연구방법 14

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1 KISEP Original Articles Korean J Child & Adol Psychiatr 913~25 부모학대청소년의정신병리 * PSYCHOPATHOLOGY IN ADOLESCENTS WITH PARENT ABUSE 곽영숙 ** 방현숙 ** Young Sook Kwak, M.D., Ph.D.,** Hyun Soog Bang, M.D.** 요약 중심단어 서 론 Department of Child-Adolescent Psychiatry Seoul National Mental Hospital, Seoul Corresponding author 13

2 연구방법 14

3 1. 사회인구학적특징 연구결과 2. 정신병리 3. 가족배경 Table 1. 인구사회학적특징 Table 2. 진단 Table 3. 주증상 , Table 4. 부모학대가일어난상황 Table 5. 지능검사 <11명 > Table 6. 부모의부부관계

4 4. 발달력 5. 치료 6. 발달상정신병리에따른분류 어머니와공생적인관계에있는환자군 경계선인격장애군 품행장애군 어머니와공생적인관계에있는군 Table 7. 형제간관계 Table 8. 부모의성격 7, ,, 2, 2 Table 9. 양육태도 Table 10. 애착대상 Table 11. 어머니와의이별경험시기 Table 12. 발달상이상소견 , Table 13. 병전대인관계

5 증례 1: 17

6 증례 2: 18

7 경계선인격장애군 증례 3: 품행장애군 19

8 증례 4: 연구고찰 20

9 21

10 22

11 References 1) Narita Y(1995):family violence in Japan particularly childrens Violence against their parents, 동아시아문화정신의학회학술대회, 동경, 대한신경정신의학회 2) 홍강의 (1995): 패륜아사례분석, 패륜아예방과상담. 서울, 청소년대화의광장 3) 이시형 (1995): 어머니를구타한정신과환자. 대한신경정신의학회 34(2): ) 이시형 (1997): 청소년의부모폭행. 대한신경정신의학회추계학술대회, 서울, 대한신경정신의학회 5) 이시형 (1998): 효와패륜, 대한사회정신의학회춘계학술대회, 서울, 대한사회정신의학회 6) 최인섭, 김지선 (1996): 존속범죄의실태에관한연구. 한국형사정책연구원, pp147 7) 심재근 (1988): 가정내의폭력과공격성. 탐구당, pp ) 김광일 (1985): 구타당하는아내 50 례의정신의학적연구. 정신건강연구 3: ) Pizzey E(1974):Scream quietly or the neighbours will hear you. London, Penguin 10) Walker JE(1979):The battered women, New York, Harper and Row 11) Hilberman E(1980):The wife-beater s wife reconsidered. Am J Psychiatry 137: ) 김현우, 한성희, 김상태 (1995): 패륜의이해와그방지대책, 사랑의전화 / 대한사회정신의학회. 서울, 대한사회정신의학회 13) Henry T. Harbin, MD(1977):Episodic dyscontrol and family dynamics. Am J Psychiatry 134:10, October 14) 김혜숙 (1995): 패륜적행동의이해, 패륜의예방 과상담, 서울, 청소년대화의광장, pp ) Wei-Tsuen Soog, Ko-Ping Liu, M.S.(1995): 대만의가정내청소년부모폭력, 동아시아권의가정내청소년폭력관련국제심포지움. 서울, 삼성생명사회정신건강연구소 16) 이옥주, 김유숙, 김용태 (1996): 청소년가족치료. 서울, 청소년대화의광장 17) 김광일 (1988): 폭력과사회. 가정폭력-그실상과대책-. 서울, 탐구당, pp ) Bandura A(1986):Social foundations of thought and action:a social cognitive theory. NJ:Prentice- Hall 19) Kim H(1993):Beliefs about parent-adolescent role relationships and psychological adjustment, Doctoral Dissertation Stanford University 20) 연문희 (1995): 패륜적행위의원인과대책. 패륜의예방과상담, 서울청소년대화의광장, pp ) Margaret S. Mahler(1968):On human symbiosis and the vicissitudes of individuation, vol. 1:Infantile psychosis, New York:Int. Univ. Press 22) Spiegel L(1959):The self, the sense of self, and perception. The Psychoanalytic Study of the Child, 14: , New York:International Universities Press 23) Rose GJ(1964):Creative imagination in terms of ego core and boundaries. Int J Psycho-Anal 45: ) Elkisch P(1957):psychological significance of the mirror. J Amer PSA assn 5: ) Heide, Kathleen M(1992):Why Kids Kill Parents: Child and adolescent homicide, Thousand Oaks and London and New Delhi 26) Sydney Smith phd Topeka Kan(1965):The adolescent murderer:arch Gen Psychiatry Vol 13, Oct 27) Henry T, Harbin M.D. and Denis J, Madden Ph.D. (1979):Battered parents:a new syndrome. Am J Psychiatry 136:10, October 28) Stierlin H(1972):family dynamics and separation patterns of potential schizophrenics, in Rubenstein D, Alanen YO(eds):Proceedings of the IVth International Symposium on Psychotherapy of Schizophrenia, Amsterdam, Excerpta Medica, pp ) Stierlin H, Ravenscroft Jr K(1972):varieties of adolescent seperation conflicts. Br J Med Psychol 45: ) Dinkmeyer D and Mckay GD(1989):The parent s handbook:systematic training for effective parenting, MN:American Guidance Service 23

12 31) Abner Barcal MD, Miriam K. Rosenthal Ph D, Jerusalem, Israel(1974):fears and tyranny. Arch Gen Psychiatry Vol 30, March 32) Masterson J, Rinsley D(1975):The borderline syndrome:the role of the mother in the genesis and psychic structure of the borderline personality, Int. J Psychoanal 56: ) Kernberg O(1975):Borderline conditions and pathological Narcissism, New York:Jason Aronson 34) Klein M(1932):The psychoanalysis of children, London Hogarth 35) Easson WM and Steinhilber RM(1961):Murderous aggression by children and adolescents. Arch Gen Psychiatry 4:1-0(Jan) 36) Jacobson E(1954):Self and the object world, Psychoanal Stud Child 9:

13 ABSTRACT Korean J Child & Adol Psychiatr 913~25, 1998 PSYCHOPATHOLOGY IN ADOLESCENTS WITH PARENT ABUSE Young Sook Kwak, M.D., Ph.D., Hyun Soog Bang, M.D. Department of Child-Adolescent Psychiatry, Seoul National Mental Hospital AimWe think that the most important etiology in parent abuse is the psychodynamic and psychopathology in the family. So, we investigated the adolescents being admitted in SNMH, whose chief complaints were parent abuse. We were trying to explore families psychodynamic and psychopathology, especially mother-child interaction and to differentiate them in according to developmental psychopathology. MethodOur objects were the adolescent patients admitted in SNMH from 1987 to 1997 because they attacked parents verbally and physically. We examined 21 adolescents except those with psychosis, organic mental disorder, autism and mental retardation by means of interview or chart review. Result and ConclusionThe number of male patients was 14 and the number of female patients was 7. The most common diagnosis was conduct disorder and borderline personality disorder. The mean age was in the mid-teens. We observed 4 subgroups that were divided developmentally in object relation. 1 Symbiotic group with mother1 They did not separate and remain in symbiotic relationships with their mothers based on insecure attachment. Fathers were abscent emotionally and physically, and their mothers were prominent in close relationships with the patients in their family, where as the patients were the only man in the family. Adolescents entered the second separation-individuation. They expressed anger and internal tension involved with the close attachment with their mothers and also attempted separation from their mothers through physically attacking them. 2 These patients had suffered from physical illness and developmental delay since birth. Therefore the parents overprotected their children. The children had persistent infantile omnipotence and fantasies of power, so they could not deal with unrealistic states, adapt to reality, and depended on their parents overtly. They easily acted out unless their demands were fulfilled. 2 Borderline personality disorderwe observed deficiencies in care taking. Their parents had personality problems and immaturity. They coulden t help their children to be separated in the rapproachment phase. Their conflict about dependence-independence was revived in the second separation-individuation adolescent period. We understand parent abuse as an attempt to overcome the conflict. 3 Conduct disorderthey did not build up basic attachment with their parents. They think of their parents as only a means of fulfilling their needs. When patients need were not fulfilled and remained in a conflicted state, they attacked their parents, unable to control their aggressions and impulses. KEY WORDSParent abuse Symbiotic relationship with mother Father s absence emotionally and physically The second separation-individuation period. 25

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