Background: Guilt and shame regulate basic human processes such as social cognition and relations. Both emotions are also involved in the aetiology and maintenance of trauma-related mental disorders such as posttraumatic stress disorder (PTSD). However, a concise scale that adequately captures these constructs is currently lacking, impeding research efforts to understand them more thoroughly.Objective: To this end, we developed the eight-item Guilt and Shame Questionnaire (GSQ-8) in English, German, and Dutch.Method: We examined the reliability and validity of the GSQ-8 in a clinical sample of adults seeking treatment for childhood-trauma-related posttraumatic stress disorder (n = 209), a sample of adults who had suffered at least one traumatic life event reporting different levels of PTSD symptoms (n = 556), and a non-clinical sample of adults (n = 156).Results: Theory-driven confirmatory factor analyses confirmed two correlated latent factors guilt and shame with four items for each factor. Across all samples, two-factor models yielded better model fit than one-factor solutions. Measurement invariance across the three samples, gender, and Dutch and German language was mostly established. Guilt and shame composite scores were associated with PTSD symptoms, depressive symptoms, life satisfaction, mental health-related quality of life, and self-blame, thus supporting scale validity. Importantly, both subscales predicted PTSD symptoms, depression, life satisfaction, and mental health-related quality of life over and above cognitions of self-blame.Conclusions: The GSQ-8 is a parsimonious, reliable, and valid tool to assess guilt and shame in clinical, sub-clinical, and non-clinical populations, allowing applications across a broad range of research questions.
We present the 8-item Guilt and Shame Questionnaire (GSQ-8), a parsimonious tool to assess guilt and shame.We found strong psychometric properties of the GSQ-8 across three samples and different languages.The GSQ-8 can be reliably used to assess shame and guilt in clinical and non-clinical work.

Background: Maladaptive trauma appraisal plays an important role in the development and maintenance of posttraumatic stress disorder (PTSD). While studies have demonstrated the effectiveness of exposure and cognitive treatments for PTSD symptomatology, the effect of such treatments on specific trauma appraisals is still not well understood.Objective: The study investigated the effect of an exposure and a cognitive restructuring internet-based treatment on specific trauma appraisals in Arabic-speaking participants with PTSD.Method: 334 participants received either an exposure (n = 167) or a cognitive restructuring (n = 167) internet-based treatment. PTSD symptom severity (PCL-5) and specific trauma appraisals (TAQ) were assessed at pre- and post-treatment. Changes in specific trauma appraisals within and between the two treatments were analyzed using multi-group change modelling. Associations between changes in PTSD symptom severity and changes in trauma appraisals were evaluated using Pearson product-moment correlation. For both treatments, participants with versus without reliable improvement were compared regarding changes in specific trauma appraisals using Welch tests. Analyses were performed on 100 multiple imputed datasets.Results: Both treatments yielded significant changes in shame, self-blame, fear, anger, and alienation (all ps < .001). Changes in betrayal were only significant in the cognitive restructuring treatment (p < .001). There was no evidence of differences between treatments for any specific trauma appraisal. Changes in PTSD symptom severity were significantly associated with changes in trauma appraisals (all ps < .001). In both treatments, participants who experienced reliable improvement in PTSD symptom severity showed significantly larger pre- to post-treatment changes in specific trauma appraisals compared to those without reliable improvement. Again, differences in betrayal were only significant in the cognitive restructuring treatment.Conclusions: The findings indicate that both treatments are effective in reducing trauma appraisals in Arabic-speaking people with PTSD. Changes in trauma appraisal seem to be associated with changes in PTSD symptomatology.Trial registration: German Clinical Trials Register identifier: DRKS00010245.
Exposure and cognitive restructuring treatment in Arabic-speaking individuals with PTSD yield significant changes in shame, self-blame, fear, anger, and alienation.Changes in PTSD symptoms are positively associated with changes in specific trauma appraisals.There is no evidence of differences between both treatments for any specific trauma appraisal.

Background: Victims of physical/sexual violence or sexual abuse commonly experience defense responses that result in feelings of guilt and shame. Although trauma-focused interventions are effective in treating post-traumatic stress disorder symptoms, the presence of trauma-related shame and guilt can potentially hinder the process of disclosure during treatment, thus diminishing their overall effectiveness. It is hypothesized that providing psychoeducation about common defense responses will reduce feelings of shame and guilt, thereby increasing receptivity to trauma-focused treatment.Objective: This paper describes the rationale, study design, and methods of the BLAME-LESS study. The effects of a brief online psychoeducation program will be compared with a waiting-list control group. The intervention aims to reduce feelings of trauma-related shame and guilt that adolescents experience regarding their own defense responses during and after physical/sexual violence or sexual abuse.Methods: Adolescents (12 - 18 years old) with a history of physical/sexual violence or sexual abuse who suffer from trauma-related feelings of shame and guilt can participate in the study. The study follows a two-arm RCT that includes 34 participants. The primary outcomes includes trauma-related feelings of shame and guilt. The secondary outcomes includes PTSD symptoms, anxiety and depression symptoms, traumatic cognitions, readiness to disclose details of memories of the trauma, and motivation to engage in trauma-focused therapy. Assessments take place after screening, at baseline, two weeks after allocation to the intervention or waiting-list, and, only for the waiting-list participants, seven weeks after allocation to the intervention.Conclusions: There is a need for treatment approaches that target trauma-related feelings of shame and guilt. A recently developed brief online psychoeducation program on defense responses during and after trauma offers victims of physical/sexual violence or sexual abuse a free and accessible way to obtain reliable and valid information. The proposed RCT will evaluate the effectiveness of this online psychoeducation program.Trial Registration: Request is pending.
Some defense responses to physical/sexual violence or sexual abuse, such as tonic immobility and appeasement behaviour, are common but unknown and raise feelings of shame and guilt.BLAME-LESS (In Dutch: On(t)schuldig) is a newly developed online psychoeducation programme that aims to reduce feelings of trauma-related shame and guilt. This programme includes explanatory animations, in-depth interviews with experts and victims, and written information accompanied by case reports.The proposed study examines the effectiveness of the brief online psychoeducation programme BLAME-LESS in a well-controlled study.

Background: Guilt and Shame, two core self-related emotions, often emerge following trauma and play an important role in the development and maintenance of post-traumatic stress disorder (PTSD). Importantly, Guilt and Shame exhibit specific focal and non-specific global impacts of trauma on self-perception, respectively.Objective and Methods: Integrating psychological theories with neuroscientific knowledge, we suggest a scheme of two diverging clinical phenotypes of PTSD, associated with distinct self-related processes and differential functionality of relevant neural networks.Proposal: The Guilt-driven phenotype is characterized by preoccupation with negative self-attributes of one\'s actions in the traumatic event. It involves altered functionality of both the salience network (SN) and the default-mode network (DMN), associated with heightened interoceptive signalling and ruminative introspection which may lead to hyperarousal and intrusive symptoms, respectively. On the contrary, the Shame-driven phenotype is characterized by global, identity-related negative self-attributions. It involves altered functionality of both the SN and the DMN, associated with blunted interoceptive signalling and diminished introspection which may result in withdrawal and anhedonia symptoms together with dissociative experiences, respectively.Conclusion: The proposed PTSD phenotypes may inform neuropsychological therapeutic interventions (e.g. self-focused psychotherapy and neuromodulation) aiming to restore the function of large-scale self-related neural processing.
Guilt and Shame are two self-related emotions that often emerge following traumatic events and may contribute to the clinical profile of post-traumatic stress disorder (PTSD).Our framework suggests Guilt and Sham driven phenotypes of post-traumatic psychopathology, associated with two self-processing deficiencies related to specific action or global identity, respectively.The proposed phenotypes may inform neuropsychological treatments aiming to restore dysfunctional neural networks, later to be evident in alleviating Guilt and Shame and improving clinical outcomes.

Moral injury is an emerging concept that captures the psychosocial consequences of involvement in and exposure to morally transgressive events. In the past decade, research on moral injury has grown exponentially. In this special collection we review papers on moral injury published in the European Journal of Psychotraumatology from its inception until December 2022, that have a primary focus on moral injury as evidenced by the words \'moral injury\' in the title or abstract. We included 19 papers on quantitative (n = 9) and qualitative (n = 5) studies of different populations including (former) military personnel (n = 9), healthcare workers (n = 4) and refugees (n = 2). Most papers (n = 15) focused on the occurrence of potentially morally injurious experiences (PMIEs), moral injury and associated factors, while four papers primarily concerned treatment. Together, the papers offer a fascinating overview of aspects of moral injury in different populations. Research is clearly widening from military personnel to other populations such as healthcare workers and refugees. Focal points included the impact of PMIEs involving children, the association of PMIEs and personal childhood victimisation, the prevalence of betrayal trauma, and the relationship between moral injury and empathy. As for treatment, points of interest included new treatment initiatives as well as findings that PMIE exposure does not impede help-seeking behaviour and response to PTSD treatment. We further discuss the wide range of phenomena that fall under moral injury definitions, the limited diversity of the moral injury literature, and the clinical utility of the moral injury construct. From conceptualisation to clinical utility and treatment, the concept of moral injury matures. Whether or not moral injury becomes a formal diagnosis, the need to examine tailored interventions to alleviate moral injury is clear.
Moral injury is increasingly studied outside military populations, such as in healthcare workers and refugees.Among the most impactful potentially morally injurious experiences (PMIEs) are those involving children, but betrayal trauma may be the most prevalent type of PMIE.There is a need for tailored, evidence-based interventions to alleviate moral injury.

OBJECTIVE: The experience of family caregivers after nursing home admission has received much less attention, probably because many caregivers experience an initial sense of initial emotional relief. However, for some caregivers nursing home admission is a stressor despite the reduced physical burden of caregiving. Caregiver distress following institutionalization has been related to the new burdens and challenges encountered in the nursing home. Ambivalence and guilt related to the institutionalization decision have been identified as sources of stress. Therefore, this study examined the effect of guilt and well-being on the perceived stress of family caregivers of institutionalized dependent persons.
METHODS: Two hundred and one family caregivers of institutionalized persons in a nursing home (La Rioja, Spain) participated. Perceived stress, caregiving guilt and subjective well-being, sociodemographic and caregiving-related variables were assessed. Linear regression analyses and correlations between variables were performed.
RESULTS: Guilt and five dimensions of well-being (anxiety, vitality, self-control and depression, except general health) significantly predicted stress (R2adj=.552 (F (6, 198)=41.71, P<.001)). The effect size was large (95% CI=.461).
CONCLUSIONS: Paying attention to family caregivers\' feelings of guilt during institutionalization is important. This will enable the design and implementation of psychosocial interventions that improve caregiver adjustment immediately after institutionalization.

The ego-dystonic experience refers to the negative assessment that the subject makes of some of their thoughts or emotions, in the context of a conserved state of consciousness, as well as other aspects of their social and intrapersonal life that are relatively intact. Ego-dystonia is a widely used construct, but one that has not been defined in reasonably operational terms. Perhaps this explains why it is no longer used in contemporary classifications of mental disorders such as the ICD-11 and DSM-5. It is related to the awareness of the mental illness, with feelings of guilt and shame, but intuitively we perceive relevant differences between all these experiences. Psychoanalytic theory conceives the ego-dystonic as an alteration in the early structuring of the ego. Cognitive psychology conceives it as a dysfunction of the corrective mechanisms that harmonise the cognitive and the metacognitive. Evolutionary theory has not addressed the issue directly, but through the analysis of guilt, to which it attributes a high adaptive value, since it limits aggression and promotes reparative behaviours. Given the importance of the concept of self-attunement, it is surprising how little theoretical and empirical research there is on the subject, the clarification of which could represent a considerable advance in the field of mental health.

This paper explores some features of the theoretical and clinical problem of narcissism in the light of Bion\'s model of the mind, with particular reference to the distinction between narcissism and \'social-ism\'. This model is compared and contrasted to Jung\'s speculations on the relationship between adaptation and individuation as a process implying a sense of guilt. Jung\'s highlighting of the element of guilt is directly connected to his subjective experience depicted in the Red Book in the episode of the \'Murder of the hero\'. Aspects of pathological narcissism are also explored in the paper, through briefly analysing some passages of Pasolini\'s movie Salò or the 120 days of Sodom.
Cet article étudie quelques caractéristiques du problème théorique et clinique du narcissisme, à la lumière du modèle de l’esprit de Bion, en faisant particulièrement référence à la distinction entre narcissisme et ‘social-isme’. Ce modèle est comparé et mis en contraste avec les spéculations de Jung concernant la relation entre adaptation et individuation, en tant que processus impliquant un sentiment de culpabilité. L’accent que met Jung sur l’élément de culpabilité est directement relié à son expérience subjective décrite dans le Livre Rouge dans l’épisode du « Meurtre du héros». L’article explore également des aspects du narcissisme pathologique, en analysant brièvement des passages du film de Pasolini « Salo, ou les 120 journées de Sodome ».
Dieser Artikel untersucht einige Merkmale des theoretischen und klinischen Problems des Narzißmus im Licht von Bions Modell des Geistes, mit besonderem Bezug auf die Unterscheidung zwischen Narzißmus und \'Sozialismus\'. Dieses Modell wird mit Jungs Spekulationen über die Beziehung zwischen Anpassung und Individuation als einem Prozeß, der ein Schuldgefühl impliziert, verglichen und kontrastiert. Jungs Hervorhebung des Elementes der Schuld steht in direktem Zusammenhang mit seiner subjektiven Erfahrung, die im Roten Buch in der Episode \'Heldenmord\' dargestellt ist. Auch werden Aspekte des pathologischen Narzißmus in der Arbeit untersucht, indem einige Passagen von Pasolinis Film Salò oder die 120 Tage von Sodom kurz analysiert werden.
Questo articolo esplora alcune caratteristiche del problema teorico e clinico del narcisismo alla luce del modello della mente di Bion, con riferimenti particolari alla distinzione tra narcisismo e ‘social-ismo’. Questo modello viene confrontato e contrapposto alle speculazioni di Jung sulla relazione tra adattamento e individuazione come un processo che implica un senso di colpa. La valorizzazione dell’elemento di colpa da parte di Jung è direttamente collegata alla sua esperienza soggettiva descritta nel Libro Rosso nell’episodio dell’Uccisione dell’Eroe. Nell’articolo vengono inoltre esplorati aspetti di narcisismo patologico, tramite una breve analisi di alcuni passaggi del film di Pasolini, Salò o le 120 giornate di Sodoma.
В данной статье рассматриваются некоторые аспекты теоретической и клинической проблемы нарциссизма в свете модели психики Биона, при этом особое внимание уделяется различиям между нарциссизмом и «социал-измом». Данная модель сравнивается и противопоставляется рассуждениям Юнга о связи между адаптацией и индивидуацией как процессом, подразумевающим чувство вины. Акцент Юнга на элементе вины напрямую связан с его субъективным опытом, запечатленным в Красной книге в эпизоде «Убийство героя». В статье также рассматрены аспекты патологического нарциссизма на примере краткого анализа ряда эпизодов из фильма Пазолини «Сало, или 120 дней Содома».
El presente trabajo explora algunos rasgos del problema teórico y clínico del narcisismo a la luz del modelo de la mente de Bion, con particular referencia a la distinción entre narcisismo y ‘social-ismo’. Este modelo es comparado y contrastado con la especulación de Jung sobre la relación entre adaptación e individuación como un proceso que implica un sentimiento de culpa. La acentuación de Jung del elemento de culpa está directamente conectada con su experiencia subjetiva ilustrada en el Libro Rojo, en el episodio de la ‘Muerte del héroe’. Se exploran también aspectos del narcisismo patológico, a través de un breve análisis de algunos pasajes de la película de Pasolini: Saló o los 120 días de Sodoma.
关于法西斯精神状态的题外话。关于自恋和“社会化主义”的精神分析观点。 本文根据比昂的心智模型探讨了自恋的理论和临床问题的一些特征, 特别提到了自恋和“社会化主义”之间的区别。文章把模型与荣格关于适应和自性化之间关系的推测进行了比较和对比, 并把这当作是一种隐含了负罪感的过程。荣格对内疚元素的重视, 与他在《红书》“英雄的谋杀”一集中所描绘的主观体验有直接的联系。本文简要分析了帕索里尼的电影《萨罗》或《所多玛的 120 天》中的一些段落, 用以探讨病理性自恋的各个方面。.
Este artigo explora algumas características do problema teórico e clínico do narcisismo à luz do modelo mental de Bion, com particular referência à distinção entre narcisismo e \"socialismo\". Esse modelo é comparado e contrastado com as especulações de Jung sobre a relação entre adaptação e individuação como um processo que implica um sentimento de culpa. O destaque de Jung sobre o elemento de culpa está diretamente ligado à sua experiência subjetiva descrita no Livro Vermelho no episódio do \'Assassinato do herói\'. Aspectos do narcisismo patológico também são explorados no artigo, analisando brevemente algumas passagens do filme Salò de Pasolini ou os 120 dias de Sodoma.

This paper explores the healthy narcissism related to self-expression and looks at how this is frequently pathologized and split-off, with problematic consequences for the individual and for culture. This is explored through Yeats\' poem, \'The Second Coming\', as are other personal, cultural and clinical manifestations, with a split evident between those who advocate self-denial and those who are \'full of passionate intensity\' and seen as narcissistic. The paper argues that the process of individuation requires us to embrace a multiplicity of self-states, and thus a broadening of ego-identifications, including states of vulnerability, self-denial, self-centredness, murderousness and power, in contrast to the unworkable unitary identifications of previous eras, where such states were projected onto scapegoat groups in, for example, racism. The neurobiological underpinnings of the core self are outlined which, the paper argues, help us better understand and accept the broad range of narcissistic phenomena. Embracing guilt, out of care and concern as described by Loewald (1979), and thus addressing states of both passive and active blindness to the other, allows us to put a \'human head on the lion\'s body\', described in Yeats\' poem. Some clinical manifestations and dynamics are also outlined.
Cet article explore le bon narcissisme, qui est en lien avec l’expression de soi. L’article observe comment cela est fréquemment considéré comme pathologique et clivé, avec des conséquences problématiques pour l’individu et la culture. Ceci est examiné à travers le poème de Yeats « La Seconde Venue », comme le sont d’autres manifestations personnelles, culturelles et cliniques, avec un clivage évident entre ceux qui se font l’avocat du déni de soi et ceux qui sont « plein d’intensité passionnée » et considérés comme narcissiques. L’article soutient que le processus d’individuation nous demande d’englober une multiplicité d’états de soi, et ainsi un élargissement d’identifications du moi, qui incluent des états de vulnérabilité, de déni de soi, de centration sur soi, de puissance et d’envie de meurtre, en contraste avec les identifications d’époques précédentes, unitaires et impraticables. Dans ces époques précédentes de tels états furent projetés sur des groupes pris comme boucs émissaires, par exemple dans le racisme. Les fondations neurobiologiques du noyau du soi sont exposées dans les grandes lignes afin, comme le soutient l’article, de nous aider à mieux comprendre et à accepter le vaste panorama des phénomènes narcissiques. Accepter pleinement la culpabilité, motivée par le soin et la sollicitude - tels qu’ils sont décrits par Loewald (1979) - et ainsi s’occuper d’états passifs et actifs d’aveuglement à l’autre, nous permet de mettre « une tête humaine sur un corps de lion » comme Yeats le décrit dans son poème. Quelques manifestations et dynamiques cliniques sont également soulignées.
Dieser Beitrag untersucht den gesunden Narzißmus im Zusammenhang mit der Selbstdarstellung und untersucht, wie dieser häufig pathologisiert und abgespalten wird, mit problematischen Folgen für das Individuum und die Kultur. Dies wird durch Yeats’ Gedicht \'The Second Coming\' [deutsch: \'Das zweite Kommen\'] ebenso wie andere persönliche, kulturelle und klinische Manifestationen untersucht, wobei eine Spaltung offensichtlich wird zwischen denen, die Selbstverleugnung befürworten, und denen, die \'voller leidenschaftlicher Intensität\' sind und als narzißtisch angesehen werden. Im Text wird argumentiert, daß der Prozeß der Individuation von uns verlangt, eine Vielzahl von Selbstzuständen zu akzeptieren und damit auch eine Erweiterung der Ich-Identifikationen, einschließlich Zustände der Verletzlichkeit, Selbstverleugnung, Selbstbezogenheit, Mörderhaftigkeit und Macht, im Gegensatz zu den nicht praktizierbaren einheitlichen Identifikationen früherer Epochen, in denen solche Zustände auf Sündenbockgruppen projiziert wurden, beispielsweise im Rassismus. Die neurobiologischen Grundlagen des Kern-Selbst werden skizziert, die uns, so der Beitrag, helfen, das breite Spektrum narzißtischer Phänomene besser zu verstehen und zu akzeptieren. Die Annahme von Schuldgefühlen aus Sorge und Besorgnis, wie von Loewald (1979) beschrieben, und damit sowohl passive als auch aktive Blindheit gegenüber dem anderen anzusprechen ermöglicht es uns, einen \'menschlichen Kopf auf den Körper des Löwen\' zu setzen, wie in Yeats’ Gedicht beschrieben. Einige klinische Manifestationen und Dynamiken werden ebenfalls skizziert.
Questo articolo esplora il narcisismo sano legato all’espressione di sé e osserva come questo sia frequentemente patologizzato e scisso, con conseguenze problematiche per l’individuo e per la cultura. Questo viene esplorato tramite il poema di Yeats, ‘La Seconda Venuta’, così come altre manifestazioni personali, culturali e cliniche, con una scissione evidente tra coloro che sostengono l’abnegazione e coloro che sono ‘pieni di intensità appassionata’ e vengono visti come narcisisti. L’articolo sostiene che il processo di individuazione ci richiede di accogliere una molteplicità di stati del Sé, e quindi un ampliamento delle identificazioni dell’Io, inclusi stati di vulnerabilità, abnegazione, egocentrismo, impulso omicida e potere, in contrasto con le identificazioni unitarie impraticabili di epoche precedenti, in cui tali stati sono stati proiettati su gruppi di capri espiatori attraverso, ad esempio, il razzismo. Sono delineati i fondamenti neurobiologici del nucleo del Sé che, sostiene l’articolo, ci aiutano a comprendere e accettare meglio l’ampia gamma di fenomeni narcisistici. Accogliere la colpa, per cura e preoccupazione come descritto da Leowald (1979), e quindi affrontando gli stati di cecità attiva e passiva all’altro, ci permette di mettere una ‘testa umana sul corpo del leone’, come descritto nel poema di Yeats. Sono inoltre delineate alcune manifestazioni e dinamiche cliniche.
В этой статье исследуется здоровый нарциссизм, связанный с самовыражением, и рассматривается, как он часто патологизируется и отщепляется, что приводит к проблемным последствиям для человека и культуры. Приводится стихотворение Йетса «Второе пришествие», а также другие личные, культурные и клинические проявления, в которых очевиден расколом между теми, кто выступает за самоотрицание, и теми, кто «полон страстной силы» и считается нарциссическим. В статье утверждается, что процесс индивидуации требует от нас охвата множества состояний самости и, таким образом, расширения эго-идентификаций, включая состояния уязвимости, самоотречения, эгоцентризма, убийства и власти, в отличие от неработоспособных унитарных идентификаций предыдущих эпох, когда такие состояния проецировались на группы козлов отпущения, например, в расизме. Обозначены нейробиологические основы ядерного «я», которые, как утверждается в статье, помогают нам лучше понять и принять широкий спектр нарциссических явлений. Принятие вины из-за заботы и беспокойства, как описано Лёвальдом (1979), и, таким образом, обращение к состояниям как пассивной, так и активной слепоты по отношению к другому, позволяет нам положить «человеческую голову на тело льва», описанное в стихотворении Йетса. Также обозначены некоторые клинические проявления и динамика.
El presente trabajo explora el narcisismo saludable con relación a la autoexpresión, y examina cómo esto es frecuentemente patologizado y disociado, con consecuencias problemáticas para el individuo y la cultura. A través del poema de Yeats ‘The Second Coming’, se explora este tema junto a las manifestaciones personales, culturales y clínicas, con una disociación evidente entre quienes son partidarios de la auto negación, y quienes están ‘llenos de una intensidad apasionada’ y son vistos como narcisistas. El trabajo argumenta que el proceso de individuación requiere que aceptemos la multiplicidad de estados del self, ampliando así las identificaciones del ego, incluyendo estados de: vulnerabilidad, autonegación, auto-centración, sentimientos homicidas, y poder, en contraste con las identificaciones unitarias inviables de eras previas, en las que estos estados eran proyectados en grupos chivos expiatorios, por ejemplo, el racismo. Se describen las bases neurobiológicas del self nuclear, las cuales nos ayudan a comprender mejor y a aceptar un amplio espectro de fenómenos narcisistas. Abrazar la culpa, desde el cuidado y el interés, como lo describe Loewald (1979), y así dar cuenta de los estados de ceguera activa y pasiva hacia el otro, nos permite colocar ‘una cabeza humana en el cuerpo del león’, descripto en el poema de Yeats. También se delinean algunas manifestaciones y dinámicas clínicas.
健康的自恋和自性化--临床、文化和政治表现 本文探讨了与自我表达相关的健康自恋, 探讨了这种关联如何时常被病态化和分裂, 并对个人和文化造成困难的后果。文章通过一些例子来探索, 提倡自我否定和“充满激情张力”并被视为自恋之间的分裂的例证。这些例子是叶芝 (Yeat)的诗“第二次来临”, 以及其它个人的、文化的和临床上的呈现的例证。这篇论文认为, 自性化的过程要求我们接受多种自我状态, 从而扩大自我认同的范围, 包括脆弱的状态、自我否定、自我中心、凶残和权力的状态, 与此相对照的是那些过往使用的, 不可行的单一化的身份认同, 其中前述这些状态被投射到各种替罪羊群体上, 例如种族主义。文章概述了核心自我的神经生物学基础, 认为, 这有助于我们更好地理解和接受更广泛的自恋现象。正如 Loewald (1979) 所描述的那样, 出于关心和关注而拥抱内疚, 从而处理对他者的被动和主动失明的状态, 使我们能够如叶芝的诗中有所描述的“把人头放在狮子的身体上”。文章还概述了一些临床表现和动力。.
Este artigo explora o narcisismo saudável relacionado à autoexpressão e analisa como isso é frequentemente patologizado e dividido, com consequências problemáticas para o indivíduo e para a cultura. Explorado no poema de Yeats, \'A Segunda Vinda\', assim como em outras manifestações pessoais, culturais e clínicas, com uma divisão evidente entre aqueles que defendem a abnegação e aqueles que são \"cheios de intensidade apaixonada\" e vistos como narcísicos. O artigo argumenta que o processo de individuação exige que abracemos uma multiplicidade de autoestados e, portanto, uma ampliação das identificações do ego, incluindo estados de vulnerabilidade, abnegação, egocentrismo, assassinato e poder, em contraste com as identificações unitárias impraticáveis de eras anteriores, onde tais estados foram projetados em grupos de bodes expiatórios, por exemplo, no racismo. Os fundamentos neurobiológicos do eu central são delineados, argumenta o artigo, o que nos ajuda a entender e aceitar melhor a ampla gama de fenômenos narcísicos. Abraçar a culpa, por cuidado e preocupação, conforme descrito por Loewald (1979), e assim abordar estados de cegueira passiva e ativa para o outro, nos permite colocar uma \"cabeça humana no corpo do leão\", descrita no poema de Yeats. Algumas manifestações clínicas e dinâmicas também são descritas.

The objective was to develop the Interpersonal Triggers of Guilt in Dementia Caregiving Questionnaire (ITGDCQ). An emotion frequently experienced by caregivers is guilt. However, the studies analyzing potential factors that generate guilt are scarce. Guilt may be generated through interpersonal interactions. A total of 201 dementia caregivers were evaluated for frequency of leisure, guilt, anxiety, depression, and a pool of items measuring the frequency, and guilt was derived from different behaviors performed by the care recipient (ITGDCQ-CR) and other relatives (ITGDCQ-OR). Exploratory factor analysis of the ITGDCQ-CR showed a two-factor solution, explaining 56.24% of the variance. The ITGDCQ-OR subscale also showed two factors, explaining 63.24% of the variance. All the factors had acceptable to good reliability indexes. Positive associations were found between both subscales and depression, anxiety, guilt, and stress associated with CR\'s behavioral problems. ITGDCQ-CR was negatively correlated with frequency of leisure. The interpersonal dynamics assessed with the ITGDCQ generated other emotions such as anger or sadness. Through structural equation modeling, 28% of the variance of caregivers\' distress was explained by the assessed variables, including a significant contribution of the interpersonal dynamics assessed with the ITGDCQ. The results provide preliminary support for the use of the ITGDCQ as a valid and reliable measure of care recipients\' or other relatives\' factors that trigger or facilitate the experience of guilt in the caregivers. The association between these factors and caregiver distress suggests potential clinical implications for the findings.
UNASSIGNED: El objetivo fue desarrollar el Cuestionario sobre los Desencadenantes Interpersonales de Culpa en el Cuidado de Personas con Demencia (Interpersonal Triggers of Guilt in Dementia Caregiving Questionnaire, ITGDCQ). INTRODUCCIÓN: Una emoción que generalmente sienten los cuidadores es culpa. Sin embargo, son escasos los estudios que analizan los posibles factores que la generan. La culpa puede generarse mediante las interacciones interpersonales. MÉTODOS: Se evaluó la frecuencia del ocio, la culpa, la ansiedad y la depresión de un total de 201 cuidadores de personas con demencia y se obtuvo un conjunto de ítems que miden la frecuencia y la culpa a partir de diferentes conductas adoptadas por el receptor del cuidado (ITGDCQ-CR) y otros familiares (ITGDCQ-OR).
UNASSIGNED: El análisis factorial confirmatorio del ITGDCQ-CR mostró una solución de dos factores, lo cual explicó un 56.24 % de la varianza. La subescala de los ITGDCQ-OR también indicó dos factores, lo cual explica el 63.24 % de la varianza. Todos los factores tuvieron índices de fiabilidad entre aceptables y buenos. Se encontraron asociaciones positivas entre ambas subescalas y la depresión, la ansiedad, la culpa y el estrés asociados con los problemas conductuales del receptor del cuidado. El ITGDCQ-CR correlacionó negativamente con la frecuencia del esparcimiento. La dinámica interpersonal evaluada con el ITGDCQ generó otras emociones, como ira o tristeza. Mediante los modelos de ecuaciones estructurales, las variables evaluadas explicaron el 28 % de la varianza del malestar de los cuidadores, incluida una contribución significativa de la dinámica interpersonal evaluada con el ITGDCQ. CONCLUSIÓN: Los resultados ofrecen un respaldo preliminar para el uso del ITGDCQ como medida válida y fiable de los factores de los receptores de cuidado o de otros familiares que desencadenan o facilitan la experiencia de culpa en los cuidadores. La asociación entre estos factores y el distrés de los cuidadores sugiere posibles implicancias clínicas de los resultados.
研究目的: 本研究旨在编制《痴呆症患者照料人内疚感的人际诱因调查表（ITGDCQ）。 背景: 照顾者时常会经历的一种情绪是内疚。然而，对产生内疚感的潜在因素进行分析的研究却很少。内疚感可能会在人际交往中产生。 研究方法: 对201名老年痴呆症患者的照料者进行了调查。主要针对他们的休息频率、内疚感、焦虑、抑郁进行评估，并从护理接受者（ITGDCQ-CR）和其他亲属（ITGDCQ-OR）的不同行为中得出测量频率和内疚感的项目题库。 研究发现: 对ITGDCQ-CR进行探索性因素分析，结果显示为双因素解，这解释了56.24%的方差。ITGDCQ-OR子量表也显示出两个因子，解释了63.24%的方差。各因素的信度指标均能接受或较好。两个子量表与CR的行为问题相关的抑郁、焦虑、内疚和压力之间均有正相关。ITGDCQ-CR与休息频率呈负相关。用ITGDCQ评估的人际动态产生了其他情绪，如愤怒或悲伤。通过结构方程建模，被评估变量解释了照料者痛苦方差的28%，包括ITGDCQ评估的人际动态的显著贡献。 结论: 研究结果为使用ITGDCQ来评估的人际动态提供了初步支持。研究表明ITGDCQ可以用作一种有效和可靠的测量方法，来测量接受护理的病人的或其他家属方面的因素，这些因素引发或者影响了照顾者的内疚感体验。这些因素与照顾者的痛苦之间的关联性表明这些调查结果可能具有临床意义。.