disorder, PTSD, and personality disorder. These indicate that patients often experience themselves as being defective in various ways, or as having an unstable or contradictory I-Self. Recognition of this neglected aspect of patients' experience has major implications for assessment and treatment. For example, acknowledgment that their sense of self may fluctuate dramatically from moment to moment, may be fragmented, or may consist of a sense of emptiness, may help to build a more empathic therapeutic relationship. If frightening or distressing pre-reflective experiences are the cause of avoidance or other maladaptive coping strategies, conscious attention paid to them in therapy may help to better integrate the I-Self and Me-Self, restoring a sense of predictability and control.
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