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Introduction: Outcome research in eating disorders (EDs) is commonly focused on psychopathological dysfunction. However, Ryff's model of psychological well-being (PWB) has shown promising-yet preliminary-results with ED patients. Additionally, despite substantial evidence highlighting the association between the therapeutic alliance and treatment outcome, findings in ED samples remain unclear. The present study aimed at exploring the direct effect of PWB dimensions and the early therapeutic alliance on ED patients' individual treatment responses, as well as the mediating role played by the early therapeutic alliance in the relationship between PWB dimensions and overall pre-post symptom change., Methods: A sample of N  = 165 ED patients assigned female at birth, who were receiving treatment in a residential program, completed the Psychological Well-Being Scale at treatment intake and the Working Alliance Inventory after the first four psychotherapy sessions. Patients also completed the Outcome Questionnaire-45.2 at the same time point and during the week prior to discharge., Results: The PWB dimensions of autonomy, positive relations, and self-acceptance were associated with clinically significant change, while the dimensions of personal growth and self-acceptance were associated with reliable change. The early therapeutic alliance showed both direct and indirect effects on therapy outcome, predicting clinically significant and reliable symptom reduction. It also emerged as a significant mediator in the relationship between all PWB dimensions and overall symptomatic change., Conclusion: The identification of individual, adaptive characteristics in ED patients that might influence their development of an early therapeutic alliance may help therapists to predict relationship ruptures and tailor their interventions to enhance treatment effectiveness., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Muzi, Carone, Mirabella, Franco, Rugo, Mazzeschi and Lingiardi.)

Trauma-related disorders are debilitating psychiatric conditions that influence people who have directly or indirectly witnessed adversities. Dramatic brain/body transformations and altered person's relationship with self, others, and the world occur when experiencing multiple types of traumas. In turn, these unfortunate modifications may contribute to predisposition to trauma-related vulnerability conditions, such as externalizing (aggression, delinquency, and conduct disorders) problems. This mini-review analyzes the relations between traumatic experiences (encoded as implicit and embodied procedural memories) and bodily self, sense of safety for the own body, and relationship with others, also in the presence of externalizing conducts. Furthermore, an emerging research area is also considered, highlighting principles and techniques of body-oriented and sensorimotor therapies designed to remodel bodily self-aspects in the presence of trauma, discussing their potential application with individuals showing externalizing problems., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Laricchiuta, Garofalo and Mazzeschi.)

This retrospective-descriptive study investigated how primary and middle-school children perceived the first COVID-19 lockdown in Italy (March-May 2020) as manifested in their drawings. Once school restarted after the first COVID-19 wave, and as part of a structured school re-entry program run in their class in September 2020, 900 Italian children aged 7-13 were asked to draw a moment of their life during the lockdown. The drawings were coded and quantitatively and qualitatively analyzed; several pictorial examples are illustrated in this article. Most children used colorful and full-body representations of the self, but in almost half of the pictures drawn by older students, the self was either missing or represented without the face visible. Most children drew the interior of their houses, and the outside world was completely invisible in over half of the pictures. The most represented activities among younger students were playing or sport, followed by screentime or technology-use. Domestic routines and distance learning were also depicted. Most children, but predominantly girls, drew characters showing emotional cohesion clues, and more younger pupils and girls depicted contentment as their main emotion. Conflicting emotions were virtually non-existent. Our data suggest that children coped with the lockdown through play, screen, and technology use. The high incidence of the missing self-representation in preadolescents could indicate how the enforced loneliness and lack of direct physical contact with others impacted their perception of the self. The findings presented here deepen our knowledge of the dynamics connected to the effects of the COVID crisis on children and young people and show how drawings can provide a valuable window into children's emotions and perceptions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Capurso, Buratta and Mazzeschi.)

The COVID-19 pandemic and the quarantine undergone by children in many countries is a stressful situation about which little is known to date. Children and adolescents' behaviors to cope with home confinement may be associated with their emotional welfare. The objectives of this study were: (1) to examine the coping strategies used out by children and adolescents during the COVID-19 health crisis, (2) to analyze the differences in these behaviors in three countries, and (3) to examine the relationship between different coping modalities and adaptation. Participants were 1,480 parents of children aged 3-18 years from three European countries ( n Spain = 431, n Italy = 712, and n Portugal = 355). The children's mean age was 9.15 years ( SD = 4.27). Parents completed an online survey providing information on symptoms and coping behaviors observed in their children. The most frequent coping strategies were accepting what is happening (58.9%), collaborating with quarantine social activities (e.g., drawings on the windows, supportive applauses) (35.9%), acting as if nothing is happening (35.5%), highlighting the advantages of being at home (35.1%), and not appearing to be worried about what is happening (30.1%). Compared to Italian and Spanish children, Portuguese children used a sense of humor more frequently when their parents talked about the situation. Acting as if nothing was happening, collaborating with social activities, and seeking comfort from others were more likely in Spanish children than in children from the other countries. Compared to Portuguese and Spanish children, Italian children did not seem worried about what was happening. Overall, an emotional-oriented coping style was directly correlated with a greater presence of anxious symptoms, as well as to mood, sleep, behavioral, and cognitive alterations. Task-oriented and avoidance-oriented styles were related to better psychological adaptation (considered a low presence of psychological symptoms). Results also show that unaffected children or children with a lower level of impact were more likely to use strategies based on a positive focus on the situation. This study provides interesting data on the strategies to be promoted by parents to cope with the COVID-19 health crisis in children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Orgilés, Morales, Delvecchio, Francisco, Mazzeschi, Pedro and Espada.)

In February 2020, the coronavirus disease 2019 (COVID-19) appeared and spread rapidly in Italy. With the health emergency and social isolation, parents started spending more time with their children, and they might have experienced greater distress. Attachment style is considered as an effective emotion regulation strategy in the parent-child relationship. However, few empirical studies have addressed this issue. Based on attachment theory, this study aimed to find parental attachment style as a candidate to moderate the relation between parents' negative emotions and their perceptions of their children's negative emotions related to COVID-19. Parents ( M age = 42.55 ± 6.56, 88.2% female) of 838 Italian children and adolescents aged 3 to 18 years participated in an online survey. Results showed that parents with a fearful attachment style had significantly higher negative emotions when facing COVID-19 than those with other attachment styles. Moreover, parents with a dismissing attachment style perceived fewer negative emotions in their children than parents with fearful and preoccupied styles. At last, higher parents' negative emotions were associated with greater perception of children's negative emotions only in parents classified as secure and fearful. These findings suggest that parents with dismissing and fearful attachment styles and their children may be at higher risk during the COVID-19 pandemic and they should be given long-term attention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Liang, Delvecchio, Cheng and Mazzeschi.)

Obesity is a widespread and broadly consequential health condition associated with numerous medical complications that could increase mortality rates. As personality concerned individual's patterns of feeling, behavior, and thinking, it may help in understanding how people with obesity differ from people with normal-weight status in their typical weight-relevant behavior. So far, studies about personality and BMI associations have mainly focused on broad personality traits. The main purpose of this study was to explore the personality and health associations among a clinical group composed of 46 outpatients with overweight/obesity (mean age = 55.83; SD = 12.84) in comparison to a healthy control group that included 46 subjects (mean age = 54.96; SD = 12.60). Both the clinical and control groups were composed of 14 males and 32 females. Several personality and psychopathological aspects were assessed with the Personality Assessment Inventory (PAI). The results of the analysis of variance of aligned rank transformed (ART) showed that patients with overweight/obesity reported higher scores for Somatic Complaints, Depression, and Borderline Features than the control group. Logistic regression highlighted specifically that the subscales of the Borderline Features assessing the Negative Relationship contributed to the increased risk of belonging to the clinical group. For the purpose of this study, the role of gender was considered. The present findings highlight the importance of focusing on assessing personality functioning in the health context and on specific characteristics of interpersonal relationships to promote more tailored treatments., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Buratta, Pazzagli, Delvecchio, Cenci, Germani and Mazzeschi.)

The COVID-19 pandemic is showing a strong impact on people in terms of uncertainty and instability it has caused in different areas of daily life. Uncertainty and instability are also emotions that characterize emerging adulthood (EA). They generate worries about the present and the future and are a source of anxiety that impacts negatively on personal and interpersonal functioning. Anxiety seems a central effect of the pandemic and recent studies have suggested that it is linked to COVID-19 risk perception. In the present study, a sample of 1045 Italian emerging adults was collected: (1) to assess anxiety severity and perceived risk related to COVID-19 and their association and (2) to compare general health and protective factors such as attitudes about security, relationships, self-esteem, and self-efficacy across anxiety severity and perceived risk categories. The findings of this study highlighted that anxiety severity categories were distributed homogeneously across the sample and that half of the participants referred to moderate-severe anxiety. A series of analysis of variances and post hoc comparisons showed that general health and all protective factors decreased according to anxiety severity. They were higher in participants with high perceived risk, with the exception of self-efficacy. Given the challenging features of the pandemic and EA, it is crucial to monitor anxiety severity in order to prevent last longing effects on mental and physical health, as well as keeping emerging adults informed about the risks related to the pandemic. Intervention and supportive programs based on improving self-esteem and self-efficacy, as well as confidence in relationships, should be offered to emerging adults over the long term, beyond the current outbreak., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Germani, Buratta, Delvecchio, Gizzi and Mazzeschi.)

The coronavirus disease (COVID-19) pandemic forced the home confinement of the majority of population around the world, including a significant number of children and adolescents, for several weeks in 2020. Negative psychological effects have been identified in adults, but research about the impact of this type of social distancing measure on children and adolescents is scarce. The present study aimed to describe and compare the immediate psychological and behavioral symptoms associated with COVID-19 quarantine in children and adolescents from three southern European countries with different levels of restrictions (Italy, Spain, and Portugal). Parents of 1,480 children and adolescents (52.8% boys) between 3 and 18 years old (M = 9.15, SD = 4.27) participated in the study. An online survey using snowball sampling techniques was conducted during 15 days between March and April 2020, representing the early phase of the quarantine associated with COVID-19 outbreak. Parents answered questionnaires about sociodemographic data, housing conditions, immediate psychological responses during quarantine (e.g., anxiety, mood, sleep, and behavioral alterations), patterns of use of screens, daily physical activity, and sleep hours before and during the quarantine. The results revealed an increase in children's psychological and behavioral symptoms, increased screen-time, reduced physical activity, and more sleep hours/night. Italian children presented less psychological and behavioral symptoms compared with Portuguese and Spanish children. In general, hierarchical multiple regressions revealed that having an outdoor exit in the house (e.g., garden, terrace) contributed to lower levels of psychological and behavioral symptomatology. Future studies are needed to identify family and individual variables that can better predict children and adolescents' well-being during and after quarantine. Recommendations for families and implications for practice are discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Francisco, Pedro, Delvecchio, Espada, Morales, Mazzeschi and Orgilés.)

The COVID-19 quarantine has affected more than 860 million children and adolescents worldwide, but to date, no study has been developed within Western countries to examine the psychological impact on their lives. The present study aims to examine for the first time the emotional impact of the quarantine on children and adolescents from Italy and Spain, two of the countries most affected by COVID-19. Participants were 1,143 parents of Italian and Spanish children aged 3 to 18 years who completed a survey providing information about how the quarantine affects their children and themselves, compared to before the home confinement. Results show that 85.7% of the parents perceived changes in their children's emotional state and behaviors during the quarantine. The most frequent symptoms were difficulty concentrating (76.6%), boredom (52%), irritability (39%), restlessness (38.8%), nervousness (38%), feelings of loneliness (31.3%), uneasiness (30.4%), and worries (30.1%). Spanish parents reported more symptoms than Italians. As expected, children of both countries used monitors more frequently, spent less time doing physical activity, and slept more hours during the quarantine. Furthermore, when family coexistence during quarantine became more difficult, the situation was more serious, and the level of stress was higher, parents tended to report more emotional problems in their children. The quarantine impacts considerably on Italian and Spanish youth, reinforcing the need to detect children with problems as early as possible to improve their psychological well-being., (Copyright © 2020 Orgilés, Morales, Delvecchio, Mazzeschi and Espada.)

Play is a natural mode of children's expression and constitutes a fundamental aspect of their life. Cognitive, affective, and social aspects can be assessed through play, considered as a "window" to observe a child's functioning. According to Russ's model, cognitive and affective components and their reciprocal connections can be assessed through the Affect in Play Scale (APS). The aim of the present study was to investigate children's representations of the three main models of disability (medical, social, and biopsychosocial) and how these models affected cognitive and affective components of children's play. Sixty-three children, aged 6-10 years, were assessed by means of the APS. Participants were randomly assigned to one of two APS task orders: the standard APS task followed by the modified APS task (including a wheelchair toy), or vice versa. The standard and modified APS sessions were coded according to the APS system. The modified APS sessions were also coded for the model of disability expressed by children. A one-way ANOVA conducted on the APS affective and cognitive indexes revealed an effect of condition on the affective components of play and no effect on cognitive components and variety of affect as assessed by the APS. In addition, when children are involved in pretend play from which concepts of disability emerge, these concepts are almost exclusively related to the medical model of disability. Results suggested implications for intervention with children in educational contexts that aim to teach children about disability.

Pretend play has a central role for children's development and psychological well-being. However, there is a paucity of standardized and valid measures specifically devoted to assess the core domains involved in play activities in preschool and primary school children. The Affect in Play Scale-Preschool (4-5 years) and the Affect in Play Scale-Preschool Extended Version (6-10 years) are semi-structured parallel tools designed to explore child's cognitive and affective processes using a standardized play task. The current study administered this 5-min play task to 538 Italian children aged 4-10. The purposes were to compare play abilities in boys vs. girls and in preschool vs. primary school children, to correlate pretend play with divergent thinking and to evaluate the structural validity of the measure along the considered age span. No differences, excepting for Organization, were found between boys and girls, whereas school age children reported higher play abilities then the younger ones. External validity was assessed using correlational analysis with the divergent thinking task (the Alternate Uses Test) for preschoolers and primary school-aged children, in line with findings from Manova. Construct validity, assessed through the Confirmatory Factor Analysis, showed good fits for the two-factor model with cognitive and affective factor for both the Affect in Play Scale-Preschool and its Extended Version. A multi-group factor analysis suggested a partial invariance of the two-factor model across preschool (4-5 years old) and primary school-aged (6-10 years old) children. Results supported the use of the Affect in Play Scale-Preschool and its Extended Version as adequate measures to assess the interplay of cognitive and affective skills in preschool and school age children. The discussion highlights clinical and research implications linked to the possibility to have a unique play task able to assess child's affective and cognitive abilities throughout a quite wide life span (from 4 to 10 years old).

The present study focuses on the multifaceted concept of self-disturbance in schizophrenia, adding knowledge about a not yet investigated aspect, which is the interoceptive accuracy. Starting from the assumption that interoceptive accuracy requires an intact sense of self, which otherwise was proved to be altered in schizophrenia, the aim of the present study was to explore interoceptive accuracy in a group of schizophrenia patients, compared to healthy controls. Furthermore, the possible association between interoceptive accuracy and patients' positive and negative symptomatology was assessed. To pursue these goals, a group of 23 schizophrenia patients and a group of 23 healthy controls performed a heartbeat perception task. Patients' symptomatology was assessed by means of the Positive and Negative Syndrome Scale (PANSS). Results demonstrated significantly lower interoceptive accuracy in schizophrenia patients compared to healthy controls. This difference was not accounted for participants' age, BMI, anxiety levels, and heart rate. Furthermore, patients' illness severity, attention and pharmacological treatment did not influence their interoceptive accuracy levels. Interestingly, a strong positive relation between interoceptive accuracy and positive symptoms severity, especially Grandiosity, was found. The present results demonstrate for the first time that interoceptive accuracy is altered in schizophrenia. Furthermore, they prove a specific association between interoceptive accuracy and positive symptomatology, suggesting that the symptom Grandiosity might be protective against an altered basic sense of self in patients characterized by higher sensibility to their inner bodily sensations.

The transition to parenthood is widely considered a period of increased vulnerability often accompanied by stress. Abidin conceived parenting stress as referring to specific difficulties in adjusting to the parenting role. Most studies of psychological distress arising from the demands of parenting have investigated the impact of stress on the development of dysfunctional parent-child relationships and on adult and child psychopathology. Studies have largely focused on mothers' postnatal experience; less attention has been devoted to maternal prenatal characteristics associated with subsequent parental stress and studies of maternal prenatal predictors are few. Furthermore, no studies have examined that association exclusively with samples of first-time mothers. With an observational prospective study design with two time periods, the aim of this study was to investigate the role of mothers' attachment style, maternal prenatal attachment to the fetus and dyadic adjustment during pregnancy (7th months of gestation) and their potential unique contribution to parenting stress 3 months after childbirth in a sample of nulliparous women. Results showed significant correlations between antenatal measures. Maternal attachment style (especially relationship anxiety) was negatively correlated with prenatal attachment and with dyadic adjustment; positive correlations resulted between prenatal attachment and dyadic adjustment. Each of the investigated variables was also good predictor of parenting stress 3 months after childbirth. Findings suggested how these dimensions could be considered as risk factors in the transition to motherhood and in the very beginning of the emergence of the caregiving system, especially with first-time mothers.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a disorder characterized by a chronic, pervasive, and developmentally inappropriate levels of impulsivity and in attention. It is associated with adverse academic and social functions and stress to families. Studies provide evidence that family variables are correlated with this disorder and that parenting styles play an important role in its complexity. However, a thorough investigation of the impact of parental affective and relational aspects on the ADHD child's areas of functioning is still needed. In designing future research on ADHD, we suggest to investigate parenting characteristics to a greater extent by adopting an attachment perspective with a focus on parental reflective functioning as it pertains to the child's ADHD clinical condition.

This study investigated the role of co-parenting alliance in mediating the influence of parents' trait anxiety on family system maladjustment and parenting stress. A sample of 1606 Italian parents (803 mothers and 803 fathers) of children aged one to 13 years completed measures of trait anxiety (State Trait Anxiety Inventory-Y), co-parenting alliance (Parenting Alliance Measure), family system maladjustment (Family Assessment Measure-III), and parenting stress (Parenting Stress Inventory-Short Form). These variables were investigated together comparing two structural equations model-fitting including both partners. A model for both mothers and fathers was empirically devised as a series of associations between parent trait anxiety (independent variable), family system maladjustment and parenting stress (dependent variables), mediated by co-parenting alliance, with the insertion of cross predictions between mothers and fathers and correlations between dependent variables for both parents. Results indicated that the relation between mothers and fathers' trait anxiety, family system maladjustment and parenting stress was mediated by the level of co-parenting alliance. Understanding the role of couples' co-parenting alliance could be useful during the family assessment and/or treatment, since it is an efficient and effective tool to improve the family system maladjustment and stress.

The Circle of Security Parenting (COS-P) is an early attachment based intervention that can be used with groups, dyads, and individuals. Created in the USA and now used in many countries, COS-P is a visually based approach that demonstrates its central principles through videos of parent/child interactions. The core purpose of the COS-P is to provide an opportunity for caregivers to reflect on their child's needs and on the challenges each parent faces in meeting those needs. Even though there is a wide range of clinical settings in which child/parent attachment is an important component of assessment there is limited empirical data on when and how attachment based interventions are appropriate for specific clinical profiles and contexts. The aim of this paper is to present a clinical application of COS-P in order to explore and reflect on some specific therapeutic tasks where it works and on some clinical indicators and contexts appropriate for its application. A single case study of a father, "M." (43 years old) in conflict for the custody of his 5 years old daughter is reported. The Adult Attachment Projective Picture System (AAP), the Parenting Stress Index, the Strengths and Difficulties Questionnaire, and the Parental Alliance Measure, were administered pre- and post-intervention. The clinical significance analysis method revealed that numerous changes occurred in the father. The AAP showed improvements in the level of agency of self. M. made gains in his capacity to use internal resources and to increase his agency of self. M. was classified as recovered in his perception of the child's functioning and as improved in his parenting stress and parenting alliance with the mother. Considerations on specific contexts and clinical indicators for the application of COS-P are proposed.

Within the research area on the determinants of childhood obesity, a relatively new approach is the use of attachment theory to explore the mechanisms underlying children's obesity risk, especially considered as emotion regulation strategies in parent-child relationship. Few are the empirical researches that have addressed this issue. The empirical investigations have used self-report measures to assess adult attachment. In attachment studies, the use of interview methods and/or performance-based instruments is advised to evaluate the entire range of possible adult attachment patterns and comprehensively explain the emotional strategies, correlates, and consequences of individual differences in attachment system functioning. The aim of this study was to explore the extent to which both parents' attachment patterns serve as self-regulative mechanisms related to childhood overweight/obesity by the Adult Attachment Projective Picture System (AAP) in a sample of 44 mothers and fathers of children referred for obesity. Insecure attachment was found as a risk factor both for mothers and fathers. Also unresolved/disorganization was found to play a significant role in childhood obesity. The role of father's attachment was explored and findings suggested considering it in etiology and treatment of childhood obesity.