Psychotherapy in clinical psychiatry practice
Tina Peraica, Marija Eterović
Somatization as defense from narcissistic injury
Somatization is a disturbance in which psychical and emotional conflicts are presented with polymorphic physical symptoms without organic substrate (base). According to DSM V difficulties occur before 30 years, with duration minimal several years and impairment in social, occupational, family and interpersonal functioning (1). Prevalence is between 0.2 and 2 % in women and 0.2% in men.
Comorbidity is very common with affective, anxiety, and personality disorders (mostly histrionic personality disorder and obsessive-compulsive disorder).
The aim is to present the development of dramatic clinical picture characterized with somatization in the female patient with histrionic personality disorder after the traumatic situation at work which she experienced as narcissistic injury.
She was admitted to the psychiatric ward after detailed physical exploration. She has complained at the intensive pain in left ear and instability during walking after she has experienced “acoustic trauma” when her chief bang ear phone during verbal conflict with her. Immediately, she felt “explosion in her head”. She was resistant to the psychological causes of her pain and she used different defense mechanisms like denial, dissociation, repression, displacement, and rationalization to avoid her fear.
At the beginning she was treated with anxiolytics and antidepressants. Psychotherapeutic treatment was able to start after reduction enormous anxiety, histrionic way of reaction, and somatization. Therapeutic aims were: development of introspection, earning insight regarding influence of her histrionic behavior to the others, learning to tolerate negative emotions, and reduction her dependent behavior. Gradually and partially she accept insight in psychological etiology of her disturbances and that the conflict with her chief was one of the potential causes of her difficulties. After demission she came only once.
Conclusion: persons with histrionic personality disorder have inability to confront (cope) with self injury which can lead to somatization, as modality (way) to figure out narcissistic injury. Untreated patients very often became resentful, angry, mistrustful, and dysfunctional in every day activity. During the treatment is very important to identify the cause (e.g. trigger) which leads to the actual disturbance and to confront the patient with the psychological and emotional etiology of the presented difficulties.
It is necessary to recognize the somatization in time because of avoiding unnecessary diagnostic physical procedures and prevention of social and working dysfunctions.
How We Assess Shame and Guilt
Shame and guilt are one of the most intimate human experiences that underlie the way we see ourselves and guide our behavior. As such, both emotions have figured prominently in psychological theories for hundreds of years. However, surprisingly little empirical research have examined these emotions. Systematic assessment of shame and guilt has been ongoing for only about two and half decades.
Two dominating approaches that assess proneness to shame and guilt are scenario-based approach and adjective checklist approach, with the Test of Self-Conscious Affect (TOSCA-3) and the Personal Feelings Questionnaire (PFQ-2), respectively, being the two most extensively used.
Both measures were mainly studied separately and among populations of healthy college students. Consequently, comparisons of their psychometric properties, as well as their, sometimes divergent, associations to measures of psychopathology, are derived from administrations to different populations. Since factors related to measure administration, as well as population characteristics, influence measurement results, administering both measures to the same population would facilitate comparison of measurement approaches.
We developed and psychometrically evaluated the Croatian versions of TOSCA-3 and PFQ-2. Our main aim was to compare measures after applying them both to the same sample of 140 healthy college students.
Our data indicate that both measures are reliable dispositional measures and confirm that they correspond to different aspects of shame- and guilt- proneness.
Tina Peraica is a certified integrative psychotherapist and MA in Social Pedagogy (Faculty of Education and Rehabilitation Sciences, Zagreb) working at the Department of Psychiatry, University Hospital Dubrava, Zagreb, Croatia. She completed postgraduate study in Social psychiatry and sociopathology and finishing PhD study in field of Biomedicine (School of Medicine, Zagreb). She is licensed to provide psychosocial treatment of perpetrators of domestic violence. She is a president of the Croatian Association of Social Pedagogues, secretary of the Croatian Association of Integrative Psychotherapy, and a head of the Domestic Violence Counseling Centre of town Zagreb.
Marija Eterović is resident of psychiatry at University Hospital Dubrava, from Zagreb, Croatia. At the moment she is a student in training (full member) at the Croatian Association for Integrative Psychotherapy