Emanuele Caroppo

Stability of Alexithymia and Its Relationships with the ‘Big Five’ Factors, Temperament, Character, and Attachment Style

Background: Controversy still exists concerning the stability of the alexithymia construct. Also, although alexithymia has been found to be related in a theoretically meaningful way to other personality constructs such as the ‘Big Five’ factors, few studies have investigated its relationship with influential constructs such as temperament and character, and attachment security. Methods: Two hundred twenty-one undergraduate and graduate students were administered the Toronto Alexithymia Scale (TAS-20), the State-Trait Anxiety Inventory (STAI), the Zung Depression Scale (ZDS), the Temperament and Character Inventory (TCI-125), the Big Five Questionnaire (BFQ), and the Experiences in Close Relationships (ECR) questionnaire. After 1 month, 115 participants completed again the TAS-20, STAI, and ZDS. Results: Alexithymia was only moderately correlated with depression and anxiety. Both the absolute and relative stability of TAS-20 total and subscale scores was high, and a negligible portion of their change over time was accounted for by changes in depression or anxiety. In separate multiple regression models including also gender, age, depression and anxiety, TAS-20 total and subscale scores were correlated with low energy/extraversion, low emotional stability, openness, low friendliness/agreeableness; harm avoidance, low self-directedness, low cooperativeness, low reward dependence; attachment-related avoidance and anxiety. Conclusions: Our findings lend support for both absolute and relative stability of alexithymia, corroborate an association between alexithymia and insecure attachment, and contribute to a coherent placing of alexithymia in the broader theoretical network of personality constructs.

Stability of attachment-related anxiety and avoidance and their relationships with the five-factor model and the psychobiological model of personality

OBJECTIVES The stability of attachment-related anxiety and avoidance and their relationship with influential personality models are issues worth further investigation. Studying discriminant validity with respect to aspects of personality deemed as prevalently heritable, such as temperament, is particularly important. Our aims were to examine the stability of attachment dimensions and to study their relationship with psychological distress, the Big Five factors, and temperament and character dimensions. METHODS The Experiences in Close Relationships (ECR) questionnaire, the State-Trait Anxiety Inventory (STAI), the Zung depression scale (ZDS), the Temperament and Character Inventory (TCI-125), and the Big Five Questionnaire (BFQ) were administered to 222 undergraduate and graduate students. After 1 month, 115 participants completed again the ECR, the STAI, and the ZDS. RESULTS Attachment-related anxiety was modestly correlated with depression and anxiety, while attachment-related avoidance was modestly correlated with depression. The test-retest reliability of ECR scores was high. Changes in attachment-related anxiety were not related to changes in depression or anxiety, and changes in attachment-related avoidance were modestly correlated with changes in depression. In separate multiple regression models also including gender and age, attachment-related anxiety was correlated with harm avoidance, reward dependence, low novelty seeking, low self-directedness and low cooperativeness; low energy/extraversion and low emotional stability; attachment-related avoidance was correlated with low reward dependence and tended to be correlated with low self-directedness. CONCLUSIONS These findings corroborate the reliability and the convergent and discriminant validity of the ECR, and support the notion that the attachment dimensions are only modestly related to psychological distress and are not redundant with constructs developed within influential personality models such as the five-factor model and the psychobiological model.

Attachment and parenting in adult patients with anxiety disorders.

Background: The literature suggests that dysfunctional parenting and insecure attachment may increase risk of anxiety-related psychopathology. This study aimed at testing the association between anxiety disorders, attachment insecurity and dysfunctional parenting while controlling for factors usually not controlled for in previous studies, such as gender, age, and being ill. Methods: A sample of 32 non-psychotic inpatients with SCID-I diagnosis of an anxiety disorder, either alone or in comorbidity, was compared with two age- and sex-matched control groups consisting of 32 non-clinical participants and 32 in-patients with drug-resistant epilepsy. Study measures included the Experience in Close Relationships questionnaire (ECR) and the Parental Bonding Instrument (PBI). Results: The patients with anxiety disorders scored significantly higher on attachment-related anxiety and avoidance than patients with drug-resistant epilepsy and non-clinical participants. These findings were independent of comorbidity for mood disorders. ECR scores did not differ among diagnostic subgroups (generalized anxiety disorder, panic disorder, other anxiety disorders). Patients with anxiety disorders scored significantly lower on PBI mother’s care and borderline significantly lower on PBI fathers care than patients with drug-resistant epilepsy. Conclusions: Although limitations such as the relatively small sample size and the cross-sectional nature suggest caution in interpreting these findings, they are consistent with the few previous adult studies performed on this topic and corroborate Bowlbys seminal hypothesis of a link between negative attachment-related experiences, attachment insecurity, and clinical anxiety. Attachment theory provides a useful theoretical framework for integrating research findings from several fields concerning the development of anxiety disorders and for planning therapeutic interventions.

Alexithymia and Severe Psychopathology: A Study on Psychiatric Inpatients

Background: The influence of severe psychopathology on alexithymic features has been poorly studied. This study aimed at investigating whether alexithymia is affected by the presence of psychosis and the severity of psychopathology. Sampling and Methods: 199 consecutive adult psychiatric inpatients, 60 of whom received a Structured Clinical Interview for DSM-IV Axis I diagnosis of psychotic disorder, were administered the 20-item Toronto Alexithymia Scale (TAS-20) and the 24-item Brief Psychiatric Rating Scale (BPRS). A random sample of 50 patients was reassessed at discharge. For all analyses, the Holm-Bonferroni correction was applied when appropriate to account for multiple testing. Results: The TAS-20 showed good internal consistency, acceptable relative stability, and good absolute stability both in patients with and without a psychotic disorder. Internal consistency and relative stability were higher in nonpsychotic than in psychotic patients. Mean TAS-20 score at admission did not differ between psychotic and nonpsychotic patients, and the TAS-20 score showed only a nonsignificant correlation (rho = 0.26) with BPRS score. Alexithymia at discharge was mostly explained (60%) by alexithymia at admission, while it was only modestly explained (4%) by BPRS scores at admission and discharge, with the latter being the only significant predictor. Changes in BPRS scores between admission and discharge explained a nonsignificant proportion (16%) of changes in TAS-20 scores and a moderate (21%) proportion of changes in difficulty identifying feelings. Conclusion: Despite some limitations, these findings suggest that the severity of psychopathology and the presence of a psychotic disorder only modestly influence alexithymic characteristics, and that the TAS-20 may provide a reliable assessment of alexithymia in patients with severe psychopathology, except the most severely impaired ones.

Health care for immigrant women in Italy: are we really ready? A survey on knowledge about female genital mutilation

BACKGROUND Because of immigration, female genital mutilation (FGM) is an issue of increasing concern in western countries. Nevertheless operators without a specific training may ignore the health condition of women subjected to this practice and fail to provide them adequate assistance. The purpose of the study was to estimate the current knowledge about FGM among social and health care assistants working with asylum seeker. MATERIAL AND METHODS From October to December 2012, a questionnaire was used to interview 41 operators working in CARA (Shelter for Refugees and Asylum Seekers) in central and southern Italy. RESULTS Only 7.3% of respondents states to know well FGM, while 4.9% do not know it at all. 70.7% declare to have never met or assisted a woman with FGM, nevertheless all respondents work with asylum seeker from countries where FGM are performed. CONCLUSIONS Migration fluxes to Italy over the past decade created a healthcare challenge: women with FGM have specific medical and psychological problems that doctors, nurses and social assistants without specific training are not usually able to manage.

Reliability of Self-Reported Attachment Style in Patients With Severe Psychopathology

Little is known about whether severe psychopathology influences the assessment of self-reported attachment style. Fifty-eight randomly selected adult psychiatric inpatients completed the Experiences in Close Relationship questionnaire (ECR; Brennan, Clark, & Shaver, 1998) and were administered the 24-item Brief Psychiatric Rating Scale (BPRS; Ventura et al., 1993) and the Hamilton Depression Rating Scale (HDRS; Hamilton, 1960) at both admission and discharge. The Structured Clinical Interview for DSM–IV (SCID–I; First, Spitzer, Gibbon, & Williams, 1996) was used to establish Axis I diagnoses. The ECR scales showed good internal consistency and absolute stability both in patients with (n = 24) and without (n = 34) a psychotic disorder. Relative stability was only fair among patients with psychotic disorders but good among patients without psychotic disorders. Neither higher BPRS or HDRS scores, nor the presence of a psychotic disorder, significantly reduced the retest reliability of the ECR scales. These findings suggest that self-report measures might provide a reliable assessment of attachment style in patients with severe psychopathology, except for the most severely impaired patients.

Measurement invariance of the experiences in close relationships questionnaire across different populations

The measurement invariance of the Experiences in Close Relationships (ECR) questionnaire was investigated across four samples of non-clinical subjects (N = 222), dermatological patients (N = 458), psychiatric inpatients (N = 156), and patients with drug-resistant epilepsy (N = 101). The results provided evidence of configural, metric, and scalar invariance across groups. Overall, our findings provide further support to the reliability and validity of the ECR.

The trauma faces: an explorative study on asylum seekers

This study aims at better understanding the traumatic experience in the asylum seekers that was transferred in Italy in application of Dublin II and III Regulation. In particular we analyzed the asylum seekers that was transferred, at the moment of the identification of the European State Members (EU SM) competence of the asylum procedure, like vulnerable target. This is a common category established by the Art. 8 of the Legislative Decree 140/2005 foresees in Italy and its including: minors, disabled people, elderly people, pregnant women, single parents with children and persons who have been subjected to torture, rape or other serious forms of psychological, physical or sexual violence. We shall highlight the particular way in which people with this legal situation perceive their trauma life events and specifically how they are exposed to the greatest risk of PTSD and suicide. To this end we shall analyze the prevalence and incidence of mental health diseases in the asylum seekers and how the bias prevalence about the Dublin Regulation increased the risk of the chronic vulnerability conditions especially the increase of psychological reactive syndromes, addiction and deliberate self-harm behaviours and suicide attempt. Our hypothesis is that the absence of a common program treatment, the dissemination of health information amongst Member States can have a negative impact on the global health of this target people. Questo studio si propone di comprendere piu efficacemente l’esperienza traumatic dei richiedenti asilo che sono stati trasferiti in Italia in applicazione delle revisioni II e III della Dublin Regulation. In particolare, abbiamo analizzato proprio i richiedenti asilo trasferiti al momento dell’identificazione, che compete allo Stato membro UE, come target di particolare vulnerabilita. Si tratta di una categoria diffusa e stabilita dall’art. 8 DL 140/2005 della nostra legislazione e riguarda: minori, disabili, anziani, donne in gravidanza, singoli genitori con bambini, persone che hanno subito torture, abuso o altre forme gravi di violenza fisica o sessuale. Vorremmo evidenziare la modalita particolare con cui i soggetti in questa situazione giuridica percepiscono i loro eventi traumatici e quanto siano esposti ad un maggiore rischio di PTSD e suicidario. A tal fine, analizzeremo la prevalenza ed incidenza dei disturbi psichici nei richiedenti asilo e vedremo quanto l’applicazione della Dublin Regulation aumenti il rischio di cronicizzare le situazioni di vulnerabilita precostituite, aumentando in particolare sindromi reattive, dipendenza, comportamenti autolesivi e tentativi suicidari. La nostra ipotesi e che l’assenza di un comune programma di trattamento, quindi formazione sulla mental health e comunicazione delle informazioni sulla loro salute tra gli Stati membri, abbia un impatto negativo sulla salute globale delle persone che rientrano in questo target.

Trauma e vulnerabilità nei migranti richiedenti protezione internazionale

INTRODUCTION: The refugee international protection seekers show high vulnerability and Post-Traumatic Stress Disorder (PTSD). OBJECTIVES: We used an integrated multidisciplinary approach to assess their vulnerability and psychopathology. METHODS: 180 refugees were assessed according to the criteria of the DSM-IV-TR. RESULTS: in a high percentage of political refugees the primary diagnosis of PTSD was associated with personality disorders and/or other mental disorders. CONCLUSION: Political refugees have more difficulty managing their emotions, this is probably due to ones personal history steeped in traumatic experiences, however, through a work both psychotherapeutic and pharmacological, it was possible to improve their conditions.