Special Issue:
Challenges and Opportunities in Personality Disorders
Brady C. Malone
University of Detroit Mercy
Steven K. Huprich
University of Detroit Mercy; Michigan State University College of Human Medicine
Abstract
In reviewing descriptions of depressive and vulnerably narcissistic personalities, it might appear as if the same condition is being described. The authors briefly review the depressive and narcissistic personality constructs, highlighting the similarities in the two, but also identifying critical differences in how the conditions are manifested. By illustration of two case vignettes and identifying primary symptomatic distinctions, the authors describe the differences in conceptualizing and treating depressive symptoms in depressive and narcissistic personalities. Important distinctions in the roles of perfectionism and living up to idealized expectations are explained, as well as how to understand the role of what appears to be grandiosity. We conclude that while depressive symptoms develop similarly in narcissistic and depressive personalities, the critical distinctions between these organizations outlined in this paper call for divergent treatment approaches. Specially, treatment of depressive symptoms in depressive personalities should involve exploring the client’s disavowed needs and offering appropriate encouragement, while treating narcissistic personalities should focus on the integration of split-off object representations through, in part, challenging their grandiose strivings. Failure to disentangle narcissistic from depressive personalities can lead to counterproductive client internalizations and therefore splitting the categories as we suggest may lead to enhanced clinical utility.
Abstract
Objective: To present an extension to Heinz Kohut’s concept of selfobjects that will allow treatment and a cure of disorders. It is proposed that the undifferentiated selfobject (Rowe, 2005, 2008, 2010, 2013, 2014, 2020) is the key to understanding the formation and treatment of disorders that are characterized by preoccupations with destructive thoughts and actions. By destructive I am referring to preoccupations that can be harmful to oneself (e.g., impulse disorders: World Health Organization [WHO], 1992, p.11; Blais et al., 2016; Clark, 2011; Heydari & Khorram, 2015; Shea et al., 1990). Since all disorders are not characterized by preoccupations with destructive thoughts and actions (ICD-10, pp. 1-3; American Psychiatric Association, 2013, pp. 101-105), the disorders described in this article will be referred to as preoccupation disorders. They include but not limited to major depressive disorders, bipolar affective disorders, obsessive compulsive disorders, obsessive compulsive personality disorders, paranoid personality disorders, eating disorders, and impulse disorders.
Abstract
It is proposed that the undifferentiated selfobject is the key to understanding the formation and treatment of disorders that are characterized by preoccupations with destructive thoughts and actions. By destructive I am referring to preoccupations that can be harmful to oneself. They include but not limited to major depressive disorders, bipolar affective disorders, obsessive-compulsive disorders, obsessive-compulsive personality disorders, paranoid personality disorders, eating disorders, and impulsive disorders. This paper emphasizes how therapists can be attuned to the undifferentiated selfobject needs of their patients and develop a treatment of disorders that is based on understanding these needs.
Annachiara Mariani
Associate Professor of Italian, Director of UTK Study Abroad in Bologna -Italy; World Languages & Cultures The University of Tennessee 605 McClung Tower Knoxville, TN 37996 -0470
Abstract
James Gandolfini’s lead role as Tony in The Sopranos has garnered critical attention for its nuanced portrayal of a mafia leader coping with mental health issues. This article explores and analyzes the dysfunctional psychological patterns exhibited by this character throughout the series and the impact on its viewers. This research offers an in-depth exploration into the development and manifestation of Tony Soprano’s psychological disorders. It examines the underlying reasons and subsequent repercussions of his behavior combining a psychoanalytic framework and a content analysis methodology. By engaging in these approaches, it provides significant insights on the complex interplay between his delinquent conduct and mental health disorders. It uses qualitative content analysis to closely analyze pivotal episodes and character interactions across all seasons of The Sopranos. Informed by established psychological theories, this study identifies and interprets recurrent behavioral, cognitive, and emotional patterns within Tony Soprano’s character. Additionally, it explores the impact of sociocultural factors on his psychological development.
This analysis uncovers a range of maladaptive psychological patterns exhibited by Tony Soprano, encompassing antisocial and borderline personality disorders, pervasive anxiety, chronic depression, anger management issues, narcissistic tendencies, and unresolved childhood trauma. These complex dynamics emerge in his relationships with others, impact his decision-making, and significantly add to the richness of his character and the series’ storytelling. The Sopranos presents Tony as an intriguing case study, revealing the complex interplay between criminal behavior and psychological dysfunction. This article underscores the significance of recognizing and addressing psychological struggles in high-stress, morally ambiguous contexts, highlighting the intricacies of human nature. By delving into the layers of Tony Soprano’s psyche, one gains valuable insights into this character’s enduring relevance and allure and its portrayal in contemporary media.
Moreover, this study suggests that Tony’s portrayal may serve as a point of identification and reflection for viewers with similar pathological profiles. Understanding his complexity may offer a platform for individuals confronting analogous challenges to cope and seek help. As a result, this study may favorably encourage viewers to empathize with Tony Soprano’s psychological difficulties, generating empathy and stimulating conversations regarding mental health depiction in media. Further research in this area has the potential to deepen our comprehension of the relationship between crime, mental health, and personal growth, with implications for both clinical practice and media studies.
Dariusz Juszczak
7Th Navy Hospital in Gdansk
Krzysztof Korzeniewski
Department of Epidemiology and Tropical Medicine in Gdynia, Military Institute of Medicine in Warsaw, Poland.
Piotr Oglaza
Department of Family Medicine Queen’s University, Kingston, Ontario, Canada.
Ewelina Puchalska-Reglińska
7Th Navy Hospital in Gdansk
Abstract
Introduction: The association of alcohol use with committing sexual offences is well established. However, there are still gaps in knowledge about the mechanisms which lead to alcohol overuse and related sexual violence occurring under the influence of alcohol among this group of perpetrators.
Goal: The goal of this paper is to describe characteristics of perpetrators of sexual offences with regards to their self-declared alcohol use status: “overusing” – declaring overusing alcohol, “not-overusing” – declaring not overusing alcohol, and “abstaining” – declaring abstinence from alcohol.
Material and Methods: Material for this study consisted of 180 individual forensic psychiatric reports issued by the experts from the Mental Health Clinic at the 10th Military Clinical Hospital in Bydgoszcz. The reports were reviewed by the study authors. Relevant data from was extracted using the survey tool developed for the purpose of this study: “Survey of Factors Determining Sexual Criminal Behaviour”
Results: Statistically significant associations between several studied variables were noted and presented in table format, see tables 1-3 for details.
Conclusions:
- Disinhibiting effect of alcohol on sexual offending is associated with coexisting personality disorders and organic personality disorders.
- Perpetrators of sexual offences overusing alcohol are characterized by poor levels of social functioning and personal history of being raised in dysfunctional families with alcohol problems.
Fuad Zeid
Department of Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA; Pulmonary and Critical Care Medicine, Department of Internal Medicine Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
Yonas Raru
Department of Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA; Pulmonary and Critical Care Medicine, Department of Internal Medicine Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
Abstract
Valproic acid (VPA) is widely used for the treatment of epilepsy, migraine, and a variety of psychiatric symptoms, including bipolar disorder, borderline personality disorder, and alcohol withdrawal. Valproate is associated with severe idiosyncratic adverse effects, the most notable being valproate-induced hyperammonemic encephalopathy (VHE). Topiramate is also a broad-spectrum anticonvulsant that is also extensively used for migraine prophylaxis, as a mood stabilizer, and for alcohol dependency. There is increased occurrence of VHE when valproate is used with other medications like phenytoin, phenobarbital, and topiramate. We report a young patient who was on valproic acid and topiramate and developed metabolic encephalopathy with hypoxic respiratory failure with review of the causes and management of the hyperammonemic encephalopathy. We believe that clinicians should be aware of possible hyperammonemic encephalopathy in any patient who is taking valproic acid and presenting with impaired consciousness and cognitive decline. We also underline the importance of early recognition and high index of suspicion of encephalopathy related to hyperammonemia.
David Southall, OBE, MD, FRCPCH
Consultant Obstetrician Liberia and Professor of Paediatrics UK Honorary Medical Director, Maternal and Child Health Advocacy International, MCAI
Rhona MacDonald, MBChB, MPH, MRCGP, DCH, DRCOG
Maternal & Child Health Advocacy International, MCAI
Siobhan MacKenzie, BA Hons
Data Manager & Logistician, Maternal & Child Health Advocacy International, MCAI
Abstract
Emergency medicine health workers have major roles in managing the clinical effects of armed conflict and domestic abuse on women and children. To safeguard vulnerable people from such criminal abuse, there is an urgent need for international and domestic action. International and national legal systems need to work more rapidly and efficiently with immediate power to protect against, and prevent, such abuse.
Internationally, the current weakness of the United Nations Security Council to provide civilian protection, such as through UN troops on the ground and no-fly zones over conflict areas, and thereby minimise the effects of armed conflict on civilians, can, and has, largely resulted from self-serving, dangerous vetoes of the 5 permanent members with major conflicts of interest, in part related to their role in the manufacturing and global distribution of weapons.
The International Court of Justice and the International Criminal Court have little immediate power to protect civilians affected by war crimes, including abuse, which breach the Geneva and other International Conventions. To date, the number of war criminals convicted by the International Criminal Court is incredibly small, and the long delay in the Courts’ decisions mean that the consequences of the war crimes sometimes continue for years.
We describe new systems to better protect women and children from abuse in the home. We propose a new definition that separates ill treatment from criminal abuse that is undertaken for gain by perpetrators (who are often carers or intimate partners with antisocial personality disorders). Ill treatment undertaken within families experiencing adversity such as homelessness, poverty, displacement, and addiction requires compassion and socio-economic support. In contrast the crimes of abuse committed for gain require stronger forensic approaches investigated and addressed by special, inter-agency, forensic taskforce units led by senior experienced detectives in partnership with social, healthcare, and legal professionals.
We also discuss additional issues linked to abuse, such as the links between animal/pet abuse and human abuse, the need for better systems to prevent and protect children living in institutions, better regulation of social media to protect children from scenes of violence and sexual abuse, and gun control needed to protect children, especially in the USA.
