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Orphans of domestic crimes experience a complex condition as they are exposed to cumulative experiences of violence of which femicide is a tragic culmination. Although over the years there has been greatly increased attention at the scientific level on Intimate Partner Violence (IPV) attributed to gender inequalities in the social and cultural context, children unfortunately still receive little reference. The present paper aims to describe the psychological functioning of feminicide orphans from an evolutionary cognitive perspective focused on pre- peri- post crime traumatic experiences. In addition, both the current state of scientific debate on the interference of traumatic development in childhood on the processing of grief and psychosocial interventions, from an ecological perspective, and promising models of cognitive behavioral psychotherapy for the treatment of traumatic bereavement are presented. Also outlined is the multilevel and multifocal intervention plan implemented by the social-health network of the Apulia Region, which from the moment of the news of feminicide, is developed along different operational guidelines (Mobile Psychological First Aid-Psychosocial Interventions-Psychological Assessment- Psychotherapy) according to the Trauma Informed Care (TIC) perspective. Data from a longitudinal retrospective study, based on a qualitative methodology, aimed at investigating the main psychosocial factors that best characterize the target population of feminicide orphans will be exposed, and data collected on the quality of adaptations achieved in the short and medium term, through follow-ups at 6 months, 18 months and 30 months after the traumatic event, will also be presented. [ABSTRACT FROM AUTHOR]

Object: Foster parenting is when a person temporarily serves as a parent for a child who has lost or has been removed from their biological family. Method: A clinical case is presented relating to the fostering history of Stefania, an eight-year-old girl who has been placed in a residential community since the earliest years of her life. Results: The child's history is characterized by a series of life events in which abandonments constituted a risk actor in relation to dysfunctional aspects in several areas of development. A psychodynamic perspective as adopted both to assess Stefania's psychic functioning and psychopathological symptomatology, and to identify the processes of intergenerational transmission of mentalization failure. Conclusions: In this paper we present a reflection about the pervasiveness of the consequences of parental neglect, and offer clinical indications on the care of foster children. [ABSTRACT FROM AUTHOR]

Insomnia symptoms are common during peripartum and are considered a critical risk factor for postpartum psychopathology. Sleep is particularly vulnerable during pregnancy and postnatal period and its alterations are associated with risks for mental health. Nonetheless, often insomnia disorder during pregnancy doesn't receive appropriate clinical attention, with consequent lack of proper treatment offer. Evaluation and treatment of insomnia during the prenatal period should be a priority in the clinical practice and should consider the whole family context. Cognitive-behavioral treatment is recognized as first line intervention for insomnia disorder from international guidelines. Many authors highlighted that during pregnancy and during the first months of child's life psychotherapy seems to be more adequate and more favorably accepted from patients than pharmacological treatment. This is also linked with possible negative consequences associated to the assumption of drugs, both for the fetus and the newborn. The aim of this paper is to examine in depth, through a narrative review, the importance of a correct evaluation of the insomnia disorder during the prenatal period and the characteristics of cognitive-behavioral therapy.. [ABSTRACT FROM AUTHOR]

Eating disorders are characterised by dysfunctional eating behaviours and deeply negative beliefs about their weight and body shape. The literature on eating symptomatology is extensive and detailed, but systematic research about how sleep is characterised in such patients is currently lacking. The results that have emerged so far are contradictory and therefore do not allow a clear understanding of this topic. This paper aims to understand the current state of the art and which aspects need to be further investigated in the future. The results highlighted an actual sleep impairment in patients, although not always consistent. The most pronounced impairment seems to be in anorexia nervosa, moreover, this disorder has proved to be the most investigated. On the contrary, very few studies have evaluated sleep in patients suffering from binge eating disorder, especially using physiological measures. Few studies have also investigated circadian preference, thus leaving several questions unanswered. Future studies will not only aim at investigating sleep and circadian preference more rigorously and systematically, but they should especially try to relate specific aspects of eating symptomatology to specific sleep parameters. One of the advantages of such an approach would be to support clinical practice through sleep-centred treatments that could indirectly act on the eating symptomatology itself. [ABSTRACT FROM AUTHOR]

This research aimed to review the existing literature on instruments used to assess Misophonia, in order to identify future research priorities in the area. A systematic search was conducted using the following databases: PubMed, Medline, PsycINFO, Scopus, Cinahl, and Eric. Search terms refer to three main concepts: "Misophonia/Sound Sensitivity", "Assessment" and "Treatment". We limited our search to peer-reviewed papers, published in English from 2012. We selected papers where an instrument was used to assess Misophonia. After removing duplicates, 289 papers remained for screening. Titles and abstracts were screened against the inclusion and exclusion criteria. We identified 80 full-text articles to be assessed for eligibility. 63 papers were included in the review. In the present review, 21 instruments were identified, 10 of which psychometrically validated. They include 9 self-report measures and 1 semi-structured interview. We found just 1 validated questionnaire for children. Different instruments are based on different definitions of Misophonia and just a few measures investigate all the areas included in the most recent definition. Results confirm a significant variability in instruments used to assess Misophonia. We argue the need to improve assessment in both children and adults, validating existing measures in larger samples and different countries. [ABSTRACT FROM AUTHOR]

Misophonia is a condition of reduced tolerance to specific sounds or stimuli associated with those sounds, characterized by intense neurophysiological activation. General symptoms include heightened sensitivity to everyday noises such as coughing, sniffing, chewing and throat clearing, which results in a strong emotional reaction followed by avoidance behaviors, distancing, and, in some cases, aggressive responses. This is followed by emotions, as of anger, disgust, anxiety and depression (Swedo et al., 2022). Despite the growing interest in this phenomenon, there is currently no diagnostic classification. The purpose of this paper is to provide an updated overview of the literature regarding the definition and the etiology of misophonia, with particular emphasis on the symptomatology and psychological and behavioral correlates. Data in the literature were collected and analyzed according to the guidelines of the PRISMA method (Moher et al., 2009). The review was conducted through the main search engines on scientific papers published between 2010 and 2022, in English. Overall, a total of 40 articles were included. The research suggests that misophonia could be classified as a discrete psychological disorder, as symptoms present in a stable and consistent pattern, and patients report similar developmental pathways (Schroder et al., 2013; Jager et al., 2020). The patient's intensity reaction is determined not so much by the physical characteristics of the trigger sound, but rather by his or her psychological profile, context, and the cognitive interpretations the individual makes about the specific source of the sounds, which influence the intensity and uncontrollability of his or her reactions (Brout et al., 2018). A difficulty in emotion regulation and the presence of affective lability, exacerbates the severity of symptoms and may impair the individual's work, school and social functioning in the long run (Guetta et al., 2022). The etiology of misophonia can be traced back to both hereditary factors and environmental causes, e.g., associative learning mechanisms. Moreover, misophonia is thought to be related to high levels of connectedness between the auditory, autonomic and limbic systems and that, in particular, it would be AIC (Anterior Insular Cortex) that plays an important role (Edelstein et al., 2013). It would be desirable to expand the research to have more clarity on the phenomenon and possible treatments useful in reducing the discomfort and improving the quality of life of the subjects. [ABSTRACT FROM AUTHOR]

The aim of this paper is to provide an overview of the most relevant contributions regarding the application of so-called third generation interventions of cognitive behavioral therapy, such as mindfulness and ACT (Acceptance and Commitment Therapy), in the context of therapy for autism spectrum disorders. In particular, our attention is focused on the application of these interventions aimed at caregivers of individuals with autism spectrum disorder who have not reached the mature age. To this end, a search was conducted on the contributions published between 2005 and 2020 through the main search engines: it led to a final number of 8 revised articles. At present, the scarce availability of reliable results does not allow to arrive at a structured, valid and reliable model of intervention; nevertheless, having ascertained the potential benefit that emerged from the few studies conducted, it is possible to deduce that the line of research undertaken may create a protocol of proven effectiveness for the future. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and related restrictive measures have had a significant impact on the mental health of the entire population, especially children and adolescents. It seems appropriate to make a distinction between stressful events, which most families have experienced, and real traumatic experiences, which only the most vulnerable individuals have been victims of. In fact, the most recent data (WHO, 2020) show a significant increase in the rates of intra-family violence against women and minors around the world, during the period of the lockdown. The aim of this paper is to illustrate the spectrum of symptoms that the experience of a complex trauma determines on children and adolescents, and at the same time to indicate the possible strategies to facilitate the early detection of distress indicators and implement the necessary interventions in emergency contexts in an integrated and multilevel perspective. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to analyse the effect that the shift from face-to-face to distance relationship had on some procedural aspects of the clinical psychological setting and on the mental setting of psychologists and psychotherapists (in particular, those who used the online setting for the first time). In this perspective, the article illustrates and analyses the results of a pilot research conducted during the Italian national lockdown. Method: The research was carried out with a semi-structured questionnaire developed with Google Forms. The questionnaire (17 closed questions and 2 open questions) was divided into four sections: 1. Personal data; 2. Professional activity; 3. External/material setting; 4. Internal/mental setting. The questionnaire was available online from 6th to 27th April 2020. 160 questionnaires were collected: 45 (28.13%) psychologists and 115 (71.87%) psychotherapists. Results: 37.50% of the respondents did not perceive any significant change in their attitude following the changeover to the online mode (6.25% reported that they felt even better compared to face-to-face interviews). 27.50% of the respondents experience a greater "familiarity" with the patient; 24.38% are curious about the domestic environment framed by the webcam; 20.63%, on the other hand, experience embarrassment when entering the patient's home. The main problems reported by psychologists/psychotherapists are of a technical nature (limited quality of devices and connections) because they make it difficult to "tune in" to the patient. 43.75% of the respondents also reported difficulties in understanding the interlocutor's non-verbal communication. 25.63% of psychologists/psychotherapists also report being more active and 18.75% admit that in the online setting it is more difficult to remain silent. Conclusions: Technology-mediated communication has made it possible to overcome the constraints imposed by the pandemic and has enabled psychotherapists and patients not to interrupt counselling and therapy. However, the online setting has different characteristics from the offline setting, characteristics that tend to influence the behaviour and mental disposition of the psychologist/psychotherapist. Curiosity, embarrassment but also greater activity and difficulty in maintaining silence seem to be some of the possible outcomes of the online setting on the clinician. On the other hand, the prevalence of the visual channel can induce the psychologist/psychotherapist to superimpose what he sees with what he is. In essence, the online setting may induce the idea that no further meaning is needed or possible than what is shown on the screen. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and related restrictive measures have had a significant impact on the mental health of the entire population, especially children and adolescents. It seems appropriate to make a distinction between stressful events, which most families have experienced, and real traumatic experiences, which only the most vulnerable individuals have been victims of. In fact, the most recent data (WHO, 2020) show a significant increase in the rates of intra-family violence against women and minors around the world, during the period of the lockdown. The aim of this paper is to illustrate the spectrum of symptoms that the experience of a complex trauma determines on children and adolescents, and at the same time to indicate the possible strategies to facilitate the early detection of distress indicators and implement the necessary interventions in emergency contexts in an integrated and multilevel perspective. [ABSTRACT FROM AUTHOR]

The aim of this paper is to provide an overview of the most relevant contributions regarding the application of so-called third generation interventions of cognitive behavioral therapy, such as mindfulness and ACT (Acceptance and Commitment Therapy), in the context of therapy for autism spectrum disorders. In particular, our attention is focused on the application of these interventions aimed at caregivers of individuals with autism spectrum disorder who have not reached the mature age. To this end, a search was conducted on the contributions published between 2005 and 2020 through the main search engines: it led to a final number of 8 revised articles. At present, the scarce availability of reliable results does not allow to arrive at a structured, valid and reliable model of intervention; nevertheless, having ascertained the potential benefit that emerged from the few studies conducted, it is possible to deduce that the line of research undertaken may create a protocol of proven effectiveness for the future. [ABSTRACT FROM AUTHOR]

The Practice Parameter Paper (Morgenthaler et al. 2006) and the Clinical Guideline (Schutte-Rodin et al. 2008) defi ne cognitive-behavioural therapy (CBT-I) as the standard treatment of choice for insomnia. The stimulus control technique (Bootzin 1972) and sleep restriction therapy (Spielman, et al. 1987) represent two of the essential components of CBT-I. The former consists of a series of rules having the purpose of reinforcing the association between bed and the act of falling asleep, eliminating some of those activities that can interfere with sleep at the moment of going to bed. The latter aims at restricting the time a patient spends in bed, augmenting, through a state of light sleep deprivation, the “sleep drive” (the push that the patient feels towards falling asleep), regulating and at the same time resynchronising sleep-wake rhythm. This paper intends to guide the reader to the correct application of these two behavioural techniques, illustrating the rationale behind them, providing instructions and examples of implementation and discussing the main obstacles and resistances that we might encounter while treating an insomniac patient. [ABSTRACT FROM AUTHOR]

In the last years, the dimensional classification of Personality Disorders and the development of manualized treatments have contributed to a new conceptualization of these disorders. Therefore, it is necessary to implement of evidence-based clinical treatments and good practices, through the application of international guidelines for the treatment of personality disorders. The aim of this paper is to analyse the main guidelines from recent literature regarding the treatment of Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD), to identify which are the recommended treatments with greater efficacy. For this reason, two of the most authoritative contributes to international guidelines were examined: National Institute for Health and Care Excellence (NICE) and the American Psychiatric Association (APA). Furthermore, given the need to provide updated scientific evidence, in addition to the guidelines, recent reviews and meta-analyses on the treatment of disorders in question were considered. In the last part of this work, the attention was placed on the current diagnostic classification of personality disorders, which aims at the functioning and personality traits rather than the nosographic diagnosis only, with a specific focus on Borderline Disorder and Antisocial Personality Disorder. In conclusion, literature seems to suggest the clinician a greater attention to the dimensional aspect of personality disorders within the psychotherapeutic intervention because it allows the use of specific traits and domains for setting up a more targeted intervention. [ABSTRACT FROM AUTHOR]

The aim of the present paper is to conduct a narrative review and meta-synthesis of existing studies on the constructs of oddity and schizotypy from an evolutionary point of view. Schizotypy may represent either a spectrum or a taxon comprising different phenomena from odd and imaginative normal experiences to psychotic states or conditions, where oddity impedes an adaptive development of the person. From an evolutionary perspective, different theoretical hypotheses explore the phylogenetic role of psychoses by alternatively considering them as an evolutionary residual or correlate. On the other hand, many studies seem to support the pathogenic role of traumatic developments from an ontogenetic viewpoint. By reviewing existing literature, the paper is aimed at describing an evolutionary model of oddity and schizotypy and assuming that these two constructs may represent a transdiagnostic dimension recurring across different psychopathological conditions. [ABSTRACT FROM AUTHOR]

This paper presents a clinical case of an inpatient women, in treatment at the intensive short residential unity for Personality Disorders of Villa Margherita. We pay attention to the comprehension of her mental functioning, that has been supported by Gianni Liotti's constant supervision. This paper represents what he left us in terms of comprehension of complex and different clinical syndromes that can be explained with different DSM5 disorders. The Motivational Systems and traumatic development experiences are the theory that we used to give meaning to the complex clinical experience of the client. We will explain our work with Diana, this is the name given to the patient, will be illustrated as integration of tools coming from DBT model, Motivational Systems model, and coordinated work with outpatient and inpatient therapists. [ABSTRACT FROM AUTHOR]

Objective: Exercise addiction (EA), compulsive exercise or excessive exercise is a behavioural addiction characterized by a multidimensional and maladaptive pattern of physical training leading to uncontrollable excessive behaviour with negative consequences, such as impairment in daily functioning and physical injuries. It has been hypothesized that, similarly to other non pharmacological addictions, it might be due to alterations of the the dopaminergic mesolimbic pathway, mainly involved in the reward system and modulated through endogenous opioids. EA subjects are costantly seeking for the feeling of wellbeing and euphoria induced by physical activity, progressively increasing its duration, frequency and intensity, until they lose control. EA individuals could experience withdrawal effects such as anxiety, irritability, restlessness and sleep problems. Several studies show that eating disorders are the most frequent comorbidities together with orthorexia, obsessive-compulsive disorder, body dysmorphic disorder (especially in the 'muscle dysmorphism' type) and other addictions (nicotine, alcohol, drugs, sex, shopping and work). As for other behavioural addictions, cognitive-behavioural therapy and mindfullnessbased interventions (MBI) seem to represent possible therapeutic approaches whereas some data suggest the possible usefulness of serotoninergic drugs, anxiolytics and both typical and atypical antipsycotics, although further studies are needed to establish a specific therapeutic strategy. Method: A search of scientific papers written in English was carried out in the Pubmed databases, using the following key words: 'behavioural addiction', 'exercise addiction', 'exercise dependence', 'compulsive exercise', 'excessive exercise'. Results: Aim of this work was to define Exercise Addiction (EA), while underlining its epidemiological, clinical, pathophysiological and therapeutic aspects approach. Conclusions: EA is a condition that is constantly increasing, showing a high percentage of comorbidity with eating disorders. Despite the debate within the scientific community, a growing number of data seems to confirm its importance as an independent disorder, with high impairment of patient's global functioning. Further studies are needed in order to recognize and treat this condition, often exacerbated by patient's lack of insight and compliance. [ABSTRACT FROM AUTHOR]

Objective: Sex addiction, also called hypersexuality or compulsive sexual behavior disorder, is a psychopathological disorder characterized by a persistent, excessive, uncontrollable desire of sexual activity and subsequent compulsive behaviors, aimed at satisfying this desire. The aim of this study is at reviewing and commenting on the current literature on sex addiction, while evaluating possible therapeutic approaches. Method: We searched and analyzed scientific literature of Pub Med, Google Scholar and Scopus. Results: We have selected 78 papers, using behavioral addiction, sex addiction, compulsive-impulsive sexual disorder, compulsive sexual behavior disorder and hypersexuality as key words. Although its prevalence is possibly understimated, it is a generally agreed that sex addiction is increasing worldwide, given the easiness to accomplish it through novel technologies. The literature indicates that people affected by sex addiction show both psychiatric and neurological comorbidities that increase the individual maladjustem and the cronicity, stimulating the research of the appropriate therapeutic strategies. Conclusion: Sex addiction is a worldwide interest disorder that can potentially lead to an alteration in the overall functioning, so a timely therapeutic approach allows to improve life prospections of subjects affected by compulsive sexual behavior disorder. [ABSTRACT FROM AUTHOR]

Objective: Compulsive shopping (CS) disorder, also known as compulsive/excessive buying/spending according to the different expressions used, is a disorder characterized by persistent thought polarization on the purchase of consumer goods associated with spending urges and behaviors that are poorly susceptible to control, often excessive and in turn determining further psychological distress, as well as socio-economic difficulties. On the other hand, consumer behavior tending to excess and not based exclusively on the needs are widespread in contemporary capitalist societies, socially well accepted and even characterizing the concept of their own wealth. This is a sociocultural factor that undoubtedly favors the undertaking of typical behaviors, that at least initially are often perceived as egosyntonic. The course is characteristically chronic or episodic. According to the most recent epidemiological studies, CS disorder has a prevalence of about 5% in the general population, with a greater involvement of the female gender and some differences between the sexes regarding preferences for consumer goods purchased. The significant comorbidity with another psychiatric disorder, in particular mood or anxiety, represents a factor of greater clinical severity. On the basis of the evidence produced so far, the treatment of the condition should include both psychotherapeutic interventions (in particular cognitive-behavioral therapy, CBT) and psychopharmacological approaches, mainly with serotonergic drugs, that, however, currently lack confirmation by more solid investigations, such as randomized controlled trials (RCTs). Method: We first carried out a collection of research papers on CS on PubMed, Scopus and Google Scholar search engines. The search was performed using sequentially in a single or combined way the corresponding keywords: compulsive/addictive/excessive shopping/buying/spending (disorder), shopaholism, spendaholism. Results: On the basis of the examined data we reviewed available notions on epidemiology, etiopathogenesis, diagnosis, comorbidity and therapeutic approaches of CS disorder. Conclusions: Currently, the neurobiology of CS disorder is still in an early stage, although growing. The most recent studies indicate the proximity of the disorder with substance addictions and pathological gambling for the involvement of the reward circuits. This seems to suggest that the framing of the corresponding psychopathological phenomenology in the group of behavioral addictions, or addictions "without substance", could lead to progress not only in the theoretical understanding, but also in the clinical and therapeutic management of the disorder. Indeed, the use of some psychotropic drugs in CS is mainly based on a few case reports or case series, thus indicating a possible role in the pharmacological treatment of the disorder, worthy of further research. [ABSTRACT FROM AUTHOR]

Objective: During the last decades a novel addictive group has been detected, the so-called 'behavioral addictions', that share several clinical features with substance addictions, such as craving, tolerance and withdrawal symptoms. Love addiction is one of these conditions and seems to result from a dysfunction of the natural characteristics of romantic love. It is characterized by a problematic pattern of love relations leading to significant distress within spite of being aware of the adverse consequences. Method: The aim of this paper was to critically review the available literature by a Pubmed and Google Scholar search. Subsequently, we implemented an electronic manual search of the reference lists of the retrieved articles. Some books, albeit popular, were also cited. Results and Conclusions: The current data would indicate the need for deepening psychopathological, clinical and neurobiological characteristics of love addiction in order to define a correct diagnosis and to implement standardized therapeutic strategies. [ABSTRACT FROM AUTHOR]

Objective: Problematic Internet use (PIU) is one of the most relevant conditions within the so-called "behavioral addictions" or "non-substance addictions". Since the end of the last century, the Internet has been designated as a revolutionary tool, capable of changing forever, amongst other things, the way we access information and communicate. On the other hand, its several opportunities are potentially capable of becoming an addiction characterized by the establishment and the perpetration of pathological behaviors, as much as the classic psychoactive substances or other activities (grouped in the heterogeneous complex of behavioral addictions) closely related to the dopaminergic circuits and the activation of the reward system. The purpose of this paper is to review the available scientific literature on PIU, starting from the still debated diagnostic framework to its clinical characteristics and possible therapeutic implications. Method: A research was conducted through PubMed and Google Scholar, according to the PRISMA guidelines, combining the terms "problematic Internet use", "Internet abuse", "Internet addiction", "behavioral addictions". Results: Problematic Internet use (PIU) has a worldwide prevalence of about 6%, with higher rates in Southeast Asian countries and in younger age groups. The clinical picture is extremely variable. Besides the typical symptoms of addictions, characterized by tolerance, abstinence, relapse and negative consequences on global functioning, important somatic symptoms are reported, ranging from low back pain to episodes of photosensitive epilepsy. There is a frequent correlation with mood disorders, anxiety disorders and substance use disorders, as well as frequent comorbidity with attention deficit/hyperactivity disorder (ADHD). The treatment of PIU consists of both pharmacological and psychotherapeutic approaches, where the best strategy seems to be a therapeutic path built "ad hoc" on the patient, also taking into account possible subtypes of PIU (i.e. the pathological behavior that is implemented through the use of the Internet). However, the numerous aspects still needed to be clarified, starting with the validation of universal diagnostic criteria, compromise a complete definition of PIU, with consequent deficits ranging from the absence of nosographic recognition to the lack of official therapeutic guidelines. Conclusions: Problematic Internet use (PIU) represents an entity still waiting for a precise psychiatric nosology diagnostic autonomy within DSM. Although in the last years important progress has been made in delineating the key characteristics of this disorder, the uncertainty of the nosographic framework still remains to date, also because of the heterogeneity of the clinical picture and the coexistence, within the wider category of PIU, of numerous sub-categories of disorders depending on the type of pathological use that the individual makes of the Internet. Consequently, the treatment encounters a similar ambiguity, with lacking guidelines, which are mostly based on the treatment indications for similar disorders. In the future, further studies are needed to shed light on the nuclear aspects of PIU, in order to provide a more tailored treatment to subjects suffering from this dramatically emerging form of behavioral addiction. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present paper is to investigate aspects of the external setting characterizing remote clinical relationships. This is also accomplished through the presentation of data from a study conducted during the CoViD-19 lockdown. Method: Research was carried out with a semi-structured questionnaire developed with Google Forms. The questionnaire, consisting of 17 multiple-choices closed questions and 2 open questions, was divided into four sections: 1. Personal data; 2. Professional activity; 3. External/material setting; 4. Internal/mental setting. The questionnaire was available online from the 6th to 27th of April 2020. 45 psychologists (28.13%) and 115 psychotherapists (71.87%) participated in the research for a total of 160 participants. Results: The need to switch to the remote clinical relationship during the CoViD-19 lockdown led to some changes in the external setting. 53.13% of participants changed the day and time of their clinical encounters and 40% changed the number of weekly meetings. Compared to the characteristics of the external setting chosen by the patients, 30.43% of our study participants reported inappropriate environments (cars, balconies, parks, bathrooms, etc.) and a certain variability of the place used for the online clinical encounters. However, the majority of participants only occasionally investigated the reasons behind their patient's choice. 29.71% of participants reported that their patients engaged in other activities while in the meeting with them (looking after a child, drinking alcohol, petting pets, etc.) and 21.74% mentioned intrusions (parents, partners, animals, etc.) in the environment where the telehealth encounter was taking place for their patients. Finally, the research has shown that in the online setting 66.88% of responding participants had difficulty tuning in adequately with the patient; 25.63% tended to be more active; 37.50% more supportive; while 18.75% have greater difficulty remaining silent. Conclusions: After a brief analysis of the concept of setting, the authors state that in remote clinical relationships the clinician delegates the identification and management of a part of the external setting to his or her patient. This delegation affects the functionality of the clinical setting, particularly to what refers to its ability to isolate and shield the relationship from “external reality” and plays a role in the inhibition of enacted behaviors. The subdivision of the external setting into two locations and separate environments across the video screen increases the patients’ responsibility towards it but also the chances of acting out common emotional patterns. In fact here the actual structure of the clinical setting changes: the side managed by the therapist is more anchored on theoretical and on “theory of the technique” foundations and can therefore be considered “an actual traditional clinical setting”; while the side of the patient has the tendency to more likely express his or her internal world. [ABSTRACT FROM AUTHOR]

The present work is the second of a corpus of two papers, aimed at proposing an original and more structured translation of the Standard Cognitive Behavioral Therapy (CBT) model of the Obsessive Compulsive Disorder (OCD), in the framework proposed by Mancini, into the language of Schema Therapy, in terms of Mode work. In the first of the two works, we illustrated OCD dynamics, the process of functioning of OCD and we suggested a proposal for the therapeutic rationale for the Mode work, characterizing the obsessive experience. In this work, a clinical example will be proposed also through a graphic representation of the translation of the CBT model of OCD into the Schema Therapy language. The main techniques of of CBT, adapted by the authors to the Schema Therapy framework will be presented. [ABSTRACT FROM AUTHOR]

Forty years ago, many people who came out of the Italian asylums could count on the support of mental health professionals, who assumed a role of active protection of the citizenship rights of these people, overshadowing the dimension of the illness. This paternalistic profile (which can be summarized in the formula of "doing for") has been maintained, very often, also for the people who now access the community services born after the Psychiatric Reform. This profile is increasingly in conflict with the new rights of citizenship, which have been affirmed in the last decade (in particular, with the right to be active subjects in the decisions concerning our health, sanctioned by the recent law on Advance Directives of Treatment). The paper takes into consideration the complexity of this transition to a "post-paternalistic" psychiatry, which implies a transition from "doing for" to "doing with" (or, better still, "being with"). Some approaches, including Open Dialogue, seem to be able to facilitate this transition towards more democratic practices of full sharing of decisions. [ABSTRACT FROM AUTHOR]

Compulsions are often the central complaint of people with obsessive-compulsive disorder (OCD) and yet we know surprisingly little about them. One reason for this neglect is that they are viewed as products 1 Questo lavoro è stato presentato al Rome Workshop on Experimental Psychopathology III, organizzato dalla Scuola di Psicoterapia Cognitiva - SPC (Roma, 26-27 Maggio 2017). 2 Tr. it. a cura di Roberta Trincas, PhD, Psicoterapeuta Cognitivo Comportamentale, docente presso Scuola di Psicoterapia Cognitiva - SPC, Viale Castro Pretorio 116, 00195, Roma. of distress over obsessional concerns; once that distress extinguishes compulsions become obsolete. We are, however, slowly starting to learn more about the complexity of compulsive behaviour and factors in its persistence. This paper reviews developments in our understanding of compulsions, synthesizes work from several different perspectives, and presents a descriptive model for the insidious cycle of compulsions. Major conclusions are that: a) repetition of checking behaviour is definitely clearly associated with a decline in memory, cognitive, and sensory confidence, as is staring; b) the need for perfect certainty may be the key factor that transforms a routine behaviour into a compulsion, resulting in behavioural parsing, increased tax on working memory, and use of (elusive) feeling-based criteria as a guide for stopping; c) what we are learning about compulsions can be directly applied to standard cognitive-behavioural approaches to treatment; and, d) we still have much to learn about compulsions, particularly covert and ordering/arranging compulsions. [ABSTRACT FROM AUTHOR]

The paper describes the Gianni Liotti's scientifi c work starting from the impact of the Attachment Theory of John Bowlby to the development of an original model of human motivation that is associated to evolutionary epistemology for the study of mental disease. About Gianni Liotti's contribution, the scientifi c and clinical value is highlighted as well as the cultural openness comprising social and existential aspects of human suffering. Finally the educational impact of Liotti's commitment and work on cognitive context is illustrated. [ABSTRACT FROM AUTHOR]

Interpretive analysis is founded on a preliminary understanding of the social interaction between therapist and patient. The stronger and more accurate the preliminary understanding, the more reliable the interpretation will be. In this paper Conversation Analysis is a preliminary step for examining a metacognitive insight by a patient with a Dissociative Disorder during a session in an individual systemic therapy. [ABSTRACT FROM AUTHOR]

In this paper Giovanni Liotti's contribution to the study of attachment disorganization and its implications for the development of dissociative disorders is reviewed. His model of dissociation based on attachment theory and research is illustrated starting from the fi rst observations on the phenotypic similarities between child disorganized behaviors and expressions of adult dissociation, the study of the controlling strategies and of multiple, disaggregated internal working models, until the last neurophysiological studies on dissociative processes. [ABSTRACT FROM AUTHOR]

This paper describes the cognitive-behavioural approach in the evaluation and treatment of childhood insomnia, considering in the current International Classifi cation of Sleep Disorders (ICSD-3). Sleep disorders must be placed in the framework of psychophysical conditions and child family context. The Cognitive-Behavioural Treatment (CBT) for insomnia in childhood is adapted considering the child age and stage of development. In the treatment of infants and young children, it is necessary to evaluate parent possible distress and psychological resources combined with their believes/emotions regarding infancy sleep. This allows to set up an effective parent training for the behavioural changes involved in CBT for childhood insomnia. Principles and strategies of CBT component are described and schematically reported in the paper. A clinical case is also reported to provide an effective implementation example. [ABSTRACT FROM AUTHOR]

The recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provided the entire scientific community with an opportunity to reflect upon the legitimacy of retaining the diagnosis related to transgender and gender-nonconforming identities (APA 2015, Drescher 2009, Drescher 2015a, Meyer-Bahlburg 2009). Aim of the present paper is reviewing the main changes in the theoretical models, in medical and psychiatric settings, for the classifification of transgender and gender-nonconforming identities. Over the years, models focusing on the concept of mental degeneration gave way to new ones, emphasizing the peculiar experience of people with trans identities (Bockting 2009b). In recent times, the emergence of a new paradigm based on civil rights is aimed to address society at large, in order to promote an inclusive and respectful approach towards gender expression. [ABSTRACT FROM AUTHOR]

The status of gender dysphoria as a mental disorder has been long debated and the final decision was, in DSM-5, a compromise, that is the diagnosis was retained but with several important differences compared to previous conceptualizations. Aim of the present paper is to provide and up-to-date review on the most frequent mental health problems in people with gender dysphoria. Data on the prevalence of mental disorders in this population will be explored to ascertain whether trans people are at higher risk of mental disorders compared to the general population. We will then examine the most frequent mental disorders in this population together with the effects of hormonal and surgical treatments for gender dysphoria on mental health. The prevalence and clinical characteristic of self-harm and suicidal behaviours in trans people will also be examined. Finally, we will explore protective factors that can buffer the risk of mental health problems in transgender individuals. [ABSTRACT FROM AUTHOR]

The paper reviews the process that led to the promulgation of Law 164 in 1982 ("Rules for rectification of sex") and the jurisprudential developments that followed. The current Italian legislation does not adequately protect the rights of all persons who do not unambiguously recognize themselves in a single gender. Despite the numerous jurisprudential interventions that, over the years, extended the decisional liberties of trans people, above all with regard to the possibility of choosing whether or not to undergo surgery, our legal system is still stuck on the assumption that each person should be identified only with one and only gender. [ABSTRACT FROM AUTHOR]

The degree of distress in gender dysphoric individual can be variable, therefore hormone therapy may not be necessary for all individuals. When it is requested by the patient, it should be tailored according to their specific needs. Only in some cases, distress is so intense for the individual as to make medical treatments necessary (Bockting e Goldberg 2006, Bockting 2008, Lev 2004). In the present paper, after a brief historical introduction and an overview of clinical guidelines made available so far, we will explore the aims of hormone therapy in FtM and MtF trans people, their masculinizing and feminizing effects, and available data on their safety for the patient's health. Finally, we will review the effects of hormone therapy on the psychological well-being of trans people. [ABSTRACT FROM AUTHOR]

Gender dysphoria in children and adolescents is a complex phenomenon, for which the number of requests for consultation in clinical settings is growing; however, in Italy, there is a very limited number of gender clinics across the country providing assistance in line with international standards of care and guidelines. This paper aims at offering an overview on gender variance and gender dysphoria in children and adolescents, focusing on: diagnosis (according to DSM-5 criteria) and differential diagnosis; clinical picture and associated disorders; epidemiology and gender differences; clinical course and models of intervention. Finally, ethical dilemmas in the medical treatment of gender dysphoric adolescents will be discussed. Early medical interventions, including GnRH analogues, represent a very promising treatment option, which might improve the quality of life and reduce psychological distress in transgender teenagers. [ABSTRACT FROM AUTHOR]

The communication and the relations with children in psychotherapy needs further studies and experimentations to develop effective methods, suitable to be taught. This paper presents the clinical experience of the authors about the use of techniques of illusionism in the clinical consultation with children with cancer, starting from a review of the scientific literature on their use in patients with organic diseases during the developmental age. [ABSTRACT FROM AUTHOR]

Pierre Janet expounded repeatedly, in his writings, the three main differences between his theory, that he had called psychological analysis, and Sigmund Freud's psychoanalytic theory. First, the concept of narrowing of consciousness as the direct effect of vehement emotions is quite different from the idea of an active defensive process displacing unacceptable mental contents outside consciousness. Second, Janet's concept of the sub-conscious (le subconscient) diverges significantly from Freud's view of the Unconscious. Third, Janet's rejected what he labeled Freud's pan-sexualism. This paper is a cursory examination of contemporary psychological and neuroscience contributions to psychotraumatology that may be matched with Janet's three contentions about the main differences between his ideas and Freud's. The aim of the paper is to foster in the reader a reflection on how contemporary psychotraumatology may provide a common background for examining what seems more vital nowadays of the two divergent roots, French and Austrian, of dynamic psychiatry. [ABSTRACT FROM AUTHOR]

The paper describes a pilot study testing the efficacy of a group intervention protocol directed to patients with anorexia nervosa, integrating behavioral-cognitive technics with behavioral technics of mirror exposure and the experiential approach of the acceptance and commitment therapy (ACT). The treatment was conducted at the Center of Eating Disorders of the public health service of the city of Trento with the general aim to support patients in developing a better relationship with their body. The intervention protocol comprised three phases: the aim of the first phase was to help patients in becoming aware of their cognitivebehavioral functioning; the second phase provided patients with a corrective emotional experience by the means of the ACT experiential approach and in vivo mirror exposure, in order to reduce bodychecking behaviors and avoidance implied in the maintenance of the disturbance. Lastly, the aim of third phase, in accordance with the ACT framework, was to help patients in choosing values of personal importance and take committed action in the direction of those values, and move beyond their disturbance. The patients filled two questionnaires twice, before and after the intervention in order to assess its efficacy in reducing dysfunctional features associated with the disturbance. The results support the efficacy of the intervention and encourage the utility to integrate the cognitive intervention with an experiential component aimed to increase the confidence with one's own emotionality. [ABSTRACT FROM AUTHOR]

The aim of this paper is to suggest a detailed analysis and a clarification about the position the concept of Verleugnung has in Freudian thinking. Through a historical survey it will be evident how this psychic mechanism, which hasn't the same meaning in all Freudian texts, undergoes each time substantial changes in his specific sense. Starting from this matter, it is possible to propose critic reflections allowing to put Verleugnung in a debate directed to establish a new function it would get on the plan of metapsychological effects. [ABSTRACT FROM AUTHOR]

The present paper provides a general overview on the main instruments used in the clinical assessment of insomnia. Firstly, we present some nosographic features of insomnia based on the DSM-5 criteria and on the 3P aethiopatogenetic model (Predisposing, Precipitating, and Perpetuating factors), which guide the clinical assessment of the disorder. Subsequently, we describe the assessment methods, which allow the clinician to formulate a preliminary hypothesis about the disorder through questionnaires (e.g. QDS, ISI, PSQI), clinical interview, and sleep diary. For further monitoring and assessment of sleep pattern, two objective methods are briefl y described: actigraphy and polysomnography. Furthermore, we present some questionnaires focused on individual cognitive and behavioural characteristics which can be related with the perpetuation of insomnia. Finally we summarize a diagnostic process in which the clinician relies on a comprehensive analysis of all the data collected, returns a diagnosis to the patient, and proposes a treatment for the insomnia disorder. [ABSTRACT FROM AUTHOR]

This paper focuses on the theoretical and clinical differences between classical a relational approach in psychoanalytic treatment of hypochondriac patients. For classical psychoanalyst, hypochondriacs are often withdrawn in narcissistic structural regressions or in early developmental trauma, this approach undervalues the environmental conflicts and the relational functions of the body. In the relational perspective, hypochondriac organization is reads as a dissociative system to mitigate the impact of the intersubjective reality on the mind of the patient. The hypochondriac's self-reference challenge with intersubjectivity and, paradoxically, can help us to better understand the nature, more deeply relational, of body's experiences. Overcoming an impasse of isolation characterized by distrust, rejection and psychological subjection, would represent an achievement needed to cure this disorder. [ABSTRACT FROM AUTHOR]

Oncological diseases in adolescence test the psychological health in a critical period for the development and the structuring of identity, relationships and autonomy. In this paper are considered aspects of descriptive psychopathology and clinical problems most common in this area, as the concerns and anxiety symptoms, insomnia, sadness and depression, pain, nausea and anticipatory emesis, the somatoform disorders, disorders in eating behavior, agitation, aggression, problems of compliance. The etiological dimensions most discussed in the literature are then taken into consideration, with reference to those somatopsychic and related treatments, both to the psychic. In this regard, it is formulated a theoretical model of trauma and dissociation as risks of the experience of disease. This experience can be traumatic if the encounter between mental functioning and personality of the adolescent and the relational context (family and équipe) does not facilitate the search for a personal and subjective meaning making specific to the adolescent. With reference to this concept are considered to assess the prevailing psychopathologically dimensions for taking care of the specific patient, with particular attention to the levels of organization of his personality. It also points to some typical methodological and technical problems of taking care the clinical psychological work in this context. [ABSTRACT FROM AUTHOR]

The present review illustrates how some psychopathological conditions are associated with increased variability of the behavioral responses. Particularly, psychopathological and neurological populations such as bipolar disorder, schizophrenia, attention deficit hyperactivity disorder ADHD, traumatic brain injury TBI, neurodegenerative pathologies, present a significant increase of the intra-subject reaction times variability (ISV- RTs), which are collected during the execution of sustained attention tasks. Conversely, the average RTs values are generally equal to those of the control group. Therefore, if we consider only the performance average value, as in the experimental practice, the risk would be not appreciating any difference between clinical and non-clinical populations. Increased ISV has been assumed to be a biomarker of underlying pathology (MacDonald et al. 2006), shows a genetic substrate, and is associated with modification of the dopaminergic system, of the frontal lobes physiology and of the midline cortical structures. The oscillation frequency of ISV and lapses in attention mirrors the activation frequency of the default mode network (a cortical circuit which is active at rest) and its intrusion into task oriented activity. The midline cortical structures of the DMN are the neural substrate of introspective thinking (Northoff e Bermpohl, 2004) and their hyper-activation and intrusion during task oriented activity is linked with abnormal introspective thinking and ruminative state. The most relevant papers on this issue and some implications for the psychopathological models are discussed in this review. [ABSTRACT FROM AUTHOR]

Emotional neglect has been recently recognized in clinical and empirical literature as a crucial risk factor for the development of mental disorders. In fact, even when other forms of child maltreatment do not occur, parenting behaviors such as neglect to the emotional needs of the child, role reversal, rejection, discrimination, threats, extreme criticism, and belittlement do not provide the child with a protective and caring environment that ensures the harmonious development of personality. This has important implications in clinical practice, since the mental states related to the experiences of child emotional neglect, when not elaborated, symbolized and integrated, can generate inexhaustible sources of psychic pain that are encysted in personality and psychological functioning of the patient, damaging the way he or she relates with external reality and the inner world. In this paper, the role of emotional neglect in the development of personality is explored through the analysis of an Adult Attachment Interview protocol. This case can help describe how emotional neglect alone could represent a pathogenic core in the patient's personality, which constantly threatens self-esteem and sense of self-worth hindering the development of mentalization and affect regulation abilities. [ABSTRACT FROM AUTHOR]

The paper concerns the clinical sketch of a man who was compelled to take short videos with his smartphone under the skirts of his office colleagues. The case stimulates some reflections about the clinical and psychodynamic meaning of the notion of perversion. It is an example of a compromise behaviour that bypasses the direct sight of a female sex organ: the look of desire of the patient tries to glimpse what cannot be seen. Some well known painters tried to turn around the same conflict with the mediation of art, showing explicitly the sexual organs and going beyond the boundaries of obscenity. On the other hand the pornographer tries to show what is usually considered obscene without any mediation, so that his products meet much more sexual "needs" than the aims of the look of desire. [ABSTRACT FROM AUTHOR]

Antisocial Personality Disorder (DAP) and Psychopatic Personality Disorder or Psychopathy (DPP) have long been considered as synonimous, so that DSM-IV-TR (2000) included only DAP while no reference about DPP was comprised. The present paper considers research works on neurobiological, emotional, cognitive, and behavioural characteristics of Psycopathy, corroborating the clinical validity and usefulness of this disorder. The empirical evidence of DPP is the basis for the proposal by Personality Disorders Work Group on DSM-V to consider and discriminate these different disorders as two subtypes of unique disorder (Antisocial/Psychopathic Personality Disorder), included in wide revision model of DP. This "alternative model" was refused at the end of DSM-V elaboration and was included in the III Section of manual dedicated to "emergent model". [ABSTRACT FROM AUTHOR]

The present paper reviewed the different contributions on maladaptive perfectionism and development or maintenance of depressive symptomatology. Particularly, the first part of the article deals with theoretical aspects, measures and models of the development of perfectionism. While, the second part is devoted to the recent literature that has investigated the relationship between maladaptive perfectionism and depressive symptoms, starting from the main cognitive theories of depression, the role of certain dimensions of perfectionism as a predisposing factor for depressive cognitions and the involvement of specific variables as potential mediators of the relationship between maladaptive perfectionism and depression. [ABSTRACT FROM AUTHOR]

This paper presents the basic concepts of Pierre Janet's psychopathological hypotheses, by placing them within the framework of the "psychology of conduct". The importance of such hypotheses for the understanding and treatment of mental disorders, essentially of dissociative type, shown by patients that have undergone a severe traumatic experience or that have developed a chronic post-traumatic disorder. [ABSTRACT FROM AUTHOR]

The paper aims to discuss the narrative as a methodological device within a clinical setting for psychological intervention. The authors present the narrative as a process of meaning of the experiences. It is always achieved within a cultural context and generates a specific relational proposal towards the interlocutor. From the psychological and clinical point of view, the interest of this contribute concerns the several possibility of transformation of the narrative process, as the goal is not the production of coherent and well packaged narratives. In order to understand complexity and dynamics of the narrative process is necessary to assume perspectives able to capture aspects, specific processes and dynamics of signification. In the light of these intentions, directions for study and use of narratives as a clinical tool are presented in this work. Starting from the contribution of the semiotic disciplines, narrative is observed through different axes of signification (paradigmatic, syntagmatic, pragmatic, pathemic axis) along which it is possible to observe the meaning making through the organization of the text. Furthermore, the distinction between history, telling and narrative/discourse is used in psychological terms to distinguish between different hermeneutics frames and the activating of specific psychological functions (referential, plot and enunciation). This distinction is used to grasp and discuss the reflexive processes and the processes of transformation of the relation between continuity/discontinuity in order to mean experiences and subjective implication within relationships. [ABSTRACT FROM AUTHOR]

The paper presents the exploration of potential of poetic and narrative creativity, as element of therapeutic process, in a relational psychoanalytic perspective. It meditates on trauma and dissociation, key issues, twisting mental process and encumbering the mind potential to generate creatively narrations, by which building subjective experience meaning. Narration loses the possibility to express authentic subjectivity, because subjectivity fragmentation, created by trauma, entails a dissociation between implicit and explicit levels of experience organization. This kind of dissociation regards the authenticity of subjective meanings experience (not only the narration of traumatic events, which can be realized, indeed, in a dissociation status). The therapeutic path of traumatized patients comes along through the construction of alternative forms of mental working, depending heavily on trauma processing and overcoming dissociation as main mental working. An alternative mental working can be reached by new experience made by the patient, supported by the therapist, as witness, reconstructing the validity of patients perceptions (post-traumatically fragmented and dissociated) by way of a new sense of reality. This process makes possible a new story, subjectively, perceived as authentic which can allow the experience of an integrated self and the experience of freedom in creating the meaning of past, present, and future, in the bonds of relational systems allowing to grow. Experience of authentic subjective borns and develops in a relational system and can live in narrative creativity, discovering it self in dialogical stories and building it self trough them. [ABSTRACT FROM AUTHOR]

The main purpose of this article is to describe hysterical pathology in a phenomenological-existential way, referring to concepts of "impersonation" and "typification" mostly in their temperamental implications rather than clearly symptomatic. These two concepts have been expanded following Charbonneau's theory on hysteria as an "aesthetic pathology", which desexualizes and defeminizes the pathology itself. Also the pathology has been described in a psychodynamic way, looking for some common elements with a close phenomenological examination. The focal point of this paper is the estrangement and the distancing of hysteric people from their bodily and instinctual dynamics in favour of an interest in more spirituality, imagination and fantasy. [ABSTRACT FROM AUTHOR]

This paper reviewed the different contributions on parental psychopathology and parenting skills, analyzing, particularly, how the presence of a maternal diagnosis of Borderline Personality Disorder (BPD) may influence the perception of self, of the son and of the parent-infant interaction. Clinical findings suggest that these mothers confront with intense stress the challenges of parenting, showing poorly responsive to the needs of their children, exposed to significant risks of developing. However, researches has dealt specifically investigate the relationship between parents and children with BPD and structuring therapeutic actions is poor, especially when they are compared with the amount of data regarding possible actions in case of other parental psychopathological diagnosis. Considering the knowledge of the functioning of these patients, is presented a proposal for a treatment aimed at promoting parental behaviours independent of emotional instability, more sensitive to the experiences and needs of their children, supporting a parent-child relationship more predictable and consistent. [ABSTRACT FROM AUTHOR]