Thesis (M.A.) University of Missouri-Columbia, 2006. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on August 28, 2007) Includes bibliographical references.

Proefschrift Maastricht. / Lit. opg. - Met samenvatting in het Nederlands.

Made available in DSpace on 2018-08-01T23:43:57Z (GMT). No. of bitstreams: 1 tese_9585_Dissertação final Flora Viguini do Amaral20161205-150640.pdf: 1488233 bytes, checksum: 4dd713171ad6b7c5b013054cf5f34c17 (MD5) Previous issue date: 2016-02-29 / O objetivo desta pesquisa é analisar o romance Borderline (2003), da escritora quebequense Marie-Sissi Labrèche, no campo da escrita de si, sob o prisma da autoficção, termo registrado pelo crítico e professor francês Serge Doubrovsky em Fils (1977). Este estudo visa averiguar, além da coincidência onomástica entre o nome da autora, da narradora e da personagem, a possibilidade de um jogo em que Labrèche cria um outro eu, capaz de fornecer supostas referências a traços autobiográficos mesclados a uma matéria ficcional. A pesquisa, portanto, consiste na investigação da relação entre o transtorno borderline e a estrutura do texto, examinando se o tema escolhe sua forma ideal de expressão, se a autora se faz valer dessa estrutura como sendo decisiva para inspirar a pensar esse transtorno psicológico. Ainda que a matriz teórica da autoficção seja francesa, não são muitas as publicações e trabalhos acadêmicos sobre esse efeito de leitura nas obras contemporâneas de autoras quebequenses. O corpus a ser analisado é Borderline. No que tange à teoria, serão utilizados os estudos acerca da perspectiva teórica da autoficção, por meio da contribuição de alguns teóricos, como Evando Nascimento e Leonor Arfuch. Palavras-chave: Autoficção. Borderline. Marie-Sissi Labrèche. Quebequense.

Orientadores: Sophie Françoise Mauricette Derchain, Liliana Aparecida Lucci De Angelo Andrade / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T03:21:08Z (GMT). No. of bitstreams: 1 Olimpio_AdrianaYoshida_M.pdf: 1413013 bytes, checksum: ed127b0f937e9350f9e3b1ab1d8d780c (MD5) Previous issue date: 2006 / Resumo: Introdução: A hipótese mais aceita atualmente na carcinogênese ovariana é a da ovulação incessante. O traumatismo causado pela ruptura do folículo ovulatório no epitélio ovariano requer uma reparação imediata, levando a uma reação inflamatória. A Ciclo-oxigenase-2 (COX-2), enzima envolvida na inflamação e outros processos patológicos, catalisa a formação de prostaglandinas a partir do ácido araquidônico e parece estar relacionada à carcinogênese de diversas neoplasias, entre elas a de ovário. Objetivos: Avaliar se os tumores serosos e mucinosos de ovário expressam a COX-2 de maneira crescente quando se comparam tumores benigno, borderline e maligno, e investigar se existe alguma relação entre a expressão da COX-2 e a proliferação celular do tumor avaliada pela expressão do Ki67. Sujeitos e métodos: Para este estudo de corte transversal foram selecionados os blocos cirúrgicos das pacientes submetidas à laparotomia por tumor de ovário seroso ou mucinoso, benigno, borderline ou maligno entre janeiro de 1997 a dezembro de 2003. O estudo foi realizado nos Departamentos de Anatomia Patológica e de Tocoginecologia, da Universidade Estadual de Campinas (Unicamp), em São Paulo, Brasil. Foram incluídos neste estudo 113 tumores serosos de ovário (67 benignos, 15 borderline e 31 malignos) e 85 tumores mucinosos de ovário (48 benignos, 28 borderline e 9 malignos). Todas as lâminas obtidas dos espécimes cirúrgicos foram revisadas por um patologista para confirmar o diagnóstico histológico. As expressões da COX-2 e do Ki67 foram obtidas através de reações de imunoistoquímica nestes cortes de tumores epiteliais ovarianos conservados em parafina. Resultados: Houve um aumento da expressão da COX-2 na progressão dos tumores benigno para maligno, tanto no seroso quanto nos mucinoso, mais evidente no mucinoso (p<0,001). Comparando os tipos histológicos, a expressão da COX-2 foi mais acentuada nos tumores benignos serosos do que nos mucinosos (p<0,01), mas esta diferença não foi significativa para os tumores borderline (p=0,11) ou malignos (p=0,71). Houve um aumento progressivo na expressão do Ki67 de acordo com o aumento do gradiente histológico para os tumores serosos (p<0,01) e mucinosos (p<0,01), mas esta maior expressão não se correlacionou com a da COX-2 no presente estudo (p=0,78). Conclusões: Houve uma maior expressão de COX-2 em tumores de ovário seroso do que no mucinoso. A positividade da COX-2 aumenta com a progressão do gradiente morfológico, do benigno para o maligno em ambos os tipos histológicos, mas foi mais acentuada no tumor mucinoso, sugerindo diferentes vias oncogênicas relacionados aos diferentes tipos histológicos. Como a COX-2, a expressão do Ki67 também mostrou maior positividade do tumor benigno para maligno, mas uma correlação entre a expressão da COX-2 e Ki67 não foi encontrada, sugerindo que a COX-2 pode ser necessária para a carcinogênese, mas esta via não é responsável pela proliferação celular em carcinomas ovarianos / Abstract: Introduction: Incessant ovulation is the most accepted hypothesis for ovarian carcinogenesis. The trauma caused by rupture of the ovulation follicle needs an immediate repair of the wound in the ovarian epithelium, which causes an inflammatory response. Cyclooxygenase-2 (COX-2) is an enzyme involved in the inflammatory process and catalyses the reaction that produces prostaglandins from arachidonic acid and has been implicated in various neoplasias, including ovarian cancer. Objectives: To evaluate if there is a progressive enhance in COX-2 expression in serous and mucinous ovarian tumors, comparing benign, borderline and malignant tumors and to investigate whether there is a correlation between COX-2 expression and tumor cell proliferation represented by Ki67 expression. Materials and methods: For this cross-sectional study, paraffin blocks were selected from women who were submitted to laparotomy and had diagnosis of benign, borderline and malignant serous and mucinous tumors between January 1997 and December 2003. The study was conducted in the Departments of Pathology and Gynecology, in the Universidade Estadual de Campinas (Unicamp), in São Paulo, Brasil. One hundred and thirteen ovarian serous tumors (67 benign, 15 borderline and 31 malignant) and 85 mucinous ovarian tumors (48 benign, 28 borderline and 9 malignant) were included. All the slides were reviewed by a pathologist to assure the histological diagnosis and COX-2 and Ki67 expressions were obtained in immunohistochemical reactions in these tumor samples. Results: From benign to malignant tumors, there was a progressive positive trend in COX-2 expression, in both serous and mucinous tumors, more evident in mucinous ones (p<0.001). Comparing histological types, COX-2 expression was more prominent in serous than in mucinous benign tumors (p<0.01), but this difference was not significant in borderline (p=0.11) or in the malignant categories (p=0.71). There was a progressive Ki 67 positivity in line with the tumor histological gradient for both serous (P<0.01) and mucinous lesions (p<0.01), but this increasing expression did not correlate with COX-2 expression in the present series (p=0.78). Conclusions: There was a higher COX-2 expression in serous ovarian tumors than in mucinous ones. COX-2 positivity increases in line to the morphologic gradient, from benign to malignant in both histological types, but it was more prominent in mucinous lesions, pointing to different oncogenic pathways related to different histological types. Like COX-2, Ki67 also showed an increasing positivity from benign to malignant tumors but a correlation between COX-2 and Ki67 expressions was not found, suggesting that COX-2 may be required for carcinogenesis, but this pathway is not responsible for cell proliferation in ovarian cancers / Mestrado / Tocoginecologia / Mestre em Tocoginecologia

This thesis presents an in-depth exploration of psychotherapists’ lived experience of working with borderline personality (BPD) disorder in psychodynamic psychotherapy, using interpretative phenomenological analysis (IPA). The existing research literature suggests that working with borderline patients is very difficult, as they can evoke negative counter transference experiences in therapists and thus make the working alliance difficult to maintain. The stigmatising and negative attitude towards BPD, which is found amongst mental health professionals, can cause many therapists to avoid working with this patient population, leaving many patients without the necessary help for treatment. Some literature also suggests that psychodynamic therapy may not be helpful for the treatment of BPD in its traditional form, because of the neutrality of the model and borderline patients’ ‘reduced capacity to mentalise’. Instead, empathy and the therapeutic relationship have been reported to be significant factors. This qualitative study aimed to provide a rich and detailed examination of the experiences, which psychodynamic psychotherapists and counselling psychologists might have in their work with BPD patients. Five psychodynamic psychotherapists were interviewed twice in one unstructured and one semi-structured interview, and IPA was used to analyse the data. The five master-themes (Negative countertransference feelings; “Sitting in the dark together”; Hindrance in therapeutic work; Therapist omnipotence; Labelling as problematic) found in this study suggested that borderline patients could benefit from a modified version of psychodynamic 1 Note that the ‘psychodynamic’ and ‘psychoanalytic’ terms will be interchangeably used in this study. 2 The researcher, as a trainee-counselling psychologist, is in favour of using the word ‘client’. However, psychodynamic practitioners talk about their ‘patients’ rather than ‘clients’, and as this study focuses on psychodynamic therapists’ experiences, the researcher will use these two terms interchangeably. Thus, the word ‘patient’ here is applied in the psychodynamic and not in the medical sense. 9 psychotherapy with a focus on empathy and a bond between therapist and patient. Furthermore, the therapists’ awareness of negative countertransference feelings and emergent obstacles in the therapeutic work, as well as their understanding of BPD as a label and its effects on their borderline patients were crucial. Finally, the therapists’ experienced ‘omnipotent’ feelings, which may have emerged in response to their negative countertransference feelings. While these findings support many of the previous publications and accounts reported in the literature, they also shed new light on therapists’ experiences, which might have implications for the approach that psychotherapists and counselling psychologists take towards working with borderline individuals within the psychodynamic modality.

D.Litt. et Phil. / The aim of this study was to evaluate a feasible rating scale to measure the adherence of therapists carrying out Dialectical Behavior Therapy (DBT) with Borderline Personality Disorder (BPD) clients. Adherence referred to therapists carrying out DBT and how frequently and thoroughly they executed the specific targets and strategies of the therapy, which included taking the context into account. DBT is very specific in its treatment targets and in their hierarchical order of importance. The 97 item adherence scale was rated on a 7 point (0-6) scale. Some 86 items, that corresponded with the therapist ethological scale, were selected and then compared to the therapist and client ethological scales from an earlier study. These ethogram scales were process coding instruments which rated minute-by-minute, the frequency of specific categories of client and therapist verbal behaviors. The adherence scale was further compared to client self-report diary card measures. The diary card measures were also compared to the therapist and client ethological scales. Randomly selected client-therapist dyads (N = 10) were used, meeting criteria for BPD. All clients were women and between the ages of 18-45. The clients were seen by a total of 7 DBT trained therapists. Random sessions (N = 6) were selected from the first 16 sessions for each clienttherapist dyad. Some 60 sessions were chosen. 57 tapes were coded as 3 were too inaudible to code. Results indicated that the adherence rating of the respective therapist increased as the negative behaviors of the client increased (p < 0.05). Conversely, the greater the client's positive behavior on the ethological scale, the lower the DBT adherence rating of the therapist (p < 0.05). The problem solving category on both the adherence and therapist ethological scale covaried significantly (p < 0.02). Other therapist strategies (i.e., reciprocal, irreverence, primary targets 1-4, contingencies and validation) between the two scales were not significantly correlated. A test of the validity of the adherence scale to measure DBT fidelity draws its strongest support from two findings: 1) that when a client portrayed positive behaviors the therapist needed not to follow the primary targets so closely, resulting in a decrease in the adherence rating; and 2) the greater the negative behaviors of the client, the more stringently the therapist focused upon the primary targets and a wider array of strategies, which led to an overall increase in the adherence rating. The results of this study confirmed that a rating scale of therapist adherence is possible even with a flexible therapy such as DBT. Further, that minute-by-minute ethological ratings may serve to validate a more holistic adherence scale as tested here. Finally, recommendations are discussed for the further improvement and enhancement of the DBT adherence scale when used as a tool for rating DBT's treatment fidelity.

The aim of this study was to describe the female elf-mutilator's lived experience of cutting herself. A question which would elicit a description of the experience of this phenomenon was formulated. Five self-mutilators were interviewed. The four psychologically richest narratives were chosen for this study. Using the empirical phenomenological method. the four protocols were analysed in detail. Self-mutilation is conceptualized as a cycle wherein the mutilator experiences a diffuse bodily felt-sense that mounts to an unbearable point. She has an irresistible urge to alleviate the distress. She isolates herself and cuts herself with a sharp blade. Upon seeing the blood appear she is overcome with a deep sense of satisfaction. power, and ecstatic pleasure. The blood is perceived to carry the distressing contents out of the body. Concomitantly the self-mutilator recollects a sense of her feelings and her body as belonging to her. Her previously alienated body is felt to be a site of vitality. She also feels removed from further harm. encased in a cocoon of safety that renders her invulnerable to others. However. the cutting can never totally rid the body of distressing feelings. As a result the cycle of cutting wiII be re-enacted. The cutting cycle is conceptualized as a process whereby the self-mutilator suffers from a traumatization of the psyche such that the psychic container is fractured and rendered painfully porous. The act of cutting rids the psyche of unwanted contents such that a sense of going-on-being is restored. The cutting acts to temporarily shore up the rent fabric of the psychic envelope and thereby consolidate a sense of personal boundary. This is a temporary respite from the fracturing of the psychic container in that, once again confronted with interpersonal existence, the self-mutilator begins to feel vulnerable and defenceless. When it seems as if disintegration is again imminent, a cycle of cutting is reconstituted. The findings emergent from the interviews were dialogued with the literature on psychic containers, particularly that which addresses the role of the skin in the formation and functioning of psychic containers.

The longitudinal relationship between borderline personality features, disordered eating behaviour, and the role of impulsivity were examined using a sample of 643 Canadian adolescents from the McMaster Teen Study. Participants were assessed annually, beginning in Grade 7 until Grade 12.Using path analysis, the results suggest that higher symptoms of impulsivity increase an adolescent’s risk of engaging in disordered eating behaviour, as well as developing borderline personality features in later years. Results also showed a bidirectional relationship between these variables, whereby borderline personality features and disordered eating influence one another throughout time. As well, disordered eating appeared as an antecedent for borderline personality features. The findings highlight the importance for clinicians to be aware of the high comorbidity of disordered eating, borderline personality features, and impulsivity, and that early interventions that target impulsivity and problematic eating behaviour may mitigate the risk of future borderline personality features. Clinical implications, limitations, and future directions are discussed.

Bakgrund:  Självskadebeteende är ett av diagnoskriterierna vid diagnosen borderline personlighetsstörning. Varje år vårdas många personer inom slutenvården i Sverige till följd av självskadebeteende. Inom vården finns stigmatisering och negativa attityder associerat med självskadebeteende. Kunskap och utbildning är viktiga faktorer för att förbättra bemötande och omvårdnad för dessa personer. Syfte: Att belysa personers upplevelse av att leva med självskadebeteende vid borderline personlighetsstörning. Metod: Studien har en kvalitativ ansats och är baserad på fyra patografier. Analysen baseras på Graneheim och Lundmans beskrivning av hur en innehållsanalys kan utföras.  Resultat: Fyra kategorier, med tillhörande tio underkategorier framkom under analysen. Kategorierna var Att drivas av en inre smärta, Att leva med en sjuk identitet, Skam och rädsla i mötet med omgivningen och Att forma en ny identitet. Kategorierna och underkategorierna beskriver på olika sätt upplevelsen av att leva med självskadebeteende. Slutsats: Det framkom en rad olika upplevelser där en del berörde upplevelsen av stigmatisering och fördomar. Sjuksköterskan har en betydelsefull roll när det gäller utformande av omvårdnaden och bemötande. Utbildning och kunskap har visats minska negativa attityder och stigmatisering och är således nödvändiga faktorer för att skapa förutsättningar för en god omvårdnad.

No description available.