Exploring the connection between childhood trauma, dissociation, and borderline personality disorder in forensic psychiatry: a comprehensive case study

This case study examines the complex relationship between childhood trauma, dissociation, and Borderline Personality Disorder (BPD) within the context of forensic psychiatry. It focuses on a young murder defendant named "Paul," who has experienced various traumatic events, including childhood maltreatment and domestic violence. These experiences have led to dissociative states marked by high emotional intensity, particularly of an aggressive nature, and impaired impulse control, resulting in violent behavior during dissociative episodes. The study employs advanced assessment tools like Raven's Standard Progressive Matrices (SPM), the Millon Clinical Multiaxial Inventory-III (MCMI-III), and the Level of Service/Case Management Inventory (LS/CMI) to gain a comprehensive understanding of Paul's psychopathological condition, risk factors, and rehabilitation needs. The LS/CMI assessment highlights a high risk of recidivism, mainly influenced by family relationships, educational challenges, interpersonal connections, and aggressive tendencies. To address the multifaceted needs of individuals like Paul, the study emphasizes the importance of using transdiagnostic models for trauma and dissociation. This approach informs tailored treatment programs that include processing past traumatic experiences, improving self-identity, nurturing healthy relational patterns, and enhancing emotional regulation. Although this study is based on a single case, it serves as a model for integrating assessment tools and theoretical-clinical models in the field of forensic psychiatry. Understanding the intricate dynamics of childhood trauma, dissociation, and BPD is crucial for making informed decisions, conducting risk assessments, and developing rehabilitation programs within the justice system. Future research should expand the scope of cases and further validate assessment tools to advance our understanding of this complex relationship.

The relationship between childhood interpersonal and non-interpersonal trauma and autobiographical memory: a systematic review

Childhood trauma can have negative effects on several domains of mental functioning, including Autobiographical Memory (AM). Conflicting results emerge in the scientific literature regarding the effects of childhood trauma on AM. In this review, we explored the relationship between the childhood trauma and AM, classifying childhood trauma as interpersonal, non-interpersonal and overall (interpersonal and non-interpersonal). We carried out a systematic literature review, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA statement). From searching the PubMed, Scopus, and Web of Science databases, we identified 48 studies conducted from 2014 to 2023, which were included when they: (a) were written in English, (b) investigated the relationship between AM and childhood trauma, (c) included a sample of children, adolescents, or adults who had experienced childhood interpersonal and/or non-interpersonal trauma. Of the 48 eligible studies, 29 referred to trauma of an interpersonal nature, 12 to trauma of a non-interpersonal nature, and 7 to overall trauma. Regarding the relationship between childhood trauma and AM, 24 studies found a negative relationship between childhood interpersonal trauma and AM; among the articles on non-interpersonal trauma, 10 studies found no relevant relationship; in the studies on overall trauma, 4 articles found negative relationship between overall trauma and AM. The literature explored in our systematic review supports the prevalence of a negative relationship between interpersonal childhood trauma and AM. This relationship is present regardless of psychiatric disorders (e.g., Depression, Post Traumatic Stress Disorder, and Personality Disorders), and in the presence of the latter, AM results even more fragmented. Future research should use more accurate methodologies in identifying and classifying childhood trauma in order to more precisely determine its effect on AM.

What makes us more susceptible to false memories in the era of COVID-19? A focus on vaccines and Green Pass

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic was accompanied by an overabundance of fake news increasing the risk of developing false memories (FMs). Previous studies have shown that the relationship between fake news and FMs could be mediated by some individual variables, including attitudinal biases. We explored the role of these variables in true memories (TMs) and FMs formation, with special emphasis on vaccine- and Green Pass (GP)-related topics.

METHOD

We set up a large online survey exploring several constructs including media usage, attitude toward vaccines and GP, perceived (PK) and objective knowledge (OK) about COVID-19-related information, fear of the disease, depression and anxiety symptoms, coping mechanisms, and reasoning skills. Then, we asked participants whether they remembered certain news (true or fake), providing confidence ratings.

RESULTS

Data from 289 respondents (198 females) from the general population were analyzed. Participants with positive attitude reported a greater fear that their loved ones contracted the COVID-19, a more frequent use of traditional media, and a higher PK when compared with respondents with negative attitude. On the whole sample, participants reported higher confidence levels when required to judge their memory of true than fake news; however, participants with positive attitude reported a higher confidence for both true and fake news. The relationship between attitude and TM confidence was mediated by the PK, whereas the relationship between attitude and FM confidence was probably affected by OK.

CONCLUSION

Attitude can modulate individual behaviors in the context of health issues. The PK and OK may interact with attitude in the memory formation.

Changes in Touch Avoidance, Stress, and Anxiety During the COVID-19 Pandemic in Italy

In the present study we analyzed how attitudes toward touch have changed during the COVID-19 pandemic in an Italian sample, through two different studies: in the first we contacted participants of the Italian validation study of the Touch Avoidance Questionnaire, asking them to take part in a follow-up study (N = 31, 64.5% women, age 42.58 ± 15.15); in the second we recruited a new sample of 717 people (73.92% women, age 34.25 ± 13.11), comparing it to the full validation sample of the Touch Avoidance Questionnaire (N = 335, 64.48% women, age = 35.82 ± 14.32) to further investigate the relationship between the pandemic, stress responses, fear of contagion, anxiety, and attitudes toward touch. Overall, we found higher post-pandemic scores for touch avoidance toward strangers and family members and lower scores in touch avoidance toward friends of either gender, along with a slight increase in anxiety and stress. Touch avoidance was also positively related to anxiety and/or stress levels except for touch avoidance toward same-sex friends, for which the relationship with anxiety was negative. Surprisingly, we found that young people were the most anxious, despite older people being more at-risk of dying from COVID-19. Women were slightly more stressed out. COVID-19-related fears were significant predictors of touch avoidance toward partners, friends and strangers, but not of touch avoidance toward family. The results suggest that touch avoidance increased during the pandemic (except toward same-sex friends), together with anxiety and stress levels, but the change was relatively small.

The Functional Psychotherapy Approach: A Process-Outcome Multiple Case Study

Objective: The present work aims to conduct the first naturalistic empirical investigation of the process and outcome assessment of functional psychotherapy (FP) treatment. The FP model of psychotherapy is rooted in psychoanalysis and integrates the verbal communication approach founded on transference and countertransference dynamics with the analysis of bodily processes.

Method: The study sample included ten patients recruited on a voluntary basis and treated by clinicians in their private practices. Each patient received FP with an average duration of 40 h (min 35 and max 42). Therapies had weekly sessions, were audio-recorded with the patient’s written consent, and lasted for an average of 10 months (min 9 and max 12). Outcome and process tools included the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Luborsky’s the Core Conflictual Relationship Theme (CCRT), used to assess therapeutic benefit, and the Metacognition Assessment Scale (MAS) and the Italian Discourse Attributes Analysis Program (IDAAP) system, used to evaluate therapeutic benefit and process. The MMPI-2 was used also in the follow-up assessment.

Results: Results show that FP had a positive therapeutic outcome on the patients assessed in this study, and that the therapeutic benefits were maintained over time. Some specific features of the FP approach were found to contribute more than others to the observed therapeutic benefits.

Conclusion: The current investigation constitutes a first step toward assessment of the therapeutic effectiveness of FP. Future developments should apply the methodology to a larger sample, possibly introducing different methodologies to enable detection of specific bodily oriented processes and techniques.

Objective Knowledge Mediates the Relationship between the Use of Social Media and COVID-19-Related False Memories

The exposure to relevant social and/or historical events can increase the generation of false memories (FMs). The Coronavirus Disease 2019 (COVID-19) pandemic is a calamity challenging health, political, and journalistic bodies, with media generating confusion that has facilitated the spread of fake news. In this respect, our study aims at investigating the relationships between memories (true memories, TMs vs. FMs) for COVID-19-related news and different individual variables (i.e., use of traditional and social media, COVID-19 perceived and objective knowledge, fear of the disease, depression and anxiety symptoms, reasoning skills, and coping mechanisms). One hundred and seventy-one university students (131 females) were surveyed. Overall, our results suggested that depression and anxiety symptoms, reasoning skills, and coping mechanisms did not affect the formation of FMs. Conversely, the fear of loved ones contracting the infection was found to be negatively associated with FMs. This finding might be due to an empathy/prosociality-based positive bias boosting memory abilities, also explained by the young age of participants. Furthermore, objective knowledge (i) predicted an increase in TMs and decrease in FMs and (ii) significantly mediated the relationships between the use of social media and development of both TMs and FMs. In particular, higher levels of objective knowledge strengthened the formation of TMs and decreased the development of FMs following use of social media. These results may lead to reconsidering the idea of social media as the main source of fake news. This claim is further supported by either the lack of substantial differences between the use of traditional and social media among participants reporting FMs or the positive association between use of social media and levels of objective knowledge. The knowledge about the topic rather than the type of source would make a difference in the process of memory formation.

Using Smartphones When Eating Increases Caloric Intake in Young People: An Overview of the Literature

Recent literature highlights that the use of smartphones during meals increases the number of calories ingested in young people. Although the distraction interferes with physiological signals of hunger and satiety, a social facilitation effect has also been suggested. Cognition is a pivotal component in regulating food intake, and activities requiring high perceptual demands should be discouraged during meals.

Italian Validation of the Touch Avoidance Measure and the Touch Avoidance Questionnaire

Social touch is essential in relationships and well-being, but the unique personal experience of touch is not assessed and taken into account in health and social care services. The pleasantness of gentle stroking is influenced by gender, toucher genre, toucher familiarity, culture, and age. Moreover, pleasantness is influenced by touch avoidance, the attitude toward interpersonal touch. The aim of this article is to present the translation, adaptation, and validation in Italian of two scales to measure touch avoidance. For translation and validation, we selected the most used scale, the Touch Avoidance Measure (TAM) and a more recent scale, the Touch Avoidance Questionnaire (TAQ). Confirmatory factor analyses reported good model fit for the TAM [comparative fit index (CFI) = 0.947, Tucker-Lewis index (TLI) = 0.940, root-mean-square error of approximation (RMSEA) = 0.065] and excellent model fit for the TAQ (CFI = 0.954, TLI = 0.950, RMSEA = 0.058). Internal consistency was high for all subscales, except the TAQ "Stranger" subscale. One-month test-retest reliability ranged from 0.67 to 0.90 for each subscale. Lastly, convergent validity between the TAM and TAQ was also found to be high. We conclude that the TAM and TAQ can be used to assess touch avoidance with Italian samples. The instrument can be used to support healthcare professionals and to assess attitudes toward touch in individuals with interpersonal difficulties.

An Exploratory Study of Adult Baby-Diaper Lovers' Characteristics in an Italian Online Sample

BACKGROUND

Knowledge of the Adult Baby-Diaper Lovers (ABDL) phenomena is quite recent and there are, of yet, few studies on this phenomenon.

AIM

This study was conceived to investigate the functions of ABDL behaviours and the characteristics of ABDL in an online Italian community sample. We hypothesized that ABDL phenomena were associated with general psychological maladjustment and with an experience of parental rejection during childhood. It was also assumed that there would be differences in ABDL profiles based on the age of appearance of their first Adult Baby-Diaper Lover (ABDL) fantasies.

METHOD

An internet-based study was conducted and it involved 38 adults aged between 18 and 74 years (M = 34.95; SD = 12.25). Participants were first given an ad hoc questionnaire, which was devised to obtain information about the anamnestic variables related to ABDL. Then, the participants filled out the Cognitive Behaviour Assessment 2.0 battery to obtain anamnestic information regarding their psychological, medical, and personal history and to evaluate primary psychological dimensions in clinical practice. Finally, they filled out the Adult Parental Acceptance-Rejection Questionnaire, to evaluate their recollections of parental perceived rejection, and the Personality Assessment Questionnaire, to evaluate the primary psychological aspects related to parental rejection.

RESULTS

The data indicated that adults with ABDL showed the presence of anxious traits and recollections of parental rejection during childhood. Moreover, associations were observed between current or previous ABDL phenomena enuresis and negative mood states.

CONCLUSION

Specific kinds of parental modes, anxiety traits, and enuresis seem to be the source of ABDL interests. Moreover, ADBL behaviours seem to assume different functions and meanings.

Continuity and discontinuity between psychopathology of childhood and adulthood: a review on retrospective and prospective studies

The knowledge of the possible development of a psychiatric disorder, diagnosed for the first time in childhood, is very crucial for all specialists in helping professions working with children and adults. Recent longitudinal studies have demonstrated the possibility that disturbances in childhood may increase the risk of psychiatric illnesses in adulthood, through a homotypic or heterotypic continuity. The aim of this study is to perform a systematic review of existing literature on the psychopathological progression from childhood to adulthood, taking into account both prospective and retrospective studies, and the antecedents and conditions that may encourage/disadvantage the process of continuity of psychopathological syndromes. The study of the possible trajectories of psychopathological disorders is considered fundamental, as it allows the clinician to configure prevention strategies and evaluate interventions, but also to offer to the parent a more concrete vision of the possible risks of their child's disorders to minimize them.

Obesity and brain illness: from cognitive and psychological evidences to obesity paradox

Recent findings showed that obesity represents an additional risk factor to developing brain illness such as cognitive impairments and psychopathological disorders. However, some benefits of overweight in the elderly have been identified and an "obesity paradox" has been shown. Currently, it is still unknown how obesity and brain functioning could be linked, and the process by which body fat independently injures cognitive abilities and psychological well-being remains unclear. To establish the independent role of obesity on cognitive abilities and mental health, clarifying the role played by several factors and understanding their interaction is essential. In this review, we discuss the relationship between obesity and brain illness and underline the role played by confounders and other covariates to determine this link.

Outcomes following unilateral uterine artery embolisation

Uterine artery embolisation has been described as successful only when both arteries are embolised. However, results in patients with one congenitally absent or previously ligated artery are unknown. Women suffering from symptomatic uterine myomata were treated at a university teaching hospital, a community hospital and an outpatient surgery centre. Retrospective review of patient response to embolisation was assessed by chart review and questionnaire. Uterine and dominant fibroid size response was assessed by comparing pre- and post-embolisation ultrasound examinations. This study analysed three patient groups within the general population: those who underwent unilateral embolisation because of technical failure, those who ultimately underwent bilateral embolisation after initial technical failure and those who underwent unilateral embolisation because of an absent uterine artery. 12 patients underwent unilateral embolisation, 4 of whom underwent this procedure because of an absent uterine artery. Three of these four patients had a congenitally absent uterine artery arising from the internal iliac artery and all three experienced successful outcomes. The fourth patient had a previously ligated internal iliac artery and her symptoms worsened after the procedure. Eight patients had unilateral embolisation due to technical failure. Five of these patients underwent a subsequent procedure during which the contralateral uterine artery was embolised. Four of these five patients had successful outcomes and one was lost to follow-up. Another of the eight patients suffered an arterial injury leading to technical failure, and was lost to follow-up. Of the two remaining patients with unilateral technical failure, only one had a successful outcome. This study concluded that patients who undergo unilateral embolisation for technical reasons should be offered a second embolisation procedure shortly after the initial procedure. Patients with a congenitally absent uterine artery may respond with similar success to those who underwent bilateral embolisation. In contrast, the patient with a previously ligated internal iliac artery failed. The numbers in this study are too small for statistical analysis and subsequent studies should be performed to confirm these findings.

Pregnancy following uterine fibroid embolization

OBJECTIVE

This paper seeks to evaluate the ability to deliver term pregnancies following uterine fibroid embolization, and to identify impediments to pregnancy in the embolization procedure.

STUDY DESIGN

Four physicians performed embolization procedures at various facilities. Patients were asked if fertility was an issue prior to embolization. We measured follicle-stimulating hormone levels before and after embolization. Clinical follow-up, six months following embolization was obtained by interview. Patients were questioned regarding attempts to conceive, menstrual history, and subsequent pregnancy.

MAIN OUTCOME MEASURES

Complications were calculated upon the entire patient population, whether or not fertility was identified as a goal. Fertility risks from embolization were identified. We measured radiation exposure in a random consecutive group of 50 women undergoing embolization. All patients who conceived were asked the details of the pregnancy.

RESULTS

Four hundred women underwent uterine fibroid embolization between 1996 and 1999. One hundred and thirty nine patients stated a desire for fertility after embolization. Of these, 52 were <40 years old. Seventeen pregnancies have been reported in 14 women. Five spontaneous abortions were observed. Ten women have had normal term deliveries and two women are currently pregnant. No perfusion problems, either during the pregnancy or labor, were reported. The average radiation dosage calculated for 50 women undergoing embolization was 14 rads. Four women under 45 years old suffered premature menopause (10/1000). Two women underwent hysterectomy as a complication of embolization (5/1000).

CONCLUSION

The risks of infertility following embolization, premature menopause, and hysterectomy are small, as is the radiation exposure during embolization. These risks compare favorably with those associated with myomectomy. Fertility rates appear similar to patients undergoing myomectomy. No problems, either during pregnancy or delivery, have been observed after embolization. The course of pregnancy and delivery was normal after embolization with no maternal or fetal complications reported. These findings confirm results from other centers. Desire for future pregnancy is not a contraindication to fibroid embolization.

Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids

BACKGROUND

Earlier studies demonstrated the efficacy of uterine fibroid embolization (UFE). We seek to demonstrate the success of the procedure in a community hospital setting, and we attempt to identify patients likely not to benefit from embolization, if possible, before the procedure.

STUDY DESIGN

The study followed all women treated with UFE for menorrhagia or postmenopausal bleeding at a community hospital between 1997 and 1999. Relief of symptoms, ultrasound changes, and complications were documented. Six months after the procedure, analysis was performed on ultrasound and interview data from patients who underwent UFE. A smaller number of patients has been followed for 12 months and were available for the analysis. We examined characteristics of patients and procedures performed in an attempt to identify likely failures of treatment. We calculated complication and failure rates based on the entire group of patients.

RESULTS

From 183 patients who applied for UFE, 16 were excluded because ofpathologic conditions found during preembolization evaluation; 167 women had an embolization, 163 were successfully embolized bilaterally, and 4 were embolized unilaterally because of technical failure. Eighty-eight percent of the patients (147 of 167 patients) reported an improvement or stabilization of symptoms 6 months after UFE. Forty-six patients followed for 12 months experienced myoma shrinkage of 37% (a significant shrinkage over 6 months, p < 0.001), and total uterine volume decreased 52%. Analysis of shrinkage data revealed no demographic or procedure variable associated with shrinkage. Six patients underwent hysterectomy (3.5%) after embolization, one as a result of postprocedure infection. Pain in the first 24 hours postprocedure affected almost all patients. Five percent of the patients passed submucous myomata after UFE; all these patients at risk were identified at preembolization hysteroscopy. Four patients experienced premature menopause after embolization early in the study. There were three criteria for failure, of which a patient had to meet only one: hysterectomy, < 10% shrinkage ofmyoma 6 months after UFE, or worsening symptoms after UFE. No variables of age or size of the uterus could be shown to predict failure. Patients who had undergone earlier pelvic surgery were more likely to fail UFE (p = 0.012).

CONCLUSIONS

Uterine fibroid embolization, an alternative treatment for myomas, offering low morbidity, can be performed in a community hospital setting. Eighty-eight percent of patients reported improvement or stabilization of symptoms. Total uterine volume decreased an average of 49% at 6 months after embolization. Shrinkage was unaffected by the size of the uterus, myoma, or patient characteristic before UFE. Longterm followup study reveals a significant continuing shrinkage of total uterine volume and myomata at 12 months. There has been no regrowth of fibroids. Earlier surgery was a factor predicting failure of UFE in our series. The risks to future fertility were small.

Uterine artery embolization for the treatment of uterine leiomyomata midterm results

INTRODUCTION

The authors review their midterm experience with uterine artery embolization for the treatment of uterine fibroids.

MATERIALS AND METHODS

Sixty patients were referred for permanent polyvinyl alcohol (PVA) foam particle uterine artery embolization during an 18-month period. Detailed clinical follow-up and ultrasound follow-up were obtained.

RESULTS

Bleeding was a presenting symptom in 56 patients and pain was a presenting symptom in 47 patients. All patients underwent a technically successful embolization. One of the patients underwent unilateral embolization. Fifty-nine patients underwent bilateral embolization. Of all patients undergoing bilateral embolization, at last follow-up (mean, 16.3 months), 81% had their uterus and had moderate or better improvement in their symptoms. Ninety-two percent of these patients also had reductions in uterine and dominant fibroid volumes. Overall, the mean uterine and dominant fibroid volume reduction were 42.8% and 48.8%, respectively (mean follow-up, 10.2 months). One infectious complication that necessitated hysterectomy occurred.

CONCLUSION

Uterine artery embolization for the treatment of uterine fibroids is a minimally invasive technique with low complication rates and very good clinical efficacy.

Preliminary experience with uterine artery embolization for uterine fibroids

PURPOSE

To evaluate the potential usefulness of transcatheter uterine artery embolization as a treatment for fibroid-related vaginal bleeding and pelvic pain refractory to hormonal therapy and myomectomy.

MATERIALS AND METHODS

Eleven patients (aged 27-55 years; mean, 44.2 years; none desiring future pregnancy) with refractory vaginal bleeding and/or chronic pelvic pain related to uterine leiomyomata underwent uterine artery embolization with use of polyvinyl alcohol (PVA) particles. Clinical improvement was assessed by detailed questionnaire at 2-9 months (mean, 5.8 months) after the procedure. Sonographic measurements of the uterus and dominant masses were obtained before and at 2 months after the procedure.

RESULTS

All 11 patients underwent technically successful embolization. Eight of nine women who completed the follow-up questionnaire reported noticeable symptomatic improvement, including three women with complete resolution of symptoms. One woman (the only patient undergoing unilateral embolization) exhibited no clinical response. Another patient developed endometritis and pyometra 3 weeks after the procedure, necessitating hysterectomy. Large reductions in uterine volume (average, 40%) and dominant fibroid size (average, 60%-65%) were sonographically demonstrated.

CONCLUSION

Uterine artery embolization represents a promising new method of treating fibroid-related menorrhagia and pelvic pain. Further investigation will be required to assess clinical response and durability, identify appropriate candidates, and define the optimal angiographic technique and PVA particle size.

Budd-Chiari syndrome: the results of duplex and color Doppler imaging

This study was designed to evaluate duplex and color-flow Doppler imaging as potential noninvasive methods of diagnosing patients with Budd-Chiari syndrome and following them after surgery. Five patients with confirmed hepatic venoocclusive disease were imaged. All five underwent duplex Doppler examinations; three were also evaluated with color-flow Doppler. The hepatic vasculature was examined in all five patients; decompressive mesoatrial shunts were present and were evaluated in four of the five patients. Color-flow Doppler precisely defined intrahepatic, portal, and inferior vena caval circulatory dynamics. Correlation with angiography was excellent. In the two patients in whom hepatic vasculature was evaluated with duplex Doppler alone, the results were less impressive. Intrahepatic flow abnormalities were identified, but the sites of occlusion were not determined convincingly. Signals transmitted from the heart and the inability to visualize the hepatic veins made duplex Doppler evaluation problematic. Duplex Doppler was able to define patency and the direction of flow in the portal vein and inferior vena cava. Our results suggest that color-flow Doppler is an excellent technique for the initial evaluation of patients suspected of having Budd-Chiari syndrome. In the evaluation of decompressive mesoatrial shunts, color-flow Doppler produced dramatic images. However, both duplex and color-flow Doppler were highly accurate in determining the patency of decompressive shunts. Either duplex or color-flow Doppler may be used as the primary imaging procedure to determine shunt patency.

Cerebrovascular ultrasound imaging

Advancements in technology have brought noninvasive diagnosis of cerebrovascular disease to a high level of accuracy in a relatively short period of time. Conventional duplex sonography allows precise vessel localization and Doppler quantification. The further refinement of color flow imaging promises to simplify the examination and add considerable confidence to the diagnosis. Regardless of the technology used, ultrasound evaluation of the carotid arteries remains a difficult examination to perform, and excellent results are only possible with meticulous technique. The astute sonographer or sonologist will use all aspects of available ultrasound technology to the fullest. Careful evaluation of a seemingly overwhelming array of parameters will result in an impressive degree of diagnostic accuracy.

Infant cranial sonography

Sonography is well recognized as an excellent method of imaging the infant brain. A detailed discussion of the sonography of the preterm patient forms the first portion of this article. The numerous other clinical situations in which sonography can be used either alone or in conjunction with CT follow.