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Yaakov Ophir Key words: ADHD, DSM-5-TR, FDA, neurodiversity, neuroimaging, stimulant medications, biomedical model Is Attention Deficit Hyperactivity Disorder (ADHD) a “brain disorder”? Should it be managed regularly with stimulant drugs? This article critically examines the evolving biomedical discourse surrounding these questions through a close inspection of the latest edition of the influential psychiatric manual – the DSM-5-TR – as well as additional authoritative sources (e.g., previous DSM editions, consensus statements, FDA communications). The DSM-5-TR acknowledges that “no biological marker is diagnostic for ADHD” and that “meta-analyses of all neuroimaging studies do not show differences between individuals with ADHD and control subjects.” The authors of the DSM-5-TR, therefore, conclude that “until these issues are resolved, no form of neuroimaging can be used for diagnosis of ADHD.” These statements, along with biases in the neuroimaging literature and additional empirical evidence presented in the article, challenge popular myths about the neurobiological basis of ADHD. Similarly, common beliefs about the first-line treatment of ADHD with stimulant drugs are being increasingly questioned today. For instance, the DSM-5-TR’s section on Stimulant-Related Disorders introduces a new diagnostic entity named: Stimulant-Induced Mild Neurocognitive Disorder. This addition aligns with a recent FDA Drug Safety Communication for “all prescription stimulants,” which highlights longstanding concerns regarding the safety of medications prescribed to millions of diagnosed individuals, primarily children. The FDA now mandates that “the Boxed Warning, FDA’s most prominent warning, will describe the risks of misuse, abuse, addiction, and overdose,” emphasizing that such “misuse and abuse of prescription stimulants can result in overdose and death.” In light of these challenges to the biomedical discourse, this article offers a neurodiversity-oriented alternative. Using evolutionary principles and historical context, it argues that most cases of ADHD fall under the DSM’s socio-philosophical category of “conflicts that are primarily between the individual and society” (similar to homosexuality, which was removed from the DSM in 1973), and are therefore “not mental disorders”.
Gloria Lagetto, Arianna Teti, Lucia Fortunato, Chiara Urone, Salvatore Gullo, Gabriele Ciccarese, Pier Paolo Lardo, and Omar C. G. Gelo Key words: therapeutic relationship, videoconferencing psychotherapy, thematic analysis, psychotherapists, qualitative methods Objective: The growth of videoconferencing psychotherapy (VP) requires a closer conceptualization of the therapeutic relationship in VP. Therefore, we investigated the therapeutic relationship in VP from the clinicians’ perspective. Method: We conducted three focus groups with 27 Italian VP professional psychotherapists of different theoretical orientations, focusing on their experience of the therapeutic relationship in VP. Data analysis was conducted through inductive thematic analysis. Results: The following themes emerged: (a) construction and management of the online setting (regarding the complexity of the therapeutic boundaries in VP and the efforts to manage this); (b) meaning construction of the request for help and the therapeutic process (regarding how patients and therapist represent the meaning of the therapeutic space and work in VP); (c) patient and therapist involvement in the online relationship (addressing the depth of the therapeutic relationship in VP in terms of intimacy, openness/closure, distance/closeness, and involvement); (d) new elements of the therapeutic relationship introduced by VP (regarding the source and nature of information about the patient and the effects of the technical environment on the relationship); (e) nonverbal aspects and corporeality in VP (dealing with how different aspects of para- and extralinguistic communication may impact the therapeutic relationship in VP); (f) differences in the quality of the emotional and relational level of VP (regarding the emotional attitudes and reactions of patients and therapists and the overall quality of the therapeutic relationship); (g) treatment satisfaction and drop-out (regarding ease of leaving the session, patient satisfaction, and difficulties in terminating therapy); and (h) personal characteristics of patient and therapist that influence VP (regarding the impact of patients personality and therapists training/approach on the progress of VP). Conclusions: Results suggest that the therapeutic relationship in VP has specific features that distinguish it from face-to-face psychotherapy. Implications for practice, training, and research are discussed.
The Role of Safety in Change-Promoting Therapeutic Relationships: An Integrative Relational Approach
Martin Podolan and Omar C. G. Gelo Key words: safety, attachment, therapeutic relationship, therapeutic change Objective: The significance of the psychotherapeutic relationship in promoting psychotherapeutic change is widely recognized. In this paper, we contribute to the relational orientation of psychotherapy through a transtheoretical exploration of safety. We aimed to identify and integrate those relational and change-promoting principles and aspects of safety that are school-independent. Method: We conducted an overview and synthesis of the clinical-theoretical and empirical literature that we believe has significantly addressed the role of safety in regulating change-promoting therapeutic relationships. Results: The relational and change-promoting aspects of safety form a dynamic system involving the therapist, the client, and the relationship. These interact, influence each other, and perform multiple homeostatic functions: they allow to resist change, assimilate small changes that do not disrupt the client’s way of functioning, regulate major changes that disrupt and alter the client’s way of functioning, and regulate adjustments in the way the therapist and client work together. From an integrative-relational perspective, a safe therapist is a precondition for co-creating a safe environment. This establishes trust and fosters an affective bond that provides additional sources of safety for the therapeutic relationship and the client. To promote change, however, the relational aspects of safety need to be fine-tuned (calibrated and personalized) for each therapy in terms of intensity, duration, timing, scope, and sources, accommodating developmental, individual, and situational differences. Crucially, the safety of the therapist, the client, and the relationship must be neither perfect, steady, or static, but rather safe enough, adaptive, and dynamic, leaving space not only for self-discovery and self-awareness but also for the co-regulation of tolerable frustrations, disappointments, and insecurities that facilitate the client’s resilience and adaptation. Conclusions: Focusing on school-independent, safety-based relational principles and understanding how they evolve and adapt over time and across circumstances can make a significant contribution to the current relational orientation in psychotherapy. This has important implications for psychotherapy practice, training, and research.
Laura Palagini, Mario Miniati, Donatella Marazziti, Dieter Riemann, Pierre A. Geoffroy, Angelo Gemignani Key words: insomnia, mood disorders, hypnotics, benzodiazepines, z-drugs, melatonin 2 mg pr, daridorexant, suvorexant Objective: Insomnia can be a contributing factor, a comorbid disorder, or a transdiagnostic element to several mental disorders, including mood disorders (MDs). A recent meta-analysis has already shown the effectiveness of cognitive behavioral treatment (CBT) for insomnia that is comorbid with MDs. This work aimed to systematically review data on pharmacological insomnia treatment in the context of MDS. In agreement with the current guidelines, pharmacological interventions for insomnia include gamma-aminobutyric acid (GABA)A receptor agonists such as short-medium acting benzodiazepines and benzodiazepine receptor agonists – Z-drugs, melatonergic receptors agonists, specifically melatonin 2 mg Prolonged Release (PR) and ramelteon, and dual orexin receptors antagonists (DORA) such as daridorexant, lemborexant, and suvorexant. Method: A systematic search was carried out on PUBMED database, according to the PRISMA Guidelines. Results: Thirty-three papers, 15 on gabaergic receptor agonists, 14 on melatonergic receptor agonists and 4 on DORA, were selected. Conclusions: Available data suggests that the treatment of insomnia symptoms with specific pharmacological options can improve both insomnia and comorbid conditions. Specifically, eszopiclone and melatonin 2 mg PR have demonstrated promising outcomes. Moreover, daridorexant and suvorexant, both belonging to the DORA class, have demonstrated efficacy in treating insomnia and mood symptoms. To summarize, current literature would suggest that targeting insomnia could potentially regulate the sleep system and, as such, improve mood symptoms.
Aysylu Galiautdinova, Iuliia Dolgopolova, Daria Troshina, Dmitry Petelin and Beatrice Volel Key words: atypical depression, depression with atypical features, genetic marker, single nucleotide polymorphism, weight gain, hypersomnia, increased appetite Objective: Atypical depression (AD) is a clinical subtype of depression characterised by mood reactivity and at least two of the following features: significant weight gain/increased appetite, hypersomnia, leaden paralysis, and/or interpersonal rejection sensitivity. The role of genetics in the development of depression remains a considerable level of interest among individuals. Due to the large number of breakthrough studies in genetics, there is currently a wealth of heterogeneous data on the existence of genetic markers for depression, including AD. However, it appears that there is a gap in the literature, as we were unable to identify any systematic reviews or meta-analyses that comprehensively describe these data. Therefore, our research aims to provide high-quality, solid evidence for further studies in this area. Method: Electronic bibliographic databases (Scopus, MEDLINE) were systematically searched from inception to September 2023. We searched for any specific genetic markers that could be retrieved associated with AD. The quality of studies has been assessed by means of the Q-genie tool. Results: Nine studies meeting the inclusion criteria were selected, which appeared to link genetic polymorphisms to atypical depression. Four studies examined genetic polymorphisms associated with the serotonin transporter gene (5-HTT), three studies examined genetic polymorphisms associated with endocrine regulation, two studies considered genetic polymorphisms associated with immune and/or cellular regulation, specifically the melanin-concentrating hormone receptor 2 (MCHR2), mineralocorticoid receptor (MR), and fat mass and obesity-associated protein (FTO) genes involved in the regulation of energy balance. Conclusions: The extracted data confirm that the atypical type of major depressive disorder is heritable to a certain extent. Individual risk markers for developing this type of depression may be identified in the future.
Gaia Cuzzocrea, Andrea Fontana, Marta Mascanzoni, Francesco Manca, Riccardo Pecora, Lucrezia Trani, Cristiana Guido, Alberto Spalice, Paolo Versacci, Lucia Sideli, Vincenzo Caretti Key words: children, adolescents, syncope, psychopathology, systematic review Objective: Syncope is defined as a spontaneous and transient loss of consciousness and postural tone due to brief and reversible cerebral hypoperfusion. This review aimed to summarize the research findings regarding the psychological correlates associated with pediatric syncope. Moreover, the study aimed to deepen the understanding of the relationship between psychological disorders and the onset of syncopal episodes in childhood, focusing on clinical features and different clinical classifications. Method: A systematic review was carried out from inception to January 2023, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using the CINAHL Plus, APA PsycArticles, APA PsycInfo, MEDLINE, and Psychology and Behavioral Sciences Collection databases. The study search and selection were based on the Population Intervention Comparison Outcome Study Design (PICOS) strategy and the Quality Assessment was carried out using Critical Appraisal Skills Programme (CASP) scales. A combination of keywords related to a) syncope; b) psycho*; and c) child* (Subjects) was used. Studies concerning epilepsy-related syncope were excluded. Results: Overall, 912 records were identified. After excluding non-English, non-original, and duplicate studies, 579 records were selected for the title screening, 88 for the abstract screening, 37 full-text articles were assessed for eligibility and a total of 14 were included. The Risk of Bias in the included studies was assessed and 78,6% of the studies satisfied robustness quality criteria. The findings highlighted that children and adolescents with syncope showed a higher rate of psychopathology as compared to the healthy and clinical controls. Furthermore, patients reported social withdrawal and poor quality of life. Conclusions: The findings suggest that there is a robust relationship between psychopathology and syncope. Children and adolescents with syncope frequently report clinical symptoms related to emotional, relational, and psychosomatic dysregulation. Psychological assessment should be routinely included in the integrated care to identify potential targets for treatment and improve early differential diagnosis.
Graeme J. Taylor, Piero Porcelli, R. Michael Bagby Key words: alexithymia, attention-appraisal model, attachment, emotion and imagination, emotion regulation, trauma Objective: Our goal was to compare the original conceptualization of the alexithymia construct with the attention-appraisal model, focusing primarily on the removal of the reduced imaginal activity component, a seminal aspect of the construct in the original model. We also examined associations between alexithymia and emotional distress and emotion regulation, attachment, and trauma, and whether alexithymia is a transdiagnostic risk factor. We discuss differences between the models in the treatment of alexithymia and also differences in measurement. Method: We conducted a narrative review of the scientific literature validating the original model of alexithymia and examined the comparatively few empirical studies evaluating the attention-appraisal model. Articles describing contemporary theoretical ideas about the relationship between imagination and emotion were reviewed, as well as studies exploring associations between alexithymia and imaginal activity. Results: The attention-appraisal model of alexithymia is theoretically derived and examined empirically in studies using correlation/measurement-based methods that employed self-report measures with mostly non-clinical samples and conducted primarily by researchers led by developers of the model. The original model of alexithymia is derived from observations of patients in clinical settings; its validity is supported by findings from hundreds of empirical investigations spanning nearly four decades with nonclinical and a variety of clinical samples using both correlation-based and experimental studies and methods of measurement other than self-report, and by independent teams of researchers. The reduced imaginal activity component of the alexithymia construct is mostly supported by these studies. Conclusions: Because of the dearth of studies with clinical samples, the absence of investigations by independent researchers, and the limited range of methods and measurements to evaluate and assess the model, there is insufficient evidence to warrant removal of the imaginal activity component of the alexithymia construct and for replacing the original conceptualization of the construct with the attention-appraisal model.
Nicolaja Girone, Ivan Limosani, Camilla Ciliberti, Martina Turco, Laura Longo, Maria Adele Colletti, Maddalena Cocchi, Gianmaria Zita, Mara Ida Fiocchi, Beatrice Benatti, Caterina Viganò, Mauro Percudani and Bernardo Dell’Osso Key words: gambling disorder, gender differences, pathological gambling, psychopathology Objective: Although gender-specific evidence on Gambling Disorder (GD) is still limited, some studies reported specific differences, mainly in psychopathological profiles, gambling behavior patterns, and pathogenesis. In order to further examine the role of gender in GD, we conducted a multicenter investigation in a sample of Italian outpatients. Method: One hundred-four outpatients with a diagnosis of GD based on DSM-5 criteria were consecutively recruited at two clinics based in Milan. Socio-demographic and clinical variables were collected for the whole sample and analyzed for the effect of gender. The severity of illness was assessed using the Canadian Problem Gambling Index and the Gambling Attitudes and Beliefs (GABS). Results: Among females, a significantly higher mean age (52.23 ± 10.95 vs. 40.96 ± 15.76; p=0.005) and older age at illness onset emerged (43.5 ± 11.92 vs. 29.22 ± 14.26; p<0.001). Females showed a significantly higher rate of psychiatric comorbidities, lifetime suicide ideation, stressful events at GD onset, and positive family history for GD compared to males. A predictive effect of male gender was found for the GABS questionnaires by performing a linear regression model, with males showing a higher risk to reach higher scores compared to females (B= 11.833; t=2.177; p=0.034). Conclusions: Our study seems to confirm the hypotheses that gender in GD may influence psychopathological profiles, course, and comorbidity. GD in female gender is frequently a comorbid condition with other specific clinical characteristics compared to males. Identifying specific clinical factors by gender may prompt more focus on the public health of women in relation to gambling, while still recognizing that males are at-risk of earlier gambling problems. These findings should be considered in therapeutic perspectives.
Flavia Spagnuolo, Antonella Somma, Andrea Fossati, Martin Sellbom, Carlo Garofalo Key words: psychopathic traits, Self-Report Psychopathy Short-Form, Triarchic Psychopathy Measure, romantic attachment avoidance, romantic attachment anxiety, emotion dysregulation Objective: Research so far has investigated the bivariate relationships between psychopathic traits, romantic attachment, and emotion dysregulation. However, no research thus far has examined these concepts in their interrelatedness. The aim of the present study was therefore to shed light on the possible linking mechanisms among these concepts, examining the mediating role of emotion dysregulation in the psychopathic traits-romantic attachment link. Method: The present study was based on an undergraduate (N = 238, M age = 20.36 years) and a community sample (N = 521, M age = 35.27 years) from the Dutch population. Participants were administered self-report measures of psychopathic traits (measured with both the Self-Report Psychopathy Short-Form and the Triarchic Psychopathy Measure), emotion dysregulation (Difficulties in Emotion Regulation Scale – Brief Version) and romantic attachment (Experiences in Close Relationships–Revised). Correlation analyses and mediation analyses using a bootstrapping approach were conducted. Results: Results showed that all the dimensions of psychopathic traits were related to both romantic attachment avoidance and anxiety, and that emotion dysregulation mediated all these associations (with only few exceptions). Except for boldness, all other dimensions of psychopathic traits were related to greater emotion dysregulation and, in turn, to insecure romantic attachment. Conclusions: It is argued that the role of emotion regulation processes deserves more attention for the theoretical and clinical understanding of psychopathic traits and their correlates in the interpersonal domain, such as romantic attachment (in)security. When their interrelationships will be better understood, emotion regulation and attachment could represent relevant targets for intervention with individuals presenting psychopathic traits.
Mattia Pezzi, Paola Corsano, Gianluca Santoro, Alessio Gori, Manuel Gámez-Guadix, Alessandro Musetti Key words: aloneness, loneliness, problematic social media use, social media, solitary experience, solitude Objective: This study was conducted to summarize existing studies on the association between solitary experiences and problematic social media use (PSMU) among young adults. Method: A systematic review was performed according to the PRISMA guidelines, implemented in Scopus, Web of Science, PubMed and PsycINFO. We selected studies if they presented original data, assessed solitary experiences and PSMU in young adults (i.e., 18-30 age range), were published in peer reviewed journals between 2004 and 2023, and were written in English. Results: After duplicate removal, 1,841 eligible studies were found. From these, 12 articles were selected, encompassing 4,009 participants. Most studies showed a positive association between general loneliness and PSMU. Some of these suggested that this relationship varies based on the facets of loneliness, other potential variables, and the type of social media. No mediating factors were found. Few studies assessed solitary experiences other than general loneliness, highlighting the need for a multidimensional perspective on solitary experience in investigating PSMU. Conclusions: Implications and future research orientations are discussed.
Gianluca Sesso, Fulvio Guccione, Lorenzo Conti, Elena Valente, Antonio Narzisi, Stefano Berloffa, Pamela Fantozzi, Valentina Viglione, Gabriele Masi, Annarita Milone Key words: emotional dysregulation, affective reactivity, questionnaire, parent report, adolescents Objective: Emotional Dysregulation (ED) is characterized by the inability to manage emotions effectively, leading to maladaptive behaviors, and often co-occurs with psychiatric conditions carrying significant long-term consequences. Early diagnosis of ED is thus essential for targeted interventions. To address this need, we developed and validated the “Reactivity of Emotions in Adolescents: Caregivers’ Tool” (REACT), a novel parent-rated questionnaire designed to assess ED in adolescents. Method: The present study involved two samples, one drawn from the general population (n = 89 healthy controls from local schools) and the other composed of clinical patients (n = 76 adolescents with different psychiatric and/or neurodevelopmental conditions). Patients’ diagnoses were confirmed through the clinical interview K-SADS-PL to explore the presence of any psychopathological conditions. Participants from both groups completed the RIPoSt-Y questionnaire, providing a measure of ED, while their parents filled out the ARI, measuring affective reactivity in youth. Confirmatory and exploratory factor analyses were performed to refine the questionnaire’s internal structure. Results: The final REACT questionnaire consists of 55 items distributed across three subscales, namely Negative Emotionality, Irritability, and Excitability. Psychometric evaluation showed that these subscales demonstrated excellent internal consistency and strong construct validity, with clinical patients scoring higher on all subscales compared to healthy controls. The REACT questionnaire showed also high convergent validity by exhibiting significant positive correlations with established measures of ED. Conclusions: This novel tool represents a valuable improvement in the assessment of ED in adolescence as it may facilitate tailored interventions to provide emotional well-being and long-term outcomes.
Emanuele Maria Merlo, Federica Sicari, Liam Alexander MacKenzie Myles, Salvatore Settineri Key words: affectivity, clinical psychology, euthymia, mental health, mood, well-being Objective: Euthymia is a transdiagnostic construct characterized by the presence of positive mood states, psychological flexibility and resilience. These components contribute to psychological wellbeing and support mental functioning. Exposure to suffering and high levels of stress can lead to the onset of burnout and secondary traumatic stress, but also lack of compassion satisfaction. The study aimed to test the existing relationships between euthymia, psychological well-being, and factors associated with quality of life of healthy participants involved in medical settings. Method: The sample was composed of 177 healthy participants involved in medical settings, 118 women (66.7%) and 59 men (33.3%) aged between 19 and 69 years old (mean = 27.16; SD = 8.47). Standardized psychodiagnostics instruments were used to assess euthymia (Euthymia Scale-ES), psychological well-being (The Well-Being Index scale-WHO-5) and the quality of life of the involved participants (Professional Quality of Life Measure-ProQOL-5). Results: The results showed that gender, well-being and psychological well-being were predictors of compassion satisfaction and secondary traumatic stress. Specifically, female gender predicted higher levels of compassion satisfaction. Well-being and psychological flexibility predicted higher levels of compassion satisfaction and lower secondary traumatic stress. Psychological well-being predicted higher levels of compassion satisfaction. Conclusion: Promoting euthymia and well-being helps individuals to preserve psychological well-being and increase tolerance to stressful life situations. Results highlighted the need for promoting health care professionals’ euthymia and well-being. In line with evidence, encouraging interventions based on evidence appears relevant.
Marialaura Di Tella, Agata Benfante, Lorys Castelli, Mauro Adenzato, Rita B. Ardito Key words: alexithymia; social cognition; theory of mind; emotion recognition; empathy; systematic review Objective: This systematic review summarises the studies that have investigated the relationship between dimensions of social cognition (i.e., Theory of Mind – ToM, emotion recognition, and empathy) and alexithymia in the general adult non-clinical population. Method: PubMed, PsycINFO, and Scopus databases were screened, using the following strings: ("alexithymi*") AND ("theory of mind" OR "ToM"); ("alexithymi*") AND ("empath*"); ("alexithymi*") AND ("emotion recognition"); ("alexithymi*") AND ("social cognition"). Results: A total of 117 studies met the inclusion criteria and were included in this review. The total number of participants included in the reviewed studies was 40,231. Mixed results were found for alexithymia and ToM, while the relationship between emotion recognition or empathy and alexithymia was more homogeneous. Alexithymia was found to be significantly associated with both a reduced ability to recognise emotions and empathy. Conclusions: These results support the existence of significant relationships between alexithymia and altered social cognitive abilities. Future research is needed to confirm the present findings and further elucidate the complex relationship between these processes. Suggestions are made on how to overcome some of the theoretical and methodological problems in the literature.
Mayara Leite Alves da Silva, Thiago José Nascimento de Souza, Maykon Wanderley Leite Alves-da-Silva, Carlos Matheus Messias Remigio, Melina Pimentel Cavalcante Pedrosa, Claudio Torres de Miranda, Valfrido Leão de Melo Neto Key words: fibromyalgia, suicidal ideation, hopelessness, psychache Objective: Objective: The aim of this study was to investigate if psychache and hopelessness may serve as reliable predictors of suicidal ideation among female fibromyalgia (FM) patients. Method: This was a cross-sectional study of 50 women with FM, examining the relationship between psychological pain, hopelessness, depressive symptoms, and suicidal ideation. FM diagnosis was confirmed by the American College of Rheumatology (ACR) criteria. Demographic data, the Mini International Neuropsychiatric Interview (MINI 7.0.2), the Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS), the Pittsburgh Sleep Quality Index (PSQI) and the Psychache Scale were utilized to assess these relationships and their predictive value for suicidality. Results: The mean age of the participants was 50.2 years (±8.7). Thirty-two (64%) patients had current major depression, 11 (22%) had bipolar disorder, 20 (40%) presented passive suicidal ideation and 14 (28%) presented active suicidal ideation. Psychological pain correlated with both depressive symptoms (p<0.01; r= 0.648) and hopelessness (p=0.029; r=0.312) but did not predict suicidal ideation. Logistic regression analyses revealed depressive symptom severity as a predictor of passive suicidal ideation (odds ratio = 1.486; 95% CI: 1.017 - 2.170), while hopelessness predicted active suicidal ideation (odd ratio = 1.356; 95% CI, 1.049 – 1.753). Conclusions: FM female patients showed increased prevalence of suicidal ideation. Hopelessness predicts active suicidal ideation but psychological pain did not serve as predictive factor for suicide ideation among female FM patients.
Eleonora Topino, Nicole Pallaoro, Miriam Moyano, Silvia Casale, Alessio Gori Key words: adult attachment, behavioural addiction, dissociation, affect dysregulation, online shopping, shopping addiction Objective: Online shopping has been described by the scientific literature both for its benefits and the potential risks when excessive usage is involved. Indeed, compulsive online shopping is commonly conceptualized as a potential behavioural addiction that substantially impacts the lives of individuals afflicted by it. In light of this, the present research aimed at exploring the association between possible risk and protective factors for compulsive online shopping, by specifically exploring the role of adult attachment, affect dysregulation, and dissociation. Method: 285 participants (75% females, 25% males; Mage = 31.57, SD = 11.379) were involved in the research and completed an online survey. The collected data was analysed implementing a path analysis model. Results: Results showed significant total effects in the relationship between secure/fearful attachment patterns and compulsive online shopping. Such associations were significantly mediated by the sequential effect of affect dysregulation and dissociation. Conclusions: The present study provides useful information to guide tailored interventions concerning both preventive activity and clinical practice.
Luigi Tinella, Elisabetta Ricciardi, Teresa Cosentino, Alessandro Oronzo Caffò, Guy Doron, Andrea Bosco, Francesco Mancini
Elena De Rossi, Claudio Imperatori, Francesco Sciancalepore, Elisabeth Prevete, Annalisa Maraone, Marco Canevelli, Lorenzo Tarsitani, Massimo Pasquini, Benedetto Farina, Francesco Saverio Bersani