Objective: To explore adults' experiences of lower limb amputation, focusing on the changes in self-identity related to the impairment. Design: A cross-sectional and qualitative study, using semi-structured interviews. Interviews were transcribed, coded and analysed by two independent researchers. Setting: A rehabilitation medicine service from a general public hospital. Participants: A convenience sample of 42 patients with lower limb amputation performed after the age of 18 and followed up in the physical medicine and rehabilitation department of a general hospital. Main outcome measures: A semi-structured interview, addressing three core areas: the emotional impact of amputation; the adjustment process; and the relation with the external resources. Results: Eight themes emerged from interviews: reactions and feelings about becoming amputee; changes in own life; problems in well-being; relation with the prosthesis; self-perceptions; aims related to the rehabilitation and future plans; relation with the rehabilitation; and perceived social support. These results supported a theoretical model for the self-identity changes related to limb loss. Conclusions: The self-identity changes after a lower limb amputation appear beyond the patient's body image and functioning, affecting the patient's awareness of the impairment, biographical self and any future projections.

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This study explored the factors to which a sample of Portuguese war veterans attributed their recovery from posttraumatic stress disorder (PTSD). Participants were a sample of veterans (N = 60) with mental sequelae of the Portuguese Colonial War: 30 suffered from chronic PTSD (unrecovered) and 30 veterans with remission from PTSD (recovered). Two semistructured interviews were conducted. Analysis of the interviews was conducted using the Thematic and Categorical Analysis. Results showed that unrecovered participants reported higher postwar betrayal, appraisal of hostile societal homecoming, social stigmatization, lack of personal resources (mental fatigue and restriction of coping strategies), and reduced perceived social support. Recovered participants verbalized some capability for self-awareness of their own mental states and/or awareness of others' mental states (mentalization ability), a wider repertoire of coping strategies, and higher perceived social support. The authors discussed that recovery from PTSD among veterans can be related to the assimilation of moral injury by developing higher mentalization abilities.

This study analyzed the role of moral injury, self-awareness of mental states, self-integration of moral injury in personal schemas, and perceived social on the severity of Posttraumatic Stress Disorder (PTSD) and depression symptoms. The sample was composed of Portuguese war veterans (n ϭ 60) divided into 2 groups: 30 experienced chronic PTSD (nonrecovered) and 30 had remission from PTSD (recovered). A cross-sectional study was conducted using both qualitative and quantitative methods. Qualitative data were obtained through 2 interviews per participant, and the quantitative data were collected using the Impact of Event Scale-Revised and Brief Symptom Inventory. Content analysis was performed to analyze qualitative data. Multiple linear regression analyses were conducted predicting both PTSD and depression symptoms. Recovered participants showed higher frequencies on moral injury, high selfawareness of mental states, high self-integration of moral injury in personal schemas, and high perceived social support. Differences in moral injury (yes vs. no) showed no differences in both PTSD and depression symptoms. Participants who reported low self-awareness of mental states and self-integration of moral injury in personal schemas showed higher mean value for both PTSD and depression symptoms. Participants who reported low perceived social support showed higher mean value on depression symptoms. Self-integration of moral injury in personal schemas and self-awareness of mental states were predictors of both PTSD and depression symptoms. Combat exposure was a predictor of PTSD symptoms. The authors discuss the role of reconciliation of morally incongruent experiences in personal schemas and the ability to perceive and understand psychological states as key achievements in recovery from PTSD and depression symptoms among veterans.

Background: The Operationalized Psychodynamic Diagnosis (OPD-2) is internationally established as one of the major instruments available for clinical diagnosis and scientific research, being frequently used as an auxiliary tool in the selection of therapeutic interventions. Aims: 1) To describe the methodological aspects of the adaptation of the OPD-2 into Portuguese (Portugal and Brazil). 2) To assess inter-rater agreement for the different axes of the instrument when scoring clinical interviews. Method: The cross-cultural adaptation involved translation of the instrument by different independent translators, whose versions were compared in discussion groups in order to develop a final Portuguese version. In the presence of discrepancies regarding the translation of original concepts, the authors of the original instrument were contacted for clarification. Five interviews were used to assess inter-rater agreement. Each subject participated in two interviews, conducted by an experienced clinical psychologist. The interviews were recorded, transcribed and then analyzed by the principal investigator and by three independent examiners. Results: Axis IV (Structure) presented the highest inter-rater agreement (78%). Axes I (Experience of illness and prerequisites for treatment) and III (Conflict) showed the lowest inter-rater agreement results (66 and 57.7%, respectively). Conclusions: Our results point in the same direction as previous studies conducted in other countries. In our sample, the OPD-2 presented an acceptable inter-rater agreement; however, further studies are needed to assess the instrument's reliability.