Donatella Cavanna

When parenting fails: alexithymia and attachment states of mind in mothers of female patients with eating disorders

Introduction: In recent years alexithymia and attachment theory have been recognized as two parallel research lines trying to improve the information on the development and maintenance of eating disorders (EDs). However, no research has analyzed these constructs among patients’ families. In this study we compared alexithymia and attachment in mothers of patients with EDs and a control group. Further, we hypothesized that mothers of daughters with EDs with insecure and unresolved states of mind will reported high levels of alexithymia. Lastly, we explored the daughters’ evaluations of maternal alexithymia. Methods: 45 mothers of ED women and 48 mothers of healthy controls (N = 93) matched for age and socio-demographic variables were administered by the Toronto Alexithymia Scale-20 (TAS-20) (S), while two sub-groups of “ED” mothers (n = 20) and “non-ED” ones (n = 22) were assessed by the Adult Attachment Interview (AAI). Moreover, the Observer Alexithymia Scale (OAS) was administered to the daughters for evaluating maternal alexithymia. Results: Regarding alexithymia, no differences were found between ED and non-ED mothers according to the TAS-20, while ED mothers showed more unresolved AAI classifications than non-ED mothers. No correlations were found between the TAS-20 and the AAI. Lastly, ED mothers were evaluated more alexithymic by their daughters with the OAS than those in the control group, and their alexithymic traits were significantly correlated with dismissing states of mind (idealization and lack of memory) in the AAIs. Discussion: Our results highlighted an interesting discrepancy among mothers with ED daughters between the low level of alexithymia provided by their self-reports and the high level of alexithymia observed by their daughters, although the OAS showed severe methodological limitations. Maternal attachment states of mind characterized by the lack of resolution of past losses could be connected to a confusing and incoherent quality of parenting.

Attachment representations in late-adopted children: the use of narrative in the assessment of disorganisation, mentalising and coherence of mind

Late-adopted children have often suffered a wide range of deprivations in their pre-adoption lives. These early adverse experiences can have a negative effect on children’s attachment representations even after they have been adopted. This study assesses the attachment representations of 61 late-adopted children over the first year of placement, exploring the risk and protective factors of age at placement, length of adoption and gender. The attachment representations were captured using the Manchester Completion Attachment Story Task (MCAST), a doll-play narrative that provides four different attachment classifications – secure, avoidant, ambivalent and disorganised – and three global scorings for disorganisation, mentalising and coherence of mind. The age of adoption was negatively associated with disorganisation, while length of placement was positively correlated with mentalising. Males seemed to be more vulnerable to insecurity and disorganisation than females. The data also suggested that for children placed after the attachment-sensitive phase, the longer the time spent in the adoptive families and being female were protective factors. Moreover, attachment narratives seemed to be a useful tool to explore the inner world of late-adopted children from the first year of placement.

Children’s mental representations with respect to caregivers and post-traumatic symptomatology in Somatic Symptom Disorders and Disruptive Behavior Disorders

Introduction: In line with literature, the quality of adult–infant interactions and mental representations of the caregivers play an essential role in influencing the children’s well-being. Many studies focused the attention on the role of attachment for a better evaluation of child psychopathological outcomes. The flexibility of the child’s attachment model gives the opportunity to parents to be helped in modifying their own caregiving quality, encouraging the reflection on the children’s state of mind with respect to attachment. The aims of this study were to evaluate: (1) the attachment models in young patients diagnosed with Disruptive Behavior Disorders (DBDs) and Somatic Symptoms Disorders (SSDs); (2) the levels of post-traumatic symptomatology; (3) the association between the attachment models and post-traumatic symptomatology. Methods: Forty Italian patients, aged from 8 to 15, recruited at Gaslini Paediatric Hospital of Genoa, previously diagnosed with SSD (N = 20) and DBD (N = 20) were assessed using the Child Attachment Interview (CAI), the Separation Anxiety Test (SAT), the Trauma Symptom Checklist for Children (TSCC-A). Socio-demographic data were collected. Results: In both the clinical samples, the findings on the distribution of attachment models showed a significant presence of insecure attachment with respect to both parents in more than a half of the patients and high levels of disorganized attachment. No significant differences between DBD and SSD samples were found on post-traumatic symptomatology (Post-Traumatic Stress and Dissociation). Significant differences were found on Depression, Anxiety, and Fantasy subscales. Discussion: This study can provide a detection of dysfunctional aspects in clinical populations. The findings suggest that the quality of the attachment to parents may be a fundamental element to better assess SSD and DBD in children and adolescents. Clinical implications of this study aimed at improving parental caregiving are highlighted.

Attachment in eating-disordered outpatients with and without borderline personality disorder.

This study aims at examining the attachment states of mind in 50 female outpatients with eating disorders compared with 50 matched control participants using the Adult Attachment Interview. Moreover, the differences in attachment states of mind among eating-disordered women with and without borderline personality disorders’ diagnosis were explored. The results showed an over-representation of insecure-dismissing and unresolved states of mind in clinical group compared to controls. Patients with both diagnosis showed higher scores on involving anger and unresolved loss compared with those with only eating disorder. Implications for further research and clinical practice are discussed.

La riabilitazione oncologica: qualità della cura e benessere psicologico del paziente

This paper discusses the results of a research on the well-being and health care quality in Rehabilitation Oncology. Oncological diseases are a stressful experience, but also they can trigger positive changes in the individual, leading to a modification of self and subjective well-being. Literature shows that these aspects of post-traumatic growth depend to some extent on the level of satisfaction with the quality of care received, conceptualized as the clarity of information received and the perception of being heard within the relationships of a caring nature. The aim of this paper is to highlight efficacy, levels of satisfaction with the treatment and psychological well-being of a group of cancer patients in a Physiotherapy unit. The rehabilitation stage is a key step in the transition from illness to health and therefore it is of particular relevance. The Physical Therapist takes on a fundamental role in the rehabilitation process, carrying out therapeutic interventions involving a physical dimension as well as a physical contact with the patient. The present study was conducted in a North Italian hospital and involved 50 subjects. The results show high satisfaction for the rehabilitation treatment received. These findings are strengthened by a shared view on the effectiveness of therapy: health care professionals expressed, on one hand, a positive assessment on the functional recovery of patients and, on the other hand, patients reported a high degree of psychological well-being and a perceived high efficacy of the treatment.

Motivations and Family Functioning of Foster Families in Italy

ABSTRACT The aim of this paper was to investigate foster family care to better understand this unique care-giving context. The research objective was to understand motivation, family functioning, and individual attachment styles in foster families. Participants were 33 foster parents who completed a questionnaire that included the motivations for choosing foster care, the relationship with the birth family and with social service workers, a measure of family functioning and adult attachment. The motivations for becoming a foster family were very different between families with a birth child and families without a birth child. The results showed that for the foster mother, the relationship with the birth family constituted a very critical element of the fostering experience. The same trend emerged in the relationship with the minor. The results showed that foster families were cohesive and expressive. With respect to attachment style, foster parents had lower scores than a normative sample on the discomfort with closeness, the tendency to consider relationships as secondary and the need for approval subscales. These results have implications for the practices of social work for foster family support and developing a shared commitment to the needs of the foster family in terms of both resources and weaknesses.

Domestic Violence in Separated Couples in Italian Context: Communalities and Singularities of Women and Men Experiences

Relationship breakdown and separation represent a critical aspect in domestic violence. Few studies have investigated domestic violence in separated couples. Moreover, there is a need for a more in depth analysis of gender differences that could enhance the comprehension of the phenomenon. The primary aim of this research was to analyze, through a qualitative approach, which kinds of domestic violence are characteristic or major in separated couples in the Italian context, where this phenomenon has not yet been sufficiently investigated. Participants are 60 separated couples (mean age: M = 48; F = 44) who attended a Family Mediation Center. A descriptive study was conducted using grounded theory methodology. A brief narrative task was administered to both ex-partners separately. The transcriptions were analyzed using NVivo 11 software. From data analysis, some themes emerged regarding typology of domestic violence specific of the separation context and shared by both men and women. The analyses of gender differences showed that there is a gender specific experience of domestic violence. Results highlight that women narrate both physical and psychological violence, while men relate only psychological abuse focused on limiting access to children. We discuss these findings in relation to possible appropriate gender specific intervention and prevention efforts.

Percorsi individuali e spirituali nella risposta al cancro

The oncological disease represents an interruption of the normal existential path of a subject. The authors, starting from the biopsychosocial model, consider the importance of spirituality and religiosity as a support when facing this difficult experience. Research in this field is included in the psychosocial studies that analyze the way in which subjects react to stressful events. An analysis of the literature shows that religiosity and spirituality affect differently the coping process. Spirituality seems more related to a decrease of anxiety and depression and with more chances to have shared and more realistic choices in the care pathway, while religiosity seems to have less significant impact on the components linked to emotional state and decisions in the care pathway. However, the results of the researches are not univocal and emphasize that this research area needs to be improved, paying particular attention to both constructs and methodological aspects.

PO-0939 Post-traumatic Symptomatology And Attachment Models Among Children And Adolescents With Somatic Symptom Disorders

Background In line with a consistent literature, somatic symptom disorders (having pronounced somatic symptoms without objective somatic signs) in childhood and adolescence have experienced traumatic events, such as physical or sexual abuse, major loss, natural disasters or who have been witnesses to violence. Recent studies are focusing the attention on the role of attachment and post-traumatic symptomatology for a better evaluation of this disorder. Objective The following objectives are set by the present study: 1) to evaluate the post-traumatic stress and related psychological symptomatology in a group of children diagnosed with somatic symptom disorders; 2) to evaluate their attachment models; 3) to test the extent of the association between post-traumatic symptomatology and attachment organisation in somatic symptom disorders. Method Twenty consecutive Italian patients aged from 8 to 15 (m = 11,9; ds = 1,48), previously diagnosed with somatic symptom disorders, were administered the Trauma Symptom Checklist for Children (TSCC-A) and the Child Attachment Interview (CAI). Results Post-traumatic symptomatology, evaluated in 9 subscales, showed clinically significant scores about anxiety, depression and post-traumatic stress; dissociation symptomatology was seen only in 5% of the patients. Insecure attachment was found in more than half of the patients diagnosed with somatic symptom disorders. Conclusions This study suggests that attachment organisation may be a fundamental element to be assessed in the evaluation of somatic symptom disorders in children and adolescents. Finally, methodological limitations restricting causal inferences between attachment and dissociation are discussed.

La fatica di costruire i legami: attaccamento e rappresentazioni affettive in un nucleo adottivo

Il presente lavoro propone una riflessione sui possibili esiti del processo adottivo alla luce della storia pre-adottiva dei minori e della qualita della funzione genitoriale. La discussione di un single case puo costituire un’occasione di approfondimento del tema degli special needs che spesso caratterizzano i minori adottati, anche attraverso l’analisi qualitativa degli strumenti utilizzati per valutare il loro stato mentale rispetto ai legami di attaccamento e il complesso incontro dei loro bisogni con quelli della nuova coppia genitoriale e dei compiti educativi che si propone.