[Show abstract][Hide abstract] ABSTRACT: Introduction
Self-esteem, coping strategies and perceived social support play a role in the adaptive functioning of the human being: they allow the adjustment of the subject to his/her environment. These dimensions could be protective factors regarding multiple risks associated with adolescent development, and particularly substance use. Thus our objective was twofold: to evaluate self-esteem, coping strategies and perceived social support in adolescents and young adults with a cannabis dependence in comparison with subjects from the general population; to establish the correspondence between these psychological dimensions and the patients’ substance use pattern.
Data from 43 young patients (36 males; mean age = 19.6 ± 3), consulting for their cannabis dependence, and 50 young adults from the general population (39 males; mean age = 19.7 ± 3.4) were included. Participants completed the Rosenberg Self-Esteem Inventory, the Social Self-Esteem Inventory of Lawson, the Coping Inventory for Stressful Situation of Endler & Parker, and the Perceived Social Support Questionnaire of Sarason. The MINI was administered to evaluate cannabis abuse or dependence; a semi-structured clinical interview was given to determine psychoactive substance use.
Between-group comparisons (two independent sample t-tests) showed that the patients had significantly lower scores on global (P = 0.002) and social (P = 0.035) self-esteem, task-oriented coping (P < 0.001) and both availability and satisfaction regarding perceived social support (respectively P = 0.029 and P < 0.001). Conversely, patients had significantly higher scores on emotion-focused coping subscale (P = 0.003). Logistic regressions showed that the satisfaction regarding social support and task-oriented coping scores were the more powerful to distinguish the patients from the controls (respectively β = 1.16, P = 0.043 and β = 1.06, P = 0.015). Unvaried linear regression analyses revealed a negative association between the age of first cannabis use and the avoidant-social coping score (P = 0.025), and positive associations between the length of daily cannabis use and emotion-focused coping score (P = 0.028), and frequency of cannabis use and global self-esteem scores (P = 0.028). Moreover, polysubstance misuse is associated with low distraction-avoidant coping scores. No association was found between clinical scores and tobacco and alcohol uses variables.
These results suggest that cannabis dependent patients may present a lack in individual and interpersonal resources. This clinical study underscores the potential contribution of maladaptive coping to the development or maintenance of substance use in young adulthood.
[Show abstract][Hide abstract] ABSTRACT: 224 pages -23,80€ -Regards psy En librairie le 15 janvier 2014 Psychanalyse et adolescence : théorie et pratique Ouvrage issu du partenariat avec la Maison de Solenn • En appui sur des vignettes cliniques, un livre tout à la fois théorique et pratique, pour un public de jeunes professionnels • Qu'est-ce que la rencontre avec l'adolescent a de spécifique ? Comment choisir cadre et dispositif thérapeutiques ? Pourquoi choisir une psychothérapie psychanalytique ? Les textes réunis ici, issus de la diversité clinique des auteurs, réaffirment la fécondité de l'abord psychanalytique de la souffrance adolescente et permettent de mieux en comprendre les spécificités.
[Show abstract][Hide abstract] ABSTRACT: Our objective was to answer the following question: are there differences between diagnostic groups of eating disorders (ED) for the prevalence of depressive and anxiety disorders, when clinical differences between the groups are taken into account (ie age of subjects, ED duration, inpatient or outpatient status, and Body Mass Index)?
We evaluated the frequency of anxiety disorders and depressive disorders in 271 subjects presenting with a diagnosis of either anorexia nervosa or bulimia, using the Mini International Neuropsychiatric Interview (MINI), DSM IV version. We compared the prevalences between sub-groups of anorexics (AN-R and AN-BN), between sub-groups of bulimics (BN-P and BN-NP) and between anorexics and bulimics while adjusting for the variables defined below.
Current or lifetime comorbidity of anxiety and depressive disorders did not differ between AN-Rs and AN-BNs, nor between BN-Ps and BN-NPs. Only current diagnoses of agoraphobia and obsessive-compulsive disorder were significantly more frequent in anorexics than in bulimics.
The greater frequency of comorbidity between obsessive-compulsive disorder and AN compared to BN, already well documented, is not questioned. The remaining anxiety disorders are equally frequent among all the diagnostic types of ED.
L Encéphale 11/2013; 31(3):279-88. · 0.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to assess how far identity and self-image disturbances are features of borderline personality disorder (BPD) in adolescence.
Face-to-face interviews were carried out with a total of 50 adolescents with BPD and 50 controls, with a median age of 16 (SD 1.1; range 13 to 18) years. Data was analysed using a qualitative methodology, interpretative phenomenological analysis (IPA). Thematic statements representative of adolescents' lived experience were extracted from the interviews.
Four main themes representing the day-to-day experiences of adolescents with BPD were identified: emotional experiences characterised by the feelings of fear, sadness and pessimism; interpersonal relationships characterised by the feelings of solitude and hostility from others; a conformist self-image characterised by a feeling of normality and difficulty in projecting into time; and, a structuring of discourse characterised by discontinuity in the perception of experiences.
This qualitative study suggests that the day-to-day experiences of adolescents with borderline personality disorder is centred on the experience of the present. Discontinuity in self-image, alongside marked dysphoric manifestations, leads to distress and hinders compliance with care. These issues are highly relevant in psychotherapy and could lead to more effective treatment of the disorder in adolescents.
Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent 11/2013; 22(4):282-9.
[Show abstract][Hide abstract] ABSTRACT: Self-esteem, coping strategies and perceived social support play a role in the adaptive functioning of the human being: they allow the adjustment of the subject to his/her environment. These dimensions could be protective factors regarding multiple risks associated with adolescent development, and particularly substance use. Thus our objective was twofold: to evaluate self-esteem, coping strategies and perceived social support in adolescents and young adults with a cannabis dependence in comparison with subjects from the general population; to establish the correspondence between these psychological dimensions and the patients' substance use pattern.
Data from 43 young patients (36 males; mean age=19.6±3), consulting for their cannabis dependence, and 50 young adults from the general population (39 males; mean age=19.7±3.4) were included. Participants completed the Rosenberg Self-Esteem Inventory, the Social Self-Esteem Inventory of Lawson, the Coping Inventory for Stressful Situation of Endler & Parker, and the Perceived Social Support Questionnaire of Sarason. The MINI was administered to evaluate cannabis abuse or dependence; a semi-structured clinical interview was given to determine psychoactive substance use.
Between-group comparisons (two independent sample t-tests) showed that the patients had significantly lower scores on global (P=0.002) and social (P=0.035) self-esteem, task-oriented coping (P<0.001) and both availability and satisfaction regarding perceived social support (respectively P=0.029 and P<0.001). Conversely, patients had significantly higher scores on emotion-focused coping subscale (P=0.003). Logistic regressions showed that the satisfaction regarding social support and task-oriented coping scores were the more powerful to distinguish the patients from the controls (respectively β=1.16, P=0.043 and β=1.06, P=0.015). Unvaried linear regression analyses revealed a negative association between the age of first cannabis use and the avoidant-social coping score (P=0.025), and positive associations between the length of daily cannabis use and emotion-focused coping score (P=0.028), and frequency of cannabis use and global self-esteem scores (P=0.028). Moreover, polysubstance misuse is associated with low distraction-avoidant coping scores. No association was found between clinical scores and tobacco and alcohol uses variables.
These results suggest that cannabis dependent patients may present a lack in individual and interpersonal resources. This clinical study underscores the potential contribution of maladaptive coping to the development or maintenance of substance use in young adulthood.
[Show abstract][Hide abstract] ABSTRACT: Borderline personality disorder (BPD) is believed to be frequent among adolescents. While several prospective studies have assessed the use of mental health services among adults who suffer from BPD, few studies have provided adolescent data. This paper presents findings from the first assessment point of the European Research Network on Borderline Personality Disorder (EURNET BPD) study. In this study, we describe lifetime treatment utilization for 85 adolescents with BPD (Mean age: 16.3 years old). In line with adult findings, adolescents with BPD reported greater mental healthcare service use (outpatient: 98%; inpatient: 79%) compared to controls. Phenothiazine, a sedative neuroleptic, was the most frequently prescribed treatment. 47% of patients had received psychotherapy; in one our of three cases this was psychodynamic therapy. Patients who had received psychotherapy did not differ on any psychopathological variables from those who did not receive psychotherapy; however, psychotherapy was more frequent among females.
Journal of personality disorders 04/2013; 27(2):252-9. · 3.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: citer cet article : Dorard G, et al. Estime de soi, coping, soutien social perçu et dépendance au cannabis chez l'adolescent et le jeune adulte. Encéphale (2013),-607; No. of Pages 8 L'Encéphale (2013) xxx, xxx—xxx Disponible en ligne sur www.sciencedirect.com journal homepage: www.em-consulte.com/produit/ENCEP PSYCHOPATHOLOGIE Estime de soi, coping, soutien social perçu et dépendance au cannabis chez l'adolescent et le jeune adulte Self-esteem, coping, perceived social support and substance use in young adults with a cannabis dependence disorder
[Show abstract][Hide abstract] ABSTRACT: The object of this paper is to provide a metapsychological definition of alexithymia as described in 1967 in terms of operational thinking and negative hallucination. This is a familiar and established concept in the fields of psychopathology, psychology, and of clinical and psychosomatic medicine. From a psychoanalytic and psychosomatic point of view, the term is conceptually close to P. Marty's "operative thinking", as described in 1963, even though we know they do not belong to the same epistemological field: on one hand Neuroscience, Psychiatry and the objectalization of the symptom at different levels, and on the other, as regards mechanical functioning, a psychoanalytic clinical approach within the dynamics of the relationship between transference and counter-transference. The present authors consider that Freudian metapsychology, as now complexified by Andrè Green, allows for a metapsychological approach to alexithymia insofar as it relates to Marty's operative thinking. Thus does Green's conceptualization of the mother's negative hallucination, of negative introjection, of a psychically 'dead (and insecure) mother', now provide us with the opportunity to describe, in metapsychological terms, the genesis of this particular mode of psychical functioning. Given the mother's negative hallucination produces a host structure as a background to negativity that will fit future object representations, we will assume that in the case of … future operational or alexithymic …?, this negative hallucination will pathologically and defensively involve the endo-psychic perception of affect.
The International Journal of Psychoanalysis 12/2012; 93(6):1403-25. · 0.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Insecure attachment and the inability to identify emotions have both been put forward as possible explanations for dysfunction of the emotional system in borderline personality disorder (BPD). This study aimed to test a model according to which the influence of attachment on the development of BPD in adolescence is mediated by alexithymia. Borderline severity was assessed by means of the Structured Interview for DSM-IV Personality Disorders. Attachment and alexithymia were measured respectively with the Relationship Styles Questionnaire and the Toronto Alexithymia Scale. Mediation analyses conducted on 105 participants (54 with BPD and 51 matched controls) suggest that the role of security and negative model of self (i.e., preoccupied and fearful attachment styles) in the development of BPD symptoms are mediated by alexithymia.
Journal of personality disorders 08/2012; · 3.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors present the history of individual psychoanalytic psychodrama and its current developments as practised in France. They put forward the technique, objectives and rules, along with the indications, limits and risks that ensue from the specific nature of this therapeutic approach. Through its technical adjustments, individual psychoanalytic psychodrama provides a therapeutic option that is appropriate to the defences prevalent in many patients that cause classical psychotherapies to fail: massive inhibition, operative functioning far removed from affects or in false self mode; phobias, disavowal or splitting of the internal psychic life and emotions; prevalence of short discharge circuits in acted-out behaviours and bodily or visceral complaints and expressions. Psychodrama utilizes these defences not in order to eliminate them but to 'subvert' them so that they can continue to carry out their protective role, in particular ensuring narcissistic continuity. At the same time, psychodrama relaxes these defences and facilitates a possible filtering through of the repressed material. Through the number of actors and the diffraction of transference that this allows, psychodrama provides a possibility of adjusting the potentially traumatic effect of the encounter with the object and the instigation of the transference in the regressive dimension induced by any psychotherapeutic process.
The International Journal of Psychoanalysis 06/2012; 93(3):561-84. · 0.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Whereas severe relationship dysfunction in BPD is well described in adolescence, little is known about the way these patients process facial expressions of emotion. Because few data are available regarding this issue, the present study compared the sensitivity to morphed facial emotional expressions of 22 BPD female adolescents versus 22 matched controls. Participants had to identify as rapidly as possible the various emotions displayed progressively and continuously on faces. Results indicate that adolescents with BPD are less sensitive to facial expressions of anger and happiness, i.e. they require more intense facial expressions than control participants to correctly identify these two emotions. However, they did not exhibit any deficit in recognizing fully expressed emotions. These results suggest that sensitivity to facial emotions is impaired in adolescents with BPD. Theoretical and clinical implications are discussed.
[Show abstract][Hide abstract] ABSTRACT: To examine the factor structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for borderline personality disorder (BPD) in a sample of adolescents with a borderline symptomatology.
The latent structure of borderline criteria, assessed with the Structured Interview for DSM-IV Personality, was explored with a principal factor analysis in a sample of 107 adolescents with a borderline symptomatology drawn from a European research project on BPDs.
The principal component analysis revealed 2 homogeneous factors accounting for 66.8% of the variance. The first factor included internally oriented criteria, such as avoidance of abandonment, identity disturbance, chronic feeling of emptiness, and stress-related paranoid ideation. The second factor included externally oriented criteria, such as unstable relationships, impulsivity, suicidal or self-mutilating behaviours, and inappropriate anger. Affective instability was the only criterion loading on both factors.
The results of our study suggests that an internal or external dichotomy may be an appropriate way to conceptualize the structure of borderline criteria in adolescents with a borderline symptomatology, with affective instability being a core feature of BPD at this age.
Canadian journal of psychiatry. Revue canadienne de psychiatrie 04/2012; 57(4):230-7. · 2.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study explores the fantasy universe created by the prospect of maternity among young women suffering from eating disorders (ED), a dimension until now little discussed in the works inventoried to date. A qualitative analysis of the clinical material collected from semi-structured interviews carried out with 10 young women suffering from EDs and 10 others from the general population allows the formulation of three significant observations. The first, more formal, observation relates to the surprising verbal elaboration that the various discussion topics inspired in the subjects, while the second and the third relate more to the nature of the fantasies brought forward. Unlike the control group, the young women suffering from EDs make statements that hint at certain difficulties in freeing themselves from their initial family model. For these young women, family of origin and imaginary family seem to be superimposed, even identical, leaving little space for the creation of a story truly their own. In addition, the prospect of maternity seems to hold a self-healing opportunity for the young women suffering from EDs whereas, for the control group, the prospect seems to represent an progressive movement towards others, as well as a change of identity. Various remarks made by the ED group imply that the questions of the Ideal, the identical and of healing are at the heart of their concerns regarding the idea of maternity. The methodological limits of this study are discussed and suggestions for future research are formulated.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to explore the relationship between alexithymia and borderline personality disorder (BPD) in adolescents.
The study investigated a sample of 59 consulting or inpatient adolescents with a well-established diagnosis of BPD (SIDP-IV) and a control sample of healthy adolescents individually matched by gender, age and socio-economic status. Alexithymia, depression and trait-anxiety were rated using the Twenty-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory (BDI-II) and the trait-anxiety subscale from the State-Trait Anxiety Inventory (STAI-T), respectively. A confirmatory factorial analysis (CFA) was performed to test the fit of the three-factor structure of the TAS-20 in the adolescent sample (N=140). BPD and control groups were compared on alexithymic scores using ANCOVA analyses controlling for the potential confounding effects of depression and anxiety.
The ratio of the chi-square to its degrees of freedom, the goodness-of-fit index, the adjusted goodness-of-fit index and Steiger's root-mean-square error of approximation had satisfactory values of 1.54; 0.87; 0.83 and 0.058, respectively. The two ANCOVA demonstrated no significant difference for TAS-20 scores. BPD subjects were more alexithymic than healthy subjects but this difference was mainly explained by the levels of depression or anxiety.
Since BPD subjects have high comorbidity with depression or anxiety, longitudinal studies examining the absolute and relative stability of TAS-20 scores are necessary to determine whether alexithymia constitutes a state or a trait in BPD.
BPD adolescents are characterized by alexithymia, probably of a secondary or state-dependent nature.
Journal of psychosomatic research 02/2012; 72(2):147-52. · 2.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Research on treatments in anorexia nervosa (AN) is scarce. Although most of the therapeutic programs used in 'real world practice' in AN treatment resort to multidisciplinary approaches, they have rarely been evaluated.
To compare two multidimensional post-hospitalization outpatients treatment programs for adolescents with severe AN: Treatment as Usual (TAU) versus this treatment plus family therapy (TAU+FT).
Sixty female AN adolescents, aged 13 to 19 years, were included in a randomized parallel controlled trial conducted from 1999 to 2002 for the recruitment, and until 2004 for the 18 months follow-up. Allocation to one of the two treatment groups (30 in each arm) was randomised. The TAU program included sessions for the patient alone as well as sessions with a psychiatrist for the patient and her parents. The TAU+FT program was identical to the usual one but also included family therapy sessions targeting intra-familial dynamics, but not eating disorder symptoms. The main Outcome Measure was the Morgan and Russell outcome category (Good or Intermediate versus Poor outcome). Secondary outcome indicators included AN symptoms or their consequences (eating symptoms, body mass index, amenorrhea, number of hospitalizations in the course of follow-up, social adjustment). The evaluators, but not participants, were blind to randomization.
At 18 months follow-up, we found a significant group effect for the Morgan and Russell outcome category in favor of the program with family therapy (Intention-to-treat: TAU+FT :12/30 (40%); TAU : 5/29 (17.2%) p = 0.05; Per Protocol analysis: respectively 12/26 (46.2%); 4/27 (14.8%), p = 0.01). Similar group effects were observed in terms of achievement of a healthy weight (i.e., BMI≥10(th) percentile) and menstrual status.
Adding family therapy sessions, focusing on intra-familial dynamics rather than eating symptomatology, to a multidimensional program improves treatment effectiveness in girls with severe AN.
PLoS ONE 01/2012; 7(1):e28249. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aims of this study were to assess the prevalence of a comorbid Attention Deficit Hyperactivity Disorder (ADHD) diagnosis in Borderline Personality Disorder (BPD), and its impact on the clinical presentation of BPD in adolescents, and to determine which type of impulsivity specifically characterizes adolescents with BPD-ADHD.
ADHD diagnoses were sought in a sample of 85 DSM-IV BPD adolescents drawn from the EURNET BPD. Axis-I and -II disorders were determined with the K-SADS-PL and the SIDP-IV, respectively. Impulsivity was assessed with the BIS-11.
11% (N = 9) of BPD participants had a current ADHD diagnosis. BPD-ADHD adolescents showed higher prevalence of Disruptive disorders (Chi2 = 9.09, p = 0.01) and a non-significant trend for a higher prevalence of other cluster B personality disorders (Chi2 = 2.70, p = 0.08). Regression analyses revealed a significant association between Attentional/Cognitive impulsivity scores and ADHD (Wald Z = 6.69; p = 0.01; Exp(B) = 2.02, CI 95% 1.19-3.45).
Comorbid ADHD influences the clinical presentation of adolescents with BPD and is associated with higher rates of disruptive disorders, with a trend towards a greater likelihood of cluster B personality disorders and with higher levels of impulsivity, especially of the attentional/cognitive type. A subgroup of BPD patients may exhibit developmentally driven impairments of the inhibitory system persisting since childhood. Specific interventions should be recommended for this subsample of BPD adolescents.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to examine how far Goodman's addictive disorder criteria were met by individuals with eating disorders according to subtypes. The study provided a cross-sectional comparison among three samples of eating disorders [restricting anorexia nervosa (R-AN), N = 68; purging anorexia nervosa (P-AN), N = 42; and bulimia nervosa (BN), N = 66], a sample of substance-related disorders (SRDs, N = 48) and a sample of matched controls (N = 201). Diagnosis of addictive disorder was made following Goodman's criteria. Addictive personality traits were assessed with the Addiction Potential Scale of the Minnesota Multiphasic Personality Inventory--2 and with the Zuckerman's Sensation Seeking Scale. Results showed that individuals with BN met Goodman's addictive disorder criteria in the same proportion as drug-addicted individuals (65% vs 60%, p = NS). They both showed higher rates than R-AN individuals (35%; R-AN versus BN: F = 11.9, p < 0.001 and R-AN versus SRD: F = 7.16, p < 0.01). Although BN and SRD showed higher rates of addictive disorders compared with P-AN, differences were not significant. Scores on the Sensation Seeking and on the Addictive Potential scales paralleled the distribution of addictive disorders, with individuals with BN and with P-AN showing higher levels than individuals with R-AN. Results showed that a subgroup of individuals with an eating disorder experiences their disorder as an addiction and may deserve specific therapeutic attention.
European Eating Disorders Review 08/2011; 20(3):182-9. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Psychoanalysis highlights borderline symptoms during adolescence through an underlying psychopathology. Kernberg's conceptualization of borderline symptoms is represented with borderline organization. Nevertheless, such conceptual organization of symptoms during adolescence hardly agrees with borderline disorder diagnosis. After considering validity of borderline personality disorder at the adolescence, a dimensional approach of such disorder would be more appropriate both with adult and adolescent people. In that sense, borderline organization and borderline personality disorder would be closer than before. Future DSM-V should answer this question.
Neuropsychiatrie de l Enfance et de l Adolescence 08/2011; 59(5):316-322.
[Show abstract][Hide abstract] ABSTRACT: An increasing interest in the study of facial emotion recognition in many psychiatric disorders has emerged over the past few years. The morphing technique allowed opening new perspectives in experimentation, by using dynamic expressions of emotions, such as in the Multimorph task. Based on a literature review, we present here the interest of the Multimorph task. It includes 36 trials where a neutral (0%) face expresses increasing degrees of emotional intensity, slowly changing to a full-blend (100%) emotion. Then, the example of borderline personality disorder in adolescence is developed to examine how the observed pattern of results could account for the reported clinical characteristics. Limitations and prospects of the Multimorph are further discussed.