Patrizia Velotti

Cultural Adaptation of the Difficulties in Emotion Regulation Scale: Reliability and Validity of an Italian Version

OBJECTIVE The aim of this study was to evaluate the reliability and validity of an Italian version of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004). METHOD Three studies were completed. First, factorial structure, internal consistency, and concurrent validity of our Italian version of the DERS were examined with a sample of 323 students (77% female; mean age 25.6). Second, test-retest analyses were completed using a different sample of 61 students (80% female; mean age 24.7). Third, the scores produced by a small clinical sample of participants (N = 38; mean age = 24.2) affected by anorexia, binge eating disorder, or bulimia were compared to those of an age-matched, nonclinical female sample (N = 38; mean age = 24.7). RESULTS The factorial structure replicated quite well the six-factor structure proposed by Gratz and Roemer. The internal consistency and test-retest reliability were adequate and comparable to previous findings. The validity was good, as indicated by both the concurrent validity analysis and the clinical-nonclinical sample comparison. CONCLUSIONS These studies provide further support for the multidimensional model of emotion regulation postulated by Gratz and Roemer and strengthen the rationale for cross-cultural utilization of the DERS.

Understanding the connection between self-esteem and aggression: The mediating role of emotion dysregulation.

The purpose of the present study was to extend previous knowledge concerning the link between self-esteem and aggression by examining the mediating role of emotion dysregulation among offenders and community participants. A sample of 153 incarcerated violent offenders and a community sample of 197 individuals completed self-report measures of self-esteem level, emotion dysregulation, and trait aggression. Offenders reported lower levels of self-esteem than community participants, as well as greater levels of emotional nonacceptance and hostility. Bootstrapping analyses were performed to test whether emotion dysregulation mediated the association between self-esteem level and aggression. In the offender sample, mediation models were significant for three of the four aspects of trait aggression that were considered. Emotion dysregulation fully mediated the links that low self-esteem had with physical aggression, anger, and hostility. The same pattern (with the addition of full mediation for verbal aggression) was confirmed in the community sample. Our findings suggest that emotion dysregulation may play an important role in the connection between low self-esteem and aggression. Alternative models of the associations among these variables were tested and discussed. As a whole, the present results are consistent with those of other studies and suggest that it may be beneficial to include emotion regulation modules as part of prevention and treatment programs for violent offenders.

Alexithymia, emotion dysregulation, impulsivity and aggression: a multiple mediation model

There is a need to better understand the antecedent of aggressive behaviors in order to tailor treatments and reduce the associated damage to the others and the self. Possible mechanisms underlying aggression are poor emotional awareness and emotion dysregulation, as well as impulsivity. Here, we examined the relationships among alexithymia, emotion dysregulation, impulsivity and aggression, comparing a mixed psychiatric sample (N=257) and a community sample (N=617). The clinical sample reported greater levels of alexithymia, emotion dysregulation, trait impulsivity and aggression, than the community sample. Furthermore, in the community sample, emotion dysregulation and impulsivity mediated the relationship (i.e., accounted for the shared variance) between alexithymia and aggression. In the clinical sample, only emotion dysregulation explained the alexithymia-aggression link. In particular, specific dimensions of the emotion dysregulation (i.e., Negative Urgency) and impulsivity constructs (i.e., cognitive and motor impulsivity) played a unique role in explaining these associations. Finally, controlling for depressive symptoms reduced some of the findings involving impulsivity to nonsignificant results. Overall, our findings add to the extant literature attesting to the relevance of alexithymia and emotion dysregulation for understanding aggression, and providing concrete recommendation for the treatment and prevention of aggressive tendencies.

Emotional suppression in early marriage: Actor, partner, and similarity effects on marital quality

Although habitual use of suppression has been consistently linked to adverse consequences for overall social functioning, little is known about the implications of using this emotion regulation strategy in the context of romantic relationships. The current longitudinal study tests whether husbands’ and wives’ habitual use of suppression, as well as couple similarity in the use of this strategy, influence marital quality over the first couple of years of marriage. A total of 229 newlywed couples reported their habitual use of suppression and perceived marital quality at two time points, 5 months and 2 years after marriage. Results showed that husbands’ habitual use of suppression was the most consistent predictor of (lower) marital quality over time. Couples showed significant levels of similarity in suppression at the initial assessment, consistent with positive assortment, and this similarity was a significant predictor of higher marital quality as reported by wives regardless of overall levels of suppression use. These findings suggest that husbands’ use of suppression is more harmful for marital satisfaction than wives’ use and wives are more sensitive to their partners’ use of suppression as well as to couple similarity.

Mindfulness moderates the relationship between aggression and Antisocial Personality Disorder traits: Preliminary investigation with an offender sample

INTRODUCTION Poor mentalizing has been described as a characteristic of Antisocial Personality Disorder (ASPD), along with the well-established role of aggressiveness. In the current study, we tested this hypothesis focusing on a specific aspect of mentalization (i.e., mindfulness). METHOD We explored the unique and joint contribution of aggression dimensions and mindfulness facets to ASPD traits in an offender sample (N=83). RESULTS Mindfulness deficits were associated with ASPD traits, and a significant unique association emerged between difficulties in acting with awareness and ASPD traits. Likewise, physical aggression confirmed its association with ASPD traits. Moderation analyses revealed that mindfulness interacted with aggression in predicting ASPD. Specifically, at low levels of mindfulness, the association between aggression and ASPD dropped to nonsignificance. CONCLUSIONS Results suggest that fostering self-mentalizing is a relevant treatment target when treating offenders with ASPD.

Alcohol misuse in psychiatric patients and nonclinical individuals: The role of emotion dysregulation and impulsivity

Abstract Notwithstanding the relevance of both emotion dysregulation and impulsivity to alcohol misuse, there is a dearth of study addressing their reciprocal interaction. The first aim of this study was to confirm the role played by difficulties in emotion regulation and trait impulsivity in explaining maladaptive alcohol use, comparing a mixed psychiatric sample (N = 130; 64.4% males; mean age = 43.30 years, SD = 11.83) with community-dwelling individuals (N = 307; 54.3% males; mean age = 36.01 years, SD = 11.88). Results corroborate this hypothesis, with emotion dysregulation and impulsiveness showing their significant association with alcohol misuse, and with levels of all these three components being significantly higher in the clinical sample. This study also extended extant research by explicating the hypothesised indirect effect of emotion dysregulation on alcohol misuse, through the effect of trait impulsivity. Results are also consistent with this latter hypothesis, with trait impulsivity accounting for the association between emotion dysregulation and alcohol misuse, albeit partially. As a whole, findings of this study highlight the potential utility of prevention and intervention efforts targeting emotion dysregulation and impulsivity in reducing alcohol misuse.

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.

Emotion dysregulation, symptoms, and interpersonal problems as independent predictors of a broad range of personality disorders in an outpatient sample

Emotion dysregulation (ED) is considered a hallmark of borderline personality disorder and is prominent in other personality disorders (PDs). Its presence and contribution to personality pathology need to be explored in the whole range of PDs. In this study, we investigated the association of ED with the whole range of PD traits, symptoms, and interpersonal problems and then investigated whether ED had a unique contribution in predicting the different PDs. A sample of 478 treatment-seeking outpatients was interviewed with the SCID-II. The patients were then tested for symptoms (SCL-90-R), interpersonal problems (IIP-32), and ED (DERS). RESULTS ED correlated with the large majority of PDs and with symptoms and interpersonal problems. Regression showed how ED explained a unique part of the variance for many PDs. ED appears to be a relevant feature of pathology in many PDs; with replication, it can be considered a treatment target in this population. PRACTITIONER POINTS Emotion dysregulation is present in many personality disorders. Emotion dysregulation is not just explained by heightened symptoms and interpersonal problems in personality disorders. Emotion dysregulation could be considered a treatment target in personality disorders other than borderline.

Inappropriate Sexual Behaviors Among Community-Dwelling Patients with Dementia

OBJECTIVE Inappropriate sexual behaviors (ISBs) represent challenging and stressful manifestations of dementia and are highly burdening for patients, families, and healthcare providers. Nevertheless, ISBs have so far attracted limited clinical and scientific interest compared with other neuropsychiatric symptoms occurring in dementing illnesses. The authors aimed to systematically investigate the prevalence and characteristics of ISBs in a population of patients with dementia attending a memory clinic. METHODS In this cross-sectional study, individuals with dementia attending our memory clinic were consecutively enrolled between January 2015 and February 2016. Participating subjects underwent a detailed medical history collection and a comprehensive cognitive, functional, and neuropsychiatric assessment. The presence of ISBs (in the previous 30 days) was investigated by the adoption of an ad hoc questionnaire, administered to informants. A logistic regression model was carried out to identify sociodemographic and clinical variables associated with ISBs. RESULTS In the 195 patients (48.7% women) with dementia recruited for the study, ISBs were detected in 35 patients (17.9% of the total sample). The logistic regression model showed that male sex (OR: 5.14; 95% CI: 1.44-18.41) and anxiety (OR: 4.92; 95% CI: 1.44-16.84) were statistically significantly associated with the presence of ISBs. CONCLUSION ISBs represent common manifestations of dementing illnesses. Given the significant burden of ISBs on patients and families and the impact on care management, their occurrence should always be investigated in the clinical care of individuals with dementia. For this purpose, specific screening/assessment tools should be properly designed and validated.

Emotion dysregulation and hypersexuality: Review and clinical implications

ABSTRACT There is a long and varied history of research on hypersexuality, but no consensus on either etiology or therapeutic interventions. In an effort to advance understanding of hypersexuality, we review the largely separate literatures on hypersexuality and emotion dysregulation, which has recently been suggested to be a critical factor in the development and maintenance of mental health problems. Unfortunately, there is also a lack of consensus on the various primary and intervening factors involved in development of emotion regulation or emotion dysregulation. First, we review theories and empirical evidence to try to explain how emotion dysregulation could contribute to the onset of hypersexuality or other inappropriate sexual behavior. Next, an attachment-theory perspective is used to develop a common etiological model for both emotion dysregulation and hypersexuality. Finally, we address the issue of hypersexual behavior in the context of couple relationships, taking an interpersonal perspective on emotion and emotion regulation. We refer to different age categories, ranging from adolescence to elderly, as emotion regulation skills are likely to change throughout the lifespan.