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Uma abordagem psicodinâmica à endometriose : Vivência da doença e da dor física e vulnerabilidade ao sofrimento mental
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Abstract(s)
A Endometriose é uma doença crónica de foro ginecológico que afeta cerca de 10% das mulheres em idade fértil. Os sintomas mais frequentes são a dismenorreia, dispareunia, disúria, disquesia, infertilidade e dor pélvica crónica. A maioria dos estudos sobre o sofrimento psicológico na endometriose centra-se na identificação de depressão, ansiedade ou perda de qualidade de vida, muito frequentemente como consequência da dor. No entanto, têm sido realizados poucos estudos que visem a compreensão do sofrimento psicológico a partir de uma perspetiva psicodinâmica.
O presente trabalho assume um olhar psicodinâmico sobre o impacto psicológico da endometriose, pretendendo contribuir para uma compreensão do sofrimento psicológico das mulheres com esta doença a partir das suas experiências relacionais e de diferentes variáveis do seu funcionamento psicológico. Esta compreensão pode ter impacto na intervenção clínica, no sentido em que programas de intervenção futuros podem tentar promover nestas mulheres uma melhor adaptação à sua condição de saúde, levando em consideração a importância da subjetividade do seu mundo interno.
Foram desenvolvidos quatro estudos empíricos. O Estudo 1 abordou a relação entre a intensidade da dor física e a representação da dor como objeto interno malevolente, tendo-se concluído que esta relação é moderada por representações da infância marcadas por níveis baixos de afeto e segurança. A representação da dor como objeto interno malevolente relaciona-se, por sua vez, com sintomatologia depressiva.
O Estudo 2 focou-se na relação entre infertilidade e preocupações com as relações sexuais com a intrusão da doença, tendo-se também testado o efeito mediador da representação da dor como objeto interno malevolente nessas relações. Os resultados demonstraram que a representação da dor como objeto interno malevolente medeia totalmente a relação entre infertilidade e intrusão da doença, assim como entre preocupações com as relações sexuais e intrusão da doença.
O Estudo 3 procurou olhar para a relação entre vinculação e catastrofização da dor, tendo-se observado que existe uma relação entre vinculação ansiosa e catastrofização da dor, e que esta é mediada pela representação de suporte negativo por parte da principal figura cuidadora.
Finalmente, o Estudo 4 abordou a relação entre características anaclíticas e introjetivas de personalidade e sintomatologia depressiva e ansiosa, assim como o papel mediador da catastrofização da dor. Verificou-se que ambas as características de personalidade se relacionam com a sintomatologia depressiva e ansiosa e que a catastrofização da dor medeia parcialmente a relação entre ambas as características de personalidade e a sintomatologia ansiosa, mas não entre as características de personalidade e a sintomatologia depressiva.
Os resultados mostram a importância de se olhar, a partir de uma perspetiva psicodinâmica, para diferentes variáveis do funcionamento psicológico, como os traços de personalidade ou as representações precoces, na forma como as mulheres com endometriose lidam com a sua dor. Este olhar pode ter repercussões na intervenção psicológica com esta população, permitindo uma análise mais profunda do funcionamento mental das mulheres com esta doença crónica.
Endometriosis is a chronic gynecological disease that affects 10% of fertile women. Typical presenting features include dysmenorrhea, dyspareunia, dysuria, dyschezia, infertility, and chronic pelvic pain. Most studies on psychological distress in endometriosis have focused on the diagnosis of depression, anxiety and loss of quality of life oftentimes as a consequence from pain. However, in-depth investigations are still scarce, particularly those from a psychodynamic perspective. In order to gain understanding of psychological distress in endometriosis, we elaborated our investigation from a psychodynamic point of view. We believe this will improve our understanding of women’s emotional pain in light of their relational experiences and other psychological variables. This investigation could have an impact on clinical interventions, given its contributions to the importance of vulnerabilities that potentially hinder these women’s adaptation to this chronic illness. Four empirical studies were conducted. Study 1 focused on the relationship between physical pain intensity and pain representation as a malevolent object, having been found that this relationship is moderated by childhood representations with low levels of warmth and safeness. Pain representation as a malevolent object was also proven to be related to depressive symptoms. Study 2 focused on the relationship between illness intrusiveness and both infertility and sexual intercourse concerns, having tested as well the mediating effect of pain representation as a malevolent object on those relationships. Results demonstrated that pain representation as a malevolent object totally mediates the relationship between infertility and illness intrusiveness as well as that between sexual intercourse concerns and illness intrusiveness. Study 3 looked into the relationship between attachment and pain catastrophizing, and results confirmed that not only does attachment anxiety and pain catastrophizing relate, but also that the representation of negative primary caregiver support mediates this relationship. Study 4 studied the relationship between needy and self-critical personality traits and depression and anxiety, and the mediating role of pain catastrophizing. We verified that both personality characteristics are significantly associated with depression and anxiety, and also that pain catastrophizing partially mediates the relationship between both personality characteristics and anxiety, but not between personality characteristics and depression. Results draw attention to the importance of early relationships on emotional development, making it essential that intervention planning for endometriosis incorporates a deep analysis of mental functioning from psychodynamic theories.
Endometriosis is a chronic gynecological disease that affects 10% of fertile women. Typical presenting features include dysmenorrhea, dyspareunia, dysuria, dyschezia, infertility, and chronic pelvic pain. Most studies on psychological distress in endometriosis have focused on the diagnosis of depression, anxiety and loss of quality of life oftentimes as a consequence from pain. However, in-depth investigations are still scarce, particularly those from a psychodynamic perspective. In order to gain understanding of psychological distress in endometriosis, we elaborated our investigation from a psychodynamic point of view. We believe this will improve our understanding of women’s emotional pain in light of their relational experiences and other psychological variables. This investigation could have an impact on clinical interventions, given its contributions to the importance of vulnerabilities that potentially hinder these women’s adaptation to this chronic illness. Four empirical studies were conducted. Study 1 focused on the relationship between physical pain intensity and pain representation as a malevolent object, having been found that this relationship is moderated by childhood representations with low levels of warmth and safeness. Pain representation as a malevolent object was also proven to be related to depressive symptoms. Study 2 focused on the relationship between illness intrusiveness and both infertility and sexual intercourse concerns, having tested as well the mediating effect of pain representation as a malevolent object on those relationships. Results demonstrated that pain representation as a malevolent object totally mediates the relationship between infertility and illness intrusiveness as well as that between sexual intercourse concerns and illness intrusiveness. Study 3 looked into the relationship between attachment and pain catastrophizing, and results confirmed that not only does attachment anxiety and pain catastrophizing relate, but also that the representation of negative primary caregiver support mediates this relationship. Study 4 studied the relationship between needy and self-critical personality traits and depression and anxiety, and the mediating role of pain catastrophizing. We verified that both personality characteristics are significantly associated with depression and anxiety, and also that pain catastrophizing partially mediates the relationship between both personality characteristics and anxiety, but not between personality characteristics and depression. Results draw attention to the importance of early relationships on emotional development, making it essential that intervention planning for endometriosis incorporates a deep analysis of mental functioning from psychodynamic theories.
Description
Keywords
Endometriose Estilos de vinculação Representações precoces Personalidade Dor Depressão Ansiedade Endometriosis Attachment styles Early childhood representations Personality Pain Depression Anxiety