Giulia Fioravanti

Adolescent Internet Addiction: Testing the Association Between Self-Esteem, the Perception of Internet Attributes, and Preference for Online Social Interactions

There is a general consensus that Internet addiction (IA) is mainly related to social aspects of the Web, especially among adolescents. The empirical link between poor social skills and IA is well documented; however, theoretical explanations for this relationship are less developed. One possibility is that people with poor social skills are especially prone to develop a preference for online social interaction (POSI), which, in turn, predicts problematic usage. This hypothesis has been tested for loneliness and social anxiety, but not for self-esteem (SE; one of the main antecedents of IA). Furthermore, the mediating role of the perceived relevance of some Internet features (e.g., anonymity) in the relationship between SE and POSI has never been investigated. A cross-sectional study was conducted with 257 adolescents. Using mediation analyses, we found evidence among females for the mediating role of (a) POSI in the relationship between SE and IA, and (b) the subjective relevance of some Internet features in the association between SE and POSI. No significant effects were found for males.

The Role of Life Events and HPA Axis in Anxiety Disorders: A Review

Stressful life events and dysfunctional Hypothalamic Pituitary Adrenal (HPA) axis have been implicated in the pathogenesis of psychiatric disorders, including anxiety disorders. This paper attempts to review the existing literature on childhood traumata, recent life events, HPA axis functioning and their relationship in Post-Traumatic Stress Disorder, Panic Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder and Social Phobia. Preclinical and clinical models will be analyzed. Stressful life events seem to have a role in the onset and in the course of these disorders and HPA axis abnormalities have been reported in almost all anxiety disorders. The hypothesis that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology, will be evaluated.

Childhood stressful events, HPA axis and anxiety disorders

Anxiety disorders are among the most common of all mental disorders and their pathogenesis is a major topic in psychiatry, both for prevention and treatment. Early stressful life events and alterations of hypothalamic pituitary adrenal (HPA) axis function seem to have a significant role in the onset of anxiety. Existing data appear to support the mediating effect of the HPA axis between childhood traumata and posttraumatic stress disorder. Findings on the HPA axis activity at baseline and after stimuli in panic disordered patients are inconclusive, even if stressful life events may have a triggering function in the development of this disorder. Data on the relationship between stress, HPA axis functioning and obsessive-compulsive disorder (OCD) are scarce and discordant, but an increased activity of the HPA axis is reported in OCD patients. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. While several hypothesis have attempted to explain these findings over time, currently the most widely accepted theory is that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology. All theories are reviewed and the authors conclude that childhood life events and HPA abnormalities may be specifically and transnosographically related to all anxiety disorders, as well as, more broadly, to all psychiatric disorders.

Emotional eating in anorexia nervosa and bulimia nervosa

OBJECTIVES The relationship between emotional states and eating behaviors is complex, and emotional eating has been identified as a possible factor triggering binge eating in bulimia nervosa (BN) and binge eating disorder. Few studies considered emotional eating in patients with anorexia nervosa. METHODS The present study evaluated the clinical correlates of emotional eating in 251 eating-disordered (EDs) subjects (70 AN restricting type, 71 AN binge eating/purging type, 110 BN purging type) and in a group of 89 healthy control subjects. Subjects were assessed by means of a clinical interview (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and several self-reported questionnaires, including the Emotional Eating Scale (EES). RESULTS No significant differences were found between the 3 EDs groups in terms of EES total score, and all patients with ED showed higher EES scores compared with control subjects. Emotional eating was associated with subjective binge eating in AN binge eating/purging type and with objective binge eating in patients with BN. Among patients with AN restricting type, emotional eating was associated with restraint, but this association was lost when controlling for fear of loss of control over eating, which was the principal determinant of restraint. CONCLUSION Emotional eating and fear of loss of control over eating are significantly associated with specific eating attitudes and behaviors, according to the different diagnoses. Emotional eating is a relevant psychopathologic dimension that deserves a careful investigation in both anorectic and bulimic patients.

Psychometric Evaluation of the Generalized Problematic Internet Use Scale 2 in an Italian Sample

The 15-item Generalized Problematic Internet Use Scale 2 (GPIUS2) is one of the few theory-driven instruments to measure problematic Internet use (PIU). Since PIU has emerged in several cultural contexts, it seems relevant to evaluate the psychometric properties of the scale across various cultures. The aim of the present study was to test the psychometric properties (i.e., dimensionality, reliability, and validity) of the Italian version of the GPIUS2. The sample consisted of 371 participants (128 males and 243 females), and their age ranged from 14 to 33 years (M=18.07 years, SD=5.58). The GPIUS2 and the Internet Addiction Test (IAT) were administered individually in both high school and college classes. With regard to scale dimensionality, the best-fit measurement model includes four first-order factors: preference for online social interaction, mood regulation, deficient self-regulation, and negative outcomes (Satorra-Bentler scaled chi-square [S-Bχ(2)]/df=2.27; comparative fit index [CFI]=0.94; Tucker-Lewis index [TLI]=0.93; root mean square error of approximation [RMSEA]=0.05). With regard to reliability, internal-consistency Cronbachs alpha ranged from 0.78 to 0.89. Convergent validity is demonstrated with significant correlations between GPIUS2 (total score and all the subscale scores) and IAT score. Results showed that GPIUS2 scores significantly discriminated between high school and undergraduate students. The overall findings of the present study provide evidence that the Italian version of the GPIUS2 appears to be an adequate measure of generalized PIU cognitions, behaviors, and outcomes. Suggestions for further research are provided.

Social support and self-efficacy in patients with Myasthenia Gravis: a common pathway towards positive health outcomes

Social support and self-efficacy, that was defined as one’s belief in one’s capabilities to enact a certain behaviour, have a mediating effect on health outcomes and, by facilitating healthy behaviours and compliance to treatment, reduce morbidity and mortality. This pilot study aims to test whether social support and self-efficacy have a positive effect in improving health outcomes of patients with Myasthenia Gravis. 74 patients (mean age 48.1; 67.6% female) were enrolled and reported low self-efficacy and health status, but good perceived social support. Men reported better self-efficacy than women, and those living with a partner reported higher social support levels. No differences were found stratifying for disease onset, disease stage and patients’ working situation. Self-efficacy and tangible support were independent predictors of mental health status. These results provide a preliminary indication that psychosocial interventions aimed to increase self-efficacy could positively mediate mental health status in myasthenic patients, especially among women.

Anorectic and Bulimic Patients Suffer from Relevant Sexual Dysfunctions

INTRODUCTION Sexual life is often impaired in anorexia nervosa (AN) and bulimia nervosa (BN), and few studies have evaluated the possible relationships between body image concerns, eating disorder psychopathology, and sexual functioning in these syndromes. AIM To evaluate sexual functioning in AN patients, BN patients, and healthy controls, and to define the predictors of sexual dysfunction in the AN and BN groups. METHODS Eighty-eight eating disorders patients (44 AN, 44 BN) referring to the Outpatient Clinic for Eating Disorders of the University of Florence, and 72 healthy females were evaluated. MAIN OUTCOME MEASURES The subjects were studied by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV, the Female Sexual Function Index (FSFI), the Eating Disorder Examination Questionnaire, the Emotional Eating Scale, the Beck Depression Inventory, the Spielbergs State-Trait Anxiety Inventory, the Barratt Impulsiveness Scale, and the Symptom Checklist 90. RESULTS AN restricting/type patients had lower FSFI total scores (median; quartiles: 4.8; 2.1-15.4), compared with AN binge/purging type (28.3; 20.6-30.7) and BN patients (20.1; 3.8-30.3). Multiple linear regression analysis showed that shape concern was associated with sexual dysfunction in AN restricting type patients (β=-0.61, P<0.01), whereas emotional eating (β=-0.42, P<0.01), and subjective binge eating (β=-0.55, P<0.01) were significantly associated with FSFI scores in AN binge/purging type and BN patients. CONCLUSIONS Considering the sample size, the present results must be considered as preliminary. Sexual dysfunction was found to be a relevant concern in both AN and BN patients and was associated with different pathological eating behaviors. Sexual functioning should be carefully investigated in eating disorders patients, and treatments focused on shape concern, emotional eating, and binge eating could improve the sexual life of AN and BN patients.

Positive metacognitions about Internet use: The mediating role in the relationship between emotional dysregulation and problematic use

The present study hypothesized that two specific positive metacognitions about Internet use (i.e. the belief that Internet use is useful in regulating negative emotions and the belief that it affords greater controllability) mediate the association between emotional dysregulation and problematic Internet use (PIU). A total of 293 undergraduate university students (male 48.4%; mean age=21.73+2.17) participated in the study. The assessed structural model produced adequate fit to the data (χ(2)=203.76; df=81; p<.001; RMSEA [90% CI]=.07 [.06-.08]; CFI=.95; SRMR=.08). Variables accounted for 46% of the variance in PIU levels. A partial mediation model in which emotional dysregulation predicted PIU levels through positive metacognitions associated with Internet use was found. The presence of a direct relationship between emotional dysregulation and PIU was also detected. Moreover, the study found that emotional dysregulation might drive symptoms of PIU to a greater extent than high negative emotionality.

The Association Between Psychological Well-Being and Problematic Use of Internet Communicative Services Among Young People

ABSTRACT Previous studies on problematic Internet use have focused almost exclusively on the fact that presence of negative functioning, such as social anxiety, depressive symptoms, or loneliness, represents a risk factor for unhealthy use of the web. For this reason the aim of the present study was to investigate the association between psychological well-being dimensions and problematic use of Internet communicative services. In the current study 495 undergraduate students were recruited. The Italian adaptations of the Psychological Well-being Scales and the Generalized Problematic Internet Use Scale 2 (GPIUS2) were used to assess psychological well-being dimensions and generalized problematic Internet use, respectively. Psychological well-being dimensions explained a significant portion of variance for the GPIUS2 total score levels, after controlling for sex, age, and occupational status. The levels of Autonomy, Environmental Mastery, and Positive Relations with Others acted as significant negative predictors of the tendency to use the web for regulating negative feelings, compulsive use of the web, and the negative outcomes that can arise as a result. The overall findings of the present study provide preliminary evidence that low psychological well-being is associated with problematic use of Internet communicative services.

Satisfying needs through Social Networking Sites: A pathway towards problematic Internet use for socially anxious people?

Introduction Following the theoretical frameworks of the dual-factor model of Facebook use and the Self Determination Theory, the present study hypothesizes that the satisfaction of unmet needs through Social Networking Sites (SNSs) may represent a pathway towards problematic use of Internet communicative services (GPIU) for socially anxious people. Methods Four hundred undergraduate students (females = 51.8%; mean age = 22.45 + 2.09) completed three brief scales measuring the satisfaction via SNSs of the need to belong, the need for self-presentation and the need for assertiveness, the Generalized Problematic Internet Use Scale 2 and the Social Interaction Anxiety Scale. Structural equation modeling was performed separately for males and females. Results A direct effect of social anxiety on GPIU was found among both genders. Socially anxious males and females tend to use SNSs for self-presentation purposes, as well as for the opportunity to be more assertive. The association between social anxiety and GPIU was partially mediated by the need for self-presentation only among males. Conclusions The present results extend our understanding of the development of problematic use of Internet communicative services, based on the framework of the dual factor model of Facebook use and the Self Determination Theory. The fulfillment of an unmet need for self-presentation (i.e. the desire to create a positive impression of ones self in others) through SNSs could be one of the possible pathways to GPIU for socially anxious males.