Birgit Bork Mathiesen

A Randomized Controlled Trial of Psychoanalytic Psychotherapy or Cognitive-Behavioral Therapy for Bulimia Nervosa

OBJECTIVE The authors compared psychoanalytic psychotherapy and cognitive-behavioral therapy (CBT) in the treatment of bulimia nervosa. METHOD A randomized controlled trial was conducted in which 70 patients with bulimia nervosa received either 2 years of weekly psychoanalytic psychotherapy or 20 sessions of CBT over 5 months. The main outcome measure was the Eating Disorder Examination interview, which was administered blind to treatment condition at baseline, after 5 months, and after 2 years. The primary outcome analyses were conducted using logistic regression analysis. RESULTS Both treatments resulted in improvement, but a marked difference was observed between CBT and psychoanalytic psychotherapy. After 5 months, 42% of patients in CBT (N=36) and 6% of patients in psychoanalytic psychotherapy (N=34) had stopped binge eating and purging (odds ratio=13.40, 95% confidence interval [CI]=2.45-73.42; p<0.01). At 2 years, 44% in the CBT group and 15% in the psychoanalytic psychotherapy group had stopped binge eating and purging (odds ratio=4.34, 95% CI=1.33-14.21; p=0.02). By the end of both treatments, substantial improvements in eating disorder features and general psychopathology were observed, but in general these changes took place more rapidly in CBT. CONCLUSIONS Despite the marked disparity in the number of treatment sessions and the duration of treatment, CBT was more effective in relieving binging and purging than psychoanalytic psychotherapy and was generally faster in alleviating eating disorder features and general psychopathology. The findings indicate the need to develop and test a more structured and symptom-focused version of psychoanalytic psychotherapy for bulimia nervosa.

Unstable identity and prefrontal injury

Introduction. In neuropsychological research, “organic personality disorder”, lack of social insight, and executive dysfunctions have been identified in patients with prefrontal brain injury. The assessment of personality change has, in particular, been a methodological challenge in this field of research. The aim of the present pilot study was to examine personality aspects in patients with prefrontal brain injury from a neuropsychological as well as a psychodynamic point of view. Methods. A total of 13 adults with personality change as a manifest sequel after sudden onset brain injury were assessed with neuropsychological tests of executive functions, with the European Brain Injury Questionnaire (EBIQ), and with the Karolinska Psychodynamic Profile (KAPP), which to our knowledge has not previously been used as part of a neuropsychological assessment. The personality profiles of the brain‐injured patients were compared to the personality profile of a group of 65 brain‐healthy individuals. Results. The personality organisation of the prefrontally brain‐injured patients was significantly disturbed and close to a borderline personality organisation, as defined by the KAPP. Conclusions. The results of the pilot study suggest that prefrontal brain systems may support the integration of self‐functions and play a central role for inter‐personal relations. Future research regarding the relation between brain dysfunction, executive and cognitive deficit, and personality disorder needs to be carried out in larger samples to substantiate the hypothesis of a relationship between prefrontal brain systems and self‐functions.

Affect Regulation and Loss of Initiative in a Case of Orbitofrontal Injury

Personality change after injury to the orbitofrontal cortex has frequently been described in the literature. However, there are only a few specific and reliable methods available for the assessment of personality change after brain injury. Here we present a patient, LP, whose personality has changed due to a ruptured aneurysm of the anterior communicating artery that resulted in bilateral ventromesial prefrontal lesions. Although his performance on extensive conventional neuropsychological tests was within normal range, he exhibited severe behavioral problems characterized by lack of initiative, inappropriate social timing, and blunt affect. The patient’s behavioral problems were measured with extensive assessment of personality characteristics and traits using methods from psychodynamic and psychometric traditions. Although no general signs of psychopathology were found, there were some indications that he was suffering from personal problems that fluctuated, as cognitive functions sometimes do after fro...Personality change after injury to the orbitofrontal cortex has frequently been described in the literature. However, there are only a few specific and reliable methods available for the assessment of personality change after brain injury. Here we present a patient, LP, whose personality has changed due to a ruptured aneurysm of the anterior communicating artery that resulted in bilateral ventromesial prefrontal lesions. Although his performance on extensive conventional neuropsychological tests was within normal range, he exhibited severe behavioral problems characterized by lack of initiative, inappropriate social timing, and blunt affect. The patient’s behavioral problems were measured with extensive assessment of personality characteristics and traits using methods from psychodynamic and psychometric traditions. Although no general signs of psychopathology were found, there were some indications that he was suffering from personal problems that fluctuated, as cognitive functions sometimes do after frontallobe injury. Intensive psychoanalytic psychotherapy allows us to hypothesize about some of the dynamics behind his acquired “loss of initiative,” although the very nature of his problems appears to be an obstacle to this kind of psychotherapy. This case study, like similar ones presented in the literature, reminds us to be cautious of accepting negative findings concerning standardized test performance as evidence of the absence of real-life problems after frontal-lobe injury.

Neurocognitive Deficits in Borderline Personality Disorder: Associations With Childhood Trauma and Dimensions of Personality Psychopathology

The present study evaluates the severity of neurocognitive deficits and assesses their relations with self-reported childhood trauma and dimensions of personality psychopathology in 45 outpatients with borderline personality disorder (BPD) matched to 56 non-psychiatric controls. Participants completed a comprehensive battery of neurocognitive tests, a retrospective questionnaire on early life trauma and a dimensional measure of personality psychopathology. Patients with BPD primarily showed deficits in verbal comprehension, sustained visual attention, working memory and processing speed. Comorbid posttraumatic stress disorder (PTSD) and an elevated childhood history of physical trauma were each accompanied by more severe neurocognitive deficits. There were no statistically significant associations between neurocognitive function and dimensions of personality psychopathology. These results suggest that patients with BPD display deficits mainly in higher-order thinking abilities that may be exacerbated by PTSD and substantial early life trauma. Potential relationships between neurocognitive deficits and dimensions of personality psychopathology in BPD need further examination.

Changes in Neurocognitive Functioning After 6 Months of Mentalization-Based Treatment for Borderline Personality Disorder

Patients with borderline personality disorder (BPD) have deficits in neurocognitive function that could affect their ability to engage in psychotherapy and may be ameliorated by improvements in symptom severity. In the current study, 18 patients with BPD completed neurocognitive tests prior to beginning mentalization-based therapy and again after 6 months of treatment. Twenty-eight nonpsychiatric controls were tested over the same period of time but received no intervention. Before starting treatment, patients performed lower than controls on tests assessing sustained attention and visuospatial working memory. After 6 months of treatment, patients showed significantly greater increases in sustained attention and perceptual reasoning than controls, with initial deficits in sustained attention among patients resolving after treatment. Improved emotion regulation over the follow-up period was associated with increased auditory-verbal working memory capacity, whereas interpersonal functioning improved in parallel with perceptual reasoning. These findings suggest that changes in neurocognitive functioning may track improvements in clinical symptoms in mentalization-based treatment for BPD.

Novice supervisors' tasks and training – A descriptive study

The debut as a clinical supervisor is still rather unknown. The aim of this study is to explore what kind of tasks novice supervisors undertake and how they are prepared for these. During 2009–2010, 350 Danish clinical psychologists have responded to the Development of Psychotherapists Common Core Questionnaire covering a wide range of items on professional development, experience and practice. In this paper, we focus on background data (experience, training and practice), specifically the tasks and training of the respondents as novice supervisors. The results show that a majority of novice supervisors were confronted with complicated tasks, e.g. group, internal and interdisciplinary supervision, but were not prepared, i.e. trained, prior to these tasks. These findings imply that more training is needed for novice supervisors. Preferably, this training should be introduced before, or at least parallel to, the first supervisor tasks, preparing the novice supervisors for the often complicated tasks they are meeting.

Maladaptive coping in adults who have experienced early parental loss and grief counseling

This study compares maladaptive coping, measured as substance use, behavioral disengagement, self-blame, and emotional eating, among adults (>18 years) who have experienced early parental loss (N = 1465 women, N = 331 men) with non-bereaved controls (N = 515 women, N = 115 men). We also compared bereaved adults who received grief counseling (N = 822 women, N = 190 men) with bereaved controls who had not (N = 233 women, N = 66 men). Bereaved adults reported significantly more substance use, behavioral disengagement, and emotional eating than non-bereaved adults. Counseling participants reported significantly more substance use and self-blame than non-participants. Our results suggest that early loss may negatively impact the development of adulthood coping.

Psychodynamic profile and reflective functioning in patients with bulimia nervosa

OBJECTIVE The aim of this study was to examine the general psychological functioning of patients suffering from bulimia nervosa (BN) using the Karolinska Psychodynamic Profile (KAPP). Furthermore, KAPP data and data from the Reflective Functioning scale (RF), measuring the ability to mentalize, were combined in order to examine differences in alexithymia, impulse control and affect regulation in patients with high or low RF. METHOD Seventy patients with BN were interviewed with both the KAPP and the Adult Attachment Interview (AAI) from which RF is coded. Differences in KAPP scores of patients with high or low RF were analyzed. RESULTS Most of the patients with BN were found to have a personality structure within the normal or neurotic range (n=50 of 70). BN patients with a high RF had significantly lower scores on KAPPs alexithymia scale than patients with a low RF score, demonstrating that poor mentalizing is related to alexithymia. Concurrently, patients with high RF showed problems with impulse control and coping with aggressive affects according to KAPP scores. CONCLUSION Although BN patients with high RF showed good capacities for describing their mental states, they still had difficulties regulating the emotions and impulses related to these states. SIGNIFICANT OUTCOME Among patients suffering from BN, patients with high RF were significantly less alexithymic than low RF patients. LIMITATIONS The findings of this study are limited by the relatively small numbers of participants especially in the RF subgroups, posing a danger of not finding as significant existing differences in character pathology between high and low RF groups.