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Fasolato R, De Felice M, Barbui C, Bertani M, Bonora F, Castellazzi M, Castelli S, Cristofalo D, Dall'Agnola RB, Ruggeri M, Signoretto B, Bonetto C. Early maladaptive schemas mediate the relationship between severe childhood trauma and eating disorder symptoms: evidence from an exploratory study. J Eat Disord 2024; 12:138. [PMID: 39261959 PMCID: PMC11389446 DOI: 10.1186/s40337-024-01103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 09/04/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Childhood trauma history has frequently been linked to eating disorders (EDs); nevertheless, the scientific literature calls for extending knowledge regarding mediators between EDs and childhood trauma. This study explored whether ED symptoms and early maladaptive schemas were more severe in ED patients with severe childhood trauma than in ED patients with no/mild childhood trauma and whether early maladaptive schemas mediated the relationship between childhood trauma and ED symptom severity. METHODS Data were extracted from the Regional Centre for Eating Disorders registry at the University Hospital of Verona. The extracted data included self-reported data, including the Eating Disorder Inventory-3 score, Young Schema Questionnaire score, Childhood Experience and Experience of Care and Abuse Questionnaire score, and sociodemographic and clinical information on the ED outpatients seeking care. A mediation analysis using the structural equation modeling procedure was conducted. RESULTS Forty-two outpatients, 31% of whom exhibited severe childhood trauma, satisfied the criteria for registry data extraction. The severity of ED symptoms, as well as the early maladaptive schemas' scores for emotional deprivation, defectiveness, failure, vulnerability, insufficient self-control, and negativity, were greater in ED outpatients with severe childhood trauma. Furthermore, early maladaptive schemas related to defectiveness, failure, and negativity had a mediating role in the relationship between severe childhood trauma and ED symptom severity. CONCLUSIONS This exploratory study provides preliminary evidence about the importance of early maladaptive schemas in the relationship between trauma history and ED psychopathology. In addition, ED symptoms may represent a dysfunctional attempt to avoid unpleasant emotions associated with schema activation. The results support the need to consider early maladaptive schemas in the treatment of traumatized patients with ED symptoms. Study limitations, research and clinical implications are discussed.
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Affiliation(s)
- Rachele Fasolato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Mariangela De Felice
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Corrado Barbui
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mariaelena Bertani
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Federica Bonora
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mariasole Castellazzi
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Silvia Castelli
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Doriana Cristofalo
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Rosa Bruna Dall'Agnola
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Benedetta Signoretto
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Vieira C, Kuss DJ, Griffiths MD. Early maladaptive schemas and behavioural addictions: A systematic literature review. Clin Psychol Rev 2023; 105:102340. [PMID: 37776578 DOI: 10.1016/j.cpr.2023.102340] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023]
Abstract
As observed in other mental health difficulties, behavioural addiction is a complex construct with several potential predisposing factors, which include biological factors (e.g., genetic predispositions), psychological factors (e.g., personality traits), and social factors (e.g., family, and social history). One factor that may play a significant role in both developing and perpetuating behavioural addiction is the activation of early maladaptive schemas (EMSs). The aim of the present review was to synthesize the evidence concerning the relationship between behavioural addiction and EMSs. A comprehensive literature search using keywords and subject headings was performed with three electronic databases, resulting in 20 studies that met the inclusion criteria. In relation to specific behavioural addiction, the 20 studies examined: binge-eating/food addiction (n = 6), sexual addiction/compulsive sexual behaviours (n = 3), multiple addictive behaviours (n = 2), internet addiction (n = 2), smartphone addiction (n = 2), social networking/Facebook addiction (n = 2), exercise dependence (n = 1), gambling (n = 1), and videogame addiction (n = 1). The patterns of association between EMS and behavioural addiction were examined in both clinical and non-clinical population. The 'Disconnection and Rejection' domain was the most strongly related schema domain across all addictive behaviours, followed by 'Impaired Limits'. The present review suggests a positive relationship between schema activation and several addictive behaviours, including addictions to gambling, gaming, social media use sex, exercise, and food. The clinical implications of the findings are discussed, but further research is needed to inform treatment plans and interventions for those who struggle with behavioural addictions.
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Affiliation(s)
- Claudio Vieira
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, UK.
| | - Daria J Kuss
- Psychology, Cyberpsychology Research Group, Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, UK.
| | - Mark D Griffiths
- Behavioural Addiction, International Gaming Research Unit Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, UK.
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Bär A, Bär HE, Rijkeboer MM, Lobbestael J. Early Maladaptive Schemas and Schema Modes in clinical disorders: A systematic review. Psychol Psychother 2023; 96:716-747. [PMID: 37026578 DOI: 10.1111/papt.12465] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 03/07/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Although schema therapy has been predominantly applied to treat personality disorders, interest into its application in other clinical disorders is growing. Central to schema therapy are Early Maladaptive Schemas (EMS) and Schema Modes. Since existing EMS and Schema Modes were primarily developed in the context of personality disorders, their relevance for clinical disorders is unclear. METHODS We conducted a systematic review of the presence of EMS and Schema Modes in clinical disorders according to DSM criteria. Per disorder, we evaluated which EMS and Schema Modes were more pronounced in comparison with clinical as well as non-clinical control groups and which EMS and Schema Modes were most highly endorsed within the disorder. RESULTS Although evidence concerning EMS was scarce for several disorders, and only few studies on Schema Modes survived inclusion criteria, we identified meaningful relationships and patterns for EMS and Schema Modes in various clinical disorders. CONCLUSIONS The present review highlights the relevance of EMS and Schema Modes for clinical disorders beyond personality disorders. Depending on the theme of the representation, EMS act as vulnerabilities both across diagnoses and for specific disorders. Thus, EMS and resulting Schema Modes are potential, valuable targets for the prevention and treatment of clinical disorders.
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Affiliation(s)
- Andreas Bär
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg im Breisgau, Germany
| | - Hannah E Bär
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marleen M Rijkeboer
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jill Lobbestael
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Joshua PR, Lewis V, Simpson S, Kelty SF, Boer DP. What role do early life experiences play in eating disorders? The impact of parenting style, temperament and early maladaptive schemas. Clin Psychol Psychother 2023. [PMID: 37654072 DOI: 10.1002/cpp.2904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/09/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Given that most eating disorders develop in adolescence and early adulthood, early life experiences are said to play a key role in the aetiology of eating disorders. There are well-documented relationships between early maladaptive schemas and eating disorders, early maladaptive schemas and temperament and temperament and perceived parenting style. The present study aimed to test a hypothesis that perceived parenting style predicts temperament, which predicts early maladaptive schemas, which predict eating disorder symptoms in young people. METHOD An online survey measured perceived parenting style, temperament, early maladaptive schemas and eating disorder symptoms in 397 people with disordered eating between the ages of 18 and 29. Path analysis was used to investigate the relationship between these elements. RESULTS The results found support for this hypothesis. Perceived maladaptive parenting ratings for mothers were a stronger predictor of temperament, and only two temperament factors were adequate predictors of early maladaptive schemas. CONCLUSIONS Overall, the present study found preliminary support for a linear relationship where perceived parenting style predicts temperament, which predicts early maladaptive schema levels, which predicts eating disorder symptoms. The present study was the first to propose and test this model; however, further research is required to confirm the nature and extent of this relationship.
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Affiliation(s)
- Phoebe R Joshua
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Vivienne Lewis
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Susan Simpson
- University of South Australia, Adelaide, South Australia, Australia
- NHS Forth Valley, Stirling, UK
| | - Sally F Kelty
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Douglas P Boer
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
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Fioravanti G, Nicolis M, MacBeth A, Dimaggio G, Popolo R. Metacognitive interpersonal therapy-eating disorders versus cognitive behavioral therapy for eating disorders for non-underweight adults with eating disorders: study protocol for a pilot pre-registered randomized controlled trial. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:690. [PMID: 37667887 PMCID: PMC10519278 DOI: 10.4081/ripppo.2023.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Abstract
Eating disorders (ED) are serious disorders characterized by an alteration of eating habits and excessive concern about weight and body shapes (Fairburn, 2002), accompanied by significant impairment inequality of life, high mortality rates and serious organic consequences (Jenkins et al., 2011; Treasure et al., 2015; 2020). Although evidence-based psychological therapies for nonunderweight ED presentations such as cognitive behavioral therapy for eating disorders (CBT-ED) are widely available, there is substantial scope for improvements, particularly in terms of efficacy and adherence. One option is to develop interventions to address elements of pathology not fully addressed by existing empirical supported treatments, such as incorporating techniques aimed at addressing interpersonal problems and personality disorder features into existing treatment delivery. We adapted Metacognitive Interpersonal Therapy, a psychological intervention supported by evidence for treating personality disorders and integrated it with existing CBT techniques for eating disorders (MIT-ED). MIT-ED targets aspects of ED that are not included in the transdiagnostic CBT-E model such as poor metacognition, or maladaptive interpersonal schemas. This is a pre-registered (Protocol number: 0000781) pilot randomized clinical trial aimed at assessing acceptability and feasibility of MIT-ED and establishing preliminary evidence of effectiveness for future larger studies. Twenty patients (10 in each arm) will be randomized to 20 sessions of individual psychotherapy, either MIT-ED or CBTE. Repeated follow-ups will be collected up to 24 months. Participants are recruited at a private outpatient clinic for ED treatment. Acceptability will be assessed via session attendance, completion rates and preliminary outcomes. The primary outcome is ED pathology assessed with the Eating Disorder Examination Questionnaire-6. Other ED outcomes assessed will be eating disorder attitudes, clinical impairment and binge eating pathology. Secondary treatment outcomes are anxiety, depression, and global symptomatology. We will also assess emotional awareness, emotion regulation and therapeutic alliance. Based on previous studies of MIT for personality disorders we hypothesize that MIT-ED will be acceptable to patients, evidenced by high treatment adherence and retention. We hypothesize that MIT-ED will be associated with reductions in eating disorder pathology, at least equivalent to CBT-E. Results will be used to inform the study design, sampling, likely effect sizes and choice of outcome measures for future larger trials of MIT-ED in ED samples.
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Affiliation(s)
- Gloria Fioravanti
- Centro di Trattamento Integrato Disturbi Alimentari e Obesità di Gloria Fioravanti, Verona.
| | - Martina Nicolis
- 1Centro di Trattamento Integrato Disturbi Alimentari e Obesità di Gloria Fioravanti, Verona.
| | - Angus MacBeth
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Medical School (Doorway 6), Edinburgh.
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Gilmartin TL, Gurvich C, Dipnall JF, Sharp G. Dimensional personality pathology and disordered eating in young adults: measuring the DSM-5 alternative model using the PID-5. Front Psychol 2023; 14:1113142. [PMID: 37434891 PMCID: PMC10330766 DOI: 10.3389/fpsyg.2023.1113142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/30/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction The Personality Inventory for DSM-5 (PID-5) is a self-report measure of personality pathology designed to measure pathological personality traits outlined in the DSM-5 alternative model of personality disorders. Within the extensive literature exploring the relationship between personality and disordered eating, there are few that explore the relationship between the PID-5 and disordered eating behaviours in a non-clinical sample of males and females: restrictive eating, binge eating, purging, chewing and spitting, excessive exercising and muscle building. Methods An online survey assessed disordered eating, PID-5 traits and general psychopathology and was completed by 394 female and 167 male participants aged 16-30. Simultaneous equations path models were systematically generated for each disordered eating behaviour to identify how the PID-5 scales, body dissatisfaction and age predicted behaviour. Results The results indicated that each of the six disordered behaviours were associated with a unique pattern of maladaptive personality traits. The statistical models differed between males and females indicating possible differences in how dimensional personality pathology and disordered eating relate. Discussion It was concluded that understanding disordered eating behaviour in the context of personality pathology may assist formulating potentially risky behaviour.
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Affiliation(s)
- Tanya Louise Gilmartin
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Joanna F. Dipnall
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Centre for Innovation in Mental and Physical Health and Clinical Treatment, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Gemma Sharp
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Mącik D. Are the schema modes suitable for explaining borderline and narcissistic behaviours? CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04552-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
AbstractJeffrey Young assumes that people suffering from personality disorders differ from healthy ones in schema modes intensity but not diversity. Besides, healthy people also present behaviours typical for personality disorders, but to a lesser extent. However, research lacks the interrelationships between modes, especially in healthy individuals. The presented study aimed to investigate the mutual relations between the schema modes using path analysis to understand better problematic behaviour in borderline and narcissistic types in a non-clinical sample and to verify Young assumption about the continuum of the schema modes. A sample of 467 healthy adults aged 18–50 (M = 32.87, SD = 10.56), 52.9% of whom were women, completed SMI 1.1 and SCID-II. Descriptive statistics, matrix of correlation and structural equation modelling were used. Results confirmed the significance of the theoretically assumed and previously empirically proved schema modes also for healthy people. The most important modes for both borderline and narcissistic behaviours are the Punitive Parent, the Angry Child and the Enraged Child modes. For borderline behaviour, the Detached Protector coping mode, connected to a sense of emptiness, is significant. Narcissistic behaviour relates to Bully and Attack, and Self-Aggrandiser modes and is connected to aggressive and dominant behaviour. The obtained models explain 47% of the variance in borderline and 44% in narcissistic behaviours. The study indicates the validity of analysing the modes among people with lower intensity of behaviours typical for personality disorders and also confirms Young’s assumptions about the universality of schema modes. Results are discussed in the context of their relevance for practitioners.
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Huckstepp TJ, Allen A, Maher AL, Houlihan C, Mason J. Factor structure of the Young Positive Schema Questionnaire in an eating disorder sample. Eat Weight Disord 2023; 28:13. [PMID: 36800100 PMCID: PMC9938060 DOI: 10.1007/s40519-023-01549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
PURPOSE The Young Positive Schema Questionnaire (YPSQ) measures early adaptive schemas (EAS) which could be used to develop positive psychology and schema-based interventions to benefit the treatment of eating disorders (EDs). METHODS The present study investigated the factor structure of the YPSQ in a sample of 826 participants (18-73 years; n = 753 women) with ED symptomatology (e.g., restricting, binging, and purging). The sample was randomly split into two groups for exploratory and confirmatory factor analyses. Full sample analysis using Pearson correlations was conducted to explore convergent validity of the new YSPQ factor structure with ED symptomatology, emotional regulation, and cognitive flexibility. RESULTS A nine-factor model was found, demonstrating good fit indices and internal consistency (α = 0.77-0.92). The YPSQ showed an inverse relationship to ED symptomatology and emotional suppression, and a positive relationship with cognitive flexibility and emotion reappraisal. CONCLUSION Further research is needed to explore the clinical benefits of the YPSQ to identify EAS deficits in individuals with EDs to improve treatment outcomes. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Tyrone J Huckstepp
- The Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
- Discipline of Psychology, School of Health, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Andrew Allen
- The Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
- Discipline of Psychology, School of Health, University of the Sunshine Coast, Sunshine Coast, Australia.
| | - Anthea L Maher
- Discipline of Psychology, School of Health, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Catherine Houlihan
- Wandi Nerida, Residential Eating Disorders Facility, Mooloolah Valley, Sunshine Coast, QLD, Australia
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Early Maladaptive Schemas and Mental Disorders in Adulthood: a Systematic Review and Meta-analysis. Int J Cogn Ther 2022. [DOI: 10.1007/s41811-022-00149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AbstractEarly maladaptive schemas (EMSs) are broad and pervasive themes regarding oneself and one’s relationships with others originating from adverse childhood experiences. Although the concept of EMSs was initially developed for the treatment of personality disorders, the associations of EMSs with a variety of other mental disorders have been investigated. The goal of the present study was to summarize and analyze the EMSs-disorder associations in studies in which patients with specific psychiatric diagnoses were compared to healthy controls. Of the 28 studies that met the inclusion criteria, 27 were included in a meta-analysis. Across diagnoses, all EMSs were elevated in the clinical groups. The largest effect sizes were observed for the social isolation, the negativity/pessimism, the defectiveness/shame, and social undesirability schemas. Depression (n = 8), borderline personality disorder (n = 5), and obsessive–compulsive disorder (n = 5) were the most frequently studied mental disorders. Heterogeneity between studies was high. Results suggest that mental disorders are not characterized by specific EMSs.
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Hatoum AH, Burton AL, Abbott MJ. Assessing negative core beliefs in eating disorders: revision of the Eating Disorder Core Beliefs Questionnaire. J Eat Disord 2022; 10:18. [PMID: 35144689 PMCID: PMC8830168 DOI: 10.1186/s40337-022-00542-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/26/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Increased theoretical and empirical attention has been given to examining the role of core beliefs in both the development and maintenance of eating disorders (EDs). The Eating Disorder Core Beliefs Questionnaire (ED-CBQ) is self-report measure designed to assess five dimensions of core beliefs relating to eating disorders; self-loathing, unassertive/inhibited, demanding/needing help and support, abandoned/deprived, and high standards for the self. The present study aimed to evaluate the psychometric properties of the ED-CBQ and to develop a revised and improved version of the original measure after evaluating its factor structure and related properties. METHODS A sample of undergraduate university students (N = 763) completed an online test battery of questionnaires. Putative ED-symptomatic (n = 384) and non-ED (n = 379) subgroups were created from self-reported responses from the Eating Disorder Examination Questionnaire (EDEQ). Confirmatory factor analyses (CFAs) were performed, and internal consistency, construct validity, group differences and clinical utility was examined. RESULTS An initial CFA did not support the original five-factor 40-item ED-CBQ. A revised version was developed that possessed equal or superior psychometric properties to the original 40-item measure. The ED-CBQ-R demonstrated superior model fit, similar levels of reliability and construct validity, and the ability to discriminate between putative ED diagnostic groups. CONCLUSIONS Our results suggest that the ED-CBQ-R is a valid, reliable, but more importantly an efficient and accessible measure with the potential to be utilised both clinically and in research settings.
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Affiliation(s)
- Amaani H Hatoum
- School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - Amy L Burton
- School of Psychology, The University of Sydney, Camperdown, NSW, Australia.,Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Maree J Abbott
- School of Psychology, The University of Sydney, Camperdown, NSW, Australia.
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11
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Mącik D, Mącik R. Are four maladaptive schema domains a better option than five? Recommendations based on comparison of the latent structure of schemas on a large group of healthy adults. Behav Cogn Psychother 2022; 50:1-11. [PMID: 35105394 DOI: 10.1017/s1352465821000539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Numerous publications and analyses conducted in various cultures lead to the conclusion that the latent structure of schemas is not unambiguous. The latest proposal by Bach et al. (2017a) includes 18 schemas and four domains; however, a five domain structure is also acceptable. AIM The aim of the research was to directly compare both proposals based on the research of a large group of healthy people. METHOD The schema questionnaire YSQ-S3 was completed by 2348 people aged 18-81 years, of whom women constituted slightly over 54%. RESULTS CFA analyses have demonstrated a poor fit to the data of all analysed models, with the model of four correlated domains, which is also characterised by higher loadings (standardised regression loadings), being the closest to fulfil the criteria. Exploratory factor analyses have shown an almost exact reflection of the structure with the assumed four factors; the structure of five factors has not been recreated. The released number of factors indicated a two-factor solution. The additional analysis confirmed positive medium correlations with negative affect and psychopathology symptoms. Negative correlations of self-esteem, positivity scale and positive affect indicate good divergent validity. CONCLUSION The analysis confirms the existence of 18 schemas and supports the new four-domain model of the latent structure of schemas as more appropriate than a model consisting of five domains.
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Affiliation(s)
- Dorota Mącik
- Institute of Psychology, John Paul II Catholic University of Lublin, al. Racławickie 14, 20-950 Lublin, Poland
| | - Radosław Mącik
- Institute of Management and Quality Studies, Maria Curie-Sklodowska University in Lublin, Plac M.C. Sklodowskiej 5, 20-031 Lublin, Poland
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12
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Dolan SC, Khindri R, Franko DL, Thomas JJ, Reilly EE, Eddy KT. Anhedonia in eating disorders: A meta-analysis and systematic review. Int J Eat Disord 2022; 55:161-175. [PMID: 34811779 DOI: 10.1002/eat.23645] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Anhedonia, or loss of pleasure, is related to deficits in reward processing across a variety of psychiatric disorders. In light of research suggesting abnormal reward processing in eating disorders (EDs), the study of anhedonia in EDs may yield important insights into the role of reward in eating pathology. This meta-analysis and review aimed to provide both a quantitative and qualitative synthesis of the existing literature on this topic. METHOD We conducted this research (or these meta-analyses) according to PRISMA guidelines. We searched four databases for both peer-reviewed and unpublished literature, and included studies only if a self-report or clinical interview measure of anhedonia was administered to a sample with an ED diagnosis. RESULTS We included 21 studies in the systematic review, and 10 studies in two meta-analyses that compared anhedonia between ED and control samples (n = 9 studies) and within different ED diagnoses (n = 5 studies). Meta-analyses revealed that anhedonia was significantly higher in ED groups compared to healthy controls, but there was no significant difference in anhedonia between ED diagnostic groups. A qualitative review of the literature also suggested that anhedonia may be correlated with increased ED symptom severity. DISCUSSION Findings indicated that anhedonia is elevated in EDs and may be a relevant treatment target. Future research should examine how self-reported anhedonia may correlate with components of reward processing in EDs in order to improve theoretical models as well as targeted interventions.
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Affiliation(s)
- Sarah C Dolan
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Ruchika Khindri
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Debra L Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Erin E Reilly
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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13
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Riegel KD, Konecna J, Matoulek M, Rosova L. Implementation of the DSM-5 and ICD-11 Dimensional Models of Maladaptive Personality Traits Into Pre-bariatric Assessment. Front Psychol 2022; 12:814421. [PMID: 35082734 PMCID: PMC8785802 DOI: 10.3389/fpsyg.2021.814421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Personality pathology does not have to be a contraindication to a bariatric surgery if a proper pre-surgical assessment is done. Indicating subgroups of patients with their specific needs could help tailor interventions and improve surgical treatment outcomes. Objectives: Using the Alternative DSM-5 model for personality disorders (AMPD) and the ICD-11 model for PDs to detect subgroups of patients with obesity based on a specific constellation of maladaptive personality traits and the level of overall personality impairment. Methods: 272 consecutively consented patients who underwent a standard pre-surgical psychological assessment. The majority were women (58.0%), age range was 22-79 years (M = 48.06, SD = 10.70). Patients' average body mass index (BMI) was 43.95 kg/m2. All participants were administered the Personality Inventory for DSM-5 (PID-5) from which Level of Personality Functioning Scale-Self Report (LPFS-SR) and Standardized Assessment of Severity of Personality Disorder (SASPD) scores were gained using the "crosswalk" for common metric for self-reported severity of personality disorder. The k-means clustering method was used to define specific subgroups of patients with obesity and replicated for equality testing to the samples of non-clinical respondents and psychiatric patients. Results: The cluster analysis detected specific groups in the sample of patients with obesity, which differed quantitatively from the samples of non-clinical respondents and psychiatric patients. A vast majority of patients with obesity showed above-average values in most of the PID-5 facets compared to the United States representative general community sample. In two out of the three clusters defined, patients demonstrated moderate (> M + 1.5 × SD) to severe (> M + 2.0 × SD) personality psychopathology within the Detachment and Negative Affectivity domains according to PID-5, which in one of the clusters corresponded to the mild overall impairment in both, LPFS-SR (M = 2.18, SD = 0.27) and SASPD (M = 8.44, SD = 2.38). Moreover, higher levels of psychopathology prove to be associated with higher age and use of psychiatric medication. Conclusions: The dimensional DSM-5 and ICD-11 trait models are suitable procedures for defining specific "characters" of patients in a pre-bariatric setting. As such, they help to identify subgroups of patients with obesity who are different from general population and psychiatric patients. Implications for clinical practice and further research are discussed.
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Affiliation(s)
- Karel D Riegel
- Department of Addictology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Judita Konecna
- 3rd Department of Medicine-Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia.,Department of Psychiatry, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Martin Matoulek
- 3rd Department of Medicine-Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Livia Rosova
- Department of Applied Mathematics and Statistics, Faculty of Mathematics, Physics and Informatics, Comenius University, Bratislava, Slovakia
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14
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Meneguzzo P, Cazzola C, Castegnaro R, Buscaglia F, Bucci E, Pillan A, Garolla A, Bonello E, Todisco P. Associations Between Trauma, Early Maladaptive Schemas, Personality Traits, and Clinical Severity in Eating Disorder Patients: A Clinical Presentation and Mediation Analysis. Front Psychol 2021; 12:661924. [PMID: 33868136 PMCID: PMC8044897 DOI: 10.3389/fpsyg.2021.661924] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background: The literature has shown a significant association between traumatic experiences and eating psychopathology, showing a greater symptomatology in patients with trauma history. Less is known about the associations between trauma and cognitive schemas, and personality traits and the differences between childhood and adulthood trauma experiences. Thus, this paper aims to assess the clinical and psychological characteristics of eating disorder (ED) patients, looking for differences between patients without a history of trauma and patients with trauma experiences, as well as at possible differences between exposure in childhood, adulthood, or repeated events. Another aim of the paper is to evaluate the possible mediation role of cognitive schemas and personality traits in the relationship between early trauma and eating psychopathology. Methods: From January to November 2020, 115 consecutive inpatients admitted for a specific multidisciplinary ED treatment in a dedicated Unit were evaluated for trauma, differentiating between trauma occurring in childhood and adulthood. The subjects were evaluated for early maladaptive schemas (EMS), personality traits, trauma symptomatology, quality of life, and specific psychopathologies linked to EDs. Mediation analyses between childhood and adulthood trauma and eating psychopathology were performed, with EMS and personality traits as mediators. Results: Patients with a history of trauma showed higher physical and psychological symptomatology scores, with a more impaired clinical profile in patients with both childhood and adulthood trauma exposure. The mediation analysis showed a specific mediator role for the “disconnection and rejection (DR)” EMS factor in the relationship between childhood trauma (cT) and eating psychopathology. Conclusion: Trauma experiences are associated with more severe clinical symptomatology in EDs and may need a specific assessment in patients with failed outpatient standard treatments. Specific cognitive schemas linked to DR domain should be evaluated in treatments for ED patients with history of trauma due to the mediation role between trauma and eating psychopathology. The need for outcome studies about treatment approaches for ED patients with history of trauma is discussed.
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Affiliation(s)
- Paolo Meneguzzo
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy.,Department of Neuroscience, University of Padova, Padova, Italy
| | - Chiara Cazzola
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Roberta Castegnaro
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | | | - Enrica Bucci
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Anna Pillan
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Elisa Bonello
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
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15
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Aloi M, Rania M, Carbone EA, Caroleo M, Calabrò G, Zaffino P, Nicolò G, Carcione A, Coco GL, Cosentino C, Segura-Garcia C. Metacognition and emotion regulation as treatment targets in binge eating disorder: a network analysis study. J Eat Disord 2021; 9:22. [PMID: 33588943 PMCID: PMC7885411 DOI: 10.1186/s40337-021-00376-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA) in order to identify key variables that may be considered the target for psychotherapeutic interventions. METHODS A total of 155 patients with BED completed measures of eating psychopathology, affective symptoms, emotion regulation and metacognition. A cross-sectional network was inferred by means of Gaussian Markov random field estimation using graphical LASSO and the extended Bayesian information criterion (EBIC-LASSO), and central symptoms of BED were identified by means of the strength centrality index. RESULTS Impaired self-monitoring metacognition and difficulties in impulse control emerged as the symptoms with the highest centrality. Conversely, eating and affective features were less central. The centrality stability coefficient of strength was above the recommended cut-off, thus indicating the stability of the network. CONCLUSIONS According to the present NA findings, impaired self-monitoring metacognition and difficulties in impulse control are the central nodes in the psychopathological network of BED whereas eating symptoms appear marginal. If further studies with larger samples replicate these results, metacognition and impulse control could represent new targets of psychotherapeutic interventions in the treatment of BED. In light of this, metacognitive interpersonal therapy could be a promising aid in clinical practice to develop an effective treatment for BED.
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Affiliation(s)
- Matteo Aloi
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Elvira Anna Carbone
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Mariarita Caroleo
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giuseppina Calabrò
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Paolo Zaffino
- Department of Experimental and Clinical Medicine, School of Computer and Biomedical Engineering, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giuseppe Nicolò
- Third Centre of Cognitive Psychotherapy - Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Antonino Carcione
- Third Centre of Cognitive Psychotherapy - Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Carlo Cosentino
- Department of Experimental and Clinical Medicine, School of Computer and Biomedical Engineering, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Cristina Segura-Garcia
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy. .,Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
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16
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Aloi M, Verrastro V, Rania M, Sacco R, Fernández-Aranda F, Jiménez-Murcia S, De Fazio P, Segura-Garcia C. The Potential Role of the Early Maladaptive Schema in Behavioral Addictions Among Late Adolescents and Young Adults. Front Psychol 2020; 10:3022. [PMID: 32038394 PMCID: PMC6985770 DOI: 10.3389/fpsyg.2019.03022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/20/2019] [Indexed: 12/22/2022] Open
Abstract
Background Behavioral addiction (BA) is a recent concept in psychiatry. Few studies have investigated the relationship between BA and early maladaptive schemas (EMSs). EMS is the core of Schema Therapy (ST). According to the ST model, psychiatric disorders result from the development of EMSs in response to unmet emotional needs in childhood. Bach et al. (2018) grouped the 18 EMSs into four domains: (1) disconnection and rejection; (2) impaired autonomy and performance; (3) excessive responsibility and standards; and (4) impaired limits. This study aims to assess the possible association of the most frequent BAs with EMSs in a large group of late adolescents and young adults and to evaluate their self-perceived quality of life (QoL). Methods A battery of psychological tests assessing food addiction (FA), gambling disorder (GD), internet addiction (IA), and QoL was administered to 1,075 late adolescents and young adults (N = 637; 59.3% women). A forward-stepwise logistic regression model was run to identify which variables were associated with BAs. Results Food addiction was more frequent among women and GD among men, while IA was equally distributed. Regarding the EMSs, participants with FA or IA showed significantly higher scores on all four-schema domains, whereas those with GD exhibited higher scores on impaired autonomy and performance and impaired limits. Besides, average scores of all domains increased with the association of two or more comorbid BAs. Self-perceived QoL was lower for participants with FA and IA, but not for those with GD; the presence of comorbid BAs was associated with lower Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Finally, specific EMS domains and demographic variables were associated with each BA. Conclusion Late adolescents and young adults with FA or IA have a lower perception of their mental and physical health. The most striking result is that FA appears to be associated with the disconnection and rejection schema domain, IA with all the schema domains (except for impaired autonomy and performance), and GD with impaired autonomy and performance schema domain. In conclusion, our findings suggest that EMS should be systematically assessed during psychotherapy of patients with BAs.
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Affiliation(s)
- Matteo Aloi
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Valeria Verrastro
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Raffaella Sacco
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, Barcelona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, Barcelona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Pasquale De Fazio
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Cristina Segura-Garcia
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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