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Young carers might experience both psychological distress and positive changes from living with their chronically ill parent. However, little is known about why some young carers do well with their situation and experience positive outcomes, whereas others do not. In this regard, this dissertation aims to investigate how parental chronic illness affects young carers’ psychosocial adjustment through risk (i.e., unmet needs) and protective factors (i.e., benefit finding, emotion regulation). This main goal has been addressed by conducting three studies presented in Chapters 2–4. Chapter 2 has examined the mediating role of unmet needs on the relationship between illness unpredictability and youth psychosocial adjustment (i.e., quality of life and internalizing problems). In this regard, it has been found that levels of unmet needs significantly mediated the relationship between illness unpredictability and offspring health-related quality of life. In the systematic review with meta-analysis presented within Chapter 3, it has been sought to investigate the mediating role of the protective factors (i.e., benefit finding and emotion regulation) in the relationship between caregiving components and youth psychosocial adjustment in young carers. This study has shown the significant associations between caregiving components and psychosocial adjustment in young carers not only directly, but also indirectly through protective factors. Finally, to expand on previous findings, a qualitative study in Chapter 4 has examined the unique experiences of young carers, as well as the effects of the COVID-19 global pandemic. This study has yielded a deeper understanding of how protective factors may be operated during young carers’ lived experiences before and during the COVID-19 global pandemic. Overall, this dissertation has shed light on the pivotal role played by risk and protective factors in caregiving components that serve as key determinants that can enhance positive psychosocial outcomes as well as concurrently mitigate adverse psychosocial consequences among young carers.

This doctoral thesis presents a project carried out in secondary schools located in the city of Ferrara with the primary objective of demonstrating the effectiveness of an intervention based on Well-Being Therapy (Fava, 2016) in reducing alcohol use and improving lifestyles. In the first part (chapters 1-3), an introduction on risky behaviors and unhealthy lifestyle in adolescence is presented, followed by an examination of the phenomenon of binge drinking and of the concept of psychological well-being. In the second part (chapters 4-6), the experimental study is presented. A three-arm cluster randomized controlled trial including three test periods was implemented. The study involved eleven classes that were randomly assigned to receive well-being intervention (WBI), lifestyle intervention (LI) or not receive intervention (NI). Results were analyzed by linear mixed model and mixed-effects logistic regression with the aim to test the efficacy of WBI in comparison with LI and NI. AUDIT-C total score increased more in NI in comparison with WBI (p=0.008) and LI (p=0.003) at 6-month. The odds to be classified as at-risk drinker was lower in WBI (OR 0.01; 95%CI 0.01–0.14) and LI (OR 0.01; 95%CI 0.01–0.03) than NI at 6-month. The odds to use e-cigarettes at 6-month (OR 0.01; 95%CI 0.01–0.35) and cannabis at post-test (OR 0.01; 95%CI 0.01–0.18) were less in WBI than NI. Sleep hours at night decreased more in NI than in WBI (p = 0.029) and LI (p = 0.006) at 6-month. Internet addiction scores decreased more in WBI (p = 0.003) and LI (p = 0.004) at post-test in comparison with NI. Conclusions about the obtained results, limitations of the study, and future implications are discussed. In the seventh chapter, the data of the project collected during the pandemic are presented and compared with those from recent literature.

Introduction: The role of psychosocial factors in the onset and progression of essential hypertension has been object of a large body of literature, yet findings appear to be controversial. Aims: We assessed the predictive role of psychosomatic syndromes, affective symptomatology, psychological reactance, psychological distress, well-being and quality of life on adherence to antihypertensive medications, lifestyle behaviors, hypertension severity and absolute cardiovascular risk grading, as well as their temporal stability at 1-year follow-up, in a sample of hypertensive patients. In addition, we aimed to validate the Italian version of the Hong Psychological Reactance Scale (HPRS). Methods: Eighty consecutive hypertensive outpatients treated with antihypertensive medications were compared to 80 controls. Psychosocial variables were assessed using clinical interviews and self-rating questionnaires at baseline and at 1-year follow-up. Cardiac parameters were also collected. One-hundred and fifty individuals from general population provided data for the HPRS validation. Results: Hypertensive patients reported significantly higher levels of psychological distress and lower levels of psychological well-being at baseline compared to controls. Among hypertensive patients, allostatic overload (AO) was the most frequently reported psychosomatic syndrome at baseline. Patients with AO displayed significantly greater levels of psychological distress and lower levels of well-being and quality of life than those without. Further, patients with illness denial were significantly more likely to report poor adherence to pharmacological treatment and, as well as those with higher levels of affective symptomatology, were less likely to follow a balanced diet. At follow-up, patients displayed significantly higher levels of well-being and lower levels of stress, mental pain and quality of life. Conclusions: Findings suggest the clinical relevance of psychosocial factors and psychosomatic syndromes in the progression of hypertension, with important implications for its management. As to the Italian validation of the HPRS, results support previous findings, even though a confirmatory factor analysis should be carried out.

Introduction: Current lifestyle interventions for the treatment of type 2 diabetes and weight loss show limited effects, while the promotion of psychological well-being has shown preliminary benefits in reducing psychological distress and improving self-care behaviors in type 2 diabetes and weight loss. Objectives: The aim of this study was to evaluate the feasibility, acceptability, and superiority of a 4-month combined well-being and lifestyle intervention for weight loss and distress reduction among adult patients with type 2 diabetes and overweight/obesity compared to lifestyle intervention alone. Primary efficacy outcomes included changes in weight, psychological distress, and well-being, while secondary efficacy outcomes included changes in lifestyle and physiological parameters. Methods: In this multicenter RCT, 58 consecutive patients were recruited from two outpatient endocrinology clinics and randomized to either a combined WBT-lifestyle group, receiving the combined well-being and lifestyle intervention (n=30), or a lifestyle alone group, receiving a lifestyle intervention only (n=28). Data were collected at baseline (T0), at immediate post-intervention (T1), and at a 6-month follow-up (T2). Results: The study intervention was shown to be feasible and acceptable. Compared to the lifestyle alone group, the combined WBT-lifestyle group showed significantly greater improvements in levels of depression, hostility, and personal growth at T1 and in levels of physical activity at T2. There were no significant differences between treatment groups in measures of weight and other physiological parameters at any assessment points. However, significant improvements were observed from T0 to T2 in weight in both treatment groups, and in blood pressure in the combined WBT-lifestyle group. Conclusions: The findings suggest that a well-being intervention can be a valuable addition to lifestyle interventions in improving short-term psychological outcomes and promoting healthy changes in physical activity at a 6-month follow-up.

Introduction: Behavioral lifestyle interventions focused on diet and physical activity are a cornerstone for the treatment of obesity. However, their effects vary substantially across individuals in terms of magnitude and durability. Personalized approaches that target psychological well-being may facilitate healthy behaviors and sustained weight loss. Objectives: This study aimed to explore whether the sequential combination of behavioral lifestyle and well-being intervention (BLI/WBI) may result in more favorable outcomes than behavioral lifestyle intervention alone (BLIA) in promoting weight loss (primary outcome) and improving psychological well-being, distress, dietary behaviors, and physical activity (secondary outcomes). Methods: 83 patients with obesity were randomly assigned to the BLI/WBI group (n=38) or the BLIA group (n=43). Participants in the BLIA group received a 12-week behavioral weight loss program, while those in the BLI/WBI received the same program followed by an additional 4-week well-being intervention. Data were collected at pretreatment (baseline, T1), at the end of BLI/WBI (T2), and at 6-month follow-up (T3). Results: There was a significant weight loss in both treatment groups at the end of BLI/WBI and 6-month follow-up. The BLI/WBI group showed greater improvements in anxiety symptoms (β=-1.92 [-3.66 to -0.18], p< 0.05) at the end of BLI/WBI and in depressive symptoms (β= -2.28[-4.20 to -0.37], p< 0.05) at 6-month follow-up compared to the BLIA group. Conclusions: The WBI showed no additional effect on weight loss. However, the secondary outcomes indicate that the WBI may reduce vulnerability to depressive and anxiety symptoms in obese patients. Future studies are needed to explore whether the psychological benefits of WBI can foster long-term weight loss maintenance.

Objective: Parental chronic illness has an impact on several aspects of offspring’s life. Three major impediments to research progress in this field are undeveloped and untested theoretical frameworks, no clear conceptualization of youth caregiving, and no available instrument to assess such construct in Italian. To address these weaknesses, the aims of this PhD dissertation were: (1) to investigate the psychometric properties of the Italian version of the Young Caregiver of Parents Inventory-Revised (YCOPI-R); (2) to empirically examine a model of the effects of parental illness on youth and family functioning innovatively analyzing the role of psychological flexibility; (3) to test a refined conceptualization of youth caregiving. Methods: A total of 501 adolescents aged 11 to 24 (295 young caregivers and 206 young noncaregivers) completed a questionnaire regarding youth caregiving, parental illness, and youth adjustment. In the first study, young caregivers were compared to noncaregivers, while the other studies used only the young carers subgroup. Results: The first study indicated that the Italian version of the YCOPI-R demonstrated sound psychometric and was able to discriminate between young caregivers and noncaregivers. The second study underlined the key protective role of psychological flexibility in shaping youth adjustment and family functioning in the context of parental illness. The third study innovatively clarified the nature of youth caregiving, indicating that it is a tripartite construct related to both positive and negative youth adjustment outcomes. Conclusions. This PhD project drew attention towards youth of chronically ill parents, a segment of the young population which is presently almost completely neglected in Italy by health policies and healthcare providers. This PhD project ultimately shed light into the processes through which parental illness results in detrimental youth outcomes and highlighted avenues for interventions that target empirically supported mechanisms which ameliorate the detrimental effects of parental illness on youth.

Introduction: During all phases of Liver Transplant (LT) process patients tend to develop psychological distress. Aims of the present study were to evaluate psychological variables at the time of evaluation for listing for LT (T0) and enter in the waitlist for LT (T1). Methods: We prospectively enrolled patients admitted at the Bologna Transplant Center between 2017 and 2018. Patients were compared with an age- and gender- matched control group. Significant differences between variables were estimated with non-parametric tests. χ2 or Fisher’s exact test was used for categorical variables while Mann-Whitney for continuous ones. Changes between T0 and T1 were analyzed with Wilcoxon Test. A p value less than 0.05 was pondered as noteworthy for all tests. Results: We enrolled 50 patients mainly males (68%) with mean age of 57±7 years. A DSM 5 diagnosis was present in one fifth of patients and DCPR syndrome in 44%. Enrolled subjects at T0 showed anxiety, depression and somatic symptoms. In comparison with control group, experimental one displayed lower scores in PCS and MCS of SF-12 (p=0.000, p=0.000, respectively), BC positive refraining, venting, instrumental support, humor, behavioural disengagement, emotional support, self-blame (all p

In the framework of the theoretical debate on whether it is appropriate to consider Problematic Internet Use (PIU) and problematic Social Networking sites use as addictive behaviors, the main aim of this work was to build on and extend previous findings about the psycho-physiological mechanisms underlying these problematic behaviors. In the first study, self-report instruments in a cross-sectional design highlighted a pattern of symptoms related to anxiety/mood disorders and Obsessive-Compulsive Disorder (OCD) in PIU. Interestingly, only hoarding and obsessing symptoms predicted the condition of problematic vs. non-problematic Internet use, suggesting an altered mechanism shared by OCD and PIU that may lie at the basis of PIU development. In the second study, the relationship between autonomic reactivity during a stressful task and craving was investigated in PIU. We found lower resting heart rate variability (HRV) before the stressful task in individuals with PIU vs. non-PIU. Moreover, after the stressful task, lower HRV in PIU was related to higher craving for Internet use, suggesting that, in PIU, reduced autonomic flexibility is a stable condition that is related to reduced capacity for self-regulating craving. In the third study, inhibitory processes and their relationship with HRV were assessed in PIU by an emotional Go/Nogo task. Lower performance accuracy among problematic- than non-problematic users was found. Moreover, only among problematic Internet users lower HRV predicted less efficient task performance upon the presentation of unpleasant stimuli, suggesting reduced HRV to be a potential indicator of defective inhibitory control in PIU. As for the fourth study, the cognitive-behavioral model of generalized PIU in the context of Problematic Facebook Use (PFU) was tested. The main result showed that using Facebook for mood regulation has a greater impact than preference for online social interaction on negative outcomes of PFU, suggesting that using Facebook to regulate mood is a core component of PFU. Cue-reactivity and response inhibition in the presence of Facebook-related and affective stimuli in individuals with vs. without PFU were also investigated. In the fifth study, the Event-Related Potentials (ERPs) were recorded during the passive viewing of Facebook-related, pleasant, unpleasant and neutral pictures. The results did not provide evidence for cue-reactivity to Facebook-related cues in problematic users. Rather, Facebook-related cues elicited larger ERP positivity than neutral, and comparable to unpleasant stimuli, in all Facebook users. Interestingly though, only in problematic users the ERP positivity elicited by Facebook-related cues was inversely related to subjective arousal, suggesting that negative reinforcement processes might characterize PFU as a behavioral addiction. Moreover, similarly to drug addiction, in which enhanced and sustained reward reactivity would increase the likelihood of risky behavior, we found long-lasting larger ERP positivity to pleasant than unpleasant pictures only in problematic Facebook users. In the sixth study, we investigated whether individuals with vs. without PFU show greater difficulties in inhibiting motor responses during an emotional Go/Nogo task. Overall, our findings suggest that problematic users are characterized by under-engagement of response inhibition processes in the context of natural reward- and Facebook-related stimuli, as indexed by reduced overall accuracy and Nogo-P3 amplitude to Facebook-related, pleasant and neutral stimuli than to unpleasant stimuli. Overall, the findings of these studies seem to suggest that PIU and PFU share similar affective and cognitive processes with addictive behaviors. In order to overcome some methodological problems, identifying core symptomatology and reliable diagnostic criteria of PIU has become a priority.

European population will face an unprecedented aging era in the next years. Albeit aging in itself is a success goal, it may bring with it a general decline and functional limitations. In order to decelerate such decline, one of the most efficient strategies is physical activity. The present paper reports the insight emerging from three focus-group interviews organized at the beginning of the MOTION—Remote Home Physical Training for Seniors project, whose main aim regarded the implementation of an ICT system capable of offering home-based gym sessions to healthy seniors. The sixteen interview participants (11 females and 5 males, averaged age 72.3) provided several indications, which were grouped into the following themes: (1) ICT technical characteristics; (2) Platform accessibility; (3) Physical program features; (4) Psychological factors. At the end of the thematic analysis, results suggest that theoretical frameworks mainly focusing on ICT issues might be insufficient to endorse the successful development and maintenance of ICT systems such as MOTION, which challenges seniors to accept ICT while staying committed to the physical exercise program .

The research moves from a postmodern paradigm and from the theoretical perspectives of Symbolic Interactionism (Mead, 1934; Blumer, 1969) and of Social Constructionism (Gergen, 1985; Berger e Luckmann, 1966). According to this theoretical framework, the different aspects related to identities and gender are considered plural and mutable processes of construction, historically and culturally situated and interconnected to the dimensions of the discourse and narratives, of doing and of the performance in every context of daily life (West e Zimmerman, 1987; Denzin, 2003; Salvini, 2011). There are three main objectives of the research and they concern the analysis of the discursive processes of construction of the identity related to the biographies and the narratives of gender transitions; the analysis of the discursive processes connected to the mental health professionals’ practices related to gender transitions, the diagnostic process and the psychological services, as well as possible attributions of sense on the interlocutors’ biographies by mental health professionals; and the reflection on the implications of such discursive processes and narratives in the psychological and psychiatric practices and in the processes of negotiation of meanings among professionals and people in transition, on the light of the complexity of the narratives and the exigencies of people. Narrative interviews (Hermanns, 2004) with 25 people in transition and episodic interviews (Flick, 2007) with 11 professional figures have been deployed. Both types of interviews allow to highlight points of view and personal theories used by the participants to give sense to the process of gender transition and the own experience, told and reconstructed in the dialogue. The methods for the analysis have included discourse analysis (Potter e Wheterell, 1987) and narrative analysis, in particular the version of dialogic-performative analysis (Riessman, 2008), through the identification of interpretive repertoires and self-positions. Narrative and discursive processes have been analyzed underlying the pragmatic and performative elements and the multivoiceness, mine included, as researcher in relation to the others. From the analysis of the interviews, different voices and discourses related to the own biography, as well as to the practices by the professionals, emerge. For the first objective, different narrative and discursive modalities underlie the impact and the pragmatic effect of some dimensions of meaning, such as those related to the ideal or reconstructed “normality”, to the “right-wrong body”, to the deterministic “nature”, to the interpersonal “recognition”, to “pathology” or “deviance” and finally, to the agency and the idiosyncraticity in the construction of the identity. For the second objective, it is possible to underlie the impact and the pragmatic effect of other dimensions of meaning, such as “gender dysphoria” as an ambiguous category, the “adaptation to reality” as an assumption in the transition, “subjectivity versus objectivity”, the “non-binary people” as a dilemma and finally, the “responsibility” and the “power” as critical and relevant aspects in the clinical practice. This research can contribute to highlight the narrative specificities and the exigencies of both groups, and in particular of the people in transition. This can be useful in order to inform and to offer further elements for the comprehension of trans experiences and life stories in the clinical field, problematizing the concept of diagnosis. Finally, the results can contribute to a reflexive knowledge of the clinical work for the gender transition, referring to the different modalities of signify both the diagnosis and the relationship and their pragmatic effects.

Nella pagine seguenti sono riportate le istruzioni di somministrazione della versione Italiana della check list RMBPC di Teri et al. (1992). Le proprietà psicometriche della versione italiana sono state descritte da Ottoboni et al. (In press).

Metacognitive functions play a key role in understanding which elements might lead a person with severe mental disorder to commit violent acts against others. Indeed, understanding internal states such as thoughts, emotions, desires, fears and goals, both their own and those of others and differentiating between them, is needed in order to guide behaviour towards the resolution of interpersonal conflict. This is a fundamental aspect of affronting the risk of committing aggressive acts. The aims of the study were the following: (a) to investigate the differences between patients with a poor metacognitive functioning and patients with a good metacognitive functioning in relation to history of violence; (b) to explore the differences between patients with a poor metacognitive functioning and patients with a good metacognitive functioning in relation to other important aspects potentially involved in aggressive behaviour such as personality traits, anger, impulsiveness, hostility and emotion recognition; (c) to investigate the differences between patients with a poor metacognitive functioning and patients with a good metacognitive functioning in relation to aggressive behaviour displayed by patients during the one year follow-up; (d) to analyse the predictors of aggressive behaviour and evaluate if the metacognitive functions associated with other investigated aspects are related to aggressive behaviour during the one-year follow-up. The sample included 180 patients: 56% outpatients and 44% inpatients, the majority were male (75%) with a mean age of 44 (+9,8) years and half of them had a history of violence. The sample was split into two groups: Poor Metacognition (PM) group and Good Metacognition (GM) group, according to MAI evaluation scores. The PM patients reported a history of violence more frequently than GM patients (considering MAI total score), and in particular patients with poor monitoring, differentiating and decentering. Furthermore, PM patients showed less ability in emotion recognition and more frequently paranoid and narcissistic personality traits compared to GM patients. Concerning hostility, impulsivity and anger, no significant differences were found, except for ‘Negativism’ (i.e., BDHI subscale) that was higher in PM patients. During the 1-year follow-up, no differences between the PM group and the GM group in aggressive behaviours (verbal, against objects, self-aggression, against people) were found. The strongest predictors of aggressive behavoiur were: Borderline and Passive-Aggressive personality traits, history of violence, anger and hostility. The metacognitive functions alone did not predict aggressive behaviour, but metacognitive functions interacted with hostility manifested through direct and indirect aggression (two BDHI subscales) and with angry reaction through aggressive behaviour (one STAXI-2 subscale) in predicting aggressive behaviour. Indeed, these aspects predicted aggressive behaviour only in PM patients and not in GM patients. This study leads to important conclusions: (a) certain aspects closely related with violence (e.g., hostility, anger) are predictive of aggressive behaviour only in patients with poor metacognition, thus good metacognition is a protective factors; (b) poor metacognition is associated with history of violence, which in turn increases the risk of committing aggressive behaviour. For this reason and considering that research in this field is still very limited, further studies are needed to deepen the role of metacognitive functions in relation to aggressive behaviour and to investigate whether psychotherapy focused on metacognitive functions is effective to prevent and/or reduce interpersonal violence.

Studies on Parkinson’s Disease (PD) traditionally focused on psychological symptoms and distress reported by patients and by their caregivers. However, they may sometimes experience also positive psychological changes and develop new existential resources that may help them to better face the illness.Within this perspective, only few investigations explored PD patients and their caregivers. The aim of this Phd thesis was to investigate well-being and distress in patients with PD and in their caregivers with four studies (two cross-sectional and comparative and two longitudinal). Methods: 54 patients with PD, and 60 controls were recruited together with 50 caregivers of PD patients and 70 caregivers of controls. All participants completed questionnaires to measure both well-being dimensions and distress. In addition, a physician collected PD patients’ clinical data. A six month follow-up was performed. In study 1 and study 2 patients were compared to their respective controls. Studies 3 and 4 with a longitudinal design examined the predictors of the psychological adaptation to PD of patients and of their caregivers, respectively. Results: In study 1, patients reported more distress and less life satisfaction but more well-being than controls. In study 2, caregivers reported more distress and less well-being than their controls. In studies 3 and 4 it was found that the presence of well-being at the first evaluation together with the level of disability and caregiver burden (for patients and caregivers, respectively) were found to predict the level of adaptation to the illness at the second evaluation. Conclusions: although PD patients and their caregivers may exhibit impaired levels of well-being and distress, in the long term those who report higher levels of psychological resources can experience a better adaptation to the illness. The importance of considering psychological resources when evaluating PD patients’ and their caregivers psychological functioning is suggested.

One of the main aims of awake surgery for glioma patients is to preserve quality of life, while maximizing tumor resection. Focusing on an important yet understudied aspect of quality of life, this thesis investigates to what extent written language may be affected by a glioma or glioma surgery. By reviewing current assessments of reading and spelling in awake surgery studies, we aimed to provide a better understanding of how neuroanatomical theories may guide neurosurgical practice, and to evaluate how examinations of written language in glioma patients can be improved. To provide a direct clinical application for this knowledge, we developed a theory-driven written language battery specifically for glioma patients. Lastly, we tested its efficacy and evaluated reading and spelling performance in neurosurgical practice. The studies in this thesis have provided a better understanding of written language in neurosurgical practice. In particular, it has contributed to prediction and prevention of written language disorders in glioma patients undergoing awake surgery, and it has resulted in a valid examination tool to carefully monitor reading and spelling in this patient group.

Social visual orienting in typical and atypical development.

In the last two decades several studies have been trying to explore a possible role for gut microbiota in Autism Spectrum Disorders (ASD), supported by the high incidence of gastrointestinal disorders among ASD children and by the now well recognized existence of the brain-gut-microbiota axis (the complex system of bidirectional interactions between central nervous system, gastrointestinal tract and microorganisms inhabiting the gut). Nevertheless, results about alterations in gut microbiota composition and/or activity in ASD are to date strongly contrasting. A possible explanation could be that these studies tend to treat ASD as a unique pathology, whereas it includes different cognitive-behavioural phenotypes. Moreover, they do not consider factors which are important for children’s gut flora development, such as type of delivery, nutritional history (e.g. formula milk during lactation) and medical history (e.g. antibiotics intake) as well as factors that may affect the present composition of microbiota, such as the current diet (e.g. the strong food selectivity that often occurs in ASD children) and the presence of gastrointestinal disorders. In this study, I developed an interview to parents to assess whether there are differences related to the above mentioned aspects between ASD children and typically developing children and among ASD themselves, considering differences in cognitive level and severity of autistic traits. I also explored the use of special diets such as gluten-, lactose and casein free diets, the reasons for their adoption and the possible benefits for the child. Moreover, I decided to include in this interview also a section dedicated to parental difficulties in managing mealtime in order to collect information useful to plan future interventions. I found differences between ASD- and typical children in the incidence of gastrointestinal disorders and food selectivity. Especially, some children initially eat everything and then switch to a more and more restricted diet. This could be considered an early symptom of the pathology. I also found an association between gastrointestinal disorders and severity of autistic traits. Furthermore, I collected faecal samples from ASD families (two parents, an ASD child and a typically developing sibling) and analysed them with metaproteomics and bioinformatics techniques in order to assess microbiota activity and evaluate it in light of ASD phenotype, nutritional habits, gastrointestinal disorders and genetic proximity. Demonstrating the existence of a different microbiota composition in ASD or at least in a subgroup could allow to identify a biomarker of a possible development of ASD and to design preventive interventions, even through probiotics intake. Moreover, it could help to better understand the molecular mechanism underlying this pathology.

People with Autism Spectrum Disorder (ASD) have difficulties in dealing with social interaction (DSM V, 2013). From long time, it has been reported deficit in recognizing gaze, face and intentions of others. Besides that, in the last decade numerous finds have showed an impairment in coding the human body movements. During my PhD I have explored the ability in recognizing the emotional valence of human movements in people with ASD and with typical development. In order to understand developmental changes, I have initially compared this ability between children and adults. In order to understand the role of intelligence, I have included people with high and low functioning ASD, either in children and adults samples. In the first study, we compared TD children and children with ASD with different level of functioning to investigate i) whether the difficulties in ASD population were associated to emotion comprehension or related to a more basic visual processing of biological motion, and ii) to explore whether this ability improves according to the age and to the non-verbal IQ. To this purposes, we presented point-light (PLDs) and full-light (FLDs) version of human movements with three different emotional valence (Happy, Fearful, Neutral). Our main findings showed that: -TD children were more accurate in recognizing the emotional content of body movements when the shape of the body was visible (i.e. FLDs), compared to the view of pure motion information (i.e. PLDs), but there were no differences in RT across display conditions. This result suggests that school-aged children are able to correctly identify the emotional valence of dynamic bodily expression, also when the form information is minimized by presenting PLDs. -According to the emotional content, we found that the valence had an effect on the performance of TD children. In particular, TD children recognized happy bodily expressions with lower accuracy than fearful and neutral movements. Besides, fearful movements were identified more rapidly. We hypothesized that, from an evolutionary point of view, it is more important to recognize fearful signals when they are far from us. Body movements are particularly relevant to convey other people’s state and intentions from a distance, hence bodies are preferential channels to convey fearful signals. -Comparing typical and atypical children, we found that TD were more accurate and more rapid than children with ASD in recognizing the emotional valence of body movements. Moreover, children with HF ASD outperformed children with LF ASD and their performance was significantly predicted from age and nonverbal IQ. This results suggest that the nonverbal abilities have a role in body movement comprehension, probably underpinning the development of compensatory mechanisms which improve with age. -Compared to TD children, children with ASD were impaired not only in understanding the emotional expressions, but also in recognizing the neutral actions. Irrespectively to their IQ level, children with ASD did not benefit from the richness of visual information, and their ability to recognize BM did not change according to the emotional valence. This finding suggests that the difficulty encountered by individuals with ASD in social interaction could be more generally related to biological motion elaboration, rather than being specific for the emotions comprehension. Hence, the lack in emotion recognition in ASD seems to be attributable to a deficit in elaborating motion cues rather than emotional information. To interpret the body movements, children with ASD may adopt compensatory mechanisms, which acquisition seems to be mediated by the nonverbal IQ and improving with age. If this was the case, we should expect an improvement in the ability of recognizing the BM in adults with ASD, with respect to children with ASD, and this improvement should have been correlated with the non-verbal IQ level. To explore this hypothesis, we run a second experiment, were we asked to a group of TD adults, a group of adults with high functioning Autism matched for age and non-verbal IQ, and a group of adults with low functioning Autism matched for age, to performed the same BM recognition task that children did in our first experiment. Results with adults confirmed what we found in children: the emotional valence and the richness of visual information did not modulate the Accuracy and the velocity in recognizing the BM stimuli in ASD, suggesting that the whole body movement is elaborated differently in ASD than in TD adults and that the impairment in ASD is more related to the processing of body movement, rather than being specific for the emotion comprehension. In a third study, we explored the developmental changes in the ability of recognizing the emotional meaning of human whole-body movements from childhood to adulthood. To this aim, we compared the performance between children and adults in each group of Functioning. Results showed that TD adults were more accurate and faster than TD children; FLDs were recognized with higher accuracy and quicker than PLDs; and fearful and neutral movements were recognized significantly better than happy ones. In participants with ASD, adults were significantly more accurate than children, but not faster. Also, we did not find any difference between displays or emotional categories. This results suggest that the understanding of body movements in individuals with ASD improve with age but the mechanism underpinning this ability works differently. In a fourth experiment we investigate whether the impairment in understanding social relevant signals in individuals with high functioning autism (HF ASD) was restricted to body movements or widespread to other social cues, such as facial expressions. Also, we investigated the role of movement in perceiving bodily expressions. To this aim, we explored whether there was a difference in recognizing the body expressions represented by dynamic or static stimuli. Finally, we investigated whether the vision of the body form, compared to the sight of pure motion information, could influence the identification of the emotional content of body movements. We did not found any group differences in accuracy, but there was a group difference in RTs specific for dynamic stimuli (TD were significantly faster than ASD in recognizing PLDs, and marginally in FLDs). These results suggest that HF ASD adopt compensatory mechanism to understand the meaning of facial and bodily expression that allow them to correctly recognize the emotional valence conveyed by face and body movements. However, this mechanism has a cost in terms of rapidity. In particular, ASD seems to need more time to identify dynamic body stimuli but not images of body expressions, suggesting a deficit in processing the actual body motion. In particular, the comprehension of happy body movements result difficult and time consuming. Indeed, happiness was better recognized from facial expressions and was harder to be identified when expressed by body movements. In the fifth experiment we used TMS-adaptation paradigm to explore the existence of a neural system specialized for the elaboration of emotional body movements. We first behaviourally investigated the existence of an adaptation for emotional PLDs. TD adult participant were adapted with point-light video clips depicting fearful, happy or neutral actions and then asked to recognize point-light with same/different emotional content. Results showed an adaptation after-effect only for incongruent stimuli, suggesting the existence of a neural mechanism for perceiving the body emotion specifically. Subsequently, in a TMS experiment we explore the possible brain location of this mechanism. The sites we stimulated are nodes of the neural network responsible for the human motion understanding, and they are reported to be abnormally activated in ASD. We found a reversed after-effect following TMS over aIPS, while the adaptation was still present after stimulation over pSTS and the control site. These results demonstrate that aIPS contains neurons that specifically code for the emotional body expressions, suggesting that the difficulties encountered by individuals with ASD in understanding the emotional signal during social interaction might rely to deficit in this mirror area.

My PhD project mainly focused on understanding how a child or adolescent copes with pain associated with a disease, intended in a broader sense (i.e. procedures, treatments and disease-related). I tried to prove an innovative perspective that can help understand the wide variation in children’s pain experience, by considering intra-interpersonal influences, contextual factors, and intrapsychic factors that focus on needs, defenses, and self-structure. Overall, the whole project involved three pediatric units in Italy: the pediatric wards of Trento and Rovereto hospitals and the pediatric clinic of San Gerardo hospital, Monza (Milan). This doctoral thesis has achieved five goals: 1. Providing a selective overview on current relevant topics in the pediatric pain research and state of the art regarding the existing models of pediatric pain. 2. Developing a multi-dimensional protocol with an intra-method design for the assessment of pediatric pain in several chronic illnesses (cystic fibrosis, rheumatic diseases, cancer), by using also a battery of projective tests (drawings) to screen the emotional adjustment. 3. Validating the protocol by extending the methodology of projective drawings’ scoring with a control group and adding other assessment variables on a single cohort of patients (with malignant hematologic cancer) to test the new model that I developed. Quantitative analysis phase preceded qualitative analysis phase within the same framework to yield a parallel mixed analysis. 4. Planning specific training modules about pain management, starting from a bottom-up process concerning the local health professionals’ needs. I investigated these training needs through a series of open-ended questions, analyzed by a thematic analysis method. 5. Evaluate treatment’s feasibility, acceptability, and satisfaction of a problem-solving skills training for parents of children who have received an intensive pain rehabilitation from one pediatric pain rehabilitation program (Seattle Children's Hospital). I provided a methodological contribute within the mixed-method approach (statistical analysis and grounded theory). The results presented and their implications, are discussed in a clinical perspective since the rationale of this dissertation is that effective pain assessment must be multidimensional, multidisciplinary and at the same time feasible and practical to meet each pediatric patient’s needs.

The studies reported in this thesis pertain to a project aiming at investigating the motivational underpinnings of psychopathologies characterized by negative affect, such as anxiety and depression. Unbalanced or conflicting motivational tendencies can lead to disturbances in emotional responding and ongoing affect, which are often associated with psychopathology. As it will be introduced in the first chapter, motivational drives are thought to be sustained by two main systems in the brain, namely the appetitive and the defensive motivational circuits. The appetitive system contributes to approach behaviors in response to rewarding and pleasant stimuli. On the other side, the defensive system drives withdrawal from threat and is important for triggering unpleasant emotions. Therefore, emotions can be described as action dispositions reflecting basic tendencies to both approach and withdrawal in response to emotional stimuli. Several models postulated that negative affect in psychopathology arises from an excessive activation of the defensive system, which leads to an increased and dominant tendency to actively withdrawal from potential threats in the environment. Partially contrasting with this theoretical conceptualization, the aim of this thesis was to investigate whether negative affect could also manifest in psychopathologies which are not characterized by a straightforward increase in withdrawal tendencies. In this sense, EEG correlates of motivational tendencies in response to emotional stimuli were investigated in blood phobia and in dysphoria (i.e., subclinical depression). Accordingly, blood phobia, contrary to other specific phobias, is not associated with an increase in action disposition in response to the feared stimulus. Therefore, negative affect in these individuals does not seem to arise from a pronounced tendency to actively withdrawal. Depression represents another example of condition in which it is not clear whether negative affect is subtended by a dominance of the withdrawal system or by a lack in appetitive motivation. Accordingly, it is matter of debate whether depressed mood is due to preferential processing of unpleasant stimuli or reduced sensitivity to rewards and positive emotions. In order to investigate these aspects, three studies were conducted. In study 1, it was chosen to investigate modulation of EEG bands during an emotional Go/Nogo task in blood phobia. The emotional Go/Nogo task, including phobia-related pictures, along with phobia-unrelated unpleasant, neutral and pleasant stimuli, was ideal to investigate the lack of action disposition in blood phobia. Results showed that individuals with blood phobia display a conflicting motivational pattern, characterized by co-occurring tendencies to attend and avoid the feared stimulus, in strong contrast with other phobias. In Studies 2 and 3, modulation of EEG bands during an emotional imagery task in individuals with dysphoria was investigated. The emotional imagery is an active task, in which individuals are requested to actively imagine emotional scenarios; therefore it was well suited to investigate emotional modulation of appetitive and defensive motivational tendencies. Overall, results supported the idea that depressed mood in dysphoria is due to a lack in appetitive motivation, accompanied by a reduction in processing of pleasant stimuli. Again, we found no evidences of increased defensive motivation and tendency to withdrawal in dysphoric individuals. Finally, our research focused on possible clinical implications of the abovementioned findings, concerning the application of bio-behavioral trainings for the reduction of negative affect. In line with the pertaining literature, results from of our first three studies showed that frontal alpha asymmetry is an informative index of motivational tendencies underlying affect and emotional responses. Therefore, a fourth study was conducted, aimed at evaluating the effectiveness of a frontal alpha asymmetry neurofeedback training in reducing negative affect, anxiety and depressive symptoms in healthy individuals. After five training sessions, healthy individuals succeeded in reducing right compared to left prefrontal activity, through a specific increase in right frontal alpha. In accordance with the role of the right prefrontal cortex in defensive motivation and negative affect, this increase in right frontal alpha power was associated with a significant reduction in negative affect and anxiety. In conclusion, the present thesis confirms and extends the link between motivational tendencies and negative affect, showing that negative affect is not exclusively associated with an increase in defensive motivation and in active withdrawal disposition. Accordingly, among psychopathologies characterized by negative affect, blood phobia and dysphoria do not display the typically predicted motivational pattern. A first step toward the transition from basic research to clinical application has been proposed, with the implementation of an EEG-based neurofeedback for the reduction of negative affect. Overall, the present work is of potential relevance for a better understanding of the motivational underpinnings of psychopathologies characterized by negative affect, also providing a strong rationale for the application of bio-behavioral trainings.

Anorexia nervosa is an eating disorder whose onset emerges at an increasingly early age and whose prognosis, even among adolescents, can be grave. Current scientific literature and practice guidelines on the treatment of adolescent patients with anorexia point to the key role that is played by parents and family in influencing the therapeutic possibilities and the outcomes of young patients. The aims of the thesis are to explore the relational and emotional dynamics in families of adolescents with anorexia that may influence the treatment possibilities and the outcome of the young patients. Three different research studies are presented in the thesis, all examined families of adolescents with restricting type anorexia nervosa, and explored aspects of family relations, relating in particular to the internalized parental bonding, emotion regulation and triadic mother-father-daughter interactions. The first study aims to identify any specific pattern of parental bonding and address the intergenerational transmission of these patterns in families of newly diagnosed adolescents with restricting type anorexia. The second study instead deals with emotion regulation in families with an adolescent with anorexia, exploring alexithymia in the daughter, mother and father based on clinical versus self- assessment. Whereas in the third study, a direct observational procedure based on a videotaped play section was used to explore triadic interactions. The results of the studies seem to suggest that both in the research, as well as in treatment of patients with anorexia nervosa, attention needs to be shifted from the exclusive mother-daughter relation to the involvement of the father, of the parental couple and of the family as a whole. Since family functioning is well established as a maintaining factor of anorexia nervosa or vice versa as a facilitating factor in the therapeutic process, studying the family relations may not only help clinicians to select the most suitable treatment for each patient and each family but also to predict the possibility of establishing a therapeutic alliance with the family and thus to improve the possibility of reaching a good outcome.

The more valid instrument to assess adult attachment is the Adult Attachment Interview (AAI). The most famous model of AAI coding system is the M&G model, developed by Mary Main; an alternative model is based on the Dynamic-Maturational Model (DMM), proposed by Patricia M. Crittenden. Both models have strengths and weaknesses: the M&G method loses much of its capacity to discriminate clinical population, because most of the subjects in the clinical samples fall into the Unresolved/Disorganized (U/d) and/or Cannot Classified (CC) patterns, which become a sort of garbage categories for most of mental health problems (Iyengar et al., 2014). The DMM considers specific patterns, which allow better discrimination of mental health problems. In this study, we administered the AAI to 90 Italian parents (45 males - M=35.77, SD =5.85), and we classified the interviews according to both M&G criteria and DMM criteria. We found that the two coding systems were significantly associated between them and generated sufficiently convergent results only when organized and normative attachment representations/strategies were displayed by participants. When the interviews resulted in U/d or CC (M&G) or non-normative (DMM) attachment classifications, the results of the two coding systems were not comparable. The M&G and DMM systems present deep differences in their theoretical assumptions: the M&G model refers more to discourse patterns to identify mental representations of attachment while the DMM model is more focused on the function of the attachment strategy and on the different use of cognitive and affective information, along a continuum from the use of cognitive information to the use of affective information. The findings of this study have clear implications for the use of AAI in research and clinical contexts, as they suggest that the M&G and DMM classification systems tap different features of attachment when atypical profiles are observed.

Il questionario SF-12 permette di descrivere la salute di un gruppo di persone attraverso due indici sintetici calcolati su 12 domande. L’indice denominato Physical Component Summary (PCS), riguarda lo stato fisico, mentre l’indice Mental Component Summary (MCS) misura lo stato mentale. I punti di maggior forza del questionario riguardano la brevitá e la facilitá di somministrazione. Attualmente é disponibile un manuale, guida all’utilizzo, nelle cui ultime pagine é offerto un algoritmo di calcolo per ottenere gli indici per persona. L’algoritmo è scritto peró in modo che possa essere utilizzato solo all’interno del pacchetto statistico SAS (Littell, Milliken, Stroup, & Wolfinger, 1996). Non tutti coloro che sono interessati al calcolo degli indici hanno domestichezza con questo pacchetto statistico, ragion per cui, il presente lavoro si propone di offrire due algoritmi alternativi e sviluppati per i pacchetti statistici SPSS (IBM, 2011) e R (RStudio Team, 2015), oltre alla possibilitá di utilizzare un foglio di calcolo in Microsoft-Excel.

Aims: The first study investigates the clinical characteristics of demoralization, a syndrome characterized by helplessness, hopelessness and a sense of incompetence, in eating disorder (ED) patients, in addition to examining its distinction from depressive disorders. The second study has the aim of testing the role of demoralization’s hallmark feature, subjective incompetence, in treatment response. Methods: Eighty-three ED outpatients and inpatients, undergoing cognitive-behavioral therapy-based treatment, were recruited and evaluated at baseline and mid-treatment for demoralization, subjective incompetence, depressive and eating-related symptomatology, and psychological well-being (PWB). Chi-squared test was applied to examine overlap of demoralization and depression diagnoses. Multivariate analyses of variance compared ED patients with comorbid demoralization, to those with comorbid depression and no comorbidity. Hierarchical linear regression analyses were conducted to test whether subjective incompetence reductions predicted changes in ED symptoms and psychological well-being dimensions. Logistic regression analysis was conducted to explore whether mood-related variables and psychological well-being domains predicted drop-out. Results: Demoralization was highly prevalent and associated with increased distress and impaired psychological well-being. Although cases of only demoralization in absence of depression were documented, demoralization significantly overlapped with depressive disorders. Compared to depressed ED patients, demoralized patients had less severe eating-related pathology, were impaired in fewer psychological well-being domains, did not necessarily exhibit depressed mood, anxiety, and sleep difficulties. By mid-treatment demoralization diagnoses and subjective incompetence were significantly reduced. Such decreases in subjective incompetence, controlling for depression and illness severity, significantly predicted response in ED symptomatology and positive functioning. Only PWB-autonomy predicted drop-out. Conclusions: Demoralization, unlike depression, was not associated with worse eating-related symptomatology in EDs. It emerges as an indicator of worsening status in terms of specific depressive symptoms which may not reach diagnostic thresholds, and in terms of worse psychological well-being. Subjective incompetence may be an additional therapeutic target to increment treatment response in EDs.

Body Dysmorphic Disorder (BDD) is a psychological disorder characterized by the persistent preoccupation with one or more perceived defects in physical appearance that are not observable or appear slight to others (American Psychiatric Association [APA], 2013), which is currently included into the “Obsessive-Compulsive and Related Disorders” category of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5; APA, 2013). Although any body part can be the focus of concerns, the most common areas of concern in people with BDD are the skin (presence of acne or scars), the hair (hair loss, thinning, or excessive facial or body hair), and the nose (shape or size; Phillips 2006; Phillips & Diaz 1997; Phillips, McElroy, Keck, Pope, & Hudson, 1993; Veale et al., 1996), and individuals with BDD may be concerned with multiple body parts at the same time (Phillips et al., 1993; 2005). In response to the appearance concerns, individuals with BDD engage in repetitive and time-consuming behaviors and mental actions focused on examining, being reassured about, and hiding perceived defects (Phillips & Diaz, 1997; Phillips, Menard, Fay, & Weisberg, 2005). The most common are: camouflaging (e.g., with hair, makeup, body position, or sunglasses), checking the perceived defect in mirrors or other reflecting surfaces (e.g., windows), excessively grooming (e.g., applying makeup or styling hair), seeking reassurance from family and friends about the defect, repeatedly touching the disliked areas, and comparing one’s appearance with that of other people (Phillips, 2009; Phillips & Diaz, 1997; Phillips et al., 2005; Veale & Riley, 2001). Behaviors are unlimited (Phillips, 1998) and can include seeking plastic surgery or cosmetic medical treatments in order to reduce the perceived defects (Crerand, Phillips, Menard, & Fay, 2005; Phillips, Grant, Siniscalchi, & Albertini, 2001); these procedures, however, are not beneficial (Crerand et al., 2005; Phillips et al., 2001) and do not typically result in a decrease of BDD symptoms severity (Crerand et al., 2005; Phillips et al., 1993; Phillips et al., 2001). Rather, some patients with BDD experience symptoms exacerbation and development of new appearance concerns (Crerand et al., 2005; Phillips et al., 2001; Veale, 2000; Veale et al., 1996). In addition to core concerns about appearance, BDD is characterized by low self-esteem, high perfectionism, and high comorbidity rate (Phillips, 2006; Phillips et al., 1993; Phillips et al., 2005). The most common associated disorders are: Major Depressive Disorder (MDD), Social Anxiety Disorder (SAD), Obsessive Compulsive Disorder (OCD), and Anorexia Nervosa (AN; Dingemans, van Rood, de Groot, & van Furth, 2012; Grant, Kim, & Eckert, 2002; Gunstad & Phillips, 2003). Despite increased awareness of BDD in recent years, it continues to be an under-studied disorder (Buhlmann & Winter, 2011; Buhlmann et al., 2010), particularly in the Italian context. Indeed, little is known about BDD prevalence and phenomenology in Italy, and no data are available on BDD prevalence rates using DSM-5 criteria (APA, 2013) in the Italian general population. Therefore, the current dissertation aimed at assessing BDD prevalence, phenomenology, associated clinical features, and at risk populations through three studies. The first study aimed at exploring the prevalence and the phenomenology of BDD in an Italian community sample and its associated clinical features such as self-esteem, perfectionistic traits, social anxiety, depressive, and obsessive-compulsive symptoms. Six hundred and fifteen community individuals completed a battery of self-report questionnaires assessing the above-mentioned clinical features. Results showed that 10 (1.63%) individuals met DSM-5 criteria (APA, 2013) for BDD. Hair (n = 4; 4%), nose (n = 4; 4%), and teeth (n = 4; 4%) were the most common areas of concern. With respect to the associated clinical features, individuals who satisfied BDD diagnostic criteria reported lower levels of self-esteem, more severe social anxiety symptomatology, general distress, depression, and obsessive-compulsive features than people without BDD. These findings outlined that, within the Italian context, BDD is a relatively common psychological disorder associated with significant morbidity. The second study of the current dissertation focused on the shared clinical features between BDD and AN. Indeed, both the psychopathologies are severe body image disorders (Rosen, Reiter, & Orosan, 1995) characterized by body image disturbance and dissatisfaction, intrusive thoughts about appearance, and by an overemphasis on appearance in the evaluation of self-worth (Rosen & Ramirez, 1998). Furthermore, both BDD and AN are characterized by low self-esteem (Phillips, Pinto, & Jain, 2004; Rosen & Ramirez, 1998) and high levels of perfectionism (Bardone-Cone et al., 2007; Buhlmann, Etcoff, & Wilhelm, 2008; Bulik et al., 2003; Veale, 2004). Many studies underlined the high comorbidity between BDD and AN (Dingemans et al., 2012; Fenwick & Sullivan, 2011; Grant et al., 2002; Kollei, Schieber, Zwaan, Svitak, & Martin, 2013; Ruffolo, Phillips, Menard, Fay, & Weisberg, 2006), and patients with AN frequently report nonweight-related body image concerns (Dingemans et al., 2012; Grant et al., 2002; Kollei et al., 2013). Furthermore, patients with AN and comorbid BDD report greater body image dissatisfaction and clinical symptomatology than those without comorbid BDD (Dingemans et al., 2012; Grant et al., 2002). Therefore, the first aim of this study was to assess the prevalence of BDD and the presence of nonweight- related body image concerns in patients with AN. Secondly, the study aimed at comparing patients with AN and nonweight-related body image concerns, patients with weight-related body image concerns only and a healthy control group with respect to body image and psychological and psychopathological features. For these purposes, 61 patients with AN were divided in two groups: 39 with nonweight-related body image concerns and 22 with weight-related body image concerns only. Furthermore, a group of 61 healthy controls was recruited. Main results of this study showed that 16 (26.23%) patients with AN had probable comorbid BDD. The most common nonweight-related body image concerns were: hair (41.02%), nose (30.77%), skin (30.77%), teeth (25.64%), and height (20.51%). Moreover, patients with AN and nonweight-related body image concerns reported greater levels of psychopathology not related to eating disorder than patients with weight-related body image concerns only, in accordance with previous studies (Dingemans et al., 2012; Grant et al., 2002). In conclusion, patients with AN and nonweight-related body image concerns showed a more severe body image disturbance unrelated to a more severe eating disorder. Lastly, the third study of the current dissertation aimed at assessing the prevalence of Muscle Dysmorphia (MD), its associated psychological features and possible predictors among 3 groups (N = 125) of Italian recreational athletes. MD is a subtype of BDD characterized by the preoccupation with the idea that one’s body is not sufficiently lean and muscular (APA, 2013; Pope, Gruber, Choi, Olivardia, & Phillips, 1997); however, individuals with MD have a normal-looking body or are even very muscular, much more than the average of people (Pope et al., 1997). The first aim of this study was to explore the prevalence and the phenomenology of MD in 3 groups of Italian participants who trained regularly for recreational purposes: 42 bodybuilders, 61 strength trainers, and 22 fitness wellness trainers. Secondly, we aimed at investigating MD related behaviours and psychological features such as self-esteem, perfectionistic traits, social anxiety and orthorexia nervosa symptoms, and general distress among groups. Lastly, we aimed at assessing the presence of associations between MD and related psychological features among the 3 groups and, with exploratory purposes, possible MD predictors among groups. Results revealed a MD prevalence of 6.4%: 4 participants (9.52%) in the bodybuilding group, 2 participants (3.28%) in the strength group, and 2 participants (9.09%) in the fitness/wellness group satisfied Pope et al. (1997) diagnostic criteria for MD. With respect to MD associated cognitive and behavioural symptoms, the bodybuilding group reported more frequently to think about taking anabolic- androgenic steroids (AAS), to assume more than 2 daily grams of proteins, and to experience more beliefs about being smaller and weaker than desired or wishes to be more muscular than the other groups, whereas this group reported more MD general symptomatology only with respect to the fitness/wellness group. Moreover, the strength group reported to set higher standards for themselves than the other two groups. Finally, different correlational patterns among group emerged, as well as different MD predictors. Specifically, social anxiety symptoms resulted significant predictors of MD symptomatology for both the bodybuilding and the strength group, whereas no predictors emerged for the fitness/wellness group. In conclusion, results of this study underlined that the pursuit of a lean and muscular physique in bodybuilding is not always associated with MD and related psychological features. To conclude, this dissertation provides clinical hints as far as concern both preventive strategies and psychological treatment implications for BDD across at risk populations.

What is the impact of acalculia upon an individual’s everyday life? In clinical practice, a few measures of Activities of Daily Living are available. In these batteries, however, numerical abilities were not distinguished from other abilities. As a consequence, no instrument has been made available so far to measure the nature and the extent of damage to everyday life specifically brought by acalculia in a given individual. The first aim of this series of studies was to build and validate an instrument, the Numerical Activities of Daily Living (NADL), designed to measure this impact. The first section of the thesis describes the psychometric properties of the newly created NADL and the specific profiles observed among patients suffering of several neurological diseases (a specific study was devoted to neurofibromatosis type 1) by using this instrument; patients with a right hemisphere focal lesion were also the object of a specific study). A further development of NADL (NADL-Children) was built for the assessment of numerical activities of daily living in children: it helped to predict math school performance after the first year of primary school. In the second section we deepened one particular aspect of daily living activities requiring numbers (i.e. dealing with finances) found to be critical in our studies employing NADL. Indeed, the loss of financial capacity can have serious legal, economical, and personal consequences on an individual. Therefore, we additionally created a tool (Numerical Activities of Daily Living - Financial; NADL-F) that was also successfully validated in clinical populations in Italy as the second scope of this thesis. We also explored the differences in financial and numerical domains between MCI and healthy controls by means of NADL and NADL-F. The cognitive domains found to be involved in the deficit may be appropriate targets for future intervention studies aimed at preserving functional independence in individuals with MCI. Finally we also correlated the performance in the NADL and NADL-F test with anatomical brain changes. The investigation of the neural correlates of financial and other daily numerical abilities will help us to better define the knowledge of this high-level functions; moreover the neuroimaging studies will shed light on the brain areas related to the performance in financial tasks, and will be useful to find out the predictors of the time-course of decline in financial capacities.

Introduzione. Nonostante il dolore sia un’esperienza comune a tutti gli esseri umani, è molto difficile darne una definizione esauriente sia esso fisico che psicologico. A tutt’oggi il dolore mentale è stato poco indagato. L’obiettivo principale del seguente progetto di ricerca è di delineare una più accurata definizione del costrutto di dolore mentale, verificare l’applicabilità dell’Orbach and Mikulincer Mental Pain Scale (OMMP) nella valutazione psicologica e la validazione della versione italiana di tale strumento. Metodologia. Sono stati condotti tre studi: il primo, su un campione di 15 soggetti, per verificare e confermare la validità di facciata dell’OMMP; il secondo, realizzato su un campione di 442 soggetti, oltre ad indagare le caratteristiche sociodemografiche associate con la dimensione del dolore mentale, si concentra sulla valutazione delle proprietà psicometriche dello strumento; il terzo è stato eseguito allo scopo di verificarne la struttura fattoriale ed indagare la relazione che intercorre tra dolore mentale e gli altri costrutti psicologici (n = 728). Risultati. Dai dati ottenuti è possibile delineare il profilo sociodemografico dei soggetti della popolazione generale con un maggior livello di dolore mentale: l’essere giovani, nubili/celibi e avere un livello di istruzione inferiore. L’analisi fattoriale esplorativa, non ha confermato la struttura a otto dimensioni descritta dagli autori, rivelandone una a quattro (19 item), e gli indici dell’analisi fattoriale confermativa lo supportano. Infine, le dimensioni del dolore si mostrano correlate con il distress psicologico. Discussioni e conclusioni. Il presente lavoro ha confermato la multidimensionalità del costrutto di dolore mentale nella popolazione italiana ed ha confermato la validità e l’attendibilità del OMMP_19_ITA. All’interno di diversi quadri psicopatologici è stata rilevata la presenza di un maggior livello di dolore mentale., Introduction. Despite the pain is a common experience to all human beings, it is still very difficult to give a comprehensive definition both physical and psychological. Up till now, mental pain has been understudied The main objective of the following research project is to outline a more accurate definition of the mental pain construct, to verify the applicability of the Orbach and Mikulincer Mental Pain Scale (OMMP) in the psychological evaluation and validation of the Italian version of such tool. Methodology. Three studies were conducted: the first one, on a sample of 15 subjects, to verify and confirm the validity of the OMMP face; the second, conducted on a sample of 442 subjects, as well as investigate the socio-demographic characteristics associated with the mental pain dimension, focuses on the evaluation of the psychometric properties of the instrument; the third instead, was performed in order to verify the factorial structure and investigate the relation between mental pain and other psychological constructs (n = 728). Results. From the data obtained it is possible to outline the socio-demographic profile of the subjects of the general population with a higher level of mental pain: being young, maiden / celibate and have a lower level of education. The factorial explorative analysis, has not confirmed the eight-dimensional structure described by the authors, revealing a four one (19 item), and indexes of the confirmatory factorial analysis support it. Finally, the dimensions of the pain are shown correlated with the psychological distress. Discussions and conclusions. This work confirmed the multidimensionality of mental pain construct in the Italian population and also confirmed the validity and reliability of the OMMP_19_ITA. Within different psychopathological was detected the presence of a higher level of mental pain.