Female survivors of multiple forms of trauma are increasingly found to be a significant portion of the university population (Briere, Kaltman, & Green 2008). While there is a strong literature base for understanding the effects of individual trauma on psychological functioning (e.g., Briere, 1992; Kaltman, Krumnick, Stockton, Hooper, & Green, 2005), little is known about specific symptom constellations for those who have experienced multiple traumas (Rich, Gingerich, & Roseìn, 1997). Using a clinical population of 500 female university students, this study explored the rates of multiple interpersonal traumatic experiences, the connection between multiple traumas and symptom severity, and the association of specific constellations of multiple types of traumas with specific constellations of trauma symptoms. The Trauma Symptom Inventory-Alternate (Briere, 1995) and self-report measures of demographic data and abuse histories were used to collect data, which was analyzed with frequencies, Multivariate Analysis of Variance, and a Canonical Correlation to explore the interrelationships of abuse and trauma symptoms. Multiple abuse was common, with 81% of participants experiencing two or more types of abuse. Multiple trauma generally predicted more severe trauma-related symptoms than those with no trauma or single traumas. A Canonical Correlation revealed a moderately significant relationship between participants with aggressive types of abuse (e.g., childhood physical, adult physical, and adult sexual abuse) with higher symptoms of intrusive experiences, defensive-avoidance, and dissociation. These findings suggest a differential model of trauma effects, particularly for trauma types characterized by aggression. Implications for future research and clinical practice are addressed.

The overall aim of this thesis was to describe patients’ and spouses’ experiences of suspected acute myocardial infarction in the pre-hospital phase. A descriptive survey study was conducted to identify various factors influencing patient delay in 381 patients with suspected myocardial infarction hospitalised at a Coronary Care Unit (I) and ambulance utilisation among 110 myocardial infarction patients (II). In order to obtain a deeper understanding of the myocardial infarction patients’ own conceptions about the event, an interview study with a phenomenographic approach was conducted with 15 strategically selected myocardial infarction patients (III), within 72 hours after admission to hospital. Finally, the pre-hospital experiences of 15 spouses of myocardial infarction patients were also studied through interviews with a phenomenographic approach, within 48 hours after the affected partner’s admittance to hospital (IV). The results showed that 59% of the patients with suspected acute myocardial infarction delayed > 1 hour after onset of symptoms. The most common reasons given for delay in seeking hospital admittance were: (1) Did not consider the symptoms as to be severe enough that they warranted hospital care, (2) thought the symptoms to be temporary and that they would disappear, (3) the chest pain was more of a dull pain, (4) or, as one third of the patients chose to do, contacted the general practitioner instead of going directly to the hospital (I). Furthermore, as a first action, 59% consulted their spouse for advice about what to do henceforth. The most common reason for additional delay when the decision to go to hospital had already been taken was that the myocardial infarction patients stated that they were unaware of the advantages of a rapid decision-making process. Sixty percent went by ambulance, but it was the spouse (40%) or the personnel at the general practitioner’s office (32%) who called the emergency service number, rather than the patient him/her self (5%). The most frequently given reasons for not choosing ambulance, were that the patients did not perceive their symptoms as being serious enough to require ambulance transportation (43%), followed by that they had not thought about ambulance as an alternative at all (38%). As a third reason for not going by ambulance, the patients stated that it was unnecessary to call an ambulance when being affected by symptoms related to a myocardial infarction (26%). The patients who called an ambulance differed in some respects from those who went by private alternatives; patients with large infarctions (ST-Elevation Myocardial Infarction) went by ambulance more frequently, as did patients suffering from nausea and severe chest pain (II). The patients expressed in the interviews how the interaction with others, described as the need for supportive environment, worries for the family and the utilisation of the health-care resources, was of great importance in the pre-hospital phase. Likewise, symptom awareness, with earlier experiences of a similar situation to compare with, denying the seriousness of the situation and the use of different self-care strategies, were important in order to manage the situation. Vulnerability, expressed as anxiety and a lack of control, also influenced the decision-making process in the pre-hospital phase (III). Spouses seemed to have a strong influence on the course of events when their partner suffered an acute myocardial infarction and it emerged from the interviews how the spouses in many cases were influenced into sharing the denial of the affected partner by respecting his/her independence. The spouses accepted the partner’s need for control; took earlier marital roles and experiences into account; restraining own emotions and seeking agreement with their partners, contributing to delay. However, being resourceful by sharing the experience; having knowledge; understanding the severity; being rational and consulting others when needed, seemed to have a positive influence on the decision time in the pre-hospital phase (IV). Conclusion: The reasons for delaying or not in the pre-hospital phase, as well as the reasons for utilising the ambulance services or not, varied considerably between individuals. Earlier experiences of MI did not influence what actions to take; instead patients’ feelings, emotional attitudes to MI symptoms, inadequate coping strategies, and spouses’ influences were important components in the pre-hospital phase.

Bakgrund: Hjärt- och kärlsjukdomar är den vanligaste dödsorsaken för både män och kvinnor i Sverige. Trots att lika många kvinnor som män insjuknar förekommer stora skillnader vid insjuknande och behandling. Syfte: Att ur ett genusperspektiv beskriva likheter och skillnader i samband med insjuknande och vårdförlopp hos personer som drabbats av en hjärtinfarkt. Metod: Studien genomfördes som en allmän litteraturstudie. Utifrån en litteratursökning valdes 12 artiklar, som svarade mot syftet. Artiklarna granskades enligt Röda Korsets Granskningsmall. Resultat: Flertalet artiklar påvisade att det fanns skillnader i symptom för män och kvinnor som drabbats av en hjärtinfarkt och att män sökte vård tidigare än kvinnor. Tre studier visade dock inga skillnader i symptom. Vår studie visar att män och kvinnor inte får samma bemötande eller behandling. Diskussion: Skillnad i symtom, okunskap hos både patient och sjukvårdspersonal om sjukdomsbilden samt synen på manligt och kvinnligt beteende var faktorer som bidrog till skillnader vid vård av hjärtinfarkt. Sjukvården i allmänhet och sjuksköterskan i synnerhet behöver bli medveten om och hur genus påverkar omvårdnaden. Alla patienter är unika och ska behandlas utifrån sina behov och villkor. Slutsats: Forskning behövs för att omvårdnad och behandling vid hjärtinfarkt ska kunna ske evidensbaserat till alla oavsett kön. / Background: Cardio-vascular diseases are the main cause of death for both men and women in Sweden. Although as many women as men are diagnosed there are large differences in onset and treatment. Aim: The aim was to describe similarities and differences in onset, treatment and care of myocardial infarction from a gender perspective. Method: The study was performed as a literature study. Twelve articles that matched the aim for this study were chosen. The articles were analyzed according to the Red Cross analysis model. Result: The majority of the articles pointed out differences in indications for men and women who suffered a myocardial infarction. Men sought medical assistance at an earlier stage. Three studies, however, indicated that there were no gender differences in indications. Our study shows that men and women do not receive the same treatment. Discussion: Differences in indications, ignorance concerning symptoms in both patients and in nursing staff, and also preconceived ideas about male and female behaviour were elements that contributed to differences in treatment. The nursing staff generally need enhanced awareness of how gender affects care. Conclusion: More studies will be needed to ensure that both genders receive evidence-based care.

This dissertation models the relationship between symptoms of heart rhythm fluctuations and cardiac measurements in order to better identify the probabilities of either a primarily organic or psychosomatic cause, and to better understand cognition of the internal body. The medical system needs to distinguish patients with actual cardiac problems from those who are misperceiving benign heart rhythms due to psychosomatic conditions. Cognitive neuroscience needs models showing how the brain processes sensations of palpitations. Psychologists and philosophers want data and analyses that address longstanding controversies about the validity of introspective methods. I therefore undertake a series of measurements to model how well patient descriptions of heartbeat fluctuations correspond to cardiac arrhythmias. First, I employ a formula for Bayesian inference and an initial probability for disease. The presence of particular phrases in symptom reports is shown to modify the probability that a patient has a clinically significant heart rhythm disorder. A second measure of body knowledge accuracy uses a corpus of one hundred symptom reports to estimate the positive predictive value for arrhythmias contained in language about palpitations. This produces a metric representing average predictivity for cardiac arrhythmias in a population. A third effort investigates the percentage of patients with palpitations report actually diagnosed with arrhythmias by examining data from a series of studies. The major finding suggests that phenomenological reports about heartbeats are as or are more predictive of clinically significant arrhythmias than non-introspection-based data sources. This calculation can help clinicians who must diagnose an organic or psychosomatic etiology. Secondly, examining a corpus of reports for how well they predict the presence of cardiac rhythm disorders yielded a mean positive predictive value of 0.491. Thirdly, I reviewed studies of palpitations reporters, half of which showed between 15% and 26% of patients had significant or serious arrhythmias. In addition, evidence is presented that psychosomatic-based palpitation reports are likely due to cognitive filtering and processing of cardiac afferents by brainstem, thalamic, and cortical neurons. A framework is proposed to model these results, integrating neurophysiological, cognitive, and clinical levels of explanation. Strategies for developing therapies for patients suffering from identifiably psychosomatic-based palpitations are outlined. / text

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Diss. (sammanfattning) Umeå : Umeå universitet, 2006. / Härtill 5 uppsatser.

À travers l’analyse et l’interpretation de films du panorama italien et international des années cinquante jusqu’à aujourd’hui, ce travail vise à éclairer le fonctionnement et les modalités esthétiques et perceptives d’activation de la jouissance dans le dispositif cinématographique sur la base du tout dernier enseignement de Jacques Lacan.Après un étude soigné du concept de jouissance dans la psychanalyse lacanienne – un concept qu’il faut entendre en opposition à celui de plaisir, et en conflit permanent avec celui de désir, deux fondements de la théorie psychanalythique du cinéma – on relèvera l’insuffisance du régime scopique dans la situation de jouissance cinématographique, où grâce à l’entrée en jeu du corps, la dimension d’absence, de perte et d’inaccessibilité caractérisant le cinéma et son signifiant, se fait remplacer par une condition très marquée de materialité et de surplus de presence. Ça nous oblige à une révision partielle voire à une relecture generale des théories psychanalythiques classiques du cinéma, en remettant en question les processus mȇmes d’identification, croyance, voyeurisme et plaisir vecus par le spectateur , dont le corps ne peut plus être pensé uniquement dans sa composante imaginaire, mais aussi dans sa dimension organique et physiologique, qui est néanmoins présente dans la conception lacanienne de la jouissance. Ce travail est composé par une première partie théorique, où on analysera la genèse et le déroulement général de la notion de jouissance dans la pensée lacanienne et dans le dispositif cinématographique, et par une deuxième partie plus analytique, où on présentera des exemples de films particulièrement interessés par l’action de la jouissance. / Through an indepth analysis and interpretation of selected Italian and International films from of the 1950s to the present, this thesis intends to shed light on the possible mechanism of lacanian jouissance activated and enabled by cinematographic devices.Taking into consideration the teachings of Lacan, we will explore if it is possible to formulate a “theory of jouissance” in cinema. Starting with a detailed study of the concept of jouissance in lacanian psychoanalysis, followed by an examination of cinematic dispositif, we will highlight the inadequacies of the scopic regime in the cinematographic situation of jouissance. According to Lacan, when jouissance appears, body comes into play in its organic, physiological and clinical component, so that an excess of materiality and presence replace the state of absence, stillness and inaccessibility generally associated to the cinema and its signifier. It is therefore crucial to think about jouissance as a concept in complete opposition to that of pleasure and in permanent conflict with that of desire, the two cornerstones of psychoanalytical theory of the cinema. This calls for a thorough revision of classical studies in cinema and psychoanalysis. / Attraverso l’interpretazione e l’analisi di alcuni film del panorama italiano ed internazionale dagli anni Cinquanta ad oggi, la mia tesi si propone di mettere in luce il funzionamento dei possibili meccanismi di godimento (jouissance) attivati e attivabili dal dispositivo cinematografico sulla base dell’insegnamento dell’ultimo Jacques Lacan.Partendo da uno studio accurato di tale concetto nella psicoanalisi lacaniana – concetto da intendersi fondamentalmente in opposizione a quello di piacere e in conflitto permanente con quello di desiderio: due capisaldi della teoria psicoanalitica del cinema – sarà evidenziata l’insufficienza del regime scopico nella situazione di godimento cinematografico dal momento che, quando c’è jouissance, subentra il corpo, e il regime dell'eccesso di presenza viene a sostituire quello (tradizionalmente connesso al cinema e al suo significante) della mancanza e dell'inaccessibilità. Ne conseguirà una parziale revisione e un generale ripensamento delle teorie psicoanalitiche classiche del cinema, accompagnata da una rilettura dei procedimenti stessi di identificazione, credenza, voyeurismo e piacere, prendendo in considerazione lo stato percettivo di uno spettatore il cui corpo non è più limitato alla sua (pur fondamentale) componente immaginaria, ma va inteso anche nella sua dimensione organico-fisiologica. Ad una prima parte teorica, incentrata sulle dinamiche generali del godimento nella teoria lacaniana e nel dispositivo cinematografico, seguirà una parte più analitica in cui le meccaniche della jouissance verranno analizzate in rapporto ad alcuni film particolarmente debitori alle forme e a ai luoghi principali del godimento.

CAMPOS, Renata Carvalho. Sintoma e fantasia como fundamentos da clínica psicanalítica com crianças. 2015. 121f. – Dissertação (Mestrado) – Universidade Federal do Ceará, Programa de Pós-graduação em Psicologia, Fortaleza (CE), 2015. / Submitted by Márcia Araújo (marcia_m_bezerra@yahoo.com.br) on 2015-12-22T15:16:00Z No. of bitstreams: 1 2015_dis_rccampos.pdf: 887521 bytes, checksum: 1e60ba72b92027b2f56ae5d720fdf96f (MD5) / Approved for entry into archive by Márcia Araújo(marcia_m_bezerra@yahoo.com.br) on 2015-12-22T15:31:45Z (GMT) No. of bitstreams: 1 2015_dis_rccampos.pdf: 887521 bytes, checksum: 1e60ba72b92027b2f56ae5d720fdf96f (MD5) / Made available in DSpace on 2015-12-22T15:31:45Z (GMT). No. of bitstreams: 1 2015_dis_rccampos.pdf: 887521 bytes, checksum: 1e60ba72b92027b2f56ae5d720fdf96f (MD5) Previous issue date: 2015 / É consensual entre os teóricos, a proposição de que a psicanálise é uma só, não havendo diferenças entre a análise de adultos e de crianças. Esses autores consideram, no entanto, que existem especificidades no tocante à infância, decorrentes do desenvolvimento e da linguagem, cujas repercussões comparecem na clínica. Tendo em vista essas divergências, questiona-se sobre a existência de particularidades na psicanálise com crianças e o que elas envolvem. Trata-se de uma mera questão de técnica? O que está para além da técnica e que une sob o termo psicanálise o tratamento de adultos e crianças? O que é comum às duas formas de psicanalisar? Em síntese, o que fundamenta a clínica psicanalítica? Fundamentar remete à articulação da teoria a um campo de experiência e é nesse contexto que se insere essa pesquisa, uma vez que, ela se origina nos impasses da clínica e retorna à teoria numa tentativa de aprofundar a compreensão do trabalho analítico com a criança. Nesse sentido, objetiva-se situar as diferenças que envolvem a clínica com crianças dentro da teoria psicanalítica, segundo as contribuições de Freud e Lacan. Ao investigar a clínica psicanalítica nos seus fundamentos, pretende-se estabelecer princípios para pensar a psicanálise com crianças, questionando o discurso em favor das especificidades. Sintoma e fantasia são utilizados como parâmetros por reunirem as condições necessárias para a presente investigação, a saber: correspondem à essência do que é desenvolvido num processo de análise e apresentam-se independente da idade do paciente. Dessa forma, como introdução à pesquisa, aborda-se a constituição da clínica psicanalítica com crianças, indicando as principais controvérsias acerca dessa prática. As contribuições de Lacan são contempladas numa discussão centrada na proposição do sujeito como um conceito que vem dirimir uma perspectiva desenvolvimentista da psicanálise com crianças, tendo em vista que o estatuto do sujeito em Lacan é ético e não ôntico, referindo-se ao inconsciente. Nos capítulos seguintes, sintoma e fantasia inauguram outro momento da pesquisa, ao mesmo tempo em que mantém o diálogo com o anterior. Isso porque, ao situar esses dois conceitos como parâmetros de trabalho, pretende-se compreender se a análise realizada com crianças se distancia da proposta originalmente pensada para adultos. Nesse cenário, considera-se que a presente investigação se insere no campo da psicanálise com crianças, sem, no entanto, se restringir a ele. Acredita-se que a relevância da pesquisa consista, justamente, em discutir o singular que a clínica com crianças comporta, suscitando questionamentos importantes à teoria, para, concomitantemente, localizar essas diferenças no campo da psicanálise.

In contemporary culture, while there is an excessive preoccupation with the body, there is eating symptoms emergence. Despite the previously existence of these symptoms, they were not that common and frequent in the clinic. Anorexia is considered one of these symptoms and according to that it was possible to question the relation betweenincreased anorexia incidence nowadays and idealization of thin body. The aimed of this study was to examine the relation between the cult of the body culture and anorexia in contemporaneity, reflecting on that context, if anorexia can be considered an analytical symptom. This work conducted a theoretical study, based on psychoanalysis. The method adopted was to read the texts more than once, from the researcher's encounter with the text, the purpose of producing a speech and not just the pursuit for the meaning of interpretative texts. So, it was used texts from Sigmund Freud, Jacques Lacan and authors that argue the binomials: body worship and contemporary culture, beauty codes and standards and anorexia, anorexia and ideal cultural;ideal body and ways / lifestyles; anorexia and symptoms. We also used two published clinical cases, to convey and intensifyconcepts, specifically anorexia, in psychoanalytic theory. It was observed that anorexia is presented differently nowadays, since there are individuals who participate in pro-anorexia movements and conceive it as a lifestyle. The anorexia exaltation is related to aspects of this culture and mostly with the idealization of thin body. In view of the increasing incidence of anorexia, it is understood that culture is not the cause but can propel this growth, since the constitution of the symptom is related to various life experiences of the subject. Accordingly, anorexia can only be considered an analytical symptom, from the encounter between analyst and patient. To do so, depends on the position of the subject to the treatment and the analyst’s intervention. / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Na cultura contemporânea, ao mesmo tempo que há uma preocupação excessiva com o corpo, constata-se a emergência de sintomas alimentares. Apesar de eles existirem anteriormente, não eram tão comuns e frequentes na clínica. A anorexia é considerada um desses sintomas e, nesse sentido, questionou-se a relação entre o aumento da incidência da anorexia na atualidade e a idealização do corpo magro. A pesquisa teve como objetivo analisar a relação entre a cultura do culto ao corpo e a anorexia no contemporâneo, refletindo se nesse contexto, a anorexia pode ser considerada sintoma analítico. Para tanto, foi realizado estudo teórico, fundamentado na psicanálise. O método adotado foi o da releitura, que a partir do encontro do pesquisador com o texto, tem como propósito a produção de um discurso e não apenas a busca do sentido interpretativo dos textos. Assim, foram utilizados textos de Sigmund Freud, Jacques Lacan e autores que discutem os binômios: culto ao corpo e cultura contemporânea; padrões e códigos de beleza e anorexia; anorexia e ideal cultural; corpo ideal e modos/estilos de vida; anorexia e sintoma. Também foram utilizados dois casos clínicos publicados, para transmitir e aprofundar conceitos, especificamente da anorexia, na teoria psicanalítica. Verificou-se que a anorexia se apresenta de maneira distinta na contemporaneidade, visto que há sujeitos que participam de movimentos pró-anorexia e a concebem como estilo de vida. A exaltação da anorexia está relacionada com os aspectos desta cultura e principalmente com a idealização do corpo magro. Tendo em vista o aumento da incidência da anorexia, entende-se que a cultura não é causadora, mas pode propulsionar esse aumento, uma vez que a constituição do sintoma está relacionada com diversas experiências da vida do sujeito. Nesse sentido, a anorexia só pode ser considerada um sintoma analítico a partir do encontro entre analista e analisando. Para isso, depende da posição do sujeito em face do tratamento e das intervenções do analista.