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Gander M, Buchheim A, Sevecke K. Personality Disorders and Attachment Trauma in Adolescent Patients with Psychiatric Disorders. Res Child Adolesc Psychopathol 2024; 52:457-471. [PMID: 37889355 PMCID: PMC10896792 DOI: 10.1007/s10802-023-01141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
This study examined how personality disorders (PD) differ with respect to gender, attachment status and traumatic childhood experiences in adolescent psychiatric inpatients. In particular, we investigated attachment-related traumatic material underlying adolescent PD. Our sample consisted of 175 inpatient adolescents aged 14 to 18 years (77% female, Mage = 15.13, SD = 1.35; 23% male, Mage =14.85, SD = 1.41). Thirty-nine patients (22%) fulfilled the diagnostic criteria for a PD according to the SCID-II PD: 51% avoidant, 13% obsessive-compulsive, 13% antisocial, 19% borderline, 2% paranoid and 2% histrionic. In the total sample, eighty-three (47%) of our inpatients were classified with an unresolved attachment status using the Adult Attachment Projective Picture System (AAP). We did not find any significant gender differences for patients with and without a PD. Our results revealed a higher percentage of unresolved attachment status in patients with a PD. The in-depth analysis of the total sample showed that patients with a PD demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. Furthermore, patients with a PD reported higher scores on emotional and physical neglect. Intervention strategies targeting traumatic attachment-related themes might be useful to treat adolescents with PD.
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Affiliation(s)
- Manuela Gander
- Institute of Psychology, University of Innsbruck, Universitätsstrasse 5-7, Innsbruck, 6020, Austria.
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Milserstrasse 10, 6060 Hall in Tirol, Tirol, Austria.
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Universitätsstrasse 5-7, Innsbruck, 6020, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Milserstrasse 10, 6060 Hall in Tirol, Tirol, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, 6020, Austria
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State of Mind Assessment in Relation to Adult Attachment and Text Analysis of Adult Attachment Interviews in a Sample of Patients with Anorexia Nervosa. Eur J Investig Health Psychol Educ 2022; 12:1760-1779. [PMID: 36547025 PMCID: PMC9777650 DOI: 10.3390/ejihpe12120124] [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: 08/30/2022] [Revised: 11/14/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Attachment theory represents one of the most important references for the study of the development of an individual throughout their life cycle and provides the clinician with a profound key for the purposes of understanding the suffering that underlies severe psychopathologies such as eating disorders. As such, we conducted a cross-sectional study with a mixed-methods analysis on a sample of 32 young women with anorexia nervosa (AN); this study was embedded in the utilized theoretical framework with the following aims: 1. to evaluate the state of mind (SoM) in relation to adult attachment, assuming a prevalence of the dismissing (DS) SoM and 2. to analyze the linguistic attachment profile emerging from the transcripts of the AAIs. METHODS Interviews were transcribed verbatim, coded, and analyzed using the linguistic inquiry and word count (LIWC) method. RESULTS The results were observed to be consistent with the referenced literature. The prevalence of a DS SoM (68.75%) is observed in the study sample, whereas the results of the lexical analysis of the stories deviate from expectations. Notably, the lexical results indicate the coexistence of the dismissing and entangled aspects at the representational level. CONCLUSIONS The study results suggest a high level of specificity in the emotional functioning of patients with AN, with a focusing on a pervasive control of emotions that is well illustrated by the avoidant/ambivalent (A/C) strategy described in Crittenden's dynamic-maturational model. These findings and considerations have important implications for clinical work and treatment, which we believe must be structured on the basis of starting from a reappraisal of emotional content.
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Gizzi G, Cataldi S, Mazzeschi C, Delvecchio E, Ceccarini MR, Codini M, Albi E. Hypercholesterolemia in Cancer and in Anorexia Nervosa: A Hypothesis for a Crosstalk. Int J Mol Sci 2022; 23:ijms23137466. [PMID: 35806470 PMCID: PMC9267523 DOI: 10.3390/ijms23137466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
The relationship between cholesterol and cancer has been widely demonstrated. Clinical studies have shown changes in blood cholesterol levels in cancer patients. In parallel, basic research studies have shown that cholesterol is involved in the mechanisms of onset and progression of the disease. On the other hand, anorexic patients have high cholesterol levels and a high susceptibility to cancer. In this review, we first present a brief background on the relations among nutrition, eating disorders and cancer. Using several notable examples, we then illustrate the changes in cholesterol in cancer and in anorexia nervosa, providing evidence for their important relationship. Finally, we show a new possible link between cholesterol disorder in cancer and in anorexia nervosa.
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Affiliation(s)
- Giulia Gizzi
- Department of Philosophy, Social Sciences and Education, University of Perugia, 06126 Perugia, Italy; (G.G.); (C.M.); (E.D.)
| | - Samuela Cataldi
- Department of Pharmaceutical Sciences, University of Perugia, 06126 Perugia, Italy; (S.C.); (M.R.C.); (M.C.)
| | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences and Education, University of Perugia, 06126 Perugia, Italy; (G.G.); (C.M.); (E.D.)
| | - Elisa Delvecchio
- Department of Philosophy, Social Sciences and Education, University of Perugia, 06126 Perugia, Italy; (G.G.); (C.M.); (E.D.)
| | - Maria Rachele Ceccarini
- Department of Pharmaceutical Sciences, University of Perugia, 06126 Perugia, Italy; (S.C.); (M.R.C.); (M.C.)
| | - Michela Codini
- Department of Pharmaceutical Sciences, University of Perugia, 06126 Perugia, Italy; (S.C.); (M.R.C.); (M.C.)
| | - Elisabetta Albi
- Department of Pharmaceutical Sciences, University of Perugia, 06126 Perugia, Italy; (S.C.); (M.R.C.); (M.C.)
- Correspondence: ; Tel./Fax: +39-0755857940
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Lenzo V, Sardella A, Barberis N, Isgrò C, Torrisi R, Giunta S, Petralia MC, Verrastro V, Quattropani MC. The Interplay of Attachment Styles and Defense Mechanisms on Eating Disorders Risk: Cross-Sectional Observation in the Community Population. CLINICAL NEUROPSYCHIATRY 2022; 18:296-303. [PMID: 35126531 PMCID: PMC8808290 DOI: 10.36131/cnfioritieditore20210603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Eating Disorders (Eds) are considered a broad group of pathological conditions characterized by dysregulated eating-related behaviors and habits. Attachment styles and defense mechanisms appear to be linked to the development of EDs-related unhealthy behaviors; however, these factors have been seldom investigated jointly. This study aimed at exploring the shared association between attachment styles, defense mechanisms, and EDs-related behaviors; additionally, we aimed at investigating whether defense mechanisms might be potential mediators of the association between attachment and Eds behaviors. METHOD A community-based sample was recruited (88% females, mean age= 22.33 ± 4.81 years) and underwent a comprehensive evaluation protocol assessing attachment styles, defense mechanisms, and risk of eating disorders. RESULTS Several shared associations between attachment styles, defense mechanisms, and eating disorders scores were found. Additionally, a maladaptive defense style appeared to be a significant mediator of the association between attachment styles and EDs-related symptoms. CONCLUSIONS The integrated evaluation of attachment and defense mechanisms could generate a more comprehensive framework of the psychological antecedents related to Eating Disorders, and it could be a beneficial factor involved in therapies.
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Affiliation(s)
- Vittorio Lenzo
- Department of Social and Educational Sciences of the Mediterranean Area, University for Foreigners "Dante Alighieri" of Reggio Calabria, Reggio Calabria, Italy
| | - Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Nadia Barberis
- Department of Surgical and Medical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Carmen Isgrò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberta Torrisi
- Department of Surgical and Medical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | | | | | - Valeria Verrastro
- Department of Surgical and Medical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Maria C Quattropani
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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5
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Löffler A, Kleindienst N, Neukel C, Bekrater-Bodmann R, Flor H. Pleasant touch perception in borderline personality disorder and its relationship with disturbed body representation. Borderline Personal Disord Emot Dysregul 2022; 9:3. [PMID: 35101119 PMCID: PMC8805331 DOI: 10.1186/s40479-021-00176-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/20/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by altered perception of affective stimuli, including abnormal evaluation of nociceptive input. However, whether or not perceptual alterations are present for its positive counterpart, i.e. pleasant touch (PT), has not yet been examined. METHODS In the present study, we applied standardized PT stimuli to the hands of 25 patients with BPD and 25 healthy controls (HC) and compared their perception. We used the affect-modulated acoustic startle response as a physiological correlate of affective processing. We further explored the effect of PT stimulation on dissociative experiences in BPD. RESULTS Compared to HC, BPD perceived PT as less pleasant and less intense. The effect on perceived valence of touch was large even after controlling for the effect of reduced perceived intensity of touch (ƞ2 = .29). We further found qualitative alterations in touch perception in BPD, who rated the touch as significantly rougher and firmer compared to HC. There was a positive correlation between perceived valence of touch and changes in dissociative experiences in terms of body ownership of the stimulated body part from pre to post stimulation, suggesting that a more negative evaluation of touch is associated with an increase in body-related dissociative experiences, while a positive perception of touch might be related to a reduction of these dissociative experiences. CONCLUSIONS Our results confirm BPD-associated disturbances in the processing of affective somatosensory stimuli and indicate that not only pain perception but also pleasant touch perception is diminished in BPD. We discuss the role of altered touch perception for BPD psychopathology and its potential role for new treatment approaches.
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Affiliation(s)
- Annette Löffler
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159, Mannheim, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Robin Bekrater-Bodmann
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159, Mannheim, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159, Mannheim, Germany.
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6
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Bryant E, Aouad P, Hambleton A, Touyz S, Maguire S. 'In an otherwise limitless world, I was sure of my limit.' † Experiencing Anorexia Nervosa: A phenomenological metasynthesis. Front Psychiatry 2022; 13:894178. [PMID: 35978851 PMCID: PMC9376373 DOI: 10.3389/fpsyt.2022.894178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia Nervosa (AN) has the highest mortality rate of the mental disorders, with still less than 50% of affected individuals achieving recovery. Recent calls to bring innovative, empirical research strategies to the understanding of illness and its core psychopathological features highlight the need to address significant paucity of efficacious treatment. The current study brings a phenomenological approach to this challenge, synthesizing lived experience phenomena as described by qualitative literature. Fifty-three studies published between the years 1998 and 2021 comprising a total of 1557 participants aged 12-66 suffering from AN or sub-threshold AN are included. Reciprocal and refutational analysis generated six key third-order constructs: "emotion experienced as overwhelming," "identity," "AN as a tool," "internal conflict relating to Anorexia," "interpersonal communication difficulties" and "corporeality." Twenty-six sub-themes were identified, the most common being fear, avoidance, AN as guardian/protector, and AN as intertwined with identity. Some themes associated with current treatment models such as low self-esteem, need for social approval and feelings of fatness were less common. We highlight the significant role of intense and confusing emotion in AN, which is both rooted in and engenders amplified fear and anxiety. Restrictive eating functions to numb these feelings and withdraw an individual from a chaotic and threatening world whilst providing a sense of self around which to build an illness identity. Results have implications for therapeutic practice and overly protective weight and shape focused medical treatment models, which may serve to reinforce the disease.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Phillip Aouad
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Ashlea Hambleton
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
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7
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Pellegrini RA, Finzi S, Veglia F, Di Fini G. Narrative and Bodily Identity in Eating Disorders: Toward an Integrated Theoretical-Clinical Approach. Front Psychol 2021; 12:785004. [PMID: 34975677 PMCID: PMC8714898 DOI: 10.3389/fpsyg.2021.785004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
Abstract
Eating disorders (EDs) can be viewed as “embodied acts” that help to cope with internal and external demands that are perceived as overwhelming. The maintenance of EDs affects the entire identity of the person; the lack of a defined; or valid sense of self is expressed in terms of both physical body and personal identity. According to attachment theory, primary relationships characterized by insecurity, traumatic experiences, poor mirroring, and emotional attunement lead to the development of dysfunctional regulatory strategies. Although the literature shows an association between attachment style or states of mind, trauma, behavioral strategies, and various EDs, the debate is still ongoing and the results are still conflicting. Therefore, we believe it is important to examine and treat EDs by understanding which narrative trajectory intercepts distress in relation to narrative and embodied self-concept. Drawing on clinical observation and a narrative review of the literature, we focus on the construction and organization of bodily and narrative identity. Because bodily representations are the primary tools for generating meaning, organizing experience, and shaping social identity from the earliest stages of life, we focus on the role that bodily interactions and sensorimotor and proprioceptive patterns have played in the development of EDs. We consider the role that lack of attunement, insecure attachment, and relational trauma play in mentalizing, affecting self-representation and emotion regulation strategies. The paper also considers a semantic mode of trauma in EDs that involves a top-down pathway through beliefs and narratives about oneself based on lack of amiability, on devaluation, and on humiliation memories. Finally, we would like to highlight the proposal of an integrated model with multiple access model to psychotherapy that takes into account the complexity of ED patients in whom aspects related to dysregulation, body image disintegration, and post-traumatic symptoms are associated with a suffering sense of self and a retraumatizing narrative.
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Affiliation(s)
| | - Sarah Finzi
- Centro Clinico Crocetta, Scuola di Specializzazione in Psicoterapia Cognitiva, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
- *Correspondence: Sarah Finzi,
| | - Fabio Veglia
- Centro Clinico Crocetta, Scuola di Specializzazione in Psicoterapia Cognitiva, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - Giulia Di Fini
- Centro Clinico Crocetta, Scuola di Specializzazione in Psicoterapia Cognitiva, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
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Abstract
Eating disorders mark deficits in the ability to be nourished and to symbolize embodied experience. Such deficits can be traced to difficulties in early relationships that inhibit the development of self-regulatory functions and the progressive differentiation of self from other. Often, we find mothers who are insufficiently developed, leaving the child either austerely avoiding intrusion or struggling to digest maternal provisions without becoming lost in them. Explorations that link anorexia to deficits in symbolization are in line with psychoanalytic theorizing that marks the concretization of meanings in anorexia. Bulimia, in contrast, has been linked to deficits in self-regulatory capacities that are not necessarily tied to deficits in mentalization. Clinical experience suggests that people with bulimia are often "failed anorexics" who have achieved higher levels of self-development. Case examples explore some of the dynamics underlying such difficulties and how metaphors aid the work with those for whom embodied experience remains largely unsymbolized.
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Ramalho JDAM, El Husseini M, Bloc L, Bucher-Maluschke JSNF, Moro MR, Lachal J. The Role of Food in the Family Relationships of Adolescents With Anorexia Nervosa and Bulimia in Northeastern Brazil: A Qualitative Study Using Photo Elicitation. Front Psychiatry 2021; 12:623136. [PMID: 33935829 PMCID: PMC8085302 DOI: 10.3389/fpsyt.2021.623136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/18/2021] [Indexed: 11/25/2022] Open
Abstract
Family components can play roles both as protective factors and maintenance mechanisms of eating disorders. We aimed to investigate the role of food in the family relationships of adolescents with anorexia nervosa and bulimia in northeastern Brazil. Using photo elicitation, a visual narrative method that gives insight into the participants' perspective through photograph, we conducted semi-structured interviews with 26 people: four teenage girls with anorexia, four with bulimia, eight mothers, four fathers, five grandmothers, and one sister. Data were analyzed using the principles of Interpretative Phenomenological Analysis, which highlighted the following themes: control of the parent-adolescent relationship through food; food as a mean of experiencing parental presence-absence; food as the focus of conflict in the nuclear family, and food as a source of three-generational conflict. Food seemed to be a means for teens and parents to express physical suffering and psychological violence. Moreover, mourning appeared to influence the girls' relationships with food. Conflict in these families is not focused solely on food, but extends to other subjects, and teenagers' emotional reactivity concerning their relationship with their parents and food during family mealtimes varied. These features reinforced the cultural aspect and influences of eating experiences among adolescent girls with eating disorders. Remarkable disparities exist in the generations' views on what rules and rituals these adolescents must follow at meals. These disparities can obfuscate generational boundaries in these families. Our data reinforce the need to focus on the adolescent's autonomy in the family setting and on family identity as related to food among three generations. These findings necessitate a reorganization of boundaries between these generations.
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Affiliation(s)
- Juniana de Almeida Mota Ramalho
- Université of Paris 13, Université Sorbonne Paris Cité, URTPP - Unité transversale de psychogénèse et psychopathologie, Villetaneuse, France.,University Grenoble Alpes, LIP/PC2S, Grenoble, France
| | - Mayssa' El Husseini
- University of Picardie Jules Verne, CHSSC, Amiens, France.,APHP, Hôpital Cochin, Maison de Solenn, Paris, France
| | - Lucas Bloc
- University of Fortaleza (UNIFOR), APHETO - Laboratório de Psicopatologia e Clínica Humanista-Fenomenológica, Fortaleza, Brazil
| | | | - Marie Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France.,Université de Paris, PCPP, Boulogne-Billancourt, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Jonathan Lachal
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France.,Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, Clermont-Ferrand, France
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10
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Lonigro A, Pallini S, Zanna V, Marech L, Rosa M, Criscuolo M, Chianello I, Laghi F. Autonomic response to the Adult Attachment Projective in anorexia nervosa. Eat Weight Disord 2020; 25:1799-1804. [PMID: 31650387 DOI: 10.1007/s40519-019-00792-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 10/09/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Cardiovascular complications associated with anorexia nervosa (AN) are well recognized. Whether a wide array of studies has investigated autonomic nervous system (ANS) functioning at rest in people with AN, few is yet known on their reactivity ability during stress conditions. The aim of the current study is testing ANS reactivity to a stressful task activating attachment system among adolescents with AN. METHODS Heart rate (HR) and its variability, as derived by high-frequency-heart rate variability (HF-HRV), were continuously assessed while 13 AN patients and 12 healthy controls (HCs) responded to a set of attachment-related drawings (Adult Attachment Projective, AAP). RESULTS Findings showed that patients with AN displayed a stronger parasympathetic activity, as indicated by generally a lower heart rate (HR) during the entire task and a higher HF-HRV for drawings eliciting dyadic interactions compared to HCs. CONCLUSION The study findings suggest a novel understanding of cardiovascular functioning in AN. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Antonia Lonigro
- Department of Human Sciences, Università Europea di Roma, Rome, Italy
| | - Susanna Pallini
- Department of Education, University of Rome Tre, Rome, Italy
| | - Valeria Zanna
- Neuropsychiatry Unit, Department of Neuroscience-I.R.C.C.S., Children Hospital Bambino Gesù, Rome, Italy
| | - Lucrezia Marech
- Department of Education, University of Rome Tre, Rome, Italy
| | - Martina Rosa
- Department of Social and Developmental Psychology, University of Rome Sapienza, via dei Marsi 78, 00185, Rome, Italy
| | - Michela Criscuolo
- Neuropsychiatry Unit, Department of Neuroscience-I.R.C.C.S., Children Hospital Bambino Gesù, Rome, Italy
| | - Ilenia Chianello
- Neuropsychiatry Unit, Department of Neuroscience-I.R.C.C.S., Children Hospital Bambino Gesù, Rome, Italy
| | - Fiorenzo Laghi
- Department of Social and Developmental Psychology, University of Rome Sapienza, via dei Marsi 78, 00185, Rome, Italy.
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Gander M, Diamond D, Buchheim A, Sevecke K. Use of the Adult Attachment Projective Picture System in the formulation of a case of an adolescent refugee with PTSD. J Trauma Dissociation 2018; 19:572-595. [PMID: 29547072 DOI: 10.1080/15299732.2018.1451803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Forced displacements and their psychosocial consequences in adolescent refugees and their families have received increasing attention in recent years. Although supportive family relations play a key role in buffering the impact of traumatization in adolescents, parental ability to provide such is often subject to extreme pressure. Under conditions of forced dislocation and fear, maladaptive interpersonal strategies in the parent-child relationships may develop, contributing to the onset of psychopathology. We explore new aspects of attachment-related issues for the understanding and treatment of adolescent refugees who have experienced multiple traumas in their childhood. We used a multimethod assessment battery including the Adult Attachment Projective Picture System (AAP), the Structured Clinical Interview, the Youth Self Report and the Wechsler Intelligence Scale in an adolescent boy with post-traumatic stress disorder (PTSD). Our subject was an adolescent refugee from the Middle East who demonstrated an unresolved attachment when confronted with loss and fear. His responses on the AAP evoked aspects of insecure-unresolved attachment, including his belief that it is not safe to trust in attachment figures, his limited access to traumatic attachment experiences, his impaired ability to take concrete actions when dealing with threatening attachment situations and the unintentional role-reversal shed new light on our understanding of his traumatic experiences, family functioning and psychopathological symptoms. Our results demonstrate the utility of the AAP in an adolescent refugee with PTSD by expanding our knowledge of a diverse range of experiences across the interpersonal, cognitive, cultural and developmental contexts that formed the basis for an individualized treatment plan.
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Affiliation(s)
- Manuela Gander
- a Department of Child and Adolescent Psychiatry , Medical University of Innsbruck , Innsbruck, Austria
| | - Diana Diamond
- b The Graduate Center , City College of the City University of New York , New York, USA
| | - Anna Buchheim
- c Institute of Psychology , University of Innsbruck , Innsbruck, Austria
| | - Kathrin Sevecke
- a Department of Child and Adolescent Psychiatry , Medical University of Innsbruck , Innsbruck, Austria
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12
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Gander M, Sevecke K, Buchheim A. Disorder-specific attachment characteristics and experiences of childhood abuse and neglect in adolescents with anorexia nervosa and a major depressive episode. Clin Psychol Psychother 2018; 25:894-906. [PMID: 30216616 PMCID: PMC6585713 DOI: 10.1002/cpp.2324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/15/2018] [Accepted: 07/31/2018] [Indexed: 11/08/2022]
Abstract
For the first time, the present study investigates disorder‐specific attachment characteristics and childhood trauma in adolescent inpatients with anorexia nervosa (n = 30, girls/boys: 28/2, age: M = 14.84, SD = 1.20), a major depressive episode (n = 30, girls/boys: 27/3, age: M = 15.14, SD = 1.50), and controls (n = 60, girls/boys: 44/16, age: M = 16.10, SD = 1.20). We used the Structured Clinical Interview to diagnose Axis I disorders, the Adult Attachment Projective Picture System to classify attachment representations, and the Childhood Trauma Questionnaire to assess child maltreatment. Our findings demonstrate an overrepresentation of the unresolved attachment status in the patient samples. A one‐way analysis of variance succeeded by Bonferroni post hoc tests indicated that adolescents with anorexia nervosa show more isolation and dissolution of boundaries between life and death when confronted with situations of solitude. Although they report moderate to severe levels of traumatic childhood experiences, they tend to minimize those. Adolescents with a major depressive episode report higher levels of emotional abuse and neglect in their childhood, leaving them in a state of failed protection and danger during attachment distress. Integrating these attachment‐related characteristics into specific psychotherapeutic interventions might be associated with a better outcome in that age group.
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Affiliation(s)
- Manuela Gander
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
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Delvecchio E, Di Riso D, Lis A, Salcuni S. Adult Attachment, Social Adjustment, and Well-Being in Drug-Addicted Inpatients. Psychol Rep 2017; 118:587-607. [PMID: 27154381 DOI: 10.1177/0033294116639181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In recent years, attachment studies have gathered overwhelming evidence for a relation between insecure attachment and drug addiction. The existing literature predominantly addresses attachment styles and little attention is given to attachment-pattern-oriented studies. The current study explored how attachment, social adjustment, and well-being interact in 40 (28 men, 12 women; ages 20-52 years, M = 32.3, SD = 9.4) inpatients with drug addiction. The Adult Attachment Projective Picture System (AAP), the Social Adjustment Scale-Self-report (SAS-SR), and the General Health Questionnaire-28 (GHQ-28) were administered. Descriptive statistics were computed as well as differences between patterns of attachment in all variables were measured. None of the inpatients showed a secure attachment pattern: 7 scored as dismissing (18%), 5 preoccupied (12%) and 28 unresolved (70%). AAP stories were mainly connected with themes of danger, lack of protection, and helplessness. Inpatients classified as unresolved reported significantly higher maladjustment on the SAS-SR and GHQ-28 than those with resolved attachment patterns. Implications for clinicians and researchers are presented.
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Affiliation(s)
- Elisa Delvecchio
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Daniela Di Riso
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Adriana Lis
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
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Jones-Mason K, Elaine Allen I, Hamilton S, Weiss SJ. Comparative validity of the Adult Attachment Interview and the Adult Attachment Projective. Attach Hum Dev 2015; 17:429-47. [DOI: 10.1080/14616734.2015.1075562] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Pace CS, Cavanna D, Guiducci V, Bizzi F. When parenting fails: alexithymia and attachment states of mind in mothers of female patients with eating disorders. Front Psychol 2015; 6:1145. [PMID: 26321978 PMCID: PMC4532914 DOI: 10.3389/fpsyg.2015.01145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/23/2015] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION In recent years alexithymia and attachment theory have been recognized as two parallel research lines trying to improve the information on the development and maintenance of eating disorders (EDs). However, no research has analyzed these constructs among patients' families. In this study we compared alexithymia and attachment in mothers of patients with EDs and a control group. Further, we hypothesized that mothers of daughters with EDs with insecure and unresolved states of mind will reported high levels of alexithymia. Lastly, we explored the daughters' evaluations of maternal alexithymia. METHODS 45 mothers of ED women and 48 mothers of healthy controls (N = 93) matched for age and socio-demographic variables were administered by the Toronto Alexithymia Scale-20 (TAS-20) (S), while two sub-groups of "ED" mothers (n = 20) and "non-ED" ones (n = 22) were assessed by the Adult Attachment Interview (AAI). Moreover, the Observer Alexithymia Scale (OAS) was administered to the daughters for evaluating maternal alexithymia. RESULTS Regarding alexithymia, no differences were found between ED and non-ED mothers according to the TAS-20, while ED mothers showed more unresolved AAI classifications than non-ED mothers. No correlations were found between the TAS-20 and the AAI. Lastly, ED mothers were evaluated more alexithymic by their daughters with the OAS than those in the control group, and their alexithymic traits were significantly correlated with dismissing states of mind (idealization and lack of memory) in the AAIs. DISCUSSION Our results highlighted an interesting discrepancy among mothers with ED daughters between the low level of alexithymia provided by their self-reports and the high level of alexithymia observed by their daughters, although the OAS showed severe methodological limitations. Maternal attachment states of mind characterized by the lack of resolution of past losses could be connected to a confusing and incoherent quality of parenting.
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Affiliation(s)
| | - Donatella Cavanna
- Department of Educational Science, University of Genoa , Genoa, Italy
| | | | - Fabiola Bizzi
- Department of Educational Science, University of Genoa , Genoa, Italy
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Gander M, Sevecke K, Buchheim A. Eating disorders in adolescence: attachment issues from a developmental perspective. Front Psychol 2015; 6:1136. [PMID: 26321974 PMCID: PMC4530258 DOI: 10.3389/fpsyg.2015.01136] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/21/2015] [Indexed: 11/13/2022] Open
Abstract
In the present article we review findings from an emerging body of research on attachment issues in adolescents with eating disorders from a developmental perspective. Articles for inclusion in this review were identified from PsychINFO (1966-2013), Sciencedirect (1970-2013), Psychindex (1980-2013), and Pubmed (1980-2013). First, we will outline the crucial developmental changes in the attachment system and discuss how they might be related to the early onset of the disease. Then we will report on the major results from attachment studies using self-report and narrative instruments in that age group. Studies with a developmental approach on attachment will be analyzed in more detail. The high incidence of the unresolved attachment pattern in eating disorder samples is striking, especially for patients with anorexia nervosa. Interestingly, this predominance of the unresolved category was also found in their mothers. To date, these transgenerational aspects are still poorly understood and therefore represent an exciting research frontier. Future studies that include larger adolescent samples and provide a more detailed description including symptom severity and comorbidity would contribute to a better understanding of this complex and painful condition.
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Affiliation(s)
- Manuela Gander
- Institute of Psychology, University of Innsbruck , Innsbruck, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck , Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck , Innsbruck, Austria
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Salcuni S. New frontiers and applications of attachment theory. Front Psychol 2015; 6:273. [PMID: 25814972 PMCID: PMC4356001 DOI: 10.3389/fpsyg.2015.00273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/24/2015] [Indexed: 11/21/2022] Open
Affiliation(s)
- Silvia Salcuni
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università degli Studi di Padova Padova, Italy
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