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Over the past 30 years, an increasing number of people have identified within the asexual (ACE) spectrum recognizing an absence/low/situational sexual attraction to individuals of any gender. The current study aims to deepen the knowledge of sexual desire, erotic fantasies, and related emotions within the ACE spectrum. A total of 1072 Italian volunteers were recruited to take part to the present study via social media. Data were collected from October 2021 to January 2022 using the Sexual Desire and Erotic Fantasies questionnaire and the Sexual Desire Inventory-2. Participants were divided into four groups: asexual, demisexual, gray-asexual, and questioning. Focusing on sexual desire, asexual people reported significantly lower scores than the other groups in all the dimensions except for "negative feelings to sexual desire," while demisexual participants showed the higher scores in all the domains except for "negative feelings to sexual desire." The questioning group reported the highest scores in the "negative feelings toward sexual desire" compared to the asexual and demisexual ones. The asexual group reported significantly lower scores than the other groups in fantasies frequency, fantasies importance, negative emotions, and sharing and experiencing. The demisexual group showed higher frequency of romantic fantasies than the asexual and gray-asexual ones. The results showed some specific patterns of desire and fantasies among the asexual, gray-asexual, demisexual, and questioning groups. These data may provide relevant material to clinicians working with asexual patients who need greater awareness about the diversity and heterogeneity of the sexual experience within the ACE spectrum.
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Fantasía , Conducta Sexual , Humanos , Conducta Sexual/psicología , Libido , Identidad de Género , EmocionesRESUMEN
INTRODUCTION: Adverse childhood experiences (ACEs) are psychosocial factors acknowledged as significant contributors to health consequences later in adolescence, including psychological maladjustment. The research suggests that, at a transdiagnostic and transtheoretical level, working on restoring epistemic trust (ET), mentalized affectivity (MA), and reflective functioning (RF) in adolescents with ACEs assumes a central role in the therapeutic process. However, there are still few studies that attempted to investigate the specific role of these sociocognitive factors in the detrimental positive association between levels of experienced ACEs during childhood and psychological maladjustment in nonclinical adolescents. METHODS: A community sample of 306 Italian cisgender adolescents (61.4% assigned females at birth; age range 13-19 years old; Mage = 16.1, SD = 1.64) self-reported ACEs (Childhood Trauma Questionnaire-Short Form), psychological maladjustment (Strengths and Difficulties Questionnaire), ET (Epistemic Trust, Mistrust and Credulity Questionnaire), MA (Brief-Mentalized Affectivity Scale for Adolescence), and RF (Reflective Functioning Questionnaire). A multiple mediation regression analysis has been performed to explore the association between ACEs and psychological maladjustment through the interaction with socio-cognitive factors. RESULTS: ACEs are positive predictors of psychological maladjustment later in adolescence. Regardless of gender differences, epistemic mistrust and credulity, processing and expressing emotions, and uncertainty about mental states mediated this association, while epistemic trust, identifying emotions, and certainty about mental states did not configure as significant mediators. CONCLUSION: Findings suggest that ET disruptions and deficits in RF are risk factors, while MA is a protective factor within the link between ACEs and psychological maladjustment in adolescence. These links help to specify the role of sociocognitive factors in the development of mental problems in adolescents who have been exposed to adverse experiences in childhood.
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The present study examined the attachment patterns distribution of 60 lesbian mothers, 50 gay fathers, and 42 heterosexual parents through assisted reproduction and their 76 children, using the Adult Attachment Interview (AAI) and the Friends and Family Interview (FFI), respectively. The study also explored the intergenerational transmission of attachment through reflective functioning (AAI-RF). All families lived in Italy and children were aged 6-12 years (Myears = 8.11, SD = 2.17; 48.68% assigned female at birth). The AAI patterns distribution was similar across family types and did not significantly differ from international and national normative data. Similarly, children's FFI attachment patterns were evenly distributed between family types, and no significant differences emerged in comparison to international and national normative data referring to middle childhood samples. Mediational models revealed that, in all three family types, parents with greater AAI coherence of mind exhibited higher AAI-RF, which, in turn, was associated with increased FFI attachment security in children. Furthermore, parents' AAI coherence of mind directly influenced children's FFI attachment security. The results support and expand hypotheses regarding the intergenerational transmission of attachment in lesbian, gay, and heterosexual parent families through assisted reproduction, while offering unique indications to support these families during middle childhood.
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BACKGROUND: Recently, the variability and heterogeneity of gender presentations in transgender youths have gained significant attention worldwide. Alongside this, specialized gender services have reported an increase in referrals of youths reporting non-binary identities. In Italy, studies investigating gender identity and expression in gender non-conforming youths are lacking, as are data regarding the non-binary population. AIM: The present study aimed at dimensionally exploring how transgender and non-binary Italian adolescents identify and express their gender. OUTCOMES: Gender expression in trans binary youths and non-binary youths. METHODS: The Gender Diversity Questionnaire (GDQ; Twist & de Graaf, 2019) was used to investigate gender identity, gender fluidity, and gender expression in a sample of 125 adolescent patients from the Gender Identity Development Service (SAIFIP) in Rome and the Gender Incongruence Unit of the Careggi Hospital in Florence, between April 2019-June 2021. RESULTS: The majority of participants (74.4%) identified as trans* binary and the remaining (25.6%) participants identified as non-binary. Trans binary participants reported a stable gender identity, whereas non-binary participants reported a more fluid gender identity across time and contexts. Almost all participants rated external appearance as important to their gender expression, yet trans binary participants attributed more importance to the body in this respect. Body discomfort and pubertal stage emerged as the most influential factors in participants' experiences of gender. Participants who were assigned male at birth expressed significantly more desire for puberty blockers, whereas those who were assigned female at birth had a stronger desire to engage in breast/chest surgery. Non-binary participants sought different medical interventions relative to trans binary participants. CLINICAL IMPLICATIONS: These results may be useful for clinicians working with transgender youths as they provide awareness regarding the features of young people who identify within and outside of binary constructions of gender. STRENGTHS & LIMITATIONS: This study provides useful data in gaining insight into understanding the variety of experiences and challenges of gender non-conforming youths. However as the sample was recruited from specialized services, it may not represent the entire gender non-conforming population in Italy. CONCLUSION: The results describe the range of gender identities and expressions among gender non-conforming youths attending gender specialized services in Italy, thereby improving our understanding of the variety of identities experienced and the specific medical needs of both trans binary and non-binary adolescents. Mirabella M, Piras I, Fortunato A, et al. Gender Identity and Non-Binary Presentations in Adolescents Attending Two Specialized Services in Italy. J Sex Med 2022;19:1035-1048.
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Disforia de Género , Personas Transgénero , Transexualidad , Adolescente , Femenino , Identidad de Género , Humanos , Recién Nacido , Italia , MasculinoRESUMEN
BACKGROUND: Over the last few years, the gender binary has been questioned, highlighting the existence of gender diverse people, who identify as neither (exclusively) male nor female. AIM: The present study evaluated the possible differences in terms of psychological wellbeing between binary and gender diverse individuals, as well as the role of perceived social acceptance and religious fundamentalism as possible mediators of psychopathology in gender diverse people. Furthermore, the diversity of gender-affirming hormonal treatment requests according to gender identification was investigated. METHODS: A sample of 563 transgender people aged 18-70 was enrolled (nâ¯=â¯264 assigned female at birth, AFAB and nâ¯=â¯299 assigned male at birth, AMAB), all individuals referring to several Italian gender clinics. A subdivision of the study population based on the gender identity visual analog scale (GI-VAS) median was performed, in order to distinguish between gender diverse and binary transgender individuals. Moreover, a linear regression analysis was performed entering logarithmically transformed GI-VAS (Log GI-VAS) into the models with psychometric scales. OUTCOMES: Psychometric and sociodemographic data, as well as information regarding requests for gender-affirming treatments, were extrapolated from the clinical interviews conducted during the first referral. RESULTS: Gender diverse individuals showed significantly less intense gender dysphoria and higher levels of depression and anxiety compared to binary ones; accordingly, a less binary gender identity correlated with higher levels of depression and anxiety and lower levels of gender dysphoria. The depressive symptomatology in gender diverse people was partially mediated by perceived discrimination and humiliation. Moreover, gender diverse AMAB people sought a non-standard hormonal treatment more often than their binary counterpart. CLINICAL IMPLICATIONS: The present study highlights the importance for transgender health professionals, when planning gender-affirming hormonal treatments, to offer flexible interventions, tailored on the patient's needs and goals. STRENGTHS & LIMITATIONS: Strengths included exploring whether and how perceived discrimination may affect mental health in gender diverse people. Limitations included the enrolled sample of people referring to different gender clinics, which is not fully representative of the transgender population. CONCLUSION: This study highlights the importance of evaluating each individual's unique health care needs, exploring each single request and its underlying reasons. Romani A., Mazzoli F., Ristori J., et al. Psychological Wellbeing and Perceived Social Acceptance in Gender Diverse Individuals. J Sex Med 2021;18:1933-1944.
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Disforia de Género , Transexualidad , Femenino , Identidad de Género , Humanos , Recién Nacido , Masculino , Estatus SocialRESUMEN
Internal Working Models of the attachment system modulate emotional responses and the Disorganized attachment pattern is characterized by the breakdown of such regulation. Vagally-mediated heart rate variability (vmHRV) is an index of flexible emotional responding. This study investigated vmHRV in non-clinical adults with an Organized or Disorganized attachment pattern before, during, and after the recall of attachment memories via the Adult Attachment Interview (AAI). Whereas the Organized group exhibited a typical decrease in vmHRV during the AAI and asubsequent return to a baseline-like pattern, the Disorganized group unexpectedly showed a sustained increase in vmHRV during the AAI which also persisted during the recovery phase. Results suggest that while Organized face the recollection of attachment memories by showing the adaptive stress response characterized by parasympathetic withdrawal and immediate recovery, individuals with Disorganized attachment need to keep regulating their emotions effortfully both during and after the recall of potential traumatic events.
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Emociones/fisiología , Frecuencia Cardíaca/fisiología , Apego a Objetos , Estrés Psicológico/epidemiología , Adulto , Femenino , Humanos , Masculino , Factores Socioeconómicos , Estrés Psicológico/fisiopatología , Nervio Vago/fisiologíaRESUMEN
Objective: In this paper, we test the reliability and validity of two novel ways of assessing mentalizing in the therapy context: the Reflective Functioning scale (RF) applied to code psychotherapy transcripts (In-session RF), and the Exploring scale of the Patient Attachment Coding System (PACS), which measures in-session autonomy and is linked with secure attachment in psychotherapy. Method: Before treatment, 160 patients in different types of psychotherapy and from three different countries were administered the Adult Attachment Interview (AAI), which was rated with the RF scale. One early psychotherapy session for each patient was independently rated with the In-session RF scale and with the PACS Exploring scale. Results: Both scales were found to be reliable and to have concurrent validity with the RF scale rated on the AAI, with the PACS Exploring scale found to be a better predictor of RF on the AAI. Conclusions: These results suggest that the PACS Exploring scale might be a practical method for assessing RF in psychotherapy research and a way for researchers and clinicians to track patients' RF on an ongoing basis. These results also provide information regarding the ways in which differences in RF manifest during psychotherapy sessions. Clinical or methodological significance of this article Researchers and clinicians can assess patients' mentalizing based on any single psychotherapy transcript, in many therapeutic modalities The Exploring scale of the Patient Attachment Coding System can yield a reliable measure of reflective functioning based on any single psychotherapy transcript, in many therapeutic modalities Client differences in mentalizing manifest in part independently of the therapist's contributions.
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Mentalización , Apego a Objetos , Relaciones Profesional-Paciente , Psicometría/normas , Procesos Psicoterapéuticos , Adulto , Femenino , Humanos , Lenguaje , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
The main aim of this study was to investigate the associations between personality features and attachment patterns in transsexual adults. We explored mental representations of attachment, assessed personality traits, and possible personality disorders. Forty-four individuals diagnosed with gender identity disorder (now gender dysphoria), 28 male-to-female and 16 female-to-male, were evaluated using the Shedler-Westen assessment procedure-200 (SWAP-200) to assess personality traits and disorders; the adult attachment interview was used to evaluate their attachment state-of-mind. With respect to attachment, our sample differed both from normative samples because of the high percentage of disorganized states of mind (50% of the sample), and from clinical samples for the conspicuous percentage of secure states of mind (37%). Furthermore, we found that only 16% of our sample presented a personality disorder, while 50% showed a high level of functioning according to the SWAP-200 scales. In order to find latent subgroups that shared personality characteristics, we performed a Q-factor analysis. Three personality clusters then emerged: Healthy Functioning (54% of the sample); Depressive/Introverted (32%) and Histrionic/Extroverted (14%). These data indicate that in terms of personality and attachment, GD individuals are a heterogeneous sample and show articulate and diverse types with regard to these constructs.
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Determinación de la Personalidad/estadística & datos numéricos , Transexualidad , Adulto , Femenino , Humanos , Masculino , Trastornos de la Personalidad/epidemiología , Trastornos de la Personalidad/psicología , Transexualidad/epidemiología , Transexualidad/psicologíaRESUMEN
Objective: Starting from May 2022, a growing number of monkeypox cases have been identified in several countries in Europe and the United States. To date, information on social reaction to the news circulating about monkeypox is limited. Assessing psychological and social elements related to the tendency to misinterpret monkeypox information is urgent and useful in setting up tailored education and prevention programs for specific populations. The present study aims to explore the association of selected psychological and social variables to monkeypox attitudes as fake news. Methods: Three hundred and thirty-three participants (212 women, 110 men, and 11 other genders) from the general Italian population completed nine self-report measures. Results: Results showed that people that were more likely to believe that monkeypox was a hoax were: older, heterosexual, politically conservative, and more religious. Moreoverm they were more likely to show more negative attitudes toward gay men, higher levels of sexual moralism, less knowledge and fear about monkeypox, no previous infections of COVID-19, lower number of COVID-19 vaccine doses, and being closer to no-vax theories. On the psychological side, participants that were more likely to believe that the monkeypox was a hoax were associated with lower levels of epistemic trust and order traits, with higher levels of epistemic mistrust, close-mindedness, and ability to process emotions. A full mediation model which explores the relationships between the main variables related to fake news attitudes toward monkeypox was tested, reporting good fit indices. Conclusion: Results from the current study could be helpful to improve the effectiveness of health communication, design targeted education, and support people to engage in healthier behaviors.
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BACKGROUND: A rising number of monkeypox cases have been detected in Europe and several Western nations. Evaluating the fear associated with monkeypox is crucial to determine the necessity for tailored education and prevention programs for specific populations. This study explores the psychological and social factors linked to the fear response to monkeypox. METHODS: Nine self-report measures were completed by 333 participants (212 women, 110 men, and 11 individuals identifying as other genders) from the general Italian population, investigating different psychosocial variables. RESULTS: The findings revealed that higher levels of monkeypox fear were linked to identifying as LGB+ or having close associations with the LGBTQI+ community, being single, having lower education levels, placing greater importance on religion, receiving more COVID-19 vaccine doses, having a lower current quality of life, and attributing increased impairment to the COVID-19 pandemic. Psychologically, higher levels of monkeypox fear were associated with higher levels of epistemic credulity, close-mindedness, anxiety, difficulty expressing emotions, and difficulty processing them. Conversely, lower levels of monkeypox fear were related to the belief that the media exaggerated the risks associated with monkeypox epidemics. A partial mediation model was presented and tested. CONCLUSIONS: Collecting and utilizing this data can help design targeted education and prevention programs to overcome the fear of monkeypox and promote healthier behaviors.
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The construct of epistemic trust has received much consideration in recent psychological literature, even though mainly from a theoretical perspective. The overall aim of this study was to validate the first self-report measure of epistemic trust-the Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ)-in an Italian sample. Our primary goal was to test the factorial validity of the instrument, also exploring the influence of age, gender, and level of education on epistemic trust (Study 1, n = 843). Secondarily, we investigated the associations between epistemic trust, mistrust, credulity, and other aspects of psychological functioning, as well as with the presence of adverse childhood experiences in a smaller number of participants (Study 2, n = 445). Besides the ETMCQ, the survey included an ad hoc questionnaire investigating socio-demographic characteristics and self-report measures of reflective functioning, mentalized affectivity, traumatic experiences, attachment, and psychological symptoms. Statistical analysis showed a three-factor hierarchical structure similar to the model proposed in the original validation, with some differences that suggest an influence of cultural factors in determining individuals' epistemic stance. Our results corroborate previous theoretical contributions regarding the association between epistemic trust and psychological wellbeing, and between epistemic disruptions and higher levels of psychological suffering. Both Mistrust and Credulity were significantly related to the presence of childhood traumatic experiences, attachment avoidance and anxiety, lower levels of mentalization, lower abilities in emotional regulation, and higher levels of psychopathological symptoms. The ETMCQ represents an easily administered and time-effective tool. Its use could pave the way for interesting clinical and theoretical findings.
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Mentalización , Confianza , Humanos , Confianza/psicología , Encuestas y Cuestionarios , Autoinforme , MotivaciónRESUMEN
In Italy, studies investigating gender identity and expression in gender non-conforming adults are lacking, as well as data regarding the non-binary population. The present study aimed at dimensionally exploring how transgender and non-binary Italian adults identify and express their gender. The Gender Diversity Questionnaire (GDQ) was administered to a sample of 112 adult subjects aged 18-60 years accessing a gender-specialized service in Rome. The majority of the participants were aged 18-24 years (53.6%), whereas fewer subjects were aged 25-35 years (32%) and 35 years and older (14.3%). Most participants (83.9%) identified themselves as trans binary, while the remaining (16.1%) identified as non-binary. Trans binary participants reported a stable gender identity, whereas non-binary participants reported a more fluid gender identity over time and across contexts. Younger subjects recognized the use of chosen names, pronouns, and clothes as important for their gender expression, whereas older subjects attributed more importance to physical appearance and emotions. Differences regarding gender-affirmative interventions emerged between non-binary and transbinary participants. Findings evidence that gender non-conforming adults accessing gender-specialized services have unique needs and features, thus it is essential to shed light on this population by providing greater visibility and recognition.
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The concept of mentalized affectivity (MA) encompasses the dimensions of identifying, processing, and expressing emotions and describes the process of making sense of and reevaluating one's affects in light of autobiographical memory. This construct was developed within the theoretical framework of mentalization and, due to its interpersonal nature, added further complexity to the emotion regulation construct. This research aimed to examine the factor structure and psychometric properties of the Brief-Mentalized Affectivity Scale for adolescents (B-MAS-A) on an Italian sample of young people (aged 13-19 years). Data were collected using non-probabilistic sampling and an online survey. Participants were asked to complete a large battery of instruments, including the B-MAS-A, the Toronto Alexithymia Scale, the Reflective Functioning Questionnaire, the Epistemic Trust, Mistrust, and Credulity Questionnaire, the Strengths and Difficulties Questionnaire, and the General Self-Efficacy Scale. In study 1, factor analyses carried out on a total sample of 566 adolescents identified 3 distinct dimensions of the same components of MA found in the adult population: i) identifying; ii) processing; iii) expressing emotions. The subscales showed excellent internal consistency. Study 2 (involving a subsample of 288 participants) demonstrated good levels of construct and criterion validity. These results confirm that the B-MAS-A represents a valid and robust instrument for assessing the complex and multifaceted characteristics of MA in adolescents. The B-MAS-A can make a significant contribution to clinical practice and research and encourage systematic studies on MA in psychotherapy, taking into account the developmental stage of adolescence.
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Intimate partner violence (IPV) has been examined from a range of theoretical perspectives, including attachment theory, with the aim of assessing psychosocial risk factors. Previous research has shown that a child's exposure to violence in the family is a major predictor of IPV victimization later in life. Furthermore, research on abused and traumatized adult samples has shown high frequencies of unresolved/disorganized attachment styles. In particular, disorganized attachment is associated with major problems of affect regulation and deficits in mentalizing ability. The present research had three aims: (a) to assess the childhood traumatic experiences of female victims of IPV; (b) to investigate and identify the attachment patterns of female victims of IPV; and (c) to examine reflective functioning and prementalistic modes in female victims of IPV, in relation to attachment and trauma. A sample of 31 women, recruited through anti-violence centers, were administered the Adult Attachment Interview (AAI) and the Reflective Functioning Questionnaire. The Complex Trauma Questionnaire and the Reflective Functioning Scale (RFS) were also applied to the AAI transcripts. Interviews were audio recorded and transcribed verbatim. Coding was conducted by two trained coders and certified as reliable for the AAI and RFS. Clinicians completed the Modes of Mentalization Scale (MMS) to assess participants' mentalization style. The data showed a high percentage of women with insecure attachment and lower reflective functioning. The results are discussed in terms of their clinical and theoretical implications-particularly their application to psycho-forensics, through the development of preventive programs and interventions for IPV. Efforts to understand the etiology of IPV and to intervene to prevent recidivism are fundamental in reducing this public health threat.
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Acoso Escolar , Víctimas de Crimen , Violencia de Pareja , Mentalización , Adulto , Experiencias Adversas de la Infancia , Niño , Víctimas de Crimen/psicología , Femenino , Humanos , Violencia de Pareja/psicología , Apego a Objetos , ViolenciaRESUMEN
Introduction: The COVID-19 pandemic represents risk to physical health and psychological well-being. Specifically, it causes concerns among minoritized communities, such as transgender/non-binary individuals. The study investigates the experience of this group in Italy during the pandemic and identifies risk factors that exerted negative impacts on psychological well-being and physical health. Methods: The study developed an online questionnaire to investigate psychological status, access to medical health services, and factors such as predictors of risk outcomes among transgender/non-binary people during lockdown restrictions. Responses were collected (n = 256) on April 2020. Descriptive analysis, univariate analysis of variance, and t-test were conducted. Results: The respondents confirmed several issues, such as worries about the future (58.2%), negative emotions (46.9%), and self-uncertainty (52.7%) during the pandemic. Difficulties in undertaking hormone therapy and access to health facilities were reported. Living with family members represented a significant stressor for psychological well-being, whereas lack of support from LGBT + communities was reported. Subjects undergoing psychological therapy during the pandemic reported increases in depression, anxiety, somatization, and lack of privacy in the household. Conclusions: The study findings provide a framework for critical aspects experienced by transgender/non-binary individuals during the pandemic. Specifically, the study provides evidence of the vulnerability of this population underlined by multiple difficulties. Policy Implications: The study findings provide an overview of the experience of transgender and non-binary people during the pandemic, insights regarding risk factors, and aspects that require adequate attention and care. Supplementary Information: The online version contains supplementary material available at 10.1007/s13178-021-00633-3.
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An increasing amount of literature revealed a link between GD and ASD. Both GD and ASD are complex and heterogeneous conditions characterized by a large variety of presentations. Studies have reported that individuals with GD tend to have higher prevalence rates of autistic traits in comparison to the general population. The purpose of this commentary is to provide, through the description of a clinical case, our reading and a possible interpretation of the correlation of these two conditions in light of the several methodological limitations found in literature. We hypothesize that the traits often classified as autistic could be more accurately related to the distress and discomfort evoked by GD. The autistic traits of individuals with GD as forms of psychological defenses and coping mechanisms aimed at dealing with socio-relational and identity problems are discussed.
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Trastorno del Espectro Autista , Trastorno Autístico , Disforia de Género , Trastorno del Espectro Autista/complicaciones , Trastorno del Espectro Autista/epidemiología , Trastorno del Espectro Autista/psicología , Disforia de Género/complicaciones , Disforia de Género/epidemiología , Disforia de Género/psicología , Humanos , Fenotipo , PrevalenciaRESUMEN
Non-binary people may face specific challenges in psychological settings. Psychotherapists often display a lack of preparation for non-binary gender identities, resulting in overt or subtle forms of prejudice that compromise the therapeutic alliance. The present study aimed to provide data on non-binary clients' positive and negative experiences within therapeutic relationships. Twenty-five interviews were conducted with non-binary people in the age range of 19-35. Using codebook thematic analysis, the researchers identified three main themes: (1) the self of the psychotherapist, consisting of the impact of the therapist's personal (i.e., sexual identity) and professional (i.e., competence) characteristics on the therapeutic experience; (2) the practice of the psychotherapist, emerging as affirmative (validation and microaffirmations) or negative (gender identity change efforts, manifest aggressions, and microaggressions) approaches toward non-binary identities; (3) the therapeutic relationship, referring to the alliance, rupture, and reparation based on the therapists' openness toward non-binary identities. To provide a safer setting for non-binary clients, psychotherapists should incorporate issues related to gender minority identities in their training, acknowledge clinical errors when they occur and adopt an active predisposition to learn through the client's experience, giving value to their unique contribution.
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Identidad de Género , Alianza Terapéutica , Humanos , Femenino , Masculino , Psicoterapia , Agresión , Técnicos Medios en SaludRESUMEN
BACKGROUND: Depressive disorders in adolescence are among the most challenging clinical syndromes to diagnostically identify and treat in psychotherapy. The Psychodynamic Diagnostic Manual, Second Edition (PDM-2) proposes an integration between nomothetic knowledge and an idiographic understanding of adolescent patients suffering from depression to promote a person-centered approach. This single-case study was aimed at describing and discussing the clinical value of an accurate diagnostic assessment within the PDM-2 framework. METHOD: Albert, a 16-year-old adolescent with a DSM-5 diagnosis of major depressive disorder, was assessed using instruments from various perspectives: the Structured Clinical Interview for DSM-5; the Psychodynamic Chart-Adolescent of the PDM-2, and other clinician-report instruments; and the Shedler-Westen Assessment Procedure for Adolescents and Defense Mechanisms Rating Scale Q-sort, coded by external observers. RESULTS: Albert's assessment revealed impairments in various mental capacities, especially in regulating self-esteem. He presented a borderline personality organization at a high level and an emerging narcissistic personality syndrome. CONCLUSIONS: The case discussion showed the importance of providing clinically meaningful assessments to plan for effective treatments in youth populations. Especially, it is necessary to understand the adolescent's unique characteristics in terms of mental and personality functioning and consider the developmental trajectories and adaptation processes that characterize this specific developmental period.
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Trastorno Depresivo Mayor , Adolescente , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/terapia , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Humanos , Masculino , Personalidad , Determinación de la Personalidad , Trastornos de la PersonalidadRESUMEN
Mentalizing capacities depends on the quality of primary attachment interactions with caregivers who thinks of the child as a subject with mental states. Operationalized as reflective functioning, mentalization is crucial for regulating emotions and developing of a coherent sense of identity, for interacting with individuals making sense to own and others mental states, and for distinguishing internal and external realities without distortions. Although the clinical literature on interplay between mentalization, attachment, and emotional regulation is rich, the empirical research is limited. This study sought to explore connections between reflective functioning, attachment styles, and implicit emotion regulation, operationalized as defense mechanisms, in a group of depressive patients. Twenty-eight patients were interviewed using the adult attachment interview (AAI) and diagnosed using the Psychodynamic Chart-2 of the Psychodynamic Diagnostic Manual, Second Edition. The reflective functioning scale and the defense mechanisms rating scale Qsort were applied to AAI transcriptions to assess reflective functioning and defensive profile. Patients with secure attachment showed significantly higher levels in reflective functioning and overall defensive functioning as compared to those with insecure attachment. Good reflective functioning and secure attachment correlated with mature defenses and specific defensive mechanisms that serve in better regulating affective states. Overall, the relationship between mentalization, attachment and emotion regulation lay the foundations for the delineation of defensive profiles associated with attachment patterns and reflective functioning in depressive patients. The systematic assessment of these psychological dimensions with gold-standard tools may help in tailoring personalized therapeutic interventions and promoting more effective treatments.