Traits linked to sensory processing sensitivity mediate the relationship between externally oriented thinking and fantasizing

Introduction

Alexithymia is characterized by difficulties identifying and describing feelings but expression of externally oriented thinking (EOT) and difficulty fantasizing is more variable. In two studies, we investigated whether links between EOT and fantasizing are mediated by sensory processing sensitivity (SPS).

Methods

University students completed measures of alexithymia, SPS, and fantasizing.

Results

In Study 1 (N = 700) we identified two clusters of SPS traits: a positive facet (sensitivity to subtle stimuli) and a negative facet (sensitivity to uncomfortable stimuli). In the 499 participants who completed the fantasy measure, low EOT scores predicted stronger SPS positive and negative traits, which predicted a stronger tendency to mentally project oneself into the lives of characters in books, movies, and plays. In Study 2 (N = 600), the link between EOT and this same fantasizing tendency was again mediated by features of SPS-in this case fantasy proneness and emotional reactivity.

Discussion

We suggest that, whereas individuals who score high on EOT have an impoverished fantasy life, those who score relatively low on EOT and turn their attention inward are able to maintain stronger representations of imagined events in working memory (enhancing the likelihood that they will be recalled) and react more strongly to these events (enhancing their salience). Stronger expression of these features of SPS, in turn, increases the likelihood that one will develop a cognitive style that involves the application of imagery-based strategies to support deep processing of the thoughts and feelings of characters depicted in narratives.

Science fiction and ELSI: three thoughts

Science fiction can be useful to those who analyze ethical, legal, and social issues (ELSI) in genetics and the biosciences more broadly. It can provide examples of possible technological changes, which are occasionally valuable as predictions of the future but more often helpful as indicators of the likely social consequences of such technologies. This "what-if" approach to science fiction can also provide a good pathway to exploring such issues. Science fiction can also allow a more distant, less realistic, and non-culture-specific context for exploring deep questions about humanity, ethics, and other major issues. At the same time, science fiction also has some negative effects on such analysis or its reception as a result of the need for fiction to hold its audience by providing drama through conflict. This necessity for successful fiction often leads to technological or cultural changes being portrayed as catastrophic and dystopian, much more often than beneficial or utopian. This imbalance can predispose public opinion against innovations unfairly, in part by providing "examples" from fiction of similar innovations, leading to bad outcomes. ELSI researchers should keep this fiction-induced bias in mind in their work.

Covid-19: crisis, emotional governance and populist fantasy narratives

This short article discusses how different fantasy narratives have come together during the Covid-19 crisis in various far-right movements, parties and audiences across the world and how much of these fantasies rely on racialised and gendered notions of a fantastical world-order in which particular forms of emotional governance provide a relief and sense of security to certain societal groups. This involves a close engagement with crisis and crisis narratives in relation to ontological insecurity and anxiety; how such crisis narratives have materialised in fantasies related to borders and corona nationalism, and the emotional governance of these particular fantasies in the hands of populist leaders and their increasingly receptive audiences.

Aggressive Script Rehearsal in Adult Offenders: Characteristics and Association With Self-Reported Aggression

This study explored the frequency, recency, content, severity, and targets of aggressive scripts reported by 94 incarcerated Australian males. The scripts of participants who reported a history of repeated and severe aggression were compared with the scripts of participants who reported a history of less severe and less frequent aggression. As hypothesized, participants with a history of more frequent and severe aggressive behavior reported more severe aggressive script content and more frequent script rehearsal. Furthermore, participants with a history of more frequent and severe aggressive behavior reported feelings of anticipation and excitement when they rehearsed aggressive scripts as well as an increase in the severity of aggressive scripts rehearsed over time. These results have important implications for risk assessment and treatment of violent offenders.

Why fear the coming of Winter in Game Of Thrones? The hypovitaminosis D hypothesis

Background

The Game of Thrones fiction is particularly marked by an alarmist maxim, "Winter is coming", which highlights the fear of Westeros inhabitants as Winter approaches. The threat is such that Winter has been given the face of the Night King, whose progress threatens all life north of Westeros. The objective of this narrative review was to elucidate why the coming of Winter was so threatening, particularly by exploring the hypovitaminosis D hypothesis.

Methods

Three sources of information were consulted in April-June 2019, including PubMed, the fantasy novels A Song of Ice and Fire by George R.R. Martin, and the Game of Thrones Wiki.

Results

As the sun is the primary source of vitamin D, lower serum 25-hydroxyvitamin D levels are typically observed during Winter. Vitamin D regulates hundreds of genes in almost all human tissues, with relevance for several diseases. Winter-induced hypovitaminosis D may thus initiate and/or exacerbate: i) diseases such as osteopathies, viral infections, cardiovascular diseases, autoimmune diseases and cancers; ii) decline of physical abilities and skills needed for physical trades or combat; iii) decline of cognition and decision-making abilities, which are necessary to carry out the game of thrones; iv) greater mortality risk threatening all humanity.

Conclusions

If Winter comes south of the Wall, people of all ages and conditions in Westeros would be exposed to the risks induced by hypovitaminosis D. We propose that Winter, the Night King and hypovitaminosis D are one and the same danger in Game of Thrones.

Could immersive daydreaming underlie a deficit in attention? The prevalence and characteristics of maladaptive daydreaming in individuals with attention-deficit/hyperactivity disorder

OBJECTIVE

Maladaptive daydreaming (MD) entails excessive immersion and engagement in complex fantasy worlds, causing distress and impairing functioning. Maladaptive Daydreamers often report that existing diagnostic labels are unhelpful for them. Previous studies reported high rates of comorbid attention deficit hyperactivity disorder (ADHD) among persons with MD, raising the question of their separateness. This study explored whether MD differs essentially from ADHD by examining an ADHD sample, hypothesizing a much lower incidence of MD.

METHOD

Adults diagnosed with ADHD (N = 83) were assessed for ADHD symptoms, MD, depression, loneliness, and self-esteem. Participants who exceeded the study's cutoff score for suspected MD were invited to participate in a structured diagnostic interview for MD.

RESULTS

In accordance with the hypothesis, only 20.5% of the ADHD sample met the proposed diagnostic criteria for MD. Compared with ADHD-only participants, this subgroup presented increased depression, loneliness, and lowered self-esteem.

CONCLUSION

MD has unique clinical characteristics that are distinct from ADHD. We suggest that in some cases presenting with ADHD symptoms, an MD conceptualization may better explain the clinical picture. Future research should aim at a better differentiation of daydreaming, ADHD, and related constructs such as mind-wandering.

Race and Analytic Neutrality: Clinical and Theoretical Considerations

Neutrality remains a key concept underpinning the psychoanalytic attitude, but its operation in the clinical setting must be reconfigured if the countertransference is to be used as a source of data, conveyed by projective identification. Subjective responses thus mobilized in the analyst need to be processed before attention can return to the evenly suspended state, from which greater objectivity flows. Theory, internalized as part of the analyst's emotional learning, operates preconsciously in the session; in clinical work with racial matters this includes, crucially, familiarity with internal racism, of which a model is briefly described. These ideas are illustrated via two clinical vignettes in which these themes are traced.

A study of the relationships between rumination, anger rumination, aggressive script rehearsal, and aggressive behavior in a sample of incarcerated adult males

Objective

This study explored relationships between aggressive script rehearsal, rumination, and anger rumination with aggressive behavior.

Method

One hundred and twenty‐nine incarcerated males (M = 33.54, SD = 8.67) completed the Schedule of Imagined Violence, Preservative Thinking Questionnaire, Anger Rumination Scale, and the Life History of Aggression‐Aggression subscale. Correlations were run to examine associations between the variables and a four‐step sequential multiple regression was performed to assess for the unique contribution of rumination, anger rumination, and aggressive script rehearsal to aggressive behavior.

Results

Results revealed moderate‐strong positive associations between aggressive script rehearsal, rumination, and anger rumination. Moderate‐weak associations were found between these three constructs and aggressive behavior. Regression analyses revealed aggressive script rehearsal was uniquely related with aggressive behavior and path analysis demonstrated aggressive script rehearsal mediated the relationship between rumination/anger rumination and aggression.

Conclusion

These results clarify the nature of the relationships between these conceptually connected constructs and suggest that the frequency with which someone rehearses aggressive scripts impacts on the likelihood of aggression more than anger rumination and general ruminative processes. The frequency with which a person rehearses aggressive scripts should be a critical consideration in violence risk assessment and treatment programs for people deemed to be at risk for violent behavior.

"You Have to Set the Story You Know Aside": Constructions of Youth, Adulthood and Senescence in Cinderella Is Dead

As with other twenty-first-century rewritings of fairytales, Cinderella is Dead by Kalynn Bayron complicates the classic 'Cinderella' fairytale narrative popularized by Charles Perrault and the Brothers Grimm for new audiences, queering and race-bending the tale in its decidedly feminist revision of the story. However, as we argue here, the novel also provides an interesting intervention in the construction of age as related to gender for its female protagonists. Drawing on Sylvia Henneberg's examination of ageist stereotypes in fairytale classics and Susan Pickard's construction of the figure of the hag, we explore the dialogic between the fairytale revision, traditional fairytale age ideology and the intersection of age and gender in this reinvention of the classic narrative. By focusing on constructions of age, particularly senescence, we demonstrate how complex constructions of older characters might aid in overall depictions of intergenerational relationships, and how these intergenerational relationships in turn reflect historical and cultural impetuses of retelling fairytale narratives.

Maladaptive Daydreaming: Epidemiological Data on a Newly Identified Syndrome

BACKGROUND

Maladaptive Daydreaming (MD) is a recently identified psychological disorder, characterized by excessively and addictively engaging in vivid, narrative, intensely emotional fantasy activity, at times with the aid of music and/or repetitive movements, causing distress and functional impairment. Over 100,000 self-diagnosed individuals are active online and thousands of them have been researched; yet there are no studies using clinical interviews on large, systematic general (non-MD) samples, to assess the estimated prevalence of this suggested disorder, and establish norms for its main psychometric tool.

METHODS

Four independent Israeli samples (three student samples, and one sample representing the general Jewish-Israeli population; total N = 1,023) self-reported MD. In two samples, those exceeding the cutoff score for suspected MD were invited for a structured clinical interview.

RESULTS

The skewness of most items of the 16-item Maladaptive Daydreaming Scale (MDS-16) supports the notion of MD as a binary construct rather than a normally distributed trait. In the community sample, 4.2% exceeded the cutoff for suspected MD. Rates were higher when focusing on the young adult age group or student samples (5.5-8.5%), suggesting a likely age effect. Following clinical interviews, only 60% of interviewed respondents met criteria for diagnosis, suggesting a true point-prevalence of 2.5% in the Israeli-Jewish population.

CONCLUSIONS

This is the first systematic clinical evaluation of the prevalence of MD. In an Israeli sample, a point-prevalence of 2.5% was found, like several other internalizing psychiatric syndromes. This result, along with the Non-normal nature of item distribution, both support the validity of MD as a psychological disorder, which should be considered as a potential addition to future psychiatric diagnostic manuals.

The Short-Term Impact of Animation on the Executive Function of Children Aged 4 to 7

Research has shown that animation plays an important role in the development of children's executive function (EF), and the development of EF components, inhibitory control, working memory, and cognitive flexibility, is asynchronous. Thus, this study explores the developmental trajectories and animation features (fantasy and pacing) that influence each EF component, by examining 218 children aged 4-7. Pretest information, mainly the childhood EF inventory, was provided by parents: child's age, age of first exposure to animation, animation viewing time on weekdays and weekends, family income, and parents' education. The children in each age group were randomly divided into four groups to watch animations comprised of different animation features. After watching, their EF were measured by a day-night task, backward digit-span task, and flexible item-selection task. The results showed that the children's inhibitory control, working memory and cognitive flexibility levels all improved with age. Highly fantastical animations weakened children's performance on each subsequent EF task. Pacing had no effect on any of the components of children's EF. An interactive effect on inhibitory control was only found with fantasy in younger children; specifically, high-fantastical animations had a more pronounced short-lived weakening effect on inhibitory control in younger children (4-6 years) compared with low-fantastical animations. Future research should explore the long-term impact of content rather than the form of animation on younger children's EF.

Dissociative identity disorder: out of the shadows at last?

Dissociative identity disorder (DID) is a severely debilitating disorder. Despite recognition in the current and past versions of the DSM, DID remains a controversial psychiatric disorder, which hampers its diagnosis and treatment. Neurobiological evidence regarding the aetiology of DID supports clinical observations that it is a severe form of post-traumatic stress disorder.

Childhood Trauma and Maladaptive Daydreaming: Fantasy Functions and Themes In A Multi-Country Sample

We analyzed responses of 539 adults who met an evidence-based criterion for probable maladaptive daydreaming (MD). Their reported childhood traumata were associated with the utilization of MD to distract from painful memories. A history of childhood physical and emotional neglect as well as emotional abuse was associated with daydreaming aimed to regulate emotional pain. Childhood exposure to physical and emotional abuse was associated with an increased likelihood of daydreaming about an idealized version of their original families. Themes of emotional suffering were associated with exposure to childhood emotional abuse. A range of morbid imageries and trauma-related reenacting behaviors featured in the fantasies of our respondents. Childhood emotional abuse was related to daydreaming about death, physical violence as a victim, being a captor, being rescued, and being a rescuer. Childhood sexual abuse was correlated with themes of sexual violence as a victim, being a captive, and being rescued. Childhood emotional neglect was linked with daydreaming about taking revenge, and a childhood history of physical abuse was associated with current fantasies about being captive. MD fantasy among adults exposed to childhood trauma may not only serve as mere coping mechanisms but potentially manifest a pathological preoccupation with unresolved childhood adversities.

Different cultures, similar daydream addiction? An examination of the cross-cultural measurement equivalence of the Maladaptive Daydreaming Scale

BACKGROUND AND AIMS

Maladaptive Daydreaming (MD) is a proposed mental disorder, in which absorption in rich, narrative fantasy becomes addictive and compulsive, resulting in emotional, social, vocational, or academic dysfunction. Most studies on MD were carried out on aggregated international samples, using translated versions of the Maladaptive Daydreaming Scale (MDS-16). However, it is unknown whether the properties of MD are affected by culture. Thus, we investigated the cross-cultural measurement invariance of the MDS-16.

METHODS

We recruited both individuals self-identified as suffering from MD and non-clinical community participants from four countries: the USA, Italy, Turkey, and the UK (N = 1,081).

RESULTS

Configural invariance was shown, suggesting that the hypothesized four-factor structure of the MDS-16 (including Yearning, Impairment, Kinesthesia, and Music) holds across cultures. Metric invariance was shown for Impairment, Kinesthesia, and Music, but not for Yearning, suggesting that the psychological meaning of the latter factor may be understood differently across cultures. Scalar invariance was not found, as MD levels were higher in the USA and UK, probably due to the over-representation of English-speaking members of MD communities, who volunteered for the study.

DISCUSSION AND CONCLUSIONS

We conclude that the urge to be absorbed in daydreaming and the fantasies' comforting and addictive properties may have different meanings across countries, but the interference of MD to one's daily life and its obstruction of long-term goals may be the central defining factor of MD.

Heightened Levels of Maladaptive Daydreaming Are Associated With COVID-19 Lockdown, Pre-existing Psychiatric Diagnoses, and Intensified Psychological Dysfunctions: A Multi-country Study

The COVID-19 pandemic has been spreading globally since December 2019, bringing with it anxieties, mortal risk, and agonizing psychological suffering. This study aimed to explore the relationship between maladaptive daydreaming (MD)-an addictive mental behavior to vivid fantasy associated with distress and functional impairment-and forced COVID-19 pandemic-related self-isolation and quarantine. Previous literature indicated that individuals employ MD for the regulation of distress and boredom, wish fulfillment, and entertainment experiences. The literature on the impact of the COVID-19 pandemic on mental health identifies a flareup in psychological difficulties in the general population. In this study we explored the associations between the pandemic threat and mental health indices among individuals with MD. We surveyed 1,565 adults from over 70 countries who responded to calls for participants posted in online MD communities and other general social media sites. Probable MD was determined based on an empirically derived cut-off score on a pertinent measure. After controlling for sociodemographic variables, a series of MANCOVAs, followed by post-hoc ANCOVAs, revealed that individuals with probable MD who were observing lockdown restrictions reported having spent more time in fantasy, experienced more intense and vivid daydreaming, and had a stronger urge to daydream than other participants. Similar statistical procedures indicated that, individuals with probable MD who reported pre-existing anxiety and depression disorders described a greater urge to daydream due to the pandemic and greater difficulty to control this addictive behavior. Compared to individuals with likely normal daydreaming, individuals with suspected MD reported more pandemic-attributed deterioration on a wide array of psychological distress indices. Our data show that the current worldwide pandemic threat is connected with an elevated intensity of this addictive form of mental activity, and that MD is associated with the exacerbation of psychological distress and dysfunction rather than with beneficial regulation of the experienced stressor.

Responding to the Psychological Needs of Health Workers During Pandemic: Ten Lessons From Humanitarian Work

When a complex emergency (CE) overwhelms infrastructure, the ability of health-care providers to work efficiently under duress saves lives. The author uses her experience of providing mental health supports to humanitarian aid workers and the pieces of training conducted for internal medicine practitioners to offer guidance on how to manage severe job-related stresses during the response to the coronavirus disease 2019 (COVID-19) pandemic. This work reminds responders about their professional mission and purpose, but its extreme physical and mental demands can take a toll on their well-being and health. In CEs, the sheer volume of work and the emotional over-engagement tend to produce toxic fantasies (eg, rescuer or helper fantasies), acting upon which threatens integrity of care and increases risks for both patients and providers. Accumulated fatigue and exposure to mass suffering and mortality can change the perceived value of life and increase reckless, risk-taking, and suicidal behaviors. Introducing a self-awareness framework prioritizes the awareness of the available choices and making situation-appropriate and informed decisions about balancing one's own and others' needs. The COVID-19 response has demonstrated that fostering peer supports, changing organizational culture, addressing self-awareness within a training and supervisory context, and strengthening supports for managers are important parts of disaster preparedness. It also revealed that more research is needed to better understand and meet the special psychological needs of health-care responders.

Attenuation of Deviant Sexual Fantasy across the Lifespan in United States Adult Males

Deviant sexual fantasy is identified as a risk factor for sexual offending, yet no study has examined deviant sexual fantasy across the lifespan in nonoffending adult males. To bridge this gap, this study examined the frequencies of normative and deviant sexual fantasies among 318 nonoffending adult males in the United States. Participants were recruited via Amazon Mechanical Turk™. Participants took two inventories that assessed demographics and types of sexual fantasies. Normality tests, means tests, Kruskal-Wallis 1-way analyses of variance (ANOVAs), binary logistic regressions, and odds ratio post hoc analyses were conducted. Deviant sexual fantasies progressively declined across all three age groups, while normative sexual fantasy did not. Results suggest that deviant sexual fantasy changes across the lifespan. Applicability of the findings to applied settings, such as sexually violent predator evaluations, is discussed. Limitations and future considerations are addressed.

The prevalence of Dissociative Disorders and dissociative experiences in college populations: a meta-analysis of 98 studies

This meta-analysis of 31,905 college students includes 12 studies diagnosing Dissociative Disorders (DD) and 92 studies measuring dissociation with the Dissociative Experiences Scale (DES). Prevalence rates were used to separately test the plausibility of the Trauma Model (TM) and the Fantasy Model (FM) of dissociation. Results show 11.4% of students sampled meet criteria for DD, which is consistent with the prevalence of experiencing multiple (types of) trauma during childhood (12%), but is not consistent with the very low prevalence expected from the role of fantasy-proneness proposed in the FM. DES scores varied significantly across the 16 countries and were not higher in North America, but in countries that were comparatively unsafe. The least well-known DD was the most common, which is inconsistent with the FM which holds that the diagnosed person is enacting a familiar social role. There was no evidence that DES scores had decreased over recent decades, which does not support FM assertions that DD were a fad of the 1990s. Three of the five hypotheses tested provided clear support for the TM and a fourth hypothesis provided partial support for the TM. None of the five hypotheses tested supported the FM. The finding that DD were slightly more common in college populations than the general population did not support predictions of either model. The theoretical perspective of the authors moderated DES scores, although this is unlikely due to experimenter bias as studies led by FM theorists had significantly higher DES scores than those led by TM theorists.

Reality Status Judgments of Real and Fantastical Events in Children's Prefrontal Cortex: An fNIRS Study

The present study aimed to examine neural mechanisms underlying the ability to differentiate reality from fantasy. Using functional near-infrared spectroscopy (fNIRS), we measured prefrontal activations in children and adults while they performed a reality judgment task. Participants’ task was to judge the reality status of events in fantastical and realistic videos. Behavioral data revealed that, although there was no accuracy difference, children showed significantly longer reaction times in making the judgments than did adults. The fNIRS data consistently revealed higher prefrontal activations in children than in adults when watching the videos and judging the reality of the events. These results suggest that when making judgments of event reality, children may require more cognitive resources and also mainly rely on their own personal experiences.

The Validation of the Free Fantasy Questionnaire for Children and Adolescents: From Imaginary Playmate to "Dreamtime"

Fantasy in children is a precocious and important skill. In normal subjects some imaginative events, very close to hallucinations (perception-like experiences), have been found. Therefore, a better knowledge on both fantasy and the difference between imagination and the external world is needed. The aims of this study are: (a) to validate a new questionnaire for fantasy in children and adolescents; (b) to test its clinical application in ADHD children. 1.707 participants aged 8-18 years were enrolled: 1557 were recruited from a survey in six schools, whereas 150 participants were recruited in an ADHD Center. They filled out a new questionnaire, the Free Fantasy Questionnaire for Children and Adolescents, FFQ. Statistical analyses were performed to validate the FFQ and to study five parameters of fantasy. Analyses showed good properties of the FFQ as regards factor structure and reliability. Descriptive analysis showed that: 10% of the adolescents frequently have fantasy with paracosmos and 9.5% sometimes have a fantasy with imaginary relatives. Moreover, in the 64.3% of participants of primary school, in the 34.5% of lower-secondary, and in the 27.4% of upper-secondary school Perception-like experiences, involving invisible but real personages, were found. Quality of fantasy and Lack of control on imagination are correlated with a high score in the Reality/Unreality Dimension and Perception-like experiences. As regards ADHD participants, the 40% of the group showed Perception-like experiences: the 21.66% of them reported a very high score in the dimension Reality/Unreality, have some dissociative symptoms, and the 3.33% presented a clear dissociative identity disorder. All were free from psychosis or neurologic disorders. A new questionnaire to study fantasy in children and adolescents was validated. Many children and adolescents of the general population declared Perception-like experiences. These events seem to be specific, and probably normal, features of the mind; they could be better named as "Dreamtime," whereas only in extreme conditions they could represent a risk for dissociation.

The effects of fantastical television content on Chinese preschoolers' executive function

Literature has indicated the mixed impact of television content on the executive function (EF) of preschoolers. This study investigated the short-term impact of TV fantastical events on children's EF performance and whether these impacts were different between boys and girls. This study included 143 preschoolers (M_age  = 5.88 years, SD_age  = 0.32 years) and their parents. Participating children were randomly assigned to three groups to watch cartoons of high-fantasy, mid-fantasy, and low-fantasy, and then requested to perform on a series of EF tasks. The results revealed the nonlinear pattern for the effects of fantasy on inhibitory control and cognitive flexibility. Specifically, children in the mid-fantasy group did worst on inhibitory control and cognitive flexibility and no significant group differences were found in working memory. However, no conclusive evidence existed to prove the moderating role of gender on the relationship between fantastical events and EF. Finally, the implications of the findings and future directions are discussed.

READING WILLY WONKA IN THE ERA OF ANTI-THINKING

Whether encountered as a movie or novel, Roald Dahl's Charlie and the Chocolate Factory is a childhood staple of postwar Anglophone culture. Originally published in 1964, Dahl's story of "Willie Wonka" is a morality tale for our times addressed by the present essay in relation to the precariousness, violence, intergenerational faith, and materialist fantasies reflective of contemporary life in the early twenty-first century. Compensating for the precarity of contemporary life's impoverishment as assumptions of societal stability are overthrown, this chronicle of the Bucket family details: envious desire validated by large group chosen trauma; authoritarian enslavement of inferior, colonized peoples with murderous, industrial-level human experimentation; toward gratification of the greedy fantasy of unlimited sweetness under the sway of lethal identification with the aggressor.

Trapped in a Daydream: Daily Elevations in Maladaptive Daydreaming Are Associated With Daily Psychopathological Symptoms

Background: Maladaptive Daydreaming (MD) characterizes individuals who engage in vivid, fanciful daydreaming for hours on end, neglecting real-life relationships and responsibilities, resulting in clinical distress and functional impairment. Sufferers have embraced the term MD in cyber-communities devoted to this problem because it seemed to uniquely fit their experience and since existing diagnostic labels and their therapies seemed inadequate. However, scientific research in the field has been scarce, relying on cross-sectional or case study designs. Existing knowledge on MD suggests the involvement of dissociative and obsessive-compulsive symptoms, as well as positive reinforcement comparable to processes in addiction disorders. The present study aimed to rigorously explore factors that accompany MD employing a longitudinal daily-diary design, hypothesizing that temporal increases in MD will associate concurrently with, and will temporally precede, other symptoms and emotional changes. In addition, we aimed to explore which symptoms may act as precursors to increases in MD, in order to identify possible mechanisms bringing about daydreaming in these individuals. Methods: In a sample of 77 self-diagnosed individuals with MD we assessed relevant daily symptoms for 14 days, including MD, depression, general anxiety, social anxiety, obsessive-compulsive symptoms, and dissociation, as well as positive and negative emotion. Results: Increases in MD were strongly related to concurrent increases in all other symptoms and negative emotion, and to decreased positive emotion. Obsessive-compulsive symptoms, dissociation, and negative emotion also temporally followed MD. Obsessive-compulsive symptoms were the only consistent temporal antecedent of MD. Conclusions: MD and obsessive-compulsive symptoms coincided in what seems to be a vicious cycle; understanding possible shared mechanisms between these symptoms may inform our understanding of the etiology of MD. For example, Serotonin levels may possibly be involved in the development or maintenance of this condition. The findings may also provide clues as to potentially beneficial interventions for treating MD. For example, perhaps utilizing response prevention techniques may be useful for curbing or intercepting unwanted daydreaming. Future studies on MD should address its compulsory nature.

ON THE BIRTH AND DEVELOPMENT OF PSYCHOANALYTIC FIELD THEORY, PART 2

Advances in Contemporary Psychoanalytic Field Theory: Concept and Further Development. Edited by S. Montana Katz, Roosevelt Cassorla, and Giuseppe Civitarese. London/New York: Routledge, 2017. 212 pp.

The Imaginary Companions Created by Children Who Have Lived in Foster Care

This study was designed to provide some preliminary information about the imaginary companions created by children who have lived in foster care, including prevalence rates and qualitative descriptions of the imaginary companions. We were also interested in how descriptions of the imaginary companions created by children who had lived in foster care compare to those of other children. Children with a history of foster care (n =21) and children from a low socioeconomic status community sample (n =39) were interviewed about imaginary companions. Twenty-six children (43.3%) reported having imaginary companions. Although having an imaginary companion has sometimes been believed to be more common in children with a history of maltreatment, in this preliminary study, prevalence rates did not differ between the two groups of children. In addition, both groups of children described companions that were a positive source of entertainment, friendship, and social support.

The deeper self: an expanded view of consciousness

As science continues to explore the mysteries of the unconscious, two critical questions remain. First, can unconscious impulses, desires, and feelings be willfully raised to the level of the conscious self?, and, if so, would the unveiling of unconscious mechanisms lead to genuine self-knowledge or empowerment? Second, can we methodically tap into the unconscious to gear ourselves along more creative lines? If the unconscious is a source of intuitive and creative inspiration, how might a more expansive understanding of consciousness help us to flourish? How can we harness the intuitive parts of ourselves to think "outside the box," transcending the limitations of preconceived categories? And along those same lines, how would an expanded view of the unconscious frame our spiritual experiences or offer spiritual nourishment? Writer Siri Hustvedt, historian of psychology Sonu Shamdasani, and neuropsychologist Mark Solms will tackle everything from noetic experiences and the role of intuition to the phenomenon of peak experience and Jung's "collective unconscious."

AFFECT, SYMPTOM, FANTASY, DREAM: CLINICAL AND THEORETICAL CONSIDERATIONS

A symptom being studied in the process of analysis can be seen as not unlike the unconscious affect it sprang from. The author presents a case in which a symptom, premature ejaculation, was analogous to the unconscious affect of guilt, which itself seemed to be a premature defensive transformation of a deeper current of anger. Guilt was interpreted as if it were a psychic premature ejaculation, a defensive derailment of anger. Fantasy and dream seemed to be engaged in similar transformations, with a fantasy of "premature incarceration" not unlike the symptom itself in its analogous functioning. Analysis of affect, symptom, fantasy, and dream in complex, integrative analytic process led not only to resolution of the symptom itself, but also to a deeper understanding of the mind's complex functioning in general.

'Not to escape the world but to join it': responding to climate change with imagination not fantasy

The work of climate scientists, demonstrating human-driven climate change, has not provoked the widespread and far-reaching changes to human behaviour necessary to avert potentially catastrophic environmental trajectories. This work has not yet sufficiently been able to engage the individual and collective imagination. Drawing on Samuel Taylor Coleridge (1772-1834) and Iris Murdoch (1919-1999), we can distinguish two modes under which the human imagination can operate: in Murdoch's terms, these are 'imagination' and 'fantasy'. To relate imaginatively is to be willing to allow one's internal image of the world to be changed by what one encounters, while an outlook characterized by fantasy relates to the world as one would wish it were, rather than how it actually is. Fantasy, therefore, operates not only among those who deny climate change, but also among those who entertain the promise of a technological solution too optimistically. An imaginative outlook, by contrast, evaluates actions and patterns of behaviour in terms of their relation to a wider whole. This is necessary for providing the degree of agency required to step out of a cycle of ever accelerating production, which is explored in terms of an analogy to a discussion of revenge and forgiveness from Hannah Arendt (1906-1975). Ultimately, the need to engage the imagination is an opportunity as well as a challenge. To live imaginatively is fulfilling, and that is precisely what the challenges of climate change require.This article is part of the themed issue 'Material demand reduction'.

Further developments of the concept of fantasy

After the Isaacs' seminal work on the nature and function of unconscious phantasy (1948), several authors (mostly in the British Society) have reflected on the topic and tried to extend the concept of fantasy. In this paper I shall examine the contributions of Winnicott, Gaddini, Joseph and Anne Marie Sandler that aim at broadening this psychoanalytic concept. The authors that I have considered share a focus mostly on the early stages of child development. Both Winnicott and Gaddini belong to a line of thinking that explores the vicissitudes of the primary emotional development of the infantile self (in the mother-infant relationship) involving the earliest processes of holding and bodily and kinaesthetic fantasy that form the bodily integrity of the person. The Sandlers focused mostly on the concept of the past unconscious understood as a place of primitive vicissitudes with a deficit in figuration where the process of repression is missing. The present unconscious phantasy (that is located in the here and now) has the function of rendering the past unconscious phantasy partly accessible; otherwise it would remain unknowable.

INSECURE ATTACHMENTS AND THEIR INTERMINGLING TRANSFERENCES

There are least two different but interrelated motivational systems in human beings both of which begin in infancy: the attachment system and the separate, but interacting, psychodynamic system. Each of these systems is the basis of transference. A major focus of the paper is the affect-regulating feature of the attachment system. Infants' emotional states can be well-regulated or dysregulated as they emerge in interactions with their primary caregiver. Aberrant interactions of dysregulation typically lead to the development of insecure or disorganized attachments. Rudimentary transference fantasies initially emerge as the child makes sense or meaning about such maladaptive interactions. Our complex minds comprise multi-determined, personally organized fantasies which include those derived from both the attachment system and the psychodynamic one. I present a clinical description of how these two transference fantasies intersect in the mental life of a patient. A clinical case is offered whose focus is on enactments, transferences, and countertransference.

Unconscious fantasy in context: The work of Jacob A. Arlow

For Jacob A. Arlow, understanding unconscious fantasies was central to his clinical work. These fantasies are to be found at the core of those eruptions that break without warning into our ordinary lives, whether in the form of hysterical symptoms, daydreams or nightmares. What, however, could an unconscious fantasy be on a theoretical level, beyond a vehicle for discharge? Although partly unconscious, such fantasies are sometimes composed of fixed verbal content with a high degree of internal organisation. Unconscious fantasies therefore pose many challenges to understanding.

REVISITING DESTRUCTION IN "THE USE OF AN OBJECT"

"The Use of an Object" (1969a) has been widely recognized as among Winnicott's great papers and has deservedly received a good deal of attention. Much of that attention has focused on the importance that the paper gives to the role of destruction in bringing about the experience of externality. Yet the nature of that destruction has too often been assumed based on Winnicott's earlier writings. In the view that follows from that, destruction is equated with the aggression that fails to destroy the object, and the experience of externality is regarded just as the result of that failure. In offering a rereading of "The Use of an Object," the author suggests that, while this aspect of aggression/destruction indeed plays an important role in the establishment of externality, it is only part of the story, and that the central contribution of "The Use of an Object" is Winnicott's attempt to offer a new theory of primitive destruction, one that provides an impulsive basis for separation/externality itself. This theory and Winnicott's ongoing attempts to develop it after "The Use of an Object" led him to rethink the very nature of the drives.

On Dreams and Motivation: Comparison of Freud's and Hobson's Views

The merits of Freudian dream theory continue to be debated and both supporters and critics appeal to empirical evidence to support their respective positions. What receives much less attention is the theoretical coherency of either Freudian dream theory or alternative perspectives. This paper examines Freudian dream theory and J. Allan Hobson's alternative position by addressing the role of motivation in dreams. This paper first discusses motivation in Freudian theory and its relation to dreams and disguise-censorship. The role of motivation in Hobson's theory is then considered. Hobson's claim that dream plot and content selection is random and based on design error and functional imbalance is then discussed in relation to the protoconsciousness theory proposal that dreams serve an adaptive function. While there are apparent inconsistencies in Hobson's position, his appeal to emotions and instincts provides a preliminary platform for understanding the role of motivation in dreams that is consonant with the Freudian position.

Imagination in narrative medicine: A case study in a children's hospital in Italy

This article presents a qualitative study realized in the Children's University Hospital of Parma, Italy, aimed at observing the effects of the fictional narrative in the emotions of the young patients. The results showed that, especially by means of projection, identification and symbolization, the imagination helps the children to elaborate in a positive way the bad emotions elicited by the experience of the disease and of the stay in hospital. Furthermore, the study was useful to the healthcare professionals in order to understand the emotive, cognitive and relational needs of the patients. We suggest the introduction of creative expression in the narrative medicine in addition to the autobiographical accounts, the questionnaires and the interviews in some particular care contexts.

[The silence of a body and speech set free]

Anorexia is a reflection of issues with the body in all its states. The social body and the representation of a model's body, mistreated in order to meet certain standards, the medical body shaken by the mystery of anorexia, and the subjective body and the reality of the flesh. The anorexic body is a testament to a past full of pain and neglect, a sign of emotional deficiency. Caring for the body of a person with anorexia, whatever the approach, means also and above all working with the future of a human being.

Mainstream body-character breach films and subjectivization

The authors analyze a unique cinematic corpus - 'body-character breach films' (one character, initially played by a certain actor, occupies the body of another character) - demonstrating Lacan's notion of traversing the fantasy, both on the level of the films' diegesis and that of spectatorship. Breaching the alliance between actors and their characters perturbs the viewer's fantasy of wholeness enabled by this very alliance. Consequently, a change in subject/spectatorial position in relation to the lack in the Other is induced, enhanced through the visualization of various scenarios of unconscious fantasies (mostly incest). These are meant to unsettle the spectator into an awareness of how a conscious fantasy conceals another unconscious fundamental fantasy, thereby encouraging a change in spectatorial position (from 'perverse'/fetishistic to 'neurotic'). Conflating this change with Lacan's notion of traversing the fantasy, the authors contend that mainstream cinema has the capacity to induce a process of subjectivization (assuming responsibility for one's own desire). This process is contingent on four conditions: identification with the protagonist's fantasy to conceal the lack in the Other; dissolution of this fantasy, initiated by the body-character breach; rhetorical strategies (the coding of unconscious scenarios cinematically); and an ethical dimension (encouraging the subject/spectator to follow her/his desire).

Unconscious fantasy (or phantasy) as clinical concept

A clinical phenomenology of the concept 'unconscious fantasy' attempts to describe it from a 'bottom-up' perspective, that is, from the immediate experience of the analyst working in session. Articles of psychoanalytic authors from different persuasions are reviewed, which taken as a whole would shed some light on how the concept of unconscious fantasy takes shape in the analyst's mind during the session with the patient. A clinical phenomenology in three steps is described. Each step is illustrated by clinical material. Current controversies around the concept of unconscious fantasy (or phantasy) are still trapped in the discussion about if and how they are really unconscious. The strategy to describe from a 'bottom-up' perspective the process of how the analyst's mind embraces the idea that an emerging phenomenon in the relationship with the patient can be defined as 'unconscious fantasy', allows us to elude the question as to whether or not we believe that unconscious fantasies exist at all, since we are neither required to assert or deny such a prior existence in order to describe the process of elaboration which, in the end, does formulate a fantasy as fantasy.

Influence of trait empathy on the emotion evoked by sad music and on the preference for it

Some people experience pleasant emotion when listening to sad music. Therefore, they can enjoy listening to it. In the current study, we aimed to investigate such apparently paradoxical emotional mechanisms and focused on the influence of individuals’ trait empathy, which has been reported to associate with emotional responses to sad music and a preference for it. Eighty-four elementary school children (42 males and 42 females, mean age 11.9 years) listened to two kinds of sad music and rated their emotional state and liking toward them. In addition, trait empathy was assessed using the Interpersonal Reactivity Index scale, which comprises four sub-components: Empathic Concern, Personal Distress, Perspective Taking, and Fantasy (FS). We conducted a path analysis and tested our proposed model that hypothesized that trait empathy and its sub-components would affect the preference for sad music directly or indirectly, mediated by the emotional response to the sad music. Our findings indicated that FS, a sub-component of trait empathy, was directly associated with liking sad music. Additionally, perspective taking ability, another sub-component of trait empathy, was correlated with the emotional response to sad music. Furthermore, the experience of pleasant emotions contributed to liking sad music.

"I HEAR MY VOICE, BUT WHO IS TALKING?": UNDERSTANDING DEPERSONALIZATION

Depersonalization is the frightening experience of being a shut-inside, ghostlike, "true" self that observes another part of the self interacting in the outside world. The "true" self hides safely within, while the "participating" self holds all affects and impulses. This split in the ego is created via internal projective identification in the face of overwhelming affect, unavailability of adequate identifications, and insufficient support for psychic cohesion. As the transference develops, the powerful entrapping cocoon of depersonalization can be projected onto the now-entrapping analyst, where it can be addressed. A clinical vignette illustrates these points.

HANSEL AND GRETEL: A TALE OF TERROR

In the analysis of a woman with multiple childhood traumas, the fairy tale "Hansel and Gretel" figured prominently. The author discusses the use of the fairy tale in this case at various levels. He suggests an interplay between a national myth, the fairy tale, and a personal myth-the patient's psychodynamics. The fairy tale can be used to illuminate personal meanings derived from it. In the experience of childhood trauma, the repeated reading of a fairy tale can help organize and defend against terrifying anxiety.

THE USE AND ABUSE OF OMNIPOTENCE IN THE JOURNEY OF THE HERO

The author uses Joseph Campbell's (1949) account of the "Journey of the Hero" to examine a sequence of stages in which the hero must first use omnipotence in order to embark on an adventure, and then relinquish it in order to return to the ordinary world. The author detects parallels to this theme in descriptions of the fate of Lucifer in Milton's Paradise Lost (1674), and in the development of toddlers as described in Mahler's (1972) observations on separation-individuation. Finally, he traces a similar process in clinical material drawn from near the end of a patient's analysis.

Countertransference identification and fantasy in psychoanalytic process

The development of more nuanced understandings of psychoanalytic process is among the primary tasks of contemporary psychoanalytic theorizing. One piece of this complex undertaking involves the examination of moments when the analyst's countertransference position changes. Shifts in the analyst's feelings and thoughts in relation to the patient are complex events in which experiences registered at many levels of organization and via many modes of perception combine to contribute to meaning-making and furthering of the treatment process. The author explores the role of fantasy in giving form and meaning to alterations experienced as a change of attitude or affect, through close examination of one such moment of shift.

The personal myth: a re-evaluation

This paper presents a re-evaluation of Kris's personal myth. The notion has been used rather sparingly despite the Delphi Symposium in 1984 on the question of its clinical usefulness. After framing the notion of myth, some difficulties related to the question are identified. A clinical vignette exemplifies some of the ambiguities in its definition but stresses its clinical relevance. A discussion expands on these situations so as to propose three various aspects of personal myths to account for the two variants identified by Kris. The actualization of the underlying fantasy in the character organization is a third form and the technical aspect associated with it is reviewed from a new perspective. The family romance is revisited to reassess its role as the basis of the personal myth in the face of studies favouring an earlier development of the myth.

Identifying with fictive characters: structural brain correlates of the personality trait 'fantasy'

The perception of oneself as absorbed in the thoughts, feelings and happenings of a fictive character (e.g. in a novel or film) as if the character's experiences were one's own is referred to as identification. We investigated whether individual variation in the personality trait of identification is associated with individual variation in the structure of specific brain regions, using surface and volume-based morphometry. The hypothesized regions of interest were selected on the basis of their functional role in subserving the cognitive processing domains considered important for identification (i.e. mental imagery, empathy, theory of mind and merging) and for the immersive experience called 'presence'. Controlling for age, sex, whole-brain volume and other traits, identification covaried significantly with the left hippocampal volume, cortical thickness in the right anterior insula and the left dorsal medial prefrontal cortex, and with gray matter volume in the dorsolateral prefrontal cortex. These findings show that trait identification is associated with structural variation in specific brain regions. The findings are discussed in relation to the potential functional contribution of these regions to identification.

Gradiva: freud, fetishism, and Pompeian Fantasy

This paper is a critical reconsideration of Freud's analysis (1907) of Wilhelm Jensen's novella Gradiva: A Pompeian Fantasy (1903). Freud's interest was aroused by the parallels between Jensen's presentation of dreams and Freud's model of dream formation just published in The Interpretation of Dreams (1900). Freud also acclaims Jensen's presentation of the formation and "cure" of his protagonist's delusion about a marble bas-relief of a woman walking. This paper argues for the centrality of the phenomenon of fetishism, briefly considered but excluded from Freud's analysis. The fantasy of Gradiva as "the necessary conditions for loving" (Freud 1910, pp. 165-166) is also a key thesis of the essay, which makes use of the newly translated Freud-Jensen correspondence contained in this article's Appendix.

Borges in my office: the analysis of a man dwelling outside of time

This article weaves together two threads: the intricacies of the analysis of a difficult-to-reach yet extraordinary patient and the literary works of Jorge Luis Borges, which played a significant role in the analysis as a source of inspiration, enriching the analyst's reverie and opening up new psychic spaces. The authors demonstrate the analyst's recourse to several of Borges's stories in order to enrich his own inner world and to better understand the analysand. Some of these stories are briefly presented through the analyst's dialogue with them, and there is a discussion of their function in facilitating the process of working through issues of time, memory, mortality, and identity, contributing to the enhancement of the patient's ability to come face to face with the unwanted, split-off parts of his self and of reality.

Self-image perception of 171 children and adolescents with cleft lip and palate from 22 countries

BACKGROUND

Cleft lip (CL) and cleft palate (CP) are among the most common congenital deformities of the head and neck. They are associated with many problems, physical and psychological. We describe 171 children and adolescents with CL/CP from 22 countries who were asked to draw their faces in a self-image perception drawing 2 hours before surgery to repair their deformities.

METHODS

The aim of the study was to explore whether children and adolescents with CL and CP perceived themselves as deformed when given the opportunity to draw their faces before surgery to repair their deformities. Children were asked to lie down on a large piece of paper to have their body outline traced. Subsequently, the children were asked to draw their faces within the outline.

RESULTS

All of the children included in this study drew their faces with normal mouths.

CONCLUSION

None of the 171 patients with CL/CP drew their deformity when asked to draw their faces; the reasons are not clear. The children may have wanted to compensate for their disability with the constructive use of fantasy as they anticipated the surgery to repair their CL/CP. An additional hypothesis is that the children felt the need to draw an image that they knew represented their parents' desires.