This thesis, holding firmly to the perspective of embodiment, which sees a monadic perspective of the ancient mind-body split as a priority, aims to suggest a common ground between psychoanalysis, and more generally dynamic psychology, and neuroscience. The nosographic entity under investigation is Depressive Personality Disorder, as defined by the second version of the Psychodynamic Diagnostic Manual (PDM-2; Lingiardi & McWilliams, 2017). The Depressive Personality picture, as distinct from clinical depression (Major Depression), is characterised by negative affectivity (melancholy, sadness, guilt and shame), excessive presence of self-punitiveness, fear of loss and abandonment, and peculiar defence mechanisms (such as introjection, turning against the self and, in combination, idealization of the other and devaluation of the self). Starting from a clinical-psychoanalytic view, through a systematic review, the points of connection with the underlying neurobiological mechanisms will be explored, in order to provide a holistic and integrated view of this personality disorder. During the course of the systematic review, which was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with an updated version in 2020 (Page, et al., 2021), it was decided to extend the scope of inclusion to include Persistent Depressive Disorder (or Dysthymia), due to the scarcity of studies investigating this personality disorder. The critical issues encountered show the contradictory, conflicting and fragmented nature of the nosographic taxonomy. This literature search was carried out using two major search engines, Scopus and PubMed. In these databases, the keywords referring to the two main thematic cores, such as 'Depressive Personality' and 'Dysthymic Disorder' OR 'Persistent Depressive Disorder', were entered, joined by the Boolean operator 'AND' (ergo, 'E') to the string 'Physiol*’ OR 'Brain' OR 'Neur*'. For the selection of studies, a broad time window from the year 2000 to the current year, 2023, was presented. Of the 8897 results obtained, only four articles (of which only one concerned Depressive Personality) met the eligibility criteria. Two more articles tracked down through manual search were added to the latter. Finally, careful reading of the articles examined revealed associations between alterations at a functional, rather than morphological, level and experimental groups (presenting Depressive Personality and/or Persistent Depressive Disorder). Overall, the present paper aims to propose a coherent and comprehensive view of the current state of the art of Depressive Personality Disorder.
Il presente elaborato di tesi, tenendo salda la prospettiva dell’embodiment che vede come prioritaria una prospettiva monadica dell’antica scissione mente-corpo, si propone di suggerire un terreno comune tra la psicoanalisi, e più in generale la psicologia dinamica, e le neuroscienze. L’entità nosografica oggetto di approfondimento è il Disturbo di Personalità Depressiva, per come definito dalla seconda versione del Manuale Diagnostico Psicodinamico (PDM-2; Lingiardi & McWilliams, 2017). Il quadro di Personalità Depressiva, distinto dalla depressione clinica (Depressione Maggiore), è caratterizzato da affettività negativa (malinconia, tristezza, senso di colpa e vergogna), eccessiva presenza di auto-punitività, paura della perdita e dell’abbandono, e peculiari meccanismi di difesa (come l’introiezione, il rivolgimento contro il Sé e, in combinazione, idealizzazione dell’altro e svalutazione del Sé). A partire da una visione clinico-psicoanalitica, attraverso una rassegna sistematica, si andranno ad esplorare i punti di raccordo con i meccanismi neurobiologici sottostanti, al fine di fornire una visione olistica ed integrata di questo disturbo di personalità. Durante lo svolgimento della rassegna sistematica, condotta secondo le linee PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) con versione aggiornata nel 2020 (Page, et al., 2021), è stato deciso di ampliare il raggio di inclusione anche al Disturbo Depressivo Persistente (o Distimia), a causa della scarsità di studi indaganti la Personalità in questione. Le criticità incontrate mostrano le contraddittorietà, conflittualità e frammentazioni che la tassonomia nosografica porta con sé. Questa ricerca bibliografica è stata realizzata utilizzando due importanti motori di ricerca, Scopus e PubMed. In questi database sono state inserite le parole chiave riferite ai due nuclei tematici principali, quali “Depressive Personality” e “Dysthymic Disorder” OR “Persistent Depressive Disorder”, unite dall’operatore booleano ‘AND’ (ergo, ‘E’) alla stringa ‘Physiol*’ OR ‘Brain’ OR ‘Neur*’. Per la selezione degli studi, è stata presentata un’ampia finestra temporale, che va dagli anni 2000 fino all’anno corrente, 2023. Dei 8897 risultati ricavati, solo quattro articoli (di cui solo uno riguardante la Personalità Depressiva) hanno soddisfatto i criteri di eleggibilità. A quest’ultimi sono stati aggiunti altri due articoli rintracciati attraverso ricerca manuale. Infine, dall’attenta lettura degli articoli presi in esame sono state riscontrate associazioni fra alterazioni a livello funzionale, piuttosto che morfologico, e gruppi sperimentali (presentanti Personalità Depressiva e/o Disturbo Depressivo Persistente). Complessivamente, il presente elaborato ha l’obiettivo di proporre una visione coerente e completa dell’attuale stato dell’arte del Disturbo di Personalità Depressiva.
PERSONALITA' DEPRESSIVA: STATO DELL’ARTE TRA DIAGNOSI CON PDM-2 E LETTERATURA SCIENTIFICA ATTUALE
MENICAGLI, GIULIA
2022/2023
Abstract
This thesis, holding firmly to the perspective of embodiment, which sees a monadic perspective of the ancient mind-body split as a priority, aims to suggest a common ground between psychoanalysis, and more generally dynamic psychology, and neuroscience. The nosographic entity under investigation is Depressive Personality Disorder, as defined by the second version of the Psychodynamic Diagnostic Manual (PDM-2; Lingiardi & McWilliams, 2017). The Depressive Personality picture, as distinct from clinical depression (Major Depression), is characterised by negative affectivity (melancholy, sadness, guilt and shame), excessive presence of self-punitiveness, fear of loss and abandonment, and peculiar defence mechanisms (such as introjection, turning against the self and, in combination, idealization of the other and devaluation of the self). Starting from a clinical-psychoanalytic view, through a systematic review, the points of connection with the underlying neurobiological mechanisms will be explored, in order to provide a holistic and integrated view of this personality disorder. During the course of the systematic review, which was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with an updated version in 2020 (Page, et al., 2021), it was decided to extend the scope of inclusion to include Persistent Depressive Disorder (or Dysthymia), due to the scarcity of studies investigating this personality disorder. The critical issues encountered show the contradictory, conflicting and fragmented nature of the nosographic taxonomy. This literature search was carried out using two major search engines, Scopus and PubMed. In these databases, the keywords referring to the two main thematic cores, such as 'Depressive Personality' and 'Dysthymic Disorder' OR 'Persistent Depressive Disorder', were entered, joined by the Boolean operator 'AND' (ergo, 'E') to the string 'Physiol*’ OR 'Brain' OR 'Neur*'. For the selection of studies, a broad time window from the year 2000 to the current year, 2023, was presented. Of the 8897 results obtained, only four articles (of which only one concerned Depressive Personality) met the eligibility criteria. Two more articles tracked down through manual search were added to the latter. Finally, careful reading of the articles examined revealed associations between alterations at a functional, rather than morphological, level and experimental groups (presenting Depressive Personality and/or Persistent Depressive Disorder). Overall, the present paper aims to propose a coherent and comprehensive view of the current state of the art of Depressive Personality Disorder.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/55303