F Madeddu

Psychometric properties of the Italian version of the SCL-90-R: A study on a large community sample ☆

We present the factor structure and psychometric properties of the Italian version of the SCL-90-R based on a large sample of the Italian population. The sample (N=3631) included high-school and university students and adults from the community (age range=13-70 yrs; 39.2% males). Principal component analysis (PCA) supported by parallel analysis, yielded eight components, partially overlapping those in the original version; no evidence of Psychoticism and Paranoid Ideation as separate subscales emerged. Twenty-one items were consecutively deleted, leading to a 69-item version of the scale. Internal coherence was good for all subscales (α values between 0.70 and 0.96). However, the eight-factor solution did not prove consistent when analyses were replicated after dividing the sample in subgroups according to gender and age. A second-order PCA yielded a single factor, supporting the adoption of the GSI as an index of general distress. A 69-item brief version of the scale has been empirically derived in this study, and can possibly be adopted as a screening measure for general distress in Italian adults and adolescents; however, caution should be exercised when interpreting the clinical profile due to the instability of factor structure.

Italian version of the Dutch Eating Behavior Questionnaire. Psychometric proprieties and measurement invariance across sex, BMI-status and age

The purpose of this study was to examine the basic psychometric proprieties of the Dutch Eating Behavior Questionnaire (DEBQ) and its measurement invariance across sex, BMI-status (normal weight/overweight), and age in a community sample of 990 Italian adults. The analysis of the dimensionality of the DEBQ using exploratory factor analysis revealed the existence of three major factors - emotional, restrained and external eating. Single and multi-group confirmatory factor analyses replicated the three-factor structure, and this dimensional structure proved to be invariant across sex, BMI-status, and age. Findings upheld the criterion-related validity (e.g., via its associations with Eating Attitudes Test-26). The DEBQs subscales displayed high internal consistency and test-retest reliability over a 4-week period. Statistically significant differences were found when sex, BMI and age groups are compared in the latent means of emotional, external and restrained eating and they are discussed with reference to theory, past and recent empirical findings. Overall, results support the measurement invariance of the DEBQ and suggest that the Italian version is a psychometrically reliable, valid and useful measurement instrument for assessing adult eating behaviors.

Male body dissatisfaction and eating disorder symptomatology: Moderating variables among men

Body dissatisfaction is recognized as a robust risk factor for eating disorders. Despite over 80% of college men being body dissatisfied, not all men report several levels of eating disorder symptoms. In this study, we examined poor impulse control, social anxiety and internalization of media ideals as potential moderators. Data collected from 405 college-aged men were analysed, using latent variable structural equation modelling approach. All variables investigated have been found to moderate the body dissatisfaction–eating disorder symptomatology, such that male body dissatisfaction was strongly related to men’s eating disorder symptomatology when each moderator was at its highest level. Practical implications are discussed.

Are the Male Body Dissatisfaction and Drive for Muscularity scales reliable and valid instruments

The Drive for Muscularity Scale and Male Body Dissatisfaction Scale were developed for use with men and correspond to measures of drive for thinness and body dissatisfaction in women. The psychometric properties of these measures were evaluated in a sample of 655 Italian men, who completed other 11 measures also. Both scales demonstrated excellent internal consistency and temporal stability as well as criterion-related and concurrent validity. Both measures distinguished between men with high and low levels of disordered eating. Confirmatory factor analysis replicated the unidimensional factor structure of both scales. Directions for future research are discussed.

The facets of identity: personality pathology assessment through the Inventory of Personality Organization.

This work aims to further validate the object-relations-based model of personality pathology assessment, evaluating the psychometric properties of the Italian version of the Inventory of Personality Organization (IPO), a self-report instrument for the assessment of personality organization according to O. Kernbergs model of personality pathology. Six hundred ninety-six nonclinical volunteers and 121 psychiatric patients completed a set of questionnaires including the IPO, the Severity Indices of Personality Problems, the Borderline Personality Disorder Checklist, the Response Evaluation Measure 71, and the Symptom Checklist 90-Revised. Confirmatory factor-analyses on the IPO items supported the 1-, 2-, 3-, and 4-factor solutions. The last (Instability of sense of self/others, Instability of goals, Instability of behaviors, Psychosis) resulted in relatively better fit indexes. Invariance across samples (nonclinical, clinical) and gender was confirmed. The 4 IPO subscales showed good levels of internal coherence and, in the nonclinical sample, good test-retest reliability. Associations with the convergent measures were in line with theoretical expectations and supported the benefit of adopting a 4-factor solution. The 4 factors showed the expected criterion relations: All the dimensions discriminated between clinical and nonclinical subjects, whereas only Instability of self/others and Instability of goals discriminated patients with borderline personality disorder from patients with other diagnoses. Our results suggest that the Italian version of the IPO is a reliable and valid tool for the assessment of personality organization according to Kernbergs model. Results are discussed in the context of the current directions in the evaluation of personality disorders proposed by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

Dimensions of personality structure among patients with substance use disorders and co-occurring personality disorders: A comparison with psychiatric outpatients and healthy controls

BACKGROUND Although dual diagnosis has been a topic of great scientific interest for a long time, few studies have investigated the personality traits that characterize patients suffering from substance use disorders and co-occurring personality disorders through a dimensional approach. The present study aimed to evaluate structural personality profiles among dual-diagnosis inpatients to identify specific personality impairments associated with dual diagnosis. METHODS The present study involved 97 participants divided into three groups: 37 dual-diagnosis inpatients, 30 psychiatric outpatients and 30 nonclinical controls. Dimensions of personality functioning were assessed and differences between groups were tested using Kernbergs dimensional model of personality. RESULTS Results showed that dual diagnosis was associated with the presence of difficulties in three main dimensions of personality functioning. Dual-diagnosis inpatients reported a poorly integrated identity with difficulties in the capacity to invest, poorly integrated moral values, and high levels of self-direct and other-direct aggression. CONCLUSIONS The present study highlighted that a dimensional approach to the study of dual diagnosis may clarify the personality functioning of patients suffering from this pathological condition. The use of the dimensional approach could help to advance research on dual diagnosis, and it could have important implications on clinical treatment programs for dual-diagnosis inpatients.

La sintomatologia ADHD come fattore di rischio per lo sviluppo di condotte alimentari patologiche in adolescenza: uno studio longitudinale

AIM: The aim of this study is to analyze the relationship between attention deficit hyperactivity disorder (ADHD) symptoms in childhood and early-adolescence and the development of dysfunctional eating habits later in life. The sample under investigation is composed of 217 adolescents (males: 30.9%; mean age: 17.1 ± 0.88 ys; range: 16-19 ys) voluntarily recruited in the city of Parma (Northern Italy) in the context of a longitudinal research project focused on developmental factors of antisocial behaviour. All subjects were assessed at T1 (mean age: 12 ys) and at T2 (mean age: 14 ys) using a structured clinical interview to collect information on ADHD symptoms on a lifetime basis and, at T3 (mean age: 17 ys), they were administered an interview to assess pathological eating habits. Correlation and regression analyses were carried out between scores of the three symptom domains of ADHD and eating habits as assessed at T3. Results suggest that the association between ADHD symptoms and eating habits show differences according to gender, in that in females ADHD symptoms assessed at T2 are associated with compensatory behaviours, while in males they are predictive of overweight as assessed at T3. ADHD symptoms, although under threshold, may lead to chaotic and unorganized eating habits which might put female at risk for compensatory behaviours and males for overweight.AIM The aim of this study is to analyze the relationship between attention deficit hyperactivity disorder (ADHD) symptoms in childhood and early-adolescence and the development of dysfunctional eating habits later in life. The sample under investigation is composed of 217 adolescents (males: 30.9%; mean age: 17.1 ± 0.88 ys; range: 16-19 ys) voluntarily recruited in the city of Parma (Northern Italy) in the context of a longitudinal research project focused on developmental factors of antisocial behaviour. All subjects were assessed at T1 (mean age: 12 ys) and at T2 (mean age: 14 ys) using a structured clinical interview to collect information on ADHD symptoms on a lifetime basis and, at T3 (mean age: 17 ys), they were administered an interview to assess pathological eating habits. Correlation and regression analyses were carried out between scores of the three symptom domains of ADHD and eating habits as assessed at T3. Results suggest that the association between ADHD symptoms and eating habits show differences according to gender, in that in females ADHD symptoms assessed at T2 are associated with compensatory behaviours, while in males they are predictive of overweight as assessed at T3. ADHD symptoms, although under threshold, may lead to chaotic and unorganized eating habits which might put female at risk for compensatory behaviours and males for overweight.

The Role of Identity Instability in the Relationship Between Narcissism and Emotional Empathy.

Empirical literature has shown that narcissism is often associated with limited empathy, but the mechanism underlying this association is still unclear. The present study investigated the role of identity instability as a mediator of the relationship between narcissistic traits and empathic capabilities. Narcissistic traits, identity instability, and cognitive and emotional empathic capabilities were assessed among 462 nonclinical participants through self-report measures. Results showed a positive association between narcissistic traits and cognitive empathy. On the other hand, a negative association between narcissistic traits and emotional empathy emerged. Furthermore, the study showed that the association between narcissistic traits and impairments in emotional empathy was partially explained by identity instability. Results thus demonstrated that narcissistic traits were associated with higher identity instability, and this, in turn, was associated with decreased abilities to be emotionally involved in others’ affect states. These findings are discussed in the context of an object relations formulation of narcissistic personality.

Agreement between DSM-IV and DSM-5 criteria for alcohol use disorder among outpatients suffering from depressive and anxiety disorders

BACKGROUND AND OBJECTIVES Since significant differences have been reported, we estimated agreement between DSM-5 and DSM-IV criteria for alcohol use disorder (AUD). METHODS We assessed 327 outpatients (mean age: 45.2 ± 13.4) with depressive or anxiety disorders. RESULTS Absolute differences in prevalence rates between DSM-5 and DSM-IV AUD ranged from -1.1% (subjects with anxiety disorders) to +1.8% (tobacco smokers). The agreement was excellent (k = 0.88), also accounting for specific subgroups (relevant k coefficients >0.80). DISCUSSION AND CONCLUSIONS DSM-5 criteria did not inflate AUD rates. SCIENTIFIC SIGNIFICANCE Our results have epidemiological significance since, unlike previous reports, we found diagnostic stability between new and old AUD criteria in this clinical population. (Am J Addict 2017;26:53-56).

Clinical utility of a single-item test for DSM-5 alcohol use disorder among outpatients with anxiety and depressive disorders

BACKGROUND There is a lack of studies testing accuracy of fast screening methods for alcohol use disorder in mental health settings. We aimed at estimating clinical utility of a standard single-item test for case finding and screening of DSM-5 alcohol use disorder among individuals suffering from anxiety and mood disorders. METHODS We recruited adults consecutively referred, in a 12-month period, to an outpatient clinic for anxiety and depressive disorders. We assessed the National Institute on Alcohol Abuse and Alcoholism (NIAAA) single-item test, using the Mini- International Neuropsychiatric Interview (MINI), plus an additional item of Composite International Diagnostic Interview (CIDI) for craving, as reference standard to diagnose a current DSM-5 alcohol use disorder. We estimated sensitivity and specificity of the single-item test, as well as positive and negative Clinical Utility Indexes (CUIs). RESULTS 242 subjects with anxiety and mood disorders were included. The NIAAA single-item test showed high sensitivity (91.9%) and specificity (91.2%) for DSM-5 alcohol use disorder. The positive CUI was 0.601, whereas the negative one was 0.898, with excellent values also accounting for main individual characteristics (age, gender, diagnosis, psychological distress levels, smoking status). DISCUSSION Testing for relevant indexes, we found an excellent clinical utility of the NIAAA single-item test for screening true negative cases. Our findings support a routine use of reliable methods for rapid screening in similar mental health settings.