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COVID-19 pandemic involved several psychosocial consequences. We aimed at monitoring the mental health of Italian adults during the lockdown imposed by the government. We present here results from the baseline assessment of the "EmotionalThermometer [TermometroEmotivo] project on a sample of 1548 Italian adults. We assessed the socio-demographic conditions of participants, individuals' perception of the COVID-19-situation, psychological distress, emotion regulation strategies, and perceived social support. Having a worse representation of COVID-19 and consulting news more frequently, with higher anxiety and less credibility of different sources of information, were positively associated with psychological distress and post-traumatic responses. Being female, younger age, living in high-risk regions, having symptoms of COVID-19, and having relatives/friends with such symptoms represented risk factors for a worse perception of COVID-19 and distress. Social support and cognitive reappraisal represented protective factors for mental health.

Suicide is a major cause of death in Eating Disorders (EDs) and particularly in anorexia nervosa (AN). The aim of the present mini-review was to summarize the literature focusing on the interpersonal-psychological theory of suicide (IPTS) by Thomas E. Joiner, as applied to explain suicidal risk in EDs. PubMed database was used to search articles focused on IPTS in EDs; 10 studies were eventually included. The majority of the included studies reported data from the same sample, even though the hypotheses and analyses for each study were unique. The investigated suicidal outcomes were suicidal ideation (SI) (40%), non-suicidal self-injury (10%), suicide attempt (40%) and suicide (10%). In ED patients Perceived Burdensomeness (PB) may play an important role, especially regarding SI risk. ED patients may feel like a burden to their close ones, and actually some of the ED symptoms may be an expression of anger and hate against the self. Overall, currently available research has supported some IPTS derived predictions (i.e., ED symptoms may increase PB and thereby SI), but not others (i.e., the elevated suicide rate in AN may be due to higher acquired capability for suicide). Further research on IPTS tenets as well as on other theoretical perspectives and constructs (e.g., interoceptive awareness), hopefully with a longitudinal design and adequate follow-up duration, might allow a more thorough understanding of the complex topic of suicidal behavior in ED patients.

Purpose of Review We aim to provide quantitative evidence on the psychological impact of epidemic/pandemic outbreaks (i.e., SARS, MERS, COVID-19, ebola, and influenza A) on healthcare workers (HCWs). Recent Findings Forty-four studies are included in this review. Between 11 and 73.4% of HCWs, mainly including physicians, nurses, and auxiliary staff, reported post-traumatic stress symptoms during outbreaks, with symptoms lasting after 1–3 years in 10–40%. Depressive symptoms are reported in 27.5–50.7%, insomnia symptoms in 34–36.1%, and severe anxiety symptoms in 45%. General psychiatric symptoms during outbreaks have a range comprised between 17.3 and 75.3%; high levels of stress related to working are reported in 18.1 to 80.1%. Several individual and work-related features can be considered risk or protective factors, such as personality characteristics, the level of exposure to affected patients, and organizational support. Summary Empirical evidence underlines the need to address the detrimental effects of epidemic/pandemic outbreaks on HCWs’ mental health. Recommendations should include the assessment and promotion of coping strategies and resilience, special attention to frontline HCWs, provision of adequate protective supplies, and organization of online support services. Electronic supplementary material The online version of this article (10.1007/s11920-020-01166-z) contains supplementary material, which is available to authorized users.

We argue that clinical information related to an object-relations model of personality pathology can be used by untrained and clinically inexperienced students to rate personality-disordered patients on the Level of Personality Functioning Scale (LPFS). To do so, 73 clinically inexperienced undergraduate students were asked to assess personality functioning of 10 female inpatients using the LPFS from audio recordings of the Structured Interview of Personality Organization (STIPO). LPFS ratings showed acceptable interrater reliability. Moreover, LPFS ratings were significantly associated with external measures of severity of personality pathology (number of DSM-IV-TR personality disorders) as assessed by experienced clinicians. Finally, the students' ratings were also associated with the level of personality organization as measured by experienced clinicians using the STIPO. Our findings confirm that untrained raters can reliably assess personality pathology by rating the LPFS based on material from the STIPO. Implications related to the use of the STIPO as a tool for the assessment of personality pathology according to the DSM-5 Alternative model are discussed.

Empirical literature has shown that narcissism is often associated with limited empathy, but the mechanism underlying this association is still unclear. The present study investigated the role of identity instability as a mediator of the relationship between narcissistic traits and empathic capabilities. Narcissistic traits, identity instability, and cognitive and emotional empathic capabilities were assessed among 462 nonclinical participants through self-report measures. Results showed a positive association between narcissistic traits and cognitive empathy. On the other hand, a negative association between narcissistic traits and emotional empathy emerged. Furthermore, the study showed that the association between narcissistic traits and impairments in emotional empathy was partially explained by identity instability. Results thus demonstrated that narcissistic traits were associated with higher identity instability, and this, in turn, was associated with decreased abilities to be emotionally involved in others' affect states. These findings are discussed in the context of an object relations formulation of narcissistic personality.

The Alternative Model for Personality Disorders states that personality pathology involves significant impairment in personality functioning that can be assessed using the Level of Personality Functioning Scale (LPFS). However, the ability of the LPFS to capture impairments typical of personality pathology, rather than of general psychopathology, is still unclear. The authors applied a 12-item version of the LPFS to clinical interviews (i.e., the Structured Interview of Personality Organization [STIPO]) to test whether differences in levels of impairment in domains related to both self- and interpersonal functioning can be detected among patients with personality disorders (n = 33), psychiatric outpatients (n = 30), and nonclinical controls (n = 30). Results show that the 12-item version of the LPFS scored using clinical material gathered through STIPO interviews captures impairments in identity, self-direction, and empathy uniquely linked to personality pathology. However, impairments in intimacy do not differentiate between patients with and without personality disorders.

This study investigated the association between narcissism and shame, considering different measures of narcissism, different levels of analysis, and different situational conditions. Nonclinical participants (N = 196) completed baseline measures, followed by daily questionnaires for 28 days. Multilevel models indicated that trait and daily vulnerable narcissism, as well as trait neuroticism, were positively associated with daily shame. When controlling for vulnerable narcissism, trait grandiose narcissism was unrelated to shame, and daily grandiose narcissism was mostly negatively related to it. As for situations, social stress and workload were related to increased shame, especially in those high in trait neuroticism, or narcissism scales with neurotic content. Results highlight the key role of shame in pathological narcissistic functioning.

© 2016 American Academy of Addiction PsychiatryBackground and Objectives: Since significant differences have been reported, we estimated agreement between DSM-5 and DSM-IV criteria for alcohol use disorder (AUD). Methods: We assessed 327 outpatients (mean age: 45.2 ± 13.4) with depressive or anxiety disorders. Results: Absolute differences in prevalence rates between DSM-5 and DSM-IV AUD ranged from −1.1% (subjects with anxiety disorders) to +1.8% (tobacco smokers). The agreement was excellent (k = 0.88), also accounting for specific subgroups (relevant k coefficients >0.80). Discussion and Conclusions: DSM-5 criteria did not inflate AUD rates. Scientific Significance: Our results have epidemiological significance since, unlike previous reports, we found diagnostic stability between new and old AUD criteria in this clinical population. (Am J Addict 2017;26:53–56).

There is ongoing debate about the structure of pathological narcissism. Adopting a network approach, we investigate the core features of pathological narcissism and the nature of traits interconnections in a community sample (N = 944), considering also the effect of personality structure. Results suggest that grandiose fantasies, contingent self-esteem, and entitlement rage have a central role in defining pathological narcissism. Also, differences in interconnections between traits are found when considering individuals with different levels of personality structure. Our findings shed light on the structure and nature of pathological narcissism by showing the existence of both core and peripheral features, as well as their differential role in defining narcissistic manifestations at different levels of personality functioning.

Research on personality in adolescence underlined the importance of adopting a dimensional approach to personality pathology rather than a categorical one. In this regard, the association between maladaptive versions of personality traits and pathological outcomes has been studied, neglecting the study of the severity of personality functioning. The aim of the current study is to investigate the interactions between maladaptive personality traits as conceptualized in DSM-5 Alternative Model for Personality Disorders and personality functioning in a large sample of non-clinical adolescents. Maladaptive personality traits, severity of personality functioning and psychological distress were evaluated in 562 adolescents (62.5% females, M = 16.24, SD = 1.69) recruited from middle and secondary schools in Northern Italy. Results showed that internalizing maladaptive personality traits and psychoticism were associated with psychological distress, whilst externalizing traits were not. Moreover, dimensions of personality functioning (self and interpersonal related) moderated the strength of these associations. These findings suggest the importance of taking into account the level of personality functioning in order to deeper understand the association between maladaptive personality traits and psychological distress. In particular, our results indicate that internalizing features might be highly influenced by personality dimensions in adolescence.

Background: Although dual diagnosis has been a topic of great scientific interest for a long time, few studies have investigated the personality traits that characterize patients suffering from substance use disorders and co-occurring personality disorders through a dimensional approach. The present study aimed to evaluate structural personality profiles among dual-diagnosis inpatients to identify specific personality impairments associated with dual diagnosis. Methods: The present study involved 97 participants divided into three groups: 37 dual-diagnosis inpatients, 30 psychiatric outpatients and 30 nonclinical controls. Dimensions of personality functioning were assessed and differences between groups were tested using Kernberg's dimensional model of personality. Results: Results showed that dual diagnosis was associated with the presence of difficulties in three main dimensions of personality functioning. Dual-diagnosis inpatients reported a poorly integrated identity with difficulties in the capacity to invest, poorly integrated moral values, and high levels of self-direct and other-direct aggression. Conclusions: The present study highlighted that a dimensional approach to the study of dual diagnosis may clarify the personality functioning of patients suffering from this pathological condition. The use of the dimensional approach could help to advance research on dual diagnosis, and it could have important implications on clinical treatment programs for dual-diagnosis inpatients. © 2014 Elsevier Inc. All rights reserved.

This work aims to further validate the object-relations-based model of personality pathology assessment, evaluating the psychometric properties of the Italian version of the Inventory of Personality Organization (IPO), a self-report instrument for the assessment of personality organization according to O. Kernberg's model of personality pathology. Six hundred ninety-six nonclinical volunteers and 121 psychiatric patients completed a set of questionnaires including the IPO, the Severity Indices of Personality Problems, the Borderline Personality Disorder Checklist, the Response Evaluation Measure 71, and the Symptom Checklist 90-Revised. Confirmatory factor-analyses on the IPO items supported the 1-, 2-, 3-, and 4-factor solutions. The last (Instability of sense of self/others, Instability of goals, Instability of behaviors, Psychosis) resulted in relatively better fit indexes. Invariance across samples (nonclinical, clinical) and gender was confirmed. The 4 IPO subscales showed good levels of internal coherence and, in the nonclinical sample, good test-retest reliability. Associations with the convergent measures were in line with theoretical expectations and supported the benefit of adopting a 4-factor solution. The 4 factors showed the expected criterion relations: All the dimensions discriminated between clinical and nonclinical subjects, whereas only Instability of self/others and Instability of goals discriminated patients with borderline personality disorder from patients with other diagnoses. Our results suggest that the Italian version of the IPO is a reliable and valid tool for the assessment of personality organization according to Kernberg's model. Results are discussed in the context of the current directions in the evaluation of personality disorders proposed by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

This study aims at investigating factors associated with early dropout in dual diagnosis patients, considering socio-demographic, diagnostic and personality structure variables. We hypothesized that the personality structure of the patient will show stronger associations with dropout, as compared to descriptive variables. Forty-seven patients consecutively admitted in a dual diagnosis residential treatment unit were administered the Structured Interview of Personality Organization (STIPO), the Structured Clinical Interview for Axis II Disorders (SCID II), the Response Evaluation Measure 71 (REM71), the Symptom Check List 90–R (SCL90-R), and the Borderline Personality Disorder Check List (BPDCL). Significant differences emerged between the dropout and no-dropout group: Investments and self-coherence problems (STIPO) were higher among dropouts; moreover, in the dropout group a significantly higher number of patients showed a borderline personality organization (88.9 %). Results support the use of structural interviews in the assessment of dual diagnosis patients; implications regarding research and clinical practice are discussed.

This study was designed to assess a three level model of personality impairment, as hypothesized by S. E. Hyler, in a non-clinical sample, according to the Personality Diagnostic Questionnaire (PDQ-R) total score, and the association of this three level organization with defense styles and state psycho-pathological symptoms, administering PDQ-R, Defense Style Questionnaire (DSQ-SF), and Hopkins Symptom Checklist (SCL-90) to a sample of 254 first-year medical students. Hierarchical agglomerative cluster analysis, performed on the PDQ-R total score, confirmed the three-level model. The one-way multi-variate analysis of variance showed a significant (Pillai's V = .483 p >.0001) association between levels of personality impairment, and DSQ-SF and SCL-90 scales. According to 99% Bonferroni simultaneous confidence intervals, the DSQ-SF Immature Defense and all SCL-90 scale mean scores, except So-matization and Phobic Anxiety, were significantly different in all the three levels of personality impairment. The PD...

Personality traits, family environment and maltreatment episodes are often associated with nonsuicidal self-injury (NSSI); however, research on these associations has shown mixed results. The aim of the present study was to clarify the effects of these factors on the presence and the severity of NSSI among a sample of Italian students who attended secondary schools (N = 267, mean age = 17.03 SD = 0.866). The results showed that personality traits, family environment and maltreatment differently predicted the presence and the severity of NSSI. Self-injurers were more impulsive and aggressive than non-self-injurers and reported poorer relationship quality with their mothers and more sexual and physical abuse episodes than non-self-injurers. Conversely, the frequency of NSSI behaviours was predicted by the presence of less impulsiveness, more anxiety and aggressiveness, poorer relationship quality with both parents and a lower degree of identification with the father. Finally, more frequent self-injurers also reported more sexual abuses and neglect episodes than less frequent self-injurers.

This article describes the development, the reliability, and the validity of the Personality Functioning Scale (PFS), an instrument based on the conceptual and empirical works of McGlashan and Miller (1982) and McGlashan (1984). The PFS consists of 31 items grouped into 8 domains: developmental level, aspects of the self, object relatedness, reality acceptance, fullness of experience, coping mechanisms, integrative capacity and self analytic functions. Two clinical samples (borderline personality disorder = 69; schizophrenia = 34) were used to evaluate the reliability and the validity of the PFS. The scale showed high internal consistency (.97), test-retest reliability (.90), and criterion validity (.96; .94; .98; .94; .97). The construct validity of the scale was confirmed by the results of the factor analysis. The PFS is proposed for use both in the dynamic evaluation of personality (diagnostic area) and in the evaluation of the results of psychotherapy.

The typical human proclivity of attributing one’s own afflictions to external events is currently very widespread and is often a way of building a defensive barrier. This tendency has always been connected with the genesis of permanent traits which characterize individuals and form their personality. An example is the relationship between humoral theories and astral influences. This relationship becomes even more explicit when considering behaviors currently identified as “personality disorders”: lunatic, martial, jovial are personality traits that can be related to our present distinctions.

Objective: The effectiveness of post-surgical weight loss in improv-ing body image disturbance, self-esteem and psychological well-being in morbidly obese patients, remains to date unclear. The current preliminary study intends to investigate pre and post-operative changes in psychological well-being, self-esteem and body image. Methods: 125 patients (65% Female; M age = 32.68; MBMI = 43.9) scheduled for laparoscopic adjustable gastric banding (LAGB) from three Italian hospitals completed the Body Uneasiness Test (BUT), the Psychological General Well-Being Index Short Version and the Rosenberg's Self-Esteem Scale before and 12 months after surgery. Results: Irrespective of BMI reduction, LAGB has a positive impact on psychological well-being and self-esteem. Instead the improvement in the distress related to body image depends on the pre-operative degree of severity (Global Severity Index of BUT): all patients with a body image disorder in the pre-operative stage (35%, measured using the cut-off value of BUT) continue to show this even 13 months after the operation. Conclusion: The results confirm that weight reduction leads to an improvement in psychological well-being and self-esteem. Never-theless, the improvement in the distress related to body image was found only in patients without BID. This study outlines the high prevalence of BID in LAGB setting and suggests therefore the importance of a preoperative clinical evaluation.

Introduction Based on clinical impressions personality disorders (PDs) and psychiatric disorders characterized by body image disorder (BID) have been suggested to be relatively common in cosmetic surgery settings and closely associated with patient's post-operative dissatisfaction despite technically satisfactory surgical results, leading to problems for both patients and surgeons. Aims The study investigated the prevalence and the comorbidity between BID and PDs in patients seeking cosmetic surgery, as well as the impact of the following clinical variables on patient's post-operative dissatisfaction: number of pathological personality traits, severity of body uneasiness and worries about particular body parts and intensity of these concerns. Methods Two hundred fifty patients scheduled for profile, breast and body contouring cosmetic surgery from two Italian hospitals (90% F; M age = 31.5 ± 4.0) completed the Body Uneasiness Test (BUT), the Personality Diagnostic Questionnaire-4+ (PDQ-4) before surgery and a measure of patient satisfaction 13 months after surgery. Results 18.9% of subjects, had at least 1 PD (cluster B and C's in particular). Using the BUT cut-off score as a marker of clinical significance, 48.8% of subjects had a BID, and all PD patients showed comorbidity with BID. The number of pathological personality traits, the severity of body uneasiness and the intensity of worries about body parts showed a predictive power on patients’ post-operative dissatisfaction. Conclusion PDs and BID are common in cosmetic surgery settings. Our data suggest also that a thorough pre-operative clinical assessment may allow the pre-operative identification of patients with low levels of post-operative satisfaction.