„Ich möchte an Sie glauben können!“

During daily psychoanalytic treatment something happens that can be described with a term from the Old Testament: “to know”, giving psychoanalytic praxis a religious dimension. The author illustrates this thesis with a case report. First he tries to show how an interpretation of the casuistic material appears in the scope of the well-known concept of religion as an expression of dissoluble narcissistic conflicts. Then he applies Winnicott’s idea of “potential space” as a new scope for interpretation of the case. The conception of the “destruction of the object” according to Winnicott will be related exemplarily to the history of Jesus’ death on the cross and the miracle of his survival. By heeding the world of ideas of Klein and Bion, the author comes to the conclusion that religiosity is an anthropological constant, which cannot be reduced to a pathologic narcissistic event.     

The frozen cyborg: A reply to Selinger and Engström

Selinger and Engstrom, A moratorium on cyborgs: Computation, cognition and commerce, 2008 (this issue) urge upon us a moratorium on ‘cyborg discourse’. But the argument underestimates the richness and complexity of our ongoing communal explorations. It leans on a somewhat outdated version of the machine metaphor (exemplified perhaps by a frozen 1970’s Cyborg). The modern cyborg, informed by an evolving computational model of mind, can play a positive role in the critical discussions that Selinger and Engstrom seek.     

An evaluation of the Italian version of the Fagerström Test for Nicotine Dependence

This study examined the psychometric properties of an Italian version of the Fagerstr?m Test for Nicotine Dependence in a sample of 593 smokers who were enrolled in a randomized Phase IV clinical trial to compare bupropion to placebo. This version was administered at baseline, and from each participant an expired air carbon monoxide (CO) measure was taken. Spearman correlations between the Total score and CO concentration were .27 in the combined sample and .27 and .25 among men and women. With respect to the internal consistency reliability, the coefficient alpha was low (alpha= .55) in the combined sample and among men (.59) and women (.50). While the Total score predicted abstinence at 7 wk., it was not significantly related to continuous abstinence at 12 mo. postrandomization. The properties of the Italian version of the Fagerstr?m Test for Nicotine Dependence appear to be consistent with other versions described in the literature.     

Persönlichkeitsfragebögen

The influence of defensivity, measured by validity scales of personality inventories (MMPI-K, FPI-R, GIESSEN-Test) on test results and psychotherapy outcome was studied in 309 patients treated with inpatient client-centered therapy. In general, psychotherapy patients exhibited low defensivity. 25% of patients, who denied psychopathology at admission, did so at discharge and to some extent at follow-up, demonstrating an ”especially good outcome” (means). Relative improvement (effect sizes), however, was significantly diminished in psychopathology scales and significantly enlarged in validity scales. – Results are discussed with regard to prior hypotheses about the influence of defensivity.     

Behandlungsleitlinie Persönlichkeitsstörungen

The S2 guidelines for the treatment of personality disorders (PD) are summarized. In the diagnostic assessment of personality disorders a clinical interview should be supplemented by (semi-) structured clinical interviews and self-report measures for the categorical and dimensional assessment of PDs. The results of the assessment process should be communicated to the patient based on a psycho-educational framework. The diagnosis should always be linked to the patient’s individual history. Psychotherapy is the treatment of choice for personality disorders. A detailed analysis of the patient’s problems as well as the definition of a hierarchy of treatment goals are part of the process of treatment planning. For three PDs empirical evidence for treatment approaches is available: (1) dialectical behavior therapy, mentalization-based therapy, schema focused therapy and transference focused therapy all proved beneficial in the treatment of borderline personality disorder. Cognitive-behavior therapy proved helpful in the treatment of (2) dissociative personality disorder and (3) avoidant personality disorder. There is limited evidence for interpersonal therapy and psychodynamic therapies in the treatment of avoidant personality disorder.     

Narzisstische Persönlichkeitsstörung

Narcissism is a multifaceted term which encompasses traits of normal personality as well as a specific personality disorder. While much research has been concerned with narcissism as a trait there are only few empirical studies on narcissistic personality disorder (NPS). The current diagnostic system of NPS according to DSM-5 (section II) focuses on grandiose narcissism whereas vulnerable narcissism, which is emphasized by clinicians and researchers, has not yet been recognized. While treating NPD patients an increased suicide risk has to be taken into consideration. Psychotherapy of narcissistic patients mainly focuses on processes during patient-therapist interactions, the analysis and processing of grandiose and vulnerable schemas, emotion regulation techniques and a correction of narcissistic behavior in favor of prosocial interactions.     

Persönlichkeitsstörung und Intelligenzminderung

There have previously been only few objective investigations on the combined occurrence of intellectual disability and personality disorder. Despite this difficulty, from the current clinical viewpoint there is no doubt that at least people with mild intellectual disability can also develop personality disorders. In slight degrees of intellectual disability it is possible to psychopathologically describe the typical symptoms objectively. For the disorder symptomatic of combined personality disorder in people with an intellectual disability, there are no confirmed facts, publications or diagnostic rules. The diagnostic assignment of behavioral abnormalites as combined personality disorder with dependent and infantile components in people with intellectual diasabilities still does not seem to be justified. In people with medium to severe mental disorders only the comprehensive term “behavioral abnormalities” should be applied.     

Diagnostik von Persönlichkeitsstörungen

Diagnosing and classifying personality disorders is complex and difficult from both the scientific and clinical perspectives. Dimensional and categorical models and assessment instruments of personality disorders, and different (behavioral and psychodynamic orientated) clinical procedures are described. Furthermore, an integrative view on clinical practice is presented.