Affect theory and the neurobiology of affective dysregulation

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.

The emerging dialogue between psychoanalysis and neuroscience: neuroimaging perspectives

Current progress in the cognitive neurosciences is highly relevant to the development of psychoanalytic theory and practice. Neuroscience is today becoming mature enough to provide empirical biological approaches for the investigation of psychoanalytic models and observations. The current state of functional neuroimaging techniques is reviewed, selected paradigms and findings relevant to psychotherapy research are presented, and ways to pursue the dialogue between psychoanalysts and neuroscientists are discussed, as are some related obstacles and pitfalls. The emerging dialogue between psychoanalysts and neuroscientists may help not only to reestablish a solid position of psychodynamic theory and treatment in contemporary medicine, but also to bridge the division between "psychological" and "somatic" treatments, and gain important insights into the mind-brain relationship.