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Introduction: The amount of research on the relationship between plastic surgery and psychological features, such as personality disorders and indexes of body image dissatisfaction, has increased significantly in the last years. Aim: The aim of the present study was to examine these psychological features among Italian patients who underwent aesthetic plastic surgery, testing the mediating role of the mass media influence on the relationship between them and the choice of aesthetic plastic surgery. The Personality Diagnostic Questionnaire 4+ (PDQ-4+) and the Body Uneasiness Test (BUT) were administered to patients who underwent aesthetic plastic surgery (N = 111) and participants who had no history of aesthetic plastic surgical procedures (N = 149). Results: Results showed that aesthetic patients reported higher indexes of body image disturbance than controls. No significant differences between aesthetic participants and controls were found in all three cluster B personality disorders. Moreover, the effect of body image dissatisfaction on the choice to undergo aesthetic plastic surgery was partially mediated by the influence of mass media. Conclusions: In conclusion, the present study confirmed the importance of body dissatisfaction as a predictor of the choice to undergo aesthetic surgery and highlighted the influence of media messages regarding physical appearance.

Background Gestational Trophoblastic Disease comprises a group of benign and malignant disorders that derive from the placenta. Using Leventhal’s Common-Sense Model as a theoretical framework, this paper examines illness perception in women who have been diagnosed with this disease. Methods Thirty-one women diagnosed with Gestational Trophoblastic Disease in a hospital in Italy were asked to complete the Illness Perception Questionnaire-Revised to measure the following: illness Identity, illness opinions and causes of Gestational Trophoblastic Disease. Results High mean scores were observed in the Emotional representations and Treatment control subscales. A significant difference emerged between hydatidiform mole patients and those with gestational trophoblastic neoplasia on the Identity subscale. A significant correlation emerged between “time since diagnosis” and the Treatment control subscale. Discussion This study is the first to investigate illness perception in Gestational Trophoblastic Disease. From a clinical perspective the results highlight the need for multidisciplinary support programs to promote a more realistic illness perception.

Dysfunctional eating attitudes and behaviors are very common among women. Recent findings suggest that these attitudes are linked to traits of pathological narcissism. However, mechanisms underlying this association need to be elucidated. We investigated the relationship between traits of pathological narcissism and dysfunctional eating attitudes and behaviors in women, testing whether perfectionistic tendencies mediate this association. The study involved a community-based sample of women (N = 306) who completed measures of grandiose and vulnerable narcissistic traits, attitudes of perfectionistic discrepancy and perfectionistic self-presentation, and dysfunctional eating attitudes and behaviors. Results show that vulnerable narcissistic traits are linked to dysfunctional eating attitudes and behaviors. Moreover, discrepancy between the actual self and the ideal self partially explains why women high in vulnerable narcissism engage in dysfunctional eating attitudes and behaviors. Grandiose narcissism was not uniquely associated with dysfunctional eating. The study suggests that the narcissistic need for being perfect, but not the narcissistic need for presenting oneself as perfect to others, promotes dysfunctional eating attitudes and behaviors in women.

Adolescence is a crucial period for the development of personality and its dysfunctions. In this regard, it is essential to evaluate the nature and degree of maladaptive personality functioning. However, measures currently available present some limitations, mainly being adaptations from adult’s tailored instruments and length. Moreover, no instrument considers the crucial dimensions related to body development and sexuality. This contribution presents data on the Adolescent Personality Structure Questionnaire (APS-Q) development, a self-report measure to capture core aspects of personality functioning in adolescence while being agile and reliable. On two large samples of adolescents (total N = 1,664), we investigated the psychometric properties of the APS-Q. We explored its factor structure and construct and incremental validity in the first sample, testing specific associations with existing measures of severity of personality pathology, maladaptive personality traits, and psychological distress. In the second sample, we confirmed its factor structure, assessing gender and age invariance. Overall, our findings support the APS-Q’s validity as a reliable and useful measure to assess personality functioning. Moreover, the APS-Q highlighted developmentally vital dimensions such as self-functioning (encompassing mental and bodily changes and considering the dimension of sexuality), interpersonal functioning (discriminating the dimensions of family and peers), and emotion regulation.

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.

Background Individuals with narcissistic traits, specifically vulnerable ones, are more prone to experiencing concerns related to self-worth and physical appearance and to showing heightened sensitivity to appearance evaluation. Negative body image and body image self-consciousness may, in turn, undermine sexual functioning, especially when apprehension is related to body appearance in sexual contexts. Methods We aimed to evaluate the associations between self-reported pathological narcissistic traits, both grandiose and vulnerable, and sexual functioning in a large sample of nonclinical women (N = 656). Furthermore, we tested the mediating role of body image self-consciousness in these associations. Outcomes Sexual functioning was measured through the Female Sexual Function Index. RESULTS The results highlight that vulnerable narcissistic traits are associated with lower sexual functioning, this association being mediated by higher levels of body image self-consciousness. Conversely, grandiose narcissistic traits are linked to lower body image self-consciousness and, consequently, higher levels of sexual functioning. Clinical Implications Considering the link between body image self-consciousness and sexuality is of utmost importance in clinical practice with women, as well as in promoting positive body appreciation. Clinicians working with individuals presenting with pathological personality traits should consider including an assessment of their sexual functioning.

Background Due to the high pressure they sustain, family members of substance users are thought to experience negative consequences in mental and physical health. This scoping review provided a comprehensive overview on the mental and physical health of adult Affected Family Members (AFMs). Method We searched in-journal English articles in PubMed, with no date limit, guided by the concepts of stress, strain, and burden, and including several terms related to substance use. Eligibility criteria included focus on adult AFMs, mental and physical health, and clinical forms of substance use. Results PubMed search identified 3549 articles, with 46 additional papers from other sources. Fifty-six articles were included, quantitative (N = 39), qualitative (N = 15) and both (N = 2). Quantitative findings show that AFMs are subject to increased stress and burden, and impaired mental health. Variable rates of physical problems emerge, with some medical conditions being more common among AFMs of substance users versus controls. Finally, evidence shows increased risk for aggression and reduced quality of life and social adjustment. AFMs report higher stress and strain if they are women, in low socio-economic families, and co-habiting with more severe substance users. Qualitative studies additionally suggest that stigma, self-blame, and social isolation are common. Conclusions AFMs of substance users represent a population at higher risk for negative health-related outcomes and should be systematically regarded as targets for treatment.

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.

Purpose of Review We report evidence on the negative psychological effects of pandemics in people with personality disorders (PDs) and on the role of personality pathology in compliance with mitigation-related behaviors. Considering the paucity of studies, after a description of the main features of PDs, on the basis of the current literature on pandemic and quarantine mental health impact, we trace some clinical hypotheses. Recent Findings Paranoid traits and detachment (cluster A) might lead to worse psychological outcomes. Cluster B patients may show more intense stress-related reactions and react strongly to social distancing, especially considering borderline personality disorder. Cluster C patients might be particularly prone to anxiety and stress due to fear of contagion and may be less flexible in adaptation to new routines. Evidence on compliance with mitigation measures is mixed, with lower compliance in cluster B patients and higher in cluster C ones. Summary We suggest that PD patients might be particularly affected by pandemics. Furthermore, they might react differently, according to their main diagnosis. Similarly, compliance with mitigation measures may differ according to specific PDs. Our results should be considered as a starting point to reflect on therapeutic strategies to be adopted in the post-COVID-19 situation.

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.

Gestational Trophoblastic Disease encompasses a group of pregnancy-related disorders that derive from the placenta. Taking Leventhal’s Common Sense Model as a starting point, this study aims to investigate how illness perception could influence patients’ psychological adaptation to these rare diseases. Thirty-seven women completed: the Illness Perception Questionnaire-Revised, the Beck Depression Inventory Short Form, the State-Trait Anxiety Inventory, and the Fertility Problem Inventory. Results show that the perception of severe illness consequences significantly predicts the level of anxiety patients reported at the time of questionnaire completion. Furthermore, mental representations of illness present a significant association with infertility-related stress. Specifically, the belief in the efficacy of the treatment results in fewer feelings of discomfort and isolation from family and social context due to infertility-related problems. Since patients’ illness perception was found to have a specific impact on both anxiety and infertility-related stress, this variable should be considered in the planning of a clinical intervention.

Contemporary object-relation theory of personality postulates that the level of severity of personality organization parallels the nature and extent of problems in the patient’s sexual life. The study aims at exploring the relationship between dimensions of Borderline Personality Organization (BPO) (as assessed according to Otto Kernberg’s model), sexual functioning, quality of sexual life and paraphilias in a community sample of men. One-hundred and thirty-six healthy men were asked to complete a set of questionnaires including the Inventory of Personality Organization (IPO), the International Index of Erectile Function, the Sexual Quality of Life Questionnaire, and a checklist to assess the prevalence of paraphilias. High scores on IPO subscales were significantly associated with low overall satisfaction in sexual functioning, low quality of sexual life, and the presence of paraphilias. Results expand previous findings on the relationship between features of BPO and core components of sexual life and support the need for an assessment of personality functioning in subjects reporting sexual problems.

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.

Objective: Whilst the relationship between narcissism and self-esteem has been studied for a long time, findings are still controversial. The majority of studies investigated narcissistic grandiosity, neglecting the existence of vulnerable manifestations of narcissism. Moreover, recent studies have shown that grandiosity traits are not always associated with inflated explicit self-esteem. The aim of the present study is to investigate the relationship between narcissistic traits and explicit self-esteem, distinguishing between grandiosity and vulnerability. Moreover, we consider the role of implicit self-esteem in qualifying these associations. Method: Narcissistic traits, explicit and implicit self-esteem measures were assessed among 120 university students (55.8% women, Mage = 22.55, SD = 3.03). Results: Results showed different patterns of association between narcissistic traits and explicit self-esteem, depending on phenotypic manifestations of narcissism. Narcissistic vulnerability was linked to low explicit self-evaluations regardless of one’s levels of implicit self-esteem. On the other hand, the link between narcissistic grandiosity and explicit self-esteem was qualified by levels of implicit self-views, such that grandiosity was significantly associated with inflated explicit self-evaluations only at either high or medium levels of implicit self-views. Discussion: These findings showed that the relationship between narcissistic traits and explicit self-esteem is not univocal, highlighting the importance of distinguishing between narcissistic grandiosity and narcissistic vulnerability. Finally, the study suggested that both researchers and clinicians should consider the relevant role of implicit self-views in conditioning self-esteem levels reported explicitly by individuals with grandiose narcissistic traits.

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.

Background Nonsuicidal self-injury (NSSI) is used to cope with negative affect states. We investigated the association between impulsivity and this affect-regulation process. Method Affect states associated with NSSI and impulsivity traits were evaluated in 30 Italian adolescent self-injurers (63.3% female, mean age = 16.63, SD = 0.56). Results Nonsuicidal self-injury was associated with decreases in affective arousal, but impulsivity moderated other affective changes. High impulsivity was associated with increases in negative high-arousal affects after NSSI, whereas low impulsivity was associated with increases in positive affects after NSSI. Conclusion Impulsivity traits influenced the success or failure of the NSSI affect-regulation process.

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.