Mothers' alexithymia in the context of parental Substance Use Disorder: Which implications for parenting behaviors?

BACKGROUND: Maternal substance use disorder (SUD) represents a severe risk for caregiving, affecting diverse domains of parenting behaviors, such as sensitivity, structuring, intrusiveness, and hostility. Various studies highlighted that difficulties in parenting behaviors in the context of SUD are exacerbated by the co-occurrence of psychopathological symptoms. A large body of research points out the presence of high rates of alexithymia in individuals with SUD, and some studies provide evidence of an association between this psychopathological aspect and parenting. Nevertheless, no prior research has explored how alexithymic traits could affect quality of parenting behaviors in mothers with SUD. OBJECTIVE: To investigate the impact of maternal alexithymia on parenting behaviors in mothers with SUD. METHODS: Sixty women in residential treatment for SUD and their children participated in the study. The participants were assessed with respect to alexithymia, quality of parenting behaviors, and depressive symptoms. RESULTS: Forty-three percent of the mothers reported the presence of alexithymia. These mothers presented with significantly low scores on sensitivity (ß = -.25, p < .05) and structuring (ß = -.32, p < .05). After controlling for depressive symptomatology, the effect of alexithymia on parenting behaviors remained only for structuring (ß=.35, p < .05). CONCLUSIONS: In the context of SUD, maternal alexithymia significantly impacts the quality of parenting behaviors, specifically structuring, indicating that difficulties in becoming aware of one's own feelings jeopardize the ability to scaffold interactions and set age-appropriate limits in an emotionally attuned way. Clinical implications of the findings are discussed.

Personality and Personality Disorders in Medication-Overuse Headache: A Controlled Study by SWAP-200.

Background: Medication-overuse headache (MOH) is a type of chronic headache, whose mechanisms are still unknown. The impact of psychological factors has been matter of debate from different perspectives. The role of personality and personality pathology in processes involved in MOH development has been advanced but was poorly studied. The hypothesis of addiction-like behaviors sustaining the drug misuse has been examined and reached contrasting findings. Objectives: This study is aimed at detecting personality and its disorders (PDs) in MOH, with a specific attention to the addiction aspect. Methods: Eighty-eight MOH patients have been compared with two clinical populations including 99 patients with substance use disorder (SUD) and 91 with PDs using the Shedler-Westen Assessment Procedure-200 (SWAP-200), a clinician-report tool that assesses both normal and pathological personality. MANCOVAs were performed to evaluate personality differences among MOH, SUD, and PD groups, controlling for age and gender. Results: MOH patients were predominantly women and older. They showed lower traits of the SWAP-200's cluster A and B disorders than SUD and PD patients, who presented more severe levels of personality impairment. No differences in the SWAP-200's cluster C have been found, indicating common personality features in these populations. At levels of specific PDs, MOH patients showed higher obsessive and dysphoric traits and better overall psychological functioning than SUD and PD patients. Conclusion: Although MOH, SUD, and PD populations have been evaluated in multiple sites with different levels of expertise, the study supported the presence of a specific constellation of personality in MOH patients including obsessive (perfectionist) and dysphoric characteristics, as well as good enough psychological resources. No similarities to drug-addicted and personality-disordered patients were found. Practitioners' careful understanding of the personality characteristics of MOH patients may be useful to provide a road map for the implementation of more effective treatment strategies and intervention programs.

A Theoretical and Empirical Linkage between Road Accidents and Binge Eating Behaviors in Adolescence.

This study aimed at identifying specific clusters of maladaptive emotional-behavioral symptoms in adolescent victims of motorbike collisions considering their scores on alexithymia and impulsivity in addition to examining the prevalence of clinical binge eating behaviors (respectively through the Youth Self-Report (YSR), Toronto Alexithymia Scale-20 (TAS-20), Barratt Impulsiveness Scale-11 (BIS-11), and Binge Eating Scale (BES)). Emotional-behavioral profiles, difficulties in identifying and describing feelings, impulsivity, and binge eating behaviors have been assessed in 159 adolescents addressing emergency departments following motorbike collisions. Our results showed a cluster of adolescents with clinical binge eating behaviors, high rates of motorbike accidents, and high levels of internalizing and externalizing problems, alexithymia, and impulsivity (23.3% of the sample); a second cluster of adolescents with clinical binge eating behaviors, a moderate number of collisions, and moderate levels of emotional and behavioral problems on the above four dimensions (25.8% of the sample); and a third cluster of youth without clinical binge eating behaviors, with a moderate number of accidents, and with low scores on the four dimensions (50.9% of the sample). Adolescents of Cluster 1 showed a higher likelihood to be involved in motorbike collisions than the youth in Clusters 2 and 3 (p < 0.0001). We suggest that adolescents' motor collisions could be associated with their difficulties in emotion regulation and with their impaired psychological profiles, which could also underpin their disordered eating. The identification of specific clusters of psychopathological symptoms among this population could be useful for the construction of prevention and intervention programs aimed at reducing motor collision recidivism and alleviating co-occurring psychopathologies.

Emotional Availability, Neuropsychological Functioning, and Psychopathology: The Context of Parental Substance Use Disorder.

Parental Substance Use Disorder (SUD) constitutes a high-risk condition for parent-child interactions and child development. Empirical evidence indicates high rates of psychopathology and neuropsychological impairments in individuals with SUD. Despite research indicating that parenting skills are related to psychological well-being and cognitive/neuropsychological functioning, prior studies have not examined the associations between these areas of parental functioning and the quality of parent-child interactions in the context of SUD. Aim(s). The present study adopts an integrated perspective to investigate the way in which maternal neuropsychological functioning and psychopathology are associated with mother-child emotional availability (EA), in the context of parental Substance Use Disorder. Methods. Twenty-nine mothers with SUD were assessed in interaction with their children, as well as with respect to their neuropsychological functioning and psychopathology. Results. In this group, high rates of maternal neuropsychological impairments and psychopathology, as well as generally low levels of EA, were uncovered. Regression analyses showed that maternal neuropsychological functioning was significantly associated with mother-child EA, specifically sensitivity; the role of maternal psychopathology, however, was only marginally significant. Conclusion. In the context of SUD, maternal neuropsychological impairments are significantly associated with mother-child EA. Clinical implications of the findings are discussed.

Alexithymia in Young Adults With Substance Use Disorders: Critical Issues About Specificity and Treatment Predictivity.

Several studies have reported high rates of alexithymia in drug-dependent individuals, but supporting evidence attests association between alexithymia and a variety of psychiatric disorders, raising doubts about its specificity. Moreover, controversies are emerging about alexithymia assessment: self-report measures present shortcomings with respect to discriminant validity and reliability. As regards treatment for substance use disorders (SUDs), alexithymia has been linked to poorer outcomes, but the results are inconsistent. The aim of the present study is to investigate alexithymia in substance-dependent young adults by examining: (a) the specificity of alexithymia in drug-dependent inpatients, compared to healthy individuals and patients with psychiatric disorders (behavioral and emotional disorders) and (b) the predictivity of alexithymia in determining treatment outcomes in terms of relapses, drop-outs from treatment and the rate of relapse per month of treatment. Two studies were conducted to fulfill these aims: Study 1 and Study 2. Study 1 involved 90 late adolescents, aged 17-21. To fulfill the first aim, 30 inpatients diagnosed with SUD were compared with 30 healthy controls and 30 individuals referred to an outpatient neuropsychiatric unit (a). The participants completed the Toronto Alexithymia Scale-20 (TAS-20) and the Symptom Checklist-90-Revised (SCL-90-R). The results indicated that both clinical groups reported higher TAS-20 scores than the non-clinical subjects, but they did not differ from each other (a); moreover, a large correlation was detected between alexithymia and depressive symptoms, as assessed by the SCL-90-R. Study 2 involved 55 inpatients with SUD recruited in a therapeutic community. The participants completed the TAS-20, and clinicians filled out the Observer Alexithymia Scale (OAS). No association was found between self-report and observational measures. Neither self-reported nor observed alexithymia predicted the number of relapses, drop-out from treatment, or the rate of relapses per month of treatment (b). When the interaction with gender was explored, the global score of alexithymia and the "Distant" OAS subscale predicted the number rate relapses only in males. The TAS-20 did not discriminate between the clinical groups. The limited ability of both observed and self-reported measures in predicting treatment outcome raises questions on the specificity of alexithymia among the substance-dependent inpatient population.

Attachment Theory and Maternal Drug Addiction: The Contribution to Parenting Interventions.

Children's emotional and relational development can be negatively influenced by maternal substance abuse, particularly through a dysfunctional caregiving environment. Attachment Theory offers a privileged framework to analyze how drug addiction can affect the quality of adult attachment style, parenting attitudes and behaviors toward the child, and how it can have a detrimental effect on the co-construction of the attachment bond by the mother and the infant. Several studies, as a matter of fact, have identified a prevalence of insecure patterns among drug-abusing mothers and their children. Many interventions for mothers with Substance Use Disorders have focused on enhancing parental skills, but they have often overlooked the emotional and relational features of the mother-infant bond. Instead, in recent years, a number of protocols have been developed in order to strengthen the relationship between drug-abusing mothers and their children, drawing lessons from Attachment Theory. The present study reviews the literature on the adult and infant attachment style in the context of drug addiction, describing currently available treatment programs that address parenting and specifically focus on the mother-infant bond, relying on Attachment Theory.

The Role of Father Involvement and Marital Satisfaction in the Development of Family Interactive Abilities: A Multilevel Approach.

The study aims to investigate the development of family interactions from pregnancy to preschool age in a longitudinal perspective, using multilevel analysis. Also, it explored the impact of couple relationship and father involvement in childcare on the developmental trend of the quality of mother-father-child interactions. One hundred and three primiparous families were assessed at 7th month of pregnancy, 4th, 9th, and 18th months of child's life and during preschool age (36-48th), using the observational procedure named, Lausanne Trilogue Play. Parents' perception of marital satisfaction was assessed with the Dyadic Adjustment Scale at each point of measure; moreover, in the postnatal assessment, parents completed the Father Involvement Questionnaire. Results showed that family interactions increase over time. Secondly, a decrease of marital adjustment is associated with an improvement of the quality of family interactions. Moreover, father involvement predicts the quality of family interactions from the earliest stages of child's life. In a longitudinal perspective, family interactions and marital quality show opposite developmental trends and father's involvement represents a particularly important feature of the family.

Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early.

Parental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents' addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18-24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing EF and adopting a trauma-focused approach.

Infant Massage and Quality of Early Mother-Infant Interactions: Are There Associations with Maternal Psychological Wellbeing, Marital Quality, and Social Support?

Infant massage programs have proved to be effective in enhancing post-natal development of highly risk infants, such as preterm newborns and drug or HIV exposed children. Less studies have focused on the role of infant massage in supporting the co-construction of early adult-child relationships. In line with this lack of literature, the present paper reports on a pilot study aimed at investigating longitudinally the quality of mother-child interactions, with specific reference to emotional availability (EA), in a group of mother-child pairs involved in infant massage classes. Moreover, associations between mother-child EA, maternal wellbeing, marital adjustment, and social support were also investigated, with the hypothesis to find a link between low maternal distress, high couple satisfaction and high perceived support and interactions of better quality in the dyads. The study involved 20 mothers and their children, aged between 2 and 7 months, who participated to infant massage classes. The assessment took place at three stages: at the beginning of massage course, at the end of it and at 1-month follow-up. At the first stage of assessment self-report questionnaires were administered to examine the presence of maternal psychiatric symptoms (SCL-90-R), perceived social support (MSPSS), and marital adjustment (Dyadic Adjustment Scale); dyadic interactions were observed and rated with the Emotional Availability Scales (Biringen, 2008) at each stage of data collection. The results showed a significant improvement in the quality of mother-child interactions, between the first and the last evaluation, parallel to the unfolding of the massage program, highlighting a general increase in maternal and child's EA. The presence of maternal psychological distress resulted associated with less optimal mother-child emotional exchanges, while the hypothesis regarding couple satisfaction and social support influence were not confirmed. These preliminary results, if replicated, seem to sustain the usefulness of infant massage and the importance of focusing on early mother-infant interactions.