5,299 research outputs found
Managment of the suicidal risk in Adolescence
No full textCurrent orientations indicate the necessity to understand suicidality in
adolescence as the possible outcome of a decisional process that is not
only influenced by known risk factors. To facilitate the clinician to
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monitor the actual suicidal risk an approach is needed that focuses on
the patients’ mental state with respect to thoughts concerning death and
suicide. In the present work, we use the Motivational Interview for
Suicidality in Adolescence (MIS-A) to evaluate the associations between
motivation and suicidality, to establish which motivational contents are
associated with a greater suicidal risk in terms of passage to the act,
several attempts, and potential lethality of the act. Subjects aged
between 12 and 18 years with either active suicidal ideation and/or a
recent history of suicide attempts were considered for study inclusion.
The overall clinical sample was divided into two clinical subgroups: a)
Stay-ideators: subjects who reported suicidal ideation at T1 and did not
attempt suicide from three months before to six months after the first
evaluation; b) Attempters: subjects who have committed at least one
suicide attempt between the three months preceding and the six months
following the first evaluation. Data indicates that the MIS categories of
interpersonal influence, escape fantasies, impulsivity, and low fear
significantly distinguish between ideators and attempters. Only low fear
distinguishes between low and high lethality attempters. Clinicians could
benefit from a better understanding of how patients process their
distress and how they turn it into specific suicidal thoughts within the
therapeutic relationship. Seeing the patient as an active human being
and not only as someone who is ill, could restore in the therapist a sense
of agency and help to manage the feelings of fear that can guide the
adolescent care and the management of interventions
Predicting suicide attempts in NSSI pateints: the role of suicidal motivations as an expression of borderline and narcissistic functioning.
No full textAbstract
Background: Although nosographically distinguished from sucidality, NSSI is one of the strongest
predictor of sucidal conducts. This relationship has been interpreted as caused by a common state of
mind characterized by a negative attitude toward life underlying both the spyral of NSSI and suicide
attempts.
To date, no specific hypothesis has been made as to the features that distinguish the states of mind of
sucidal NSSI from only-ideators NSSI patients.
In this study we propose that the peculiar motivations sustaining the sucidal process and their possible
relations with single pathological personality functioning may help predict sucidal conducts in NSSI
patients.
Methods: A clinical sample of 88 adolescents diagnosed with NSSI were adminstered with the Columbia
Suicide Severity Rating Scale (CSSRS), the Motivational Interview for Suicidality in Adolescence (MIS-
A) and the SCID 5 for Personality Disorders. ANOVA and correlations were performed to analyze the
associations between CSRSS variables and motivations as well as personality disorders.
Results: All NSSI adolescents presented significant associations with suicidal ideation and conducts. The
potential lethality and intensity of sucidal ideation was in particular associated with the increase in
frequency of NSSI and lethality of sucidal attempts. Only the BPD and HPD were significantly associated
with sucidal conducts. Motivations related to denial of the consequence of sucide and attempts at
controlling and maniputating the relationships predicted suicidal conducts.
Cliniciansinvolved in the management of suicidal risk in adolescence should consider that narcissistic
features may play a key role in precipitating the suicidal crisis in BPD patients diagnosed with NSSI
Studying the role of motivation for suicide in adolescence: the role of personality emerging patterns
No full textIntroduction: Personality pathology is a significant risk factor for suicide in adolescence, but only little
evidence has shed light on the differential role of specific personality emerging patterns for this outcome.
Current views posit that the role of each risk factor has to be understood within the ongoing suicidal
process being sustained by specific motivations. In this study we propose that specific emerging patterns
of personality pathology in adolescence shape specific motivations for suicide as classified according to
the Motivational Interview for Suicide (MIS), an instrument of investigation of motivations for suicide.
Two objectives are investigated: 1) to verify the differential impact of specific personality pathological
traits as dimensionally assessed by the SCID II, predict suicidality in a sample of adolescence referred for
suicidal risk as assessed by the Columbia Suicide Severity Rating Scale (CSSRS); 2) to verify the association
between specific pathological personality traits and the categories of motivations as assessed by the MIS.
Methods: A sample of 100 adolescents referred for suicidal risk have been administered at the intake the
SCID II, CSSRS, MIS. All group of adolescents were controlled for the emergence for suicidal conducts
after six months. Regressions among intensity and severity of suicidal ideation, presence and number of
attempted suicides, potential lethality of the attempts, SCID II number of criteria for each personality
disorders, scores for each motivational areas were reckoned.
Results: Significant statistical and clinically relevant associations emerge between number of criteria for
personality disorders and motivational areas for suicide. CONCLUSION: the importance to study
personality pathology for suicidal risk is confirmed, identifying the peculiar impact of each personality
emerging pattern can be related to the elaboration of specific motivation for suicide in the individual
adolescence
The role of suicidal motivations in adolescence: implications for the psychotherapeutic treatment of suicidal risk
No full textThe study of suicidal risk has increasingly emphasized the importance of assessing specific suicidal motivations. Motivations express an elaboration of the condition of psychache, representing an effective perspective on the management of suicidal risk in psychotherapy. This study explores suicidal motivations and personality pathology in a clinical sample of adolescents with suicidal ideation or a history of suicide attempts. We aim to investigate how specific motivational factors and personality disorders (PDs) contribute to the foreseeability of suicidal outcomes, such as the occurrence, number, and lethality of suicide attempts and their interaction with the impact of personality disorders. A sample of 134 adolescents aged 12-18, with active suicidal ideation or recent suicide attempts, was assessed using a combination of self-report measures and structured clinical interviews. Binomial logistic regressions and linear regressions were conducted to explore the predictive value of PDs and motivational factors on suicidal behaviors. The results indicate that specific suicidal motivations, such as interpersonal influence, escape fantasy, and absence of fear, provide an additional increase in the foreseeability value beyond personality disorder criteria alone. These findings suggest that assessing suicidal motivations can significantly enhance risk evaluation and inform more effective therapeutic interventions. Beyond identifying certain risk factors, the therapist’s ability to diss and process specific suicidal motivations in the context of the therapeutic relationship can be a decisive factor in monitoring and directly intervening on the risk
A new insight into borderline and narcissistic dissociative experience: the mentalization of attachment trauma
No full textThe perspective on traumatic attachment has opened to a new understanding of personality pathology posing the notion of dissociation at the core of
borderline and narcissistic disorders. By presenting the results of three empirical studies the following aspects will be evidenced:
1) The presence of traumatic experiences is a non-specific (transversal) predictor of personality disorders.
2) To understand the relationship between personality pathology and attachment it is not possible to rely on attachment specific categories but it
is necessary to refer to attachment processes as investigated through the Adult Attachment Interview.
3) In particular, the Unresolved State of Mind with Respect to Abuse and Losses is the process related to Adult State of Mind with Respect to
Attachment predicting the area of dissociation.
4) In order to understand the specific link between attachment processes and borderline as well as narcissistic personality disorders it is necessary to
comprehend how traumata and dissociative experiences are actively organized in peculiar configurations of the State of Mind with Respect to Attachment (states of identity) described by alternative classification modelsof the AAI.
5) The narcissistic patient’s experiences is organized around the defensive management of the rage involved in abuse and maltreatment past experiences, while the borderline patient’s experience is characterized by the prevalence of the dissociative void connected to abandonment experiences
The Study of Motivation in the Suicidal Process: The Motivational Interview for Suicidality
No full textIntroduction: Suicide is the outcome of a process starting with the experiences of an unbearable pain or hopelessness, passing from suicidal ideation and planning, to possible para-suicidal behaviors or actual attempts. Recent studies have evidenced the necessity to integrate approaches based on the identification of psychopathological diagnoses and other variables as possible predictors of suicidal conduct with a more clinically based approach. A clinical assessment is needed that focuses on the patients' mental state with respect to thoughts concerning death and suicide. In particular, a qualitative assessment of motivations underlying the suicidal process could represent an effective guide for clinicians engaged in the difficult field of preventing adolescents' suicidal gestures. Most instruments investigating the suicidal motivation are self-report measures, possibly resulting in a lack of sufficiently valid assessment of this area. In the present work, we present the Motivational Interview for Suicidality in Adolescence (MIS-A) aiming at identifying the motivational areas sustaining suicidal ideation and gestures in this phase of development.
Materials and Methods: The identification of the different areas derives from a thorough review of the empirical literature subsequently vetted by expert clinicians who selected specific reasons behind suicidal ideation and gesture.
Result: The MIS is a semi-structured clinician-report interview. The interview is composed of seven areas and 14 sub-areas, evaluated on a four-point Likert scale: illness motivated attempts area, chronic presence of internal pessimistic criticism area, sense of defeat and entrapment area, relational area, external motivated crisis area, extreme and unusual cases area, and lack of control area.
Conclusions: The path followed in the creation of the MIS reflects both an empirically orientated and a clinically informed approach. Creating this MIS is the first step within a wider research project that will allow one to test the reliability of the instrument
Suicide and personality disorder in adolescence
No full textSuicide is the outcome of a process proceeding from the experimentation of an unbearable pain (psychache) to hopelessness, to suicidal ideation, to parasuicidal behaviours and effective attempts with lethal or non-lethal outcomes. To understand suicidality means to study this staging with
respect to a variety of factors that interact to facilitate the passage from one stage to the following one. Many psychopathological conditions have been considered to account for suicidality in adolescence, but only few studies have investigated the role of personality pathology and, in particular, pathological narcissism, an aspect that at various degree influences adolescent functioning and interacts with the presentation of several clinical conditions.
The objective of this study is to analyse the relative of role of mood disorders, personality disorders and narcissistic pathological functioning in adolescence suicidality. The sample is constituted by 40 adolescents from the Mood Disorders Unit of the Ospedale Bambino Gesù di Roma assessed as at risk for suicidal behaviours. All Adolescents were administered with Columbia Suicide Severity Scale (CSSS), the Kiddie-Sads for Mood Disorders, Child Behavior Checklist (CBCL), Child-Depression Rating Scale-Revised (CDRS-R), the SCIDII, the SCID II, the Diagnostic Interview for Narcissism (DIN), a semistructured interview to assess the continuum and diverse areas of narcissistic pathological functioning. Results show that Personality Pathology, in particular BPD, is a predictor of suicidal attempts. Diverse aspects of narcissistic pathological functioning as assessed by the DIN predict diverse aspects of suicidality, suicidal ideation and attempts
Produrre sapere o costruire cultura? L'università oggi tra alienazione e ciseterosessismo
No full textSiamo un gruppo di dottorandx di Psicologia della Sapienza di Roma iscrittx ai corsi di Dottorato dei tre Dipartimenti della Facoltà: Dipartimento di Psicologia Clinica e Dinamica, Dipartimento di Psicologia, e Dipartimento di Psicologia dei Processi di Sviluppo e Socializzazione. I nostri curricula e i filoni di ricerca di cui ci occupiamo sono diversi, così come gli ambienti di lavoro in cui siamo immersx, tutte caratteristiche utili a favorire approcci interdisciplinari, propri delle prospettive transfemministe, che nei fatti si traducono invece in aumento della competizione e delle forme di gerarchie preesistenti. Nonostante determinati aspetti siano tipici di alcuni ambienti e non di altri, il confronto tra noi ha portato all’identificazione di un quadro di esperienze e vissuti comuni. In particolare, ci preme approfondire alcuni aspetti, come il ripetersi di alcune dinamiche nei diversi contesti formativi in cui siamo inseritx: battute (etero)sessiste e transfobiche, svalutazione delle diverse soggettività e richieste di specializzazione in funzione delle aspettative stereotipiche di genere. Ci vogliamo soffermare sulle micro-dinamiche interazionali più o meno implicite in cui tali manifestazioni possono esplicarsi, e sui diversi livelli di alienazione cui ci porta il lavoro accademico: come l’individualismo e, talvolta, la competizione che si alimentano, producendo diversi livelli di segregazione sessuale, di genere, etnica, di classe; la produzione culturale fine a sé stessa; la sussunzione delle identità con un background di attivismo transfemminista queer. Inoltre, vogliamo portare alla luce il tema della mancata condivisione e accessibilità dei dati e degli studi prodotti in ambito accademico, la medesima autoreferenzialità che si riscontra nel mancato dialogo fra Università e conoscenza prodotta dal basso. Partendo dalle esperienze nei nostri contesti accademici, intendiamo focalizzarci inoltre su come la situazione di lockdown dovuta all’emergenza sanitaria sia andata ad acuire o influenzare alcuni aspetti lavorativi e di relazione, rafforzando delle criticità e creandone di nuove
The relationship between mood disorders, personality disorder and suicidality in adolescence: does general personality disturbance play a significant role in predicting suicidal behavior?
No full textAbstract Introduction Current research points to the importance personality pathology and Major Depression e as relevant psycopathological risk factors for understanding suicidal risk in adolescence. Literature has mainly focused on the role of BPD, however current orientations in personality pathological functioning suggest that BPD may be the representative of a general personality disturbance, a factor of vulnerability underlying diverse psychopathological variants and aspects of maladaptive functioning. However, recent studies seem to have neglected the contributions that other specific personality disorders and personality pathology as a general factor of vulnerability for suicidality; and only marginally investigated the interaction of personality disorder (PD) as an overall diagnosis and individual PDs and major depression (MDD). In this paper, the independent and cumulative effects of MDD and DSM-IV PDs on suicidal risk are investigated in a sample of adolescents observed in a longitudinal window of observation ranging from three months preceding the assessment to a six-month follow up period of clinical monitoring. Methods A sample of 118 adolescents (mean age = 15.48 ± 1.14) referred for assessment and treatment on account of suicidal ideation or behavior were administered the CSSRS, SCID II, Kiddie-SADS at admission at inpatient and outpatient Units. All subjects included in the study had reported suicidal ideation or suicide attempts at the C-SSRS; The CSSRS was applied again to all patients who reported further suicidal episodes during the six-months follow-up period of clinical monitoring. Dimensional diagnoses of PDs was obtained by summing the number of criteria met by each subject at SCID-%-PD 5, In order, to test the significance of the associations between the variables chosen as predictors (categorical and dimensional PDs and MD diagnosis), and the suicidal outcomes variables suicide attempts, number of suicide attempts and potential lethality of suicide attempt, non-parametric bivariate correlations, logistic regression models and mixed-effects Poisson regression were performed PD. Results The categorical and dimensional diagnosis of PD showed to be a significant risk factors for suicide attempt and their recurrence, independently of BPD, that anyway was confirmed to be a specific significant risk factor for suicidal behaviors. Furthermore, PD assessed at a categorical and dimensional level and Major Depression exert an influence on suicidal behaviors and their lethality both as independent and cumulative risk factors. Limitations Besides incorporating dimensional thinking into our approach to assessing psychopathology, our study still relied on traditionally defined assessment of PD. Future studies should include AMPD-defined personality pathology in adolescence to truly represent dimensional thinking. Conclusion These results point to the importance of early identification of the level of severity of personality pathology at large and its co-occurrence with Major Depression for the management of suicidal risk in adolescence
Pathways toward suicide in adolescent patients with emerging borderline and narcissistic personality syndromes: A PDM-2-oriented empirical investigation.
No full textIntroduction: Adolescent suicide is the fourth leading cause of death in
the youth population worldwide. The Psychodynamic Diagnostic ManualSecond Edition (PDM-2) devoted a specific attention to the suicidality in
adolescence. According to its diagnostic framework,the suicidal
motivation is strongly associated with the patient’s subjective
experience, and should be understood only within the context of the
adolescent’s psychopathological functioning. The present study aimed at
exploring the suicidal process by connecting the specific emergence of
suicidal motivations and strategy for affective regulation characterizing
particular emerging personality syndromes in two single cases. Method:
Louis and Gael, two 17-year-old adolescents, were assessed using the
Psychodynamic Chart-Adolescent of the PDM-2, and the Motivational
Interview for Suicidality in Adolescence. Results: Diagnostic assessment
showed the presence of several impairments in various mental capacities
and a borderline personality organization. Notably, Louis and Gael
presented the emerging narcissistic and borderline personality
syndromes respectively. Each patient also reported prevailing suicidal
motivations that are coherent with the regulative strategies typically
employed in their pathological organization of personality. Notably, the
specific declinations of the suicidal motivations for interpersonal
influence as assessed through the MIS demonstrated the function played
by suicidal ideation and conducts within the relational strategy typical of
emerging personality syndromes in adolescence. Conclusions: The case
discussion suggests the need to understand and monitor the prevailing
suicidal motivations in adolescents considering the unique characteristics
of their personality functioning. These findingssupport the importance
for providing accurate assessment to plan individualized treatments in
youth populations at high suicide risk
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