Nicolino Rossi

Alexithymia in female patients with eating disorders

Previous studies indicate that patients with eating disorders have alexithymic characteristics, as revealed by the Toronto Alexithymia Scale (TAS). The aim of the present study was to investigate the role of negative affect (anxiety and depression) in the relationship between eating disorders and alexithymia. In addition, we have evaluated whether the relationship between negative affect and alexithymia varies according to the type of eating disorder (anorexia and bulimia). Eighteen female patients and 16 female patients who met the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) diagnostic criteria for restrictive anorexia nervosa and bulimia nervosa, respectively, and 18 healthy female controls matched by age and education were submitted to Beck Depression Inventory and Spielberger State-Trait Anxiety Inventory to assess depression and anxiety and the Toronto Alexithymia Scale (TAS-20) and the Bermond Vorst Alexithymia Questionnaire (BVAQ) to evaluate alexithymic characteristics. The findings indicated that, although anorexic and bulimic patients showed higher alexithymia scores compared to controls, this result could be mainly related to negative affect. In fact, taking negative affect into account, anorexic and bulimic patients did not show higher TAS-20 and BVAQ scores compared to controls. The only variable useful to discriminate among anorexics, bulimics and controls is the perceived inability to experience emotional feelings, which is higher in anorexic patients compared to the other two groups.

FIVE-YEAR FOLLOW-UP OF COSMETIC RHINOPLASTY

The psychological impact of rhinoplasty for aesthetic reasons on psychological well-being is controversial. The aim of the present study is to assess short- and long-term psychological changes in patients who underwent rhinoplasty. Seventy-nine patients, without traumatic lesions, who presented for cosmetic surgery, completed the MPI scales for Neuroticism and Extroversion and the IPAT scale for Anxiety, 3 months before and 6 months and 5 years after surgery. Results showed a significant decrease of anxiety and neuroticism in both postoperative evaluations and an increase on the Extroversion scale only at the 6-month follow-up. Psychological distress persisted in most patients after the operation.

Short-term outcome of rhinoplasty for medical or cosmetic indication.

Psychological effects of rhinoplastic operations were evaluated in male and female patients who had sought surgical correction because of psychological distress caused by the appearance of the nose or because of a medical referral to correct functional disorders. Seventy-two patients selected by gender and operation motivation were asked to fill out the MPI and the IPAT Anxiety scale 2-3 months before and 8 months after the operation. Results at follow-up highlighted a significant decrease of the mean Neuroticism and Anxiety scores and an increase in Extroversion scores in the group as a whole. The psychological benefits gained by the female patients were greater than those of the males. Patients whose motivation was exclusively aesthetic were, overall, more psychologically distressed than those with a functional motivation.

Institutional therapeutic alliance and its relationship with outcomes in a psychiatric day hospital program.

The article shows the results of a longitudinal study aimed to explore the institutional therapeutic alliance (ITA) that is the alliance formed by a patient and all the therapeutic staff. Fifty five patients who have psychiatric disorders in partial hospitalization were evaluated at admission (global functional level, social support, symptomatic condition, and treatment expectancies), at discharge, and after 3 months. ITA was assessed after 1 week of treatment and at discharge, from patients and staffs perspectives. Preliminary findings suggest that the ITA represents a specific phenomenon different from the classical therapeutic alliance (patienttherapist), which would be particularly relevant for the treatment of patients who are severely disturbed.

Emotion Recognition and Expression in Young Obese Participants: Preliminary Study:

This study of the presence of alexithymic characteristics in obese adolescents and preadolescents tested the hypothesis of whether they showed impaired recognition and expression of emotion. The sample included 30 obese young participants and a control group of 30 participants of normal weight for their ages. Stimuli, 42 faces representing seven emotional expressions, were shown to participants who identified the emotion expressed in the face. The Level of Emotional Awareness Scale was adapted for children to evaluate their ability to describe their emotions. Young obese participants had significantly lower scores than control participants, but no differences were found in recognition of emotion. The lack of words to describe emotions might suggest a greater prevalence of alexithymic characteristics in the obese participants, but the hypothesis of a general deficit in the processing of emotional experiences was not supported.

Narcissism versus Proneness to Shame and Guilt

The aim of this study was to evaluate the correlations between the narcissistic personality trait, measured with the Narcissistic Personality Inventory, and proneness to shame and guilt, measured with the Shame-Guilt Proneness Scale. Participants were 165 students (83 men, 82 women), aged 19–30 years. Pearson product-moment correlations, with computations comparing NPI Total score with each of the Shame-Guilt Proneness Scale subscales, were negative for scores on narcissism and shame and for those on narcissism and guilt. These data are consistent with previous findings, which suggest that the “overt” type narcissist is immune to feelings of guilt and may be characterised by a negation of the experience of shame.

Use of the Drawn Stories Technique to evaluate psychological distress in children.

This study evaluated the validity of analyzing childrens drawings using the Drawn Stories Technique for psychodiagnostic assessment and clinical investigation of children. The research was conducted on a sample of 211 subjects (102 girls, 109 boys), 99 in primary school and 112 in secondary school. Three measures of psychological distress were given: the Drawn Stories Technique (considering two types of outcome of the stories as an index of psychological distress: story with a negative outcome and story with a positive outcome), and two self-report scales, the Anxiety Scale Questionnaire for Children and the Childrens Depression Inventory. Analyses for both age groups indicate a prevalence of positive outcomes over negative outcomes, with a similar distribution in the two age groups. Greater anxiety and depression were found for subjects with a prevalence of negative outcome in the stories, and girls scored generally as more anxious and depressed than boys. These results indicate that the Drawn Stories Technique shows construct validity for use with children and is sensitive enough to detect their psychological distress, in terms of anxiety and depression.

P02-186 Institutional therapeutic alliance: Empirical, clinical and conceptual remarks

The relevance of a good therapeutic alliance development between patient and therapists in the treatment success has been documented in more than 3 decades of empirical research. In the case of the treatment of severely disturbed patients, the alliance construction process involves particular characteristics determined, in part, by the patients inability to form safety bonds with others and because of, usually, various therapeutic figures are engaged in their treatments. The present work offers a general review of the most important empirical evidence about the therapeutic alliance process in institutional context treatments (i.e., hospitalization, therapeutic community), introduces the concept of Institutional Therapeutic Alliance (ITA) - clinical and empirical phenomenon that accounts for the working bond between the patient and the therapeutic staff perceived as a whole - and reports the major results of a longitudinal study conducted to assess the ITA and explores the relationship with treatment outcomes. 55 day-hospital patients take part in the research and were evaluated at admission, before one week, at discharge and after 3 months. The assessment battery included: Symptom Check List (SCL-90), Global Assessment Scale (GAS), Multidimensional Social Perceived Support Scale (MSPSS), Institutional Working Alliance Inventory (IWAI) and Subjective Distance Scale (SDS). The results show that ITA is positively correlated with symptomatic reduction at discharge and negatively associated with patients re-hospitalization after 3 months. The work concludes by discussing, from a clinical point of view, the promoting and obstructing alliance factors linked with the patient, the staff and their relationships.

P02-187 Assessing initial patient’s affective disposition towards the hospitalization and the treatment: A validation study

The present work shows some preliminary results of a longitudinal study aimed at validating a psychometric instrument - the Subjective Distance Scale (SDS) - developed to assess the patients affective nearness/remoteness towards/from the psychiatric treatment in a Day Hospital program. 55 day hospital patients were assessed at different moments of the treatment: At admission they were evaluated by means of the SDS, the SCL-90-R (patients psychiatric symptoms) and the GAS (patients mental health level). Institutional therapeutic alliance was assessed one week from admission (IWAI-p) and finally, patients psychiatric symptoms were retested (SCL-90-R) at the end of the treatment and 3 months from discharge. The main results reveal good psychometric properties of the SDS: its factorial structure partially confirms the dimensions theoretically hypothesised; its internal consistency - total and most of its subscales - reach adequate reliability levels; and related to its predicted validity, the scale correlates with some important aspects of the treatment, like the quality of the early institutional alliance, the symptomatic improvement and the stability of the improvements in time. New studies with larger samples and conducted in additional psychiatric settings are necessary to guarantee the validity and reliability of the scale before it could be used as a clinical screening instrument.

La psicologia clinica nella formazione del medico e degli operatori dell’area sanitaria

Al termine di una appassionata lezione agli allievi del primo anno di corso del corso di laurea in Infermieristica, in cui spiegavo la complessita della vita psichica, le implicazioni affettive delle relazioni, nello sviluppo psicologico come nei rapporti di tipo assistenziale, un’allieva mi dice “ ma noi di tutto questo che cosa ce ne facciamo!?”. Il lapidario commento, espresso con malcelato astio, arrivo come una pugnalata, generandomi una dolorosa ed irritante ferita narcisistica. Il primo impulso era stato quello di chiedere all’allieva, altrettanto provocatoriamente, che uso avrebbero fatto delle dettagliate descrizioni di un osso o dei passaggi del ciclo di Krebs nella loro attivita assistenziale; ero infatti certo che siffatto apprezzamento difficilmente sarebbe stato fatto di fronte all’esposizione di tali argomenti. Naturalmente ho cercato di elaborare la mia risposta emotiva, diciamo di natura controtransferale, provando a riflettere sulle possibili ragioni dell’intervento, da un lato, e della mia risposta, dall’altro, interrogandomi sul perche, cio che a me appariva cosI interessante e coinvolgente, potesse suscitare una tale perplessita nell’ascoltatore, aldila delle reazioni idiosincratiche dell’allieva o delle mie inadeguatezze personali come docente. Penso che l’evento, per quanto isolato e casuale, possa mettere in rilievo qualcosa che attiene alla natura della disciplina ed ai suoi contenuti in quanto tali e costituire, pertanto, uno spunto di riflessione sulla didattica della psicologia clinica.