Pub Date : 2026-01-01DOI: 10.1016/j.amp.2024.12.002
Friedrich Stiefel, Sonia Krenz, Valentin Baechtold, Laurent Michaud, Céline Bourquin
Oncology clinicians are expected to have a certain insight in interactional dynamics when communicating with patients. Supervision of oncology clinicians by psycho-oncologists is an important means to enhance this insight. However, research on supervision in the oncology setting remains very scarce with most of the few studies failing to describe the supervisory process.
Objectives
To evaluate the experience of oncology physicians, who participated in a structured, psychodynamic supervision centered on the clinician-patient interaction.
Methods
Medical oncologists (n = 10) who benefited from three individual supervisions following a one-day reflexivity training were asked to report on their experience of the supervision, which specifically addressed interactional dynamics of the cases presented, focusing on countertransference reactions and links to clinicians’ repetitive relational patterns and biography. The semi-structured interviews were conducted by an experienced psychologist, who was not implicated in the training, and based on a guide addressing facilitators and barriers to engage in supervisions and the lived experience of supervisees.
Results
Facilitators and barriers to engage in supervision were related to the supervisor, the supervisees, and contextual elements. Trust towards the supervisor, who demonstrated a capacity to adapt to the supervisee and knowledge of the institutional context, without having any professional ties with the supervisees, played a facilitating role. While the supervisees’ openness to be confronted with their own psychological struggles also facilitated engagement, transferential reactions towards the supervisor had positive and negative effects. The principal barrier felt by some supervisees was the confrontational approach of this type of supervision. Most participants reported a positive experience of the supervision, which was perceived as useful, interesting, valorizing and enriching. However, one participant indicated not having benefited from supervision expressing important discomfort to talk about himself.
Conclusion
A structured, psychodynamic- and interaction-oriented supervision is a psychologically challenging experience for oncology clinicians. However, if certain prerequisites concerning the supervisor and the context can be granted and if supervisees can engage in such a supervisory process, they clearly benefit from the experience; participation, based on a well-informed and voluntary consent, is thus an implementable and promising means to address clinicians’ own psychological contributions to problematic patient interactions.
{"title":"Experience feedback on participation in a structured, psychodynamic supervision centered on the clinician-patient interaction: Are oncologists ready to talk about themselves?","authors":"Friedrich Stiefel, Sonia Krenz, Valentin Baechtold, Laurent Michaud, Céline Bourquin","doi":"10.1016/j.amp.2024.12.002","DOIUrl":"10.1016/j.amp.2024.12.002","url":null,"abstract":"<div><div>Oncology clinicians are expected to have a certain insight in interactional dynamics when communicating with patients. Supervision of oncology clinicians by psycho-oncologists is an important means to enhance this insight. However, research on supervision in the oncology setting remains very scarce with most of the few studies failing to describe the supervisory process.</div></div><div><h3>Objectives</h3><div>To evaluate the experience of oncology physicians, who participated in a structured, psychodynamic supervision centered on the clinician-patient interaction.</div></div><div><h3>Methods</h3><div>Medical oncologists (<em>n</em> <!-->=<!--> <!-->10) who benefited from three individual supervisions following a one-day reflexivity training were asked to report on their experience of the supervision, which specifically addressed interactional dynamics of the cases presented, focusing on countertransference reactions and links to clinicians’ repetitive relational patterns and biography. The semi-structured interviews were conducted by an experienced psychologist, who was not implicated in the training, and based on a guide addressing facilitators and barriers to engage in supervisions and the lived experience of supervisees.</div></div><div><h3>Results</h3><div>Facilitators and barriers to engage in supervision were related to the supervisor, the supervisees, and contextual elements. Trust towards the supervisor, who demonstrated a capacity to adapt to the supervisee and knowledge of the institutional context, without having any professional ties with the supervisees, played a facilitating role. While the supervisees’ openness to be confronted with their own psychological struggles also facilitated engagement, transferential reactions towards the supervisor had positive and negative effects. The principal barrier felt by some supervisees was the confrontational approach of this type of supervision. Most participants reported a positive experience of the supervision, which was perceived as useful, interesting, valorizing and enriching. However, one participant indicated not having benefited from supervision expressing important discomfort to talk about himself.</div></div><div><h3>Conclusion</h3><div>A structured, psychodynamic- and interaction-oriented supervision is a psychologically challenging experience for oncology clinicians. However, if certain prerequisites concerning the supervisor and the context can be granted and if supervisees can engage in such a supervisory process, they clearly benefit from the experience; participation, based on a well-informed and voluntary consent, is thus an implementable and promising means to address clinicians’ own psychological contributions to problematic patient interactions.</div></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":"184 1","pages":"Pages 41-47"},"PeriodicalIF":0.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.amp.2025.09.005
Pierre D. Dindi , Nancy Stiegler , Jean-Pierre Bouchard
Between 2015 and 2024, over 97% of the world's population was counted using population censuses–universally accepted methodical tools that demographers use to enumerate people. Since their mid-19th century adoption, global census standards have been progressively refined to guide the collection of demographic and non-demographic data. By investigating the relationships within and between these two groups of variables, in this interview with Jean-Pierre Bouchard, Pierre D. Dindi and Nancy Stiegler demonstrate the crucial role of demography and its contribution to a diverse number of disciplines including psychology. While countries are not required to adopt all United Nations-recommended census topics, they explore the constructive omission of ethnicity from official French statistics and the polemic around their inclusion in 2025. In countries where such data are collected, Pierre D. Dindi and Nancy Stiegler note the influence of psychology on the self-reporting of personal identity in the wake of socio-political and cultural pressure. They also show the positive impact of demography to medical psychology, particularly through population censuses.
2015年至2024年期间，全球97%以上的人口都是通过人口普查进行统计的。人口普查是人口统计学家用来统计人口的普遍接受的方法工具。自19世纪中期采用以来，全球人口普查标准已逐步完善，以指导人口和非人口数据的收集。通过调查这两组变量内部和之间的关系，在Jean-Pierre Bouchard， Pierre D. Dindi和Nancy Stiegler的采访中，展示了人口学的关键作用及其对包括心理学在内的多种学科的贡献。虽然各国没有被要求采用联合国建议的所有人口普查主题，但他们探讨了法国官方统计中建设性地遗漏种族问题，以及围绕2025年纳入种族问题的争论。在收集这些数据的国家，Pierre D. Dindi和Nancy Stiegler注意到在社会政治和文化压力之后，心理学对自我报告个人身份的影响。它们还显示了人口统计学对医学心理学的积极影响，特别是通过人口普查。
{"title":"Compter les personnes pour connaître les populations","authors":"Pierre D. Dindi , Nancy Stiegler , Jean-Pierre Bouchard","doi":"10.1016/j.amp.2025.09.005","DOIUrl":"10.1016/j.amp.2025.09.005","url":null,"abstract":"<div><div>Between 2015 and 2024, over 97% of the world's population was counted using population censuses–universally accepted methodical tools that demographers use to enumerate people. Since their mid-19th century adoption, global census standards have been progressively refined to guide the collection of demographic and non-demographic data. By investigating the relationships within and between these two groups of variables, in this interview with Jean-Pierre Bouchard, Pierre D. Dindi and Nancy Stiegler demonstrate the crucial role of demography and its contribution to a diverse number of disciplines including psychology. While countries are not required to adopt all United Nations-recommended census topics, they explore the constructive omission of ethnicity from official French statistics and the polemic around their inclusion in 2025. In countries where such data are collected, Pierre D. Dindi and Nancy Stiegler note the influence of psychology on the self-reporting of personal identity in the wake of socio-political and cultural pressure. They also show the positive impact of demography to medical psychology, particularly through population censuses.</div></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":"184 1","pages":"Pages 60-71"},"PeriodicalIF":0.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.amp.2024.01.006
Nicolas F. Brard
In 1881, the Société Médico-Psychologique admitted Dr Nadine Skwortzoff to its ranks as a foreign associate member. It was the first time a woman had been admitted to the learned society, which was delighted. This article explores the little-known career of this neurologist, whose work on aphasia was nevertheless recognized by her peers. Not only did Skwortzoff compile a body of clinical observations that was unique for its time, but her work also helped to make the work of Adolf Kussmaul and Carl Wernicke known in France.
{"title":"Nadine Skwortzoff (1852–1938), première admise à la Société Médico-Psychologique et pionnière de l’étude de l’aphasie","authors":"Nicolas F. Brard","doi":"10.1016/j.amp.2024.01.006","DOIUrl":"10.1016/j.amp.2024.01.006","url":null,"abstract":"<div><div>In 1881, the <em>Société Médico-Psychologique</em> admitted Dr Nadine Skwortzoff to its ranks as a foreign associate member. It was the first time a woman had been admitted to the learned society, which was delighted. This article explores the little-known career of this neurologist, whose work on aphasia was nevertheless recognized by her peers. Not only did Skwortzoff compile a body of clinical observations that was unique for its time, but her work also helped to make the work of Adolf Kussmaul and Carl Wernicke known in France.</div></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":"183 10","pages":"Pages 1009-1012"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139639166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.amp.2025.06.006
Samuel Couilliet , Gaël Galliot , Susana Tereno
<div><h3>Background</h3><div>Post-traumatic stress disorder (PTSD), characterized by its complex symptoms arising from the interaction between an individual, a traumatic event and a particular context, represents a major public health challenge. It leads to a wide range of symptoms that profoundly affect psychological, emotional, and relational functioning. Through the work of John Bowlby and Mary Ainsworth, attachment theory provides a valuable lens for understanding the impact of traumatic events on interpersonal relationships and attachment patterns.</div></div><div><h3>Objective</h3><div>This article explores how attachment styles influence the onset or worsening of post-traumatic symptoms, and how the relational dynamics inherent to the disorder affect the therapeutic alliance, through the lens of attachment theory.</div></div><div><h3>Method</h3><div>This literature review is based on research from developmental psychopathology, focusing on attachment, PTSD, and the therapeutic alliance. Sources were selected for their clinical and theoretical relevance, including reference books and specialized articles.</div></div><div><h3>Results</h3><div>PTSD can be understood as a disorganization of attachment internal working models, resulting from the simultaneous and prolonged activation of both the alarm and attachment systems. This disorganization disrupts representations of the self and others, leading to an alternation between hyperactivation and inhibition of attachment-related behaviors. Preoccupied, dismissing, and fearful attachment styles, are associated with more severe post-traumatic symptoms. The literature highlights that intense, prolonged, or interpersonal trauma, can exacerbate attachment insecurity or even disrupt a previously secure attachment style. Furthermore, chronic PTSD may itself modify attachment patterns over time. A person with a secure attachment style may develop insecurity after a traumatic experience, while someone already insecure may see their negative internal representations of self and others be reinforced. These findings support the hypothesis that the clinical manifestations of PTSD reflect, at least in part, a breakdown in attachment patterns and emotional regulation mechanisms.</div></div><div><h3>Discussion and conclusion</h3><div>An attachment therapeutic approach offers valuable insight into the relational impasses that may arise during PTSD treatment. These difficulties are particularly significant in patients with previous insecure or disorganized attachment styles, for whom relational trust and help-seeking behaviors may be impaired. The therapeutic relationship, as an attachment-relevant situation, becomes a key space for restoring emotional regulation and providing corrective relational experiences. Focusing on relational dynamics contributes to building a working alliance that functions as a secure base around which the therapeutic process can be structured. This alliance supports emotional regulatio
{"title":"Les enjeux relationnels dans la prise en charge du trouble de stress post-traumatique : un éclairage par la théorie de l’attachement","authors":"Samuel Couilliet , Gaël Galliot , Susana Tereno","doi":"10.1016/j.amp.2025.06.006","DOIUrl":"10.1016/j.amp.2025.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Post-traumatic stress disorder (PTSD), characterized by its complex symptoms arising from the interaction between an individual, a traumatic event and a particular context, represents a major public health challenge. It leads to a wide range of symptoms that profoundly affect psychological, emotional, and relational functioning. Through the work of John Bowlby and Mary Ainsworth, attachment theory provides a valuable lens for understanding the impact of traumatic events on interpersonal relationships and attachment patterns.</div></div><div><h3>Objective</h3><div>This article explores how attachment styles influence the onset or worsening of post-traumatic symptoms, and how the relational dynamics inherent to the disorder affect the therapeutic alliance, through the lens of attachment theory.</div></div><div><h3>Method</h3><div>This literature review is based on research from developmental psychopathology, focusing on attachment, PTSD, and the therapeutic alliance. Sources were selected for their clinical and theoretical relevance, including reference books and specialized articles.</div></div><div><h3>Results</h3><div>PTSD can be understood as a disorganization of attachment internal working models, resulting from the simultaneous and prolonged activation of both the alarm and attachment systems. This disorganization disrupts representations of the self and others, leading to an alternation between hyperactivation and inhibition of attachment-related behaviors. Preoccupied, dismissing, and fearful attachment styles, are associated with more severe post-traumatic symptoms. The literature highlights that intense, prolonged, or interpersonal trauma, can exacerbate attachment insecurity or even disrupt a previously secure attachment style. Furthermore, chronic PTSD may itself modify attachment patterns over time. A person with a secure attachment style may develop insecurity after a traumatic experience, while someone already insecure may see their negative internal representations of self and others be reinforced. These findings support the hypothesis that the clinical manifestations of PTSD reflect, at least in part, a breakdown in attachment patterns and emotional regulation mechanisms.</div></div><div><h3>Discussion and conclusion</h3><div>An attachment therapeutic approach offers valuable insight into the relational impasses that may arise during PTSD treatment. These difficulties are particularly significant in patients with previous insecure or disorganized attachment styles, for whom relational trust and help-seeking behaviors may be impaired. The therapeutic relationship, as an attachment-relevant situation, becomes a key space for restoring emotional regulation and providing corrective relational experiences. Focusing on relational dynamics contributes to building a working alliance that functions as a secure base around which the therapeutic process can be structured. This alliance supports emotional regulatio","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":"183 10","pages":"Pages 981-987"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145711707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.amp.2025.03.016
Julie Francols , Magali Ravit
<div><div>Despite the prohibition that condemns it, incest spans centuries and generations. Literature abounds with writings denouncing it and yet, incest remains and is perpetuated, often in silence and family and social secrecy. Incest has the power to be forgotten, to disappear from the collective consciousness as well as to escape the consciousness of the subject himself. It is this “disappearance” that we are talking about in this article, this strange “forgetting” – which is not really one – which questions as much as it divides. The scientific community speaks of “traumatic amnesia” or “dissociative amnesia”, defined in the DSM-5 as “an inability to remember certain potentially traumatic experiences, in their entirety or partially, and for a certain duration ranging from a few days to several years” – this incapacity cannot be attributed to taking toxic substances, head trauma, or a neurological disorder. Our research aims to define the different clinical criteria underlying traumatic amnesia occurring in the context of incestuous abuse. Several studies conducted since the late 1980s have highlighted the high rate of traumatic amnesia among victims of childhood sexual trauma. It also appears that victims of incest are systematically overrepresented among those who have suffered from traumatic amnesia. Some of them have reported a form of complete traumatic amnesia, others a partial form, and still others have never suffered from traumatic amnesia in their lives. Therefore, we will not attempt to fuel the decades-old debate between proponents of the “false memory” theory and defenders of the amnesia mechanism. We will draw on the reality of encounters, testimonies, and the real and subjective suffering of victims who have suffered from complete traumatic amnesia and/or who still suffer from partial traumatic amnesia. We will draw on the testimony of 400 victims of incest, men and women, aged 18 to 72, who agreed to participate in our national epidemiological study, carried out between November 2022 and March 2023. Our objective was to identify potential factors associated with the presence of traumatic amnesia in contexts of incestuous abuse. Our methodology is based on the administration of a very detailed questionnaire (around a hundred questions) distributed to several associations providing assistance to victims of incest as well as to numerous clinical psychologists. These partners were able to offer their patients or members to contribute to our research. The survey was followed by a series of individual clinical interviews with 30 volunteers, chosen randomly from among the survey respondents. We were thus able to highlight the influence of three determining factors in the manifestation of symptoms of traumatic amnesia in incestuous contexts: (1) the uniqueness of the link with the perpetrator of the abuse, (2) the age of the victims at the beginning of the abuse and (3) the nature of the incestuous acts. This article attempts to link
{"title":"L’amnésie traumatique dans les situations d’abus incestueux. Étude épidémiologique et clinique","authors":"Julie Francols , Magali Ravit","doi":"10.1016/j.amp.2025.03.016","DOIUrl":"10.1016/j.amp.2025.03.016","url":null,"abstract":"<div><div>Despite the prohibition that condemns it, incest spans centuries and generations. Literature abounds with writings denouncing it and yet, incest remains and is perpetuated, often in silence and family and social secrecy. Incest has the power to be forgotten, to disappear from the collective consciousness as well as to escape the consciousness of the subject himself. It is this “disappearance” that we are talking about in this article, this strange “forgetting” – which is not really one – which questions as much as it divides. The scientific community speaks of “traumatic amnesia” or “dissociative amnesia”, defined in the DSM-5 as “an inability to remember certain potentially traumatic experiences, in their entirety or partially, and for a certain duration ranging from a few days to several years” – this incapacity cannot be attributed to taking toxic substances, head trauma, or a neurological disorder. Our research aims to define the different clinical criteria underlying traumatic amnesia occurring in the context of incestuous abuse. Several studies conducted since the late 1980s have highlighted the high rate of traumatic amnesia among victims of childhood sexual trauma. It also appears that victims of incest are systematically overrepresented among those who have suffered from traumatic amnesia. Some of them have reported a form of complete traumatic amnesia, others a partial form, and still others have never suffered from traumatic amnesia in their lives. Therefore, we will not attempt to fuel the decades-old debate between proponents of the “false memory” theory and defenders of the amnesia mechanism. We will draw on the reality of encounters, testimonies, and the real and subjective suffering of victims who have suffered from complete traumatic amnesia and/or who still suffer from partial traumatic amnesia. We will draw on the testimony of 400 victims of incest, men and women, aged 18 to 72, who agreed to participate in our national epidemiological study, carried out between November 2022 and March 2023. Our objective was to identify potential factors associated with the presence of traumatic amnesia in contexts of incestuous abuse. Our methodology is based on the administration of a very detailed questionnaire (around a hundred questions) distributed to several associations providing assistance to victims of incest as well as to numerous clinical psychologists. These partners were able to offer their patients or members to contribute to our research. The survey was followed by a series of individual clinical interviews with 30 volunteers, chosen randomly from among the survey respondents. We were thus able to highlight the influence of three determining factors in the manifestation of symptoms of traumatic amnesia in incestuous contexts: (1) the uniqueness of the link with the perpetrator of the abuse, (2) the age of the victims at the beginning of the abuse and (3) the nature of the incestuous acts. This article attempts to link","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":"183 10","pages":"Pages 973-980"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.amp.2025.09.010
Sébastien Gardelle , Nathalie Duriez
Introduction
This review focuses on the role of aggression in family relationships during the course of neurodegenerative diseases. Several questions arise: (1) Should aggression be considered as an isolated symptom? (2) Was the quality of the caregiver/care recipient relationship already impaired before the onset of the disease? (3) Who provides help within the family, and what are the inherent risks in terms of each family member's positioning? (4) Is it possible to help a loved one without significant external social support?
Methods
To answer these questions, we conducted a literature review from 1990 to 2023 using the PubMed, PsycINFO, and Cairn databases. The results presented follow the PRISMA method. We focused on the concept of caregiver burden and the psycho-behavioral expression of neurodegenerative diseases.
Results
Overall, we identified three categories of research: those focusing on a holistic vision, seeking broad unifying concepts; those focusing on a subdomain vision, searching for the smallest common set; and those focusing on an interactional vision, taking into account the complexity of the relationship. Regardless of the chosen approach, all studies concluded that the relationship deteriorates. The proposed solutions aim to improve the medical management of the care recipient's symptoms and to educate caregivers on adapted communication methodologies.
Discussion
Studies tend to overlook the harmful effects of changes in family roles. A specific approach in family therapy, known as floating objects, could help reframe communication between the caregiver and the care recipient according to the family context in which the neurodegenerative disease arises.
{"title":"When aggression (re)structures the relationship bonds between caregiver and care receiver in neurodegenerative diseases: A systematic review","authors":"Sébastien Gardelle , Nathalie Duriez","doi":"10.1016/j.amp.2025.09.010","DOIUrl":"10.1016/j.amp.2025.09.010","url":null,"abstract":"<div><h3>Introduction</h3><div>This review focuses on the role of aggression in family relationships during the course of neurodegenerative diseases. Several questions arise: (1) Should aggression be considered as an isolated symptom? (2) Was the quality of the caregiver/care recipient relationship already impaired before the onset of the disease? (3) Who provides help within the family, and what are the inherent risks in terms of each family member's positioning? (4) Is it possible to help a loved one without significant external social support?</div></div><div><h3>Methods</h3><div>To answer these questions, we conducted a literature review from 1990 to 2023 using the PubMed, PsycINFO, and Cairn databases. The results presented follow the PRISMA method. We focused on the concept of caregiver burden and the psycho-behavioral expression of neurodegenerative diseases.</div></div><div><h3>Results</h3><div>Overall, we identified three categories of research: those focusing on a holistic vision, seeking broad unifying concepts; those focusing on a subdomain vision, searching for the smallest common set; and those focusing on an interactional vision, taking into account the complexity of the relationship. Regardless of the chosen approach, all studies concluded that the relationship deteriorates. The proposed solutions aim to improve the medical management of the care recipient's symptoms and to educate caregivers on adapted communication methodologies.</div></div><div><h3>Discussion</h3><div>Studies tend to overlook the harmful effects of changes in family roles. A specific approach in family therapy, known as floating objects, could help reframe communication between the caregiver and the care recipient according to the family context in which the neurodegenerative disease arises.</div></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":"183 10","pages":"Pages 992-1002"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.amp.2024.11.016
François Louboff
<div><h3>Background</h3><div>Dissociative Identity Disorder (DID) appeared in version IV of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994, and in version 11 of the International Classification of Diseases (ICD) in 2022. It was called “Multiple Personality Disorder” in their previous versions. DID is characterized by the presence of two or more distinct personality states within the same person, each with its own patterns of thought, behavior and ways of perceiving the world. These states alternate recurrently, resulting in gaps in the continuity of the person's memory, consciousness and identity. Despite this international recognition, more than half of psychiatrists still doubt its reality (survey conducted at the Congrès de l’Encéphale in 2023). The phantasmatic model of DID (hypnotizable, suggestible, malingerers) is still favored over the traumatic model (DID is a severe form of post-traumatic stress disorder linked to early severe abuse).</div></div><div><h3>Aim</h3><div>To enable better recognition of DID and more appropriate management of patients, more scientifically grounded arguments are needed.</div></div><div><h3>Material</h3><div>This article brings together the findings of several structural, functional and connectivity neuroimaging studies conducted with female patients with DID, post-traumatic stress disorder (PTSD) and healthy controls between 2014 and 2022, using either structural MRI, functional MRI or positron emission tomography.</div></div><div><h3>Results</h3><div>Patients with DID can be differentiated from healthy controls on the basis of structural and functional brain abnormalities. <u>Structural abnormalities</u> (Blihar et al., Chalavi et al. and Chalavi et al.): smaller cortical and subcortical volumes in the hippocampus, amygdala, parietal and frontal structures; larger white matter tracts responsible for communication between somatosensory association areas, basal ganglia and precuneus; greater striatal volume in patients with DID than in those with PTSD; much smaller volume of left inferior parietal cortex in DID patients than in PTSD patients and controls; greater reduction in hippocampal volume in DID patients than in PTSD patients and controls; abnormal shape, in both DID and PTSD patients, in different areas of the hippocampus, i.e. CA1, CA2, CA3, CA4, dentate gyrus, and subiculum; the use of probabilistic pattern recognition shows that the brain phenotype can distinguish DID patients from healthy controls with a sensitivity of 72% and a specificity of 74% (Reinders, Marquand et al.). The hypothesis that DID is a severe form of PTSD (indeed, it's virtually impossible to find a DID patient without a history of PTSD) is thus confirmed by the neuro-structural abnormalities common to both disorders, and sometimes quantitatively greater in DID than in PTSD, compared with healthy controls. <u>Functional abnormalities</u>: Lanius and his team have identified functional features that distingu
分离性身份认同障碍（DID）于1994年出现在《精神疾病诊断与统计手册》（DSM）第四版，并于2022年出现在《国际疾病分类》（ICD）第11版。在之前的版本中，它被称为“多重人格障碍”。DID的特点是在同一个人身上存在两种或两种以上截然不同的人格状态，每种人格状态都有自己的思维模式、行为模式和感知世界的方式。这些状态反复交替，导致人的记忆、意识和身份的连续性出现空白。尽管得到了国际上的认可，但超过一半的精神科医生仍然怀疑它的真实性（2023年在congrcons de l’encsamphale进行的调查）。DID（可催眠、易受暗示、装病）的幻觉模型仍然比创伤模型更受青睐（DID是一种严重的创伤后应激障碍，与早期严重虐待有关）。目的为了更好地识别DID和更适当地管理患者，需要更多有科学依据的论点。本文汇集了2014年至2022年间对患有DID、创伤后应激障碍（PTSD）和健康对照的女性患者进行的几项结构、功能和连通性神经成像研究的结果，这些研究使用了结构MRI、功能MRI或正电子发射断层扫描。结果DID患者可根据脑结构和功能异常与健康对照进行区分。结构异常（Blihar etal ., Chalavi etal .和Chalavi etal .）：海马、杏仁核、顶叶和额叶结构的皮质和皮质下体积较小；更大的白质束负责体感觉关联区、基底神经节和楔前叶之间的交流；DID患者纹状体体积大于PTSD患者；DID患者左侧顶叶下皮质体积明显小于PTSD患者和对照组；与PTSD患者和对照组相比，DID患者海马体积减少幅度更大；DID和PTSD患者海马不同区域CA1、CA2、CA3、CA4、齿状回和耻骨下形状异常；概率模式识别的使用表明，大脑表型可以将DID患者与健康对照区分开来，灵敏度为72%，特异性为74% （Reinders， Marquand等）。DID是创伤后应激障碍的一种严重形式的假设（事实上，几乎不可能找到没有创伤后应激障碍病史的DID患者）因此被两种疾病共同的神经结构异常所证实，并且与健康对照组相比，DID患者有时在数量上比PTSD患者更严重。功能异常：Lanius和他的团队已经确定了区分两种形式创伤后应激障碍的功能特征：单纯性或兴奋性创伤后应激障碍（重温创伤经历，侵入性症状，闪回，心动过速，暗示情绪调节不足）：内侧前额叶皮层和前扣带皮层活动减少，杏仁核激活增加。因此，前额叶边缘区域的抑制减少；分离性创伤后应激障碍（情绪脱离，现实感丧失和人格解体的症状，无心动过速，暗示情绪过度调节）：内侧和外侧前额叶皮层、前扣带皮层、内侧和下额叶皮层以及上部和内侧颞叶皮层的活动增加。因此，杏仁核活动的减少反映了前额叶边缘区域抑制的增加。2014年的一项研究（Reinders, Willemsen et al.）比较了患有DID的女性和模拟DID的女性在阅读中性和创伤性剧本时的脑区域血流量，发现DID的神经激活的身份状态依赖模式与Lanius神经生物学模型中发现的兴奋性和分离性PTSD两种亚型的神经激活模式相同：当DID患者处于中性身份状态时，创伤脚本产生低激活，即情绪过度调节（明显正常部分）；当DID患者处于创伤相关身份（情感部分）状态时，同样的创伤脚本会产生过度激活，即情绪调节不足。因此，DID患者至少具有两种不同的身份状态，涉及不同的主观反应，心血管反应和大脑激活模式，以创伤相关的记忆场景。这些身份状态被称为情绪状态、改变或分离状态。每个身份都有自己的感知、反应和思维模式，并呈现出DID控制无法复制的不同心理生物学特征。 模拟DID的健康女性对照组无法模拟中性和创伤相关身份的心理生物学特征。其他研究已经探索了女性DID患者的工作记忆，并将其与试图模拟DID的健康对照进行了比较，并表明（Vissia等人）：DID患者参与工作记忆的前额叶-顶叶网络的激活在中性身份状态下比在创伤相关身份状态下更大；DID模拟器无法模拟DID个体与工作记忆相关的神经激活模式。连接异常：在DID患者中发现的中央执行、突出和默认模式网络内部和之间的连接异常强化了这些发现。中央执行网络主要管理认知过程，如推理、注意力、计划、执行和记忆。突出性网络允许从中央执行网络过渡到默认网络，反之亦然。它使情感能够在来自内部环境的信息的基础上被感知。至于默认网络，当我们放任自己的思想，而不与环境互动时，它就会被激活。除此之外，它使我们能够记住过去的事件并模拟未来的事件。2022年的一项研究（Lebois等人）观察了65名患有分离性创伤后应激障碍或分离性身份障碍的女性，与26名既没有创伤后应激障碍也没有任何精神病史的健康对照组进行了比较。本研究表明，分离性身份障碍的特征是这三个网络内的超连通性，执行网络和默认网络之间的超连通性，以及执行网络和突出网络之间的低连通性。结论神经影像学研究清楚地证实了DID的存在。为了提高对这种复杂疾病的诊断和治疗，DID的创伤模型必须优于幻觉模型。
{"title":"Les recherches en neuro-imagerie structurelle et fonctionnelle confirment l’existence du trouble dissociatif de l’identité","authors":"François Louboff","doi":"10.1016/j.amp.2024.11.016","DOIUrl":"10.1016/j.amp.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div>Dissociative Identity Disorder (DID) appeared in version IV of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994, and in version 11 of the International Classification of Diseases (ICD) in 2022. It was called “Multiple Personality Disorder” in their previous versions. DID is characterized by the presence of two or more distinct personality states within the same person, each with its own patterns of thought, behavior and ways of perceiving the world. These states alternate recurrently, resulting in gaps in the continuity of the person's memory, consciousness and identity. Despite this international recognition, more than half of psychiatrists still doubt its reality (survey conducted at the Congrès de l’Encéphale in 2023). The phantasmatic model of DID (hypnotizable, suggestible, malingerers) is still favored over the traumatic model (DID is a severe form of post-traumatic stress disorder linked to early severe abuse).</div></div><div><h3>Aim</h3><div>To enable better recognition of DID and more appropriate management of patients, more scientifically grounded arguments are needed.</div></div><div><h3>Material</h3><div>This article brings together the findings of several structural, functional and connectivity neuroimaging studies conducted with female patients with DID, post-traumatic stress disorder (PTSD) and healthy controls between 2014 and 2022, using either structural MRI, functional MRI or positron emission tomography.</div></div><div><h3>Results</h3><div>Patients with DID can be differentiated from healthy controls on the basis of structural and functional brain abnormalities. <u>Structural abnormalities</u> (Blihar et al., Chalavi et al. and Chalavi et al.): smaller cortical and subcortical volumes in the hippocampus, amygdala, parietal and frontal structures; larger white matter tracts responsible for communication between somatosensory association areas, basal ganglia and precuneus; greater striatal volume in patients with DID than in those with PTSD; much smaller volume of left inferior parietal cortex in DID patients than in PTSD patients and controls; greater reduction in hippocampal volume in DID patients than in PTSD patients and controls; abnormal shape, in both DID and PTSD patients, in different areas of the hippocampus, i.e. CA1, CA2, CA3, CA4, dentate gyrus, and subiculum; the use of probabilistic pattern recognition shows that the brain phenotype can distinguish DID patients from healthy controls with a sensitivity of 72% and a specificity of 74% (Reinders, Marquand et al.). The hypothesis that DID is a severe form of PTSD (indeed, it's virtually impossible to find a DID patient without a history of PTSD) is thus confirmed by the neuro-structural abnormalities common to both disorders, and sometimes quantitatively greater in DID than in PTSD, compared with healthy controls. <u>Functional abnormalities</u>: Lanius and his team have identified functional features that distingu","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":"183 10","pages":"Pages 957-966"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.amp.2025.07.003
Julia Salomé, Marian Desouche, Gilles Thomas
Post-Traumatic Stress Disorders (PTSD) induce a rupture in the existential trajectory of those affected, not only in their psychic structure but also their temporal experience and social identity. One of the core challenges in therapeutic care lies in restoring a sense of continuity between the pre- and post-traumatic self. In this context, the trauma narrative plays a crucial role: it serves as a unifying agent that allows the subject to symbolically re-inscribe the traumatic event within the thread of personal experience. The act of narrating becomes a vector of subjectivation, helping the individual regain coherence and psychic integrity. However, this same narrative assumes a different function in expert contexts, particularly in medico-legal or institutional settings such as the military. Here, the narrative is not primarily valued for its subjective or therapeutic effects, but rather as a form of judicial evidence. It is mobilized within legal and administrative frameworks to establish causality and imputability, especially when the trauma is belatedly disclosed, initially unnoticed, or reported long after the triggering events. In such contexts, the narrative is expected to conform to criteria of consistency, plausibility, and traceability — requirements that may be at odds with the fragmented, defensive, or elliptical nature of traumatic memory. This tension may hinder recognition or subsequent support, especially in cases where psychic disorganization impairs the ability to produce a coherent account. This article aims to examine the dialectical tension between these two uses of the trauma narrative: as a clinical tool in the process of psychic reorganization, and as an expert document within medico-legal proceedings. By articulating these opposing logics, we strive to highlight the ethical, clinical, and epistemological challenges posed by the dual status of the trauma narrative, particularly in military psychiatry, where subjects often oscillate between the need for care and the quest for recognition. We illustrate our argument through a clinical case that allows us to explore these different issues. Our discussion raises broader questions about the place of subjective truth within institutional care systems, the temporality of trauma and recognition, and the risk of epistemic injustice when clinical singularity is reduced to documentary validity. Ultimately, this reflection calls for a rethinking of the interface between care and expertise, and for renewed attention to the narrative as both a site of suffering and a potential path toward reintegration.
{"title":"Le récit et la preuve : traumatisme psychique en milieu militaire","authors":"Julia Salomé, Marian Desouche, Gilles Thomas","doi":"10.1016/j.amp.2025.07.003","DOIUrl":"10.1016/j.amp.2025.07.003","url":null,"abstract":"<div><div>Post-Traumatic Stress Disorders (PTSD) induce a rupture in the existential trajectory of those affected, not only in their psychic structure but also their temporal experience and social identity. One of the core challenges in therapeutic care lies in restoring a sense of continuity between the pre- and post-traumatic self. In this context, the trauma narrative plays a crucial role: it serves as a unifying agent that allows the subject to symbolically re-inscribe the traumatic event within the thread of personal experience. The act of narrating becomes a vector of subjectivation, helping the individual regain coherence and psychic integrity. However, this same narrative assumes a different function in expert contexts, particularly in medico-legal or institutional settings such as the military. Here, the narrative is not primarily valued for its subjective or therapeutic effects, but rather as a form of judicial evidence. It is mobilized within legal and administrative frameworks to establish causality and imputability, especially when the trauma is belatedly disclosed, initially unnoticed, or reported long after the triggering events. In such contexts, the narrative is expected to conform to criteria of consistency, plausibility, and traceability — requirements that may be at odds with the fragmented, defensive, or elliptical nature of traumatic memory. This tension may hinder recognition or subsequent support, especially in cases where psychic disorganization impairs the ability to produce a coherent account. This article aims to examine the dialectical tension between these two uses of the trauma narrative: as a clinical tool in the process of psychic reorganization, and as an expert document within medico-legal proceedings. By articulating these opposing logics, we strive to highlight the ethical, clinical, and epistemological challenges posed by the dual status of the trauma narrative, particularly in military psychiatry, where subjects often oscillate between the need for care and the quest for recognition. We illustrate our argument through a clinical case that allows us to explore these different issues. Our discussion raises broader questions about the place of subjective truth within institutional care systems, the temporality of trauma and recognition, and the risk of epistemic injustice when clinical singularity is reduced to documentary validity. Ultimately, this reflection calls for a rethinking of the interface between care and expertise, and for renewed attention to the narrative as both a site of suffering and a potential path toward reintegration.</div></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":"183 10","pages":"Pages 988-991"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.amp.2024.04.008
Jean-Pierre Luauté , Harrison G. Pope Jr.
In a recent interchange in the pages of this journal, Piedfort-Marin et al. (2021, 2022, 2023) and Dodier et al. (2022) have highlighted the ongoing controversies surrounding the diagnosis of dissociative identity disorder (DID) – controversies documented by a recent survey of French psychiatrists attending the 2023 annual meeting of l’Encephale. Does DID characteristically arise as a response to early traumatic experiences such as childhood sexual abuse? Can individuals develop amnesia for these traumatic events via the mechanism of “repressed memory/dissociative amnesia,” presumably as a protective mechanism to cope with such experiences? Does the development of “alters,” who themselves report full or partial amnesia for one another, represent a further manifestation of this post-traumatic process? Or, as others claim, is DID often a product of suggestive influences, be they therapeutic techniques or cultural influences? In this paper, we suggest that some insights into this controversy may be gained by following the history of DID over the last 50 years as it has been portrayed in novels, films, television series, and most recently on social media posts that have garnered billions of views. Turning next to the output of the scientific community, we also point to the dwindling acceptance of the theory of “repressed memory/dissociative amnesia” among scientists writing in the peer-reviewed literature. These reflections compel us to confront the challenging philosophical question of how to judge whether a psychiatric syndrome is “real.”
{"title":"Dissociative Identity Disorder: A Consequence of Trauma or of Social Contagion?","authors":"Jean-Pierre Luauté , Harrison G. Pope Jr.","doi":"10.1016/j.amp.2024.04.008","DOIUrl":"10.1016/j.amp.2024.04.008","url":null,"abstract":"<div><div>In a recent interchange in the pages of this journal, Piedfort-Marin et al. (2021, 2022, 2023) and Dodier et al. (2022) have highlighted the ongoing controversies surrounding the diagnosis of dissociative identity disorder (DID) – controversies documented by a recent survey of French psychiatrists attending the 2023 annual meeting of l’Encephale. Does DID characteristically arise as a response to early traumatic experiences such as childhood sexual abuse? Can individuals develop amnesia for these traumatic events via the mechanism of “repressed memory/dissociative amnesia,” presumably as a protective mechanism to cope with such experiences? Does the development of “alters,” who themselves report full or partial amnesia for one another, represent a further manifestation of this post-traumatic process? Or, as others claim, is DID often a product of suggestive influences, be they therapeutic techniques or cultural influences? In this paper, we suggest that some insights into this controversy may be gained by following the history of DID over the last 50 years as it has been portrayed in novels, films, television series, and most recently on social media posts that have garnered billions of views. Turning next to the output of the scientific community, we also point to the dwindling acceptance of the theory of “repressed memory/dissociative amnesia” among scientists writing in the peer-reviewed literature. These reflections compel us to confront the challenging philosophical question of how to judge whether a psychiatric syndrome is “real.”</div></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":"183 10","pages":"Pages 953-956"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.amp.2025.02.007
Laure Rougegrez , Justine Poissonnier , Pierre Valette , Frédérique Warembourg , François Ducrocq
On 13 October 2023, a terrorist broke into the grounds of the Gambetta school complex in Arras, killing a teacher and injuring three other people. Around 2000 people were present at the school, directly or indirectly exposed. The nature of the attack within the school, the rapid dissemination of videos, and the length of the uncertainty as to the persistence of the threat in a context of confinement resulted in a major traumatic event. The intervention of the medical-psychological emergency unit as soon as the first few hours of the event and until D + 7, it was necessary to take into account and adjust to the limited nature of the event within the specific characteristics of the adolescent population affected. This feedback is to present and question the system put in place to draw the lessons learned from this mobilisation.
{"title":"Retour d’expérience de l’intervention de la cellule d’urgence médicopsychologique suite à l’attentat du lycée Gambetta à Arras le 13 octobre 2023","authors":"Laure Rougegrez , Justine Poissonnier , Pierre Valette , Frédérique Warembourg , François Ducrocq","doi":"10.1016/j.amp.2025.02.007","DOIUrl":"10.1016/j.amp.2025.02.007","url":null,"abstract":"<div><div>On 13 October 2023, a terrorist broke into the grounds of the Gambetta school complex in Arras, killing a teacher and injuring three other people. Around 2000 people were present at the school, directly or indirectly exposed. The nature of the attack within the school, the rapid dissemination of videos, and the length of the uncertainty as to the persistence of the threat in a context of confinement resulted in a major traumatic event. The intervention of the medical-psychological emergency unit as soon as the first few hours of the event and until D<!--> <!-->+<!--> <!-->7, it was necessary to take into account and adjust to the limited nature of the event within the specific characteristics of the adolescent population affected. This feedback is to present and question the system put in place to draw the lessons learned from this mobilisation.</div></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":"183 10","pages":"Pages 967-972"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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