Interpretation of psychic conflict and adversarial relationships: A self-psychological perspective.

Transference, as described in conflict theory, and self object transference, as considered within self psychology, are represented in a changing figure and ground relationship. An emphasis on conflict and resistance analysis may structure analytic treatment along an adversarial dimension, with implications for self object and object-related transferences. The analytic approach to psychic conflict involves interpreting what the patient defensively needs to ward off. The approach to self-pathology is to interpret the self object functions that the patient needs for self-consolidation and self-maintenance. Accurate assessment of instances in treatment where psychic conflict is the predominant configuration requires a clinical theory that embraces multiple perspectives. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma fellowship training: the insiders' perspective

Trauma care is in a period of transition from care given by surgeons at the closest community hospital to care given by trauma specialists at trauma centers and within emergency medical systems. It has thus become increasingly important for the educational goals of trauma fellowship training to reflect the needs of the future system as well as the views of future practitioners. These views differ from those of surgical colleagues practicing trauma surgery, and the views of future trauma specialists should be considered during the formulation of training guidelines. This survey appears to be the first attempt to interpret the views of trauma fellows: 48 of the 83 fellows (57.8%) in the 1991-1992 national cohort responded. They made suggestions about their own training, including ways to increase surgical experiences and opportunities for academic pursuits, but gave no insight as to an appropriate mix of critical care training. Although critical care certification is a major attraction for fellowship training, the cohort does not want to be thought of as nonoperating surgical intensivists. A second year of fellowship training is seen as necessary for research and trauma systems-related studies.     

Trauma, dissociation, and conflict: The space where neuroscience, cognitive science, and psychoanalysis overlap.

The authors describe their scientific and clinical interests in developing the panel Trauma, Dissociation, and Conflict: The Space Where Neuroscience, Cognitive Science, and Psychoanalysis Overlap, given at the 22nd Annual Spring Meeting of the Division of Psychoanalysis of the American Psychological Association. They cite the influence of the panelists, Philip M. Bromberg, Wilma Bucci, and Joseph LeDoux, on their own work. Specializing in the treatment of chronic pain, Anderson has developed a relational intersubjective technique informed by this interdisciplinary approach. Gold's work has focused on the distinction between dissociative processes and repression in traumatic memory. The relevance of trauma, dissociation, and conflict, heightened since September 11, 2001, could not have been anticipated in the planning of the panel. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overview of somatization: diagnosis, epidemiology, and management

This article outlines critical issues in the psychiatric assessment of patients presenting with medically unexplained physical symptoms that form the core of the somatoform disorders in current nosologies. The prevalence of these disorders in communities and clinical settings emphasizes that a majority of these patients are primary care service users rather than mental health clients. A brief review of previous studies on the pharmacological management of these syndromes with antidepressants highlights unique features of these disorders that are relevant to the design of double-blind studies. The promising results emerging from some of these studies bring new excitement to the field that may help counter the prevailing therapeutic nihilism, thus attracting new investigators to this area. Finally, several caveats are provided on issues of research design and interpretation for the benefit of those entering this field of research.     

Something wicked this way comes: Trauma, dissociation, and conflict: The space where psychoanalysis, cognitive science, and neuroscience overlap.

Even in routine analytic work, for what is dissociated to become symbolized and available to conflict resolution, a patient must experience sufficient interpersonal safety to free working memory while activation of unprocessed dissociated experience is taking place. The author proposes that this necessary synthesis of affective security and relational risk depends on what a given patient and analyst do in an unanticipated way that is safe but not too safe--an enactment of the relational failures of a patient's past while allowing "safe surprises" in the here-and-now to occur. Remarkable convergence is found between cognitive research (W. Bucci, 2003), neuroscience research (J. E. LeDoux, 2002), and an interpersonal/relational psychoanalytic approach that works at the interface of dissociation and conflict. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Catecholamines, stress, and disease: a psychobiological perspective

White demineralized areas after the removal of orthodontic appliances remain a problem for clinicians and patients. The main objective of this study is to assess clinical photography as a method for the evaluation of caries and white spots and the in vivo study of remineralization of carious lesions. The secondary objective was to compare the effect of different levels of both experimental and commercial fluoride solutions on the remineralization of enamel carious lesions. White spot lesions were created with an acid solution on extracted permanent human teeth, and the lesions were remineralized in remineralizing solutions with or without fluoride ions. The changes in the enamel surface during the demineralization and the remineralization processes were recorded with a 35 mm clinical camera. Photographs were taken of the experimentally created white spots, the samples were sectioned for microradiography testing, and the actual mineral contents of the white spot lesions were calculated from the microradiographs. The enamel lesions were further analyzed by powder x-ray diffraction to confirm whether fluoride was incorporated into the lesions during the remineralization period. From this experiment it can be concluded: (1) clinical photography as currently practiced is not an adequate method of monitoring the remineralization of white spots with large lesion depths and (2) the experimental solution that contains 50 ppm fluoride had a higher efficacy for remineralization than the control solution or the commercial mouth rinse, which contained 225 ppm fluoride.     

From dissociation to negotiation: A relational psychoanalytic perspective on multiple personality disorder.

Presents a model for conceptualizing the dynamics and treatment of multiple personality disorder (MPD) that integrates trauma/dissociation theories with postclassical psychoanalytic perspectives. MPD is conceptualized as a chronic trauma syndrome and as a particular variation of narcissistic personality organization involving an overreliance on omnipotent defenses, the collapse of intersubjective experiencing, and derailments of the developmental lines of aggression, fantasy, and the use of transitional phenomena. Emphasis on empathy, recognition, confrontation, and interpretation from within the transference-countertransference matrix is recommended to facilitate contactful dialog and negotiation in the interpersonal world and between traumatically dissociated, often opposing, aspects of the self. The MPD patient's capacities for mutuality, paradoxical experiencing, and restorative fantasy are seen as central to integration. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Trauma, Dissociation, and Disorganized Attachment: Three Strands of a Single Braid.

During the past decade, research findings, theoretical reflections, and clinical experiences have woven together the themes of attachment disorganization, dissociative processes, and vulnerability to trauma-related emotional disorders. The resulting unitary perspective is captured in this article by an overview of inquiries on unresolved traumatic memories based on the Adult Attachment Interview (AAI) and of studies on the sequelae of early disorganized attachments. To illustrate the intriguing clinical implications of this unitary perspective, the author considers such topics as vulnerability to complex trauma-related disorders, delayed dissociative responses to past traumatic memories, and the definition of psychological trauma. Some psychotherapeutic implications of the interplay between trauma-related disorders and attachment disorganization are briefly addressed in the concluding section. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Knowing where and knowing what: a double dissociation

We report a double dissociation between visuo-spatial abilities and semantic knowledge (knowledge of the names and attributes of objects and people), in two brain-injured people with longstanding stable impairments, using a wide range of tests to explore the extent of the dissociation, MU, who has bilateral lesions of occipito-parietal cortex, shows severe spatial disorientation with relatively well-preserved semantic knowledge. He is contrasted with JBR, who has bilateral temporal lobe damage and shows severe semantic problems and no impairment on visuo-spatial tasks. Our findings thus demonstrate a double dissociation between the performance of semantic and spatial tasks by MU and JBR. This pattern is consistent with Ungerleider and Mishkin's (1982) neurophysiological hypothesis of separable cortical visual pathways; one which is specialised for spatial perception and follows a dorsal route from occipital to parietal lobes, and the other following a more ventral route from occipital to temporal lobes, whose target is semantic information needed in specifying what an object is.     

The relationship between body dysmorphic disorder and depression, self-esteem, somatization, and obsessive-compulsive disorder

Voice disorders are thought to be one of the major occupational hazards of school teaching. The resulting symptoms can affect teachers' ability to function in the classroom and prevent them from developing effective working relationships with other staff and students. Sick leave, speech pathology management, and surgical intervention can be costly. Severe voice problems can also result in a teacher permanently leaving the classroom. Despite the significant implications of voice disorders for teachers, this review of published research demonstrates that findings concerning the prevalence of voice problems in teachers and the causes and contributing factors of those voice problems are inconclusive. Similarly, previous research on the efficacy of prevention programs and treatment of voice problems in teachers provide few firm conclusions. Further research based on sound empirical data is needed, as many past studies have relied on anecdotal or self-report data. More operational definitions of what constitutes a voice disorder and the associated contributing factors should be adopted, along with the use of more instrumental measures and careful attention to methodology and appropriate statistical analyses. Only then will we have a sound basis for the development of effective prevention and education programs for teachers.     

MR safety: past, present, and future from a historical perspective

This article focuses on both static field effects and oscillating magnetic fields associated with MR imaging and spectroscopy. Contemporary experiments and theories on health effects demonstrate that currently MR imaging is practiced in a safe manner. Technological capabilities and medical science objectives, however, will lead to procedures that will challenge the thresholds of physiological effects. Thus progress in this field will require continual surveillance and better definitions of guidelines which at present are considered prudent but too restrictive.     

Multipole storage assisted dissociation, a novel in-source dissociation technique for electrospray ionization generated ions

In this work we present a novel in-source dissociation scheme referred to as multipole storage assisted dissociation (MSAD) for electrospray ionization (ESI) generated ions in which dissociation is effected by employing extended ion accumulation intervals in a high pressure rf-only hexapole assembly prior to mass analysis. Following an extended ion accumulation interval in which ions are confined in the rf-only hexapole, ions are gated out of the hexapole, trapped, and mass analyzed in the trapped ion cell of a Fourier transform ion cyclotron resonance (FTICR) mass spectrometer. The accumulation region is comprised of an rf-only hexapole ion guide which separates two electrodes, a biased skimmer cone, and an auxiliary 'gate' electrode at the low pressure end of the hexapole. This technique should be applicable to other mass spectrometry platforms compatible with pulsed ionization sources including quadrupole ion traps, and time-of-flight mass analyzers. This concept is demonstrated with the dissociation of a small protein in which selective fragmentation is observed at labile amino acid linkages producing primarily y-type fragment ions.     

Structuralization, Trauma, and Attachment.

Attachment pathology results in deficit unconscious organizational processes within self-structure that predispose patients toward developing character disorders with many overdetermined, polysymptomatic profiles. The nature of developmental trauma on attachment capacities and corresponding emergent structuralization processes is intimately associated with a broad array of clinical presentations that are largely organized on borderline levels of functioning. The author addresses the question of trauma and structuralization and presents various case illustrations gathered from clinical observations. By examining various subgroups of structural pathology, the author hopes to advance knowledge of attachment-related disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Complex Trauma, Complex Reactions: Assessment and Treatment.

Complex trauma occurs repeatedly and escalates over its duration. In families, it is exemplified by domestic violence and child abuse and in other situations by war, prisoner of war or refugee status, and human trafficking. Complex trauma also refers to situations such as acute/chronic illness that requires intensive medical intervention or a single traumatic event that is calamitous. Complex trauma generates complex reactions, in addition to those currently included in the DSM-IV (American Psychiatric Association, 1994) diagnosis of posttraumatic stress disorder (PTSD). This article examines the criteria contained in the diagnostic conceptualization of complex PTSD (CPTSD). It reviews newly available assessment tools and outlines a sequenced treatment based on accumulated clinical observation and emerging empirical substantiation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnosis, dissociation, and simultaneous-task performance.

We contrasted the simultaneous task performance of participants high and low (simulators) in hypnotizability and high and low in dissociative ability across hypnosis, divided attention, and passive waking conditions. Findings were not consistent with neodissociation or revised neodissociation theory. Task interference was comparable in hypnotic and passive waking conditions; both conditions enhanced performance (i.e., speed) relative to divided attention. However, hypnosis also yielded more omission errors than divided attention and more commission errors than divided attention or passive waking. Hypnotized participants also made more commission errors than simulators. Hypnosis generated reports of less task awareness, effort, and interference and of more success than comparison conditions. Simulators, however, responded comparably, consistent with a sociocognitive model. Dissociative ability affected neither task performance nor subjective reports. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotizability, dissociation, and bulimia nervosa.

This study examined the levels of hypnotizability and dissociation in an outpatient sample of 17 normal-weight bulimic women and 20 healthy controls. Bulimic patients were significantly more hypnotizable than controls (pp     

Trauma, memory, and suggestibility in children

In this review we examine factors hypothesized to affect children's memory for traumatic events. Theoretical ideas on the processing and remembering of trauma are presented and critiqued. We review research on how psychopathology may generally influence and dissociation and posttraumatic stress disorder may specifically influence children's memory and suggestibility. The special case of child maltreatment is addressed as it relates to interviewing children about traumatic life experiences. Throughout we draw on current developmental, cognitive, social, and clinical theory and research. The review covers a controversial and exciting area of psychological inquiry.     

Cognitive aspects of hypochondriasis and the somatization syndrome

Formation of a dermis-like structure by a long-term culture of fibroblasts in the presence of ascorbic acid is a potential model for tissue organization or wound healing, and has its practical use as a skin graft. In the present study, solubilization of the dermis-like structure without pepsin treatment was attempted for analysis of pepsin-labile matrix components that might be involved in the formation of the dermis-like structure, as well as quantification of mutated type I collagen that could be susceptible to pepsin. The whole dermis-like structure was dissolved in a Tris buffer containing SDS and urea at 80 degreesC. Analysis of the extract by SDS-PAGE revealed several protein bands that were not found in the pepsin-treated extract. Among them, the polypeptide band migrating at 140k under reducing condition showed a similar intensity of protein staining to the alpha2(I) chain band. The N-terminal amino acid sequences of cyanogen bromide peptides derived from the 140k polypeptide band as well as the amino acid composition of the band suggested that the band essentially consisted of alpha1(VI) and alpha2(VI) chains. The results demonstrated that the type VI collagen was a major component, being a comparable in amount to type I collagen, in the dermis-like structure.