Hoarding Symptoms Are Not Exclusive to Hoarders

Hoarding Disorder (HD) was originally conceptualized as a subcategory of Obsessive Compulsive Disorder (OCD), and numerous studies have in fact focused exclusively on investigating the comorbidity between OCD and HD. Hoarding behavior can nevertheless also be found in other clinical populations and in particular in patients with eating disorders (ED), anxiety disorders (AD), major depression (MD), and psychotic disorders (PD). The current study was carried out with the aim of investigating, using a validated instrument such as the Saving Inventory-Revised (SI-R), the presence of HD symptoms in patients diagnosed with ED, AD, MD and PD. Hoarding symptomatology was also assessed in groups of self-identified hoarders (SIH) and healthy controls. The results revealed that 22.5% of the ED patients exceeded the cut-off for the diagnosis of HD, followed by 7.7% of the patients with MD, 7.4% of the patients with AD, and 5.9% of the patients with PD. The patients with ED had significantly higher SI-R scores than the other groups in the Acquisition and Difficulty Discarding scales while the AD, MD, and PD patients were characterized exclusively by Difficulty Discarding. These data suggest to clinicians that hoarding symptoms should be assessed in other types of patients and especially in those affected by Bulimia and Binge eating

Pathological Gambling: Compulsive-Impulsive Spectrum Disorder, Behavioural Addiction, or Both?

Pathological gambling (PG) is a chronic and progressive condition, defined as “persistent and recurrent maladaptive gambling behaviour”; it is currently classified among the Impulse control disorders (Not Elsewhere Classified) in the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition - Text Revision (DSM-IV-TR). The diagnostic criteria for PG resemble those of both Substance use disorders (SUDs) and Compulsive disorders (in particular, Obsessive compulsive disorder [OCD]). The terms compulsivity and impulsivity are interchangeably used to describe difficulties in self-control leading to repetitive psychopathological behaviours; nonetheless, they represent two distinct constructs. Compulsive behaviours are driven by “a tendency to perform unpleasantly repetitive acts in a habitual or stereotyped manner to prevent perceived negative consequences, leading to functional impairment”, whereas impulsivity has been described as “a predisposition toward rapid, unplanned reactions to internal or external stimuli with diminished regard to the negative consequences of these reactions to the impulsive individual or others”. Features of both compulsivity and impulsivity are involved in PG phenomenology, and a large body of literature investigated these aspects mainly making use of clinical observation and results obtained through self-report questionnaires. PG can be conceptualized as a compulsive-impulsive spectrum disorder or as a behavioural addiction: these two theoretical frameworks have been proposed for PG categorization in DSM-5, thus and understanding which of them is better suited to PG symptoms is relevant for diagnostic classification issues. Although these two approaches are not mutually exclusive, adopting one rather than the other has important clinical implications. Recently, the importance of integrating phenotypic (i.e. phenomenological) and endophenotypic (i.e. behavioural/physiological) indicators in psychodiagnostic assessment has been highlighted. Endophenotypes are measures of the individual neuropsychological, neurophysiological and biochemical functioning, and consequently anomalies in endophenotypes are supposed to reflect impairments in the underlying neurocognitive processes. Impairments in motor inhibition ability and difficulties in delaying gratification and decision making, which are prefrontally-mediated cognitive functions, have been suggested to underlie problems in behavioural regulation (i.e. compulsive and impulsive behaviours). From this perspective, both compulsive and impulsive behaviours would represent: a. the performance of an action before its complete processing or the failure of interrupting already activated actions; b. a dysfunction in behavioural choices, which are perpetrated despite bad consequences for the individual. Therefore, cognitive measures of motor inhibition and decision making abilities may represent promising endophenotipic indicators of behavioural regulation, and deficits in these functions are hypothesized to underpin PG, OCD, and SUDs. The present dissertation was conducted in the light of these considerations, and following the recommendation that directly comparing PGs with OCD patients and individuals with SUDs can represent a viable way to identify the most suitable classification for PG. A group of treatment-seeking PGs was compared with patients with OCD, Alcohol dependents (ADs) and healthy controls (HCs) on both self-report questionnaires and cognitive measures of compulsivity and impulsivity. The main aims were to investigate similarities and differences between clinical groups in such measures, as well as potentially different patterns of response in cognitive tasks. The Go/Nogo task was used to assess motor inhibition ability, whereas the Iowa Gambling Task (IGT) was administered to evaluate decision making processes. A preliminary comparison between small groups of PGs and croupiers on the same measures was also conducted; croupiers were chosen as gambling represents a relevant activity for both groups of individuals, and also in the light of the higher risks of developing problem or pathological gambling observed in casino employees than in general population. Consequently, the study of compulsivity and impulsivity in croupiers may be helpful in identifying the factors potentially involved in the development of PG. The main results showed that PGs reported higher levels of both self-reported compulsivity and impulsivity than healthy individuals. Furthermore, a number of similarities between PGs, OCD patients and ADs in the phenotypic measures of both dimensions was observed. No evidence of impaired motor inhibition ability in PGs, OCD patients or ADs emerged. In regards to decision making processes, deficits in the IGT performance were found in PGs and ADs, whereas OCD patients did as good as HCs. Both PGs and ADs were characterized by a decline of their performance towards the end of the task, which indicated difficulties in the maintenance of learning to shift from disadvantageous to advantageous decisions. The comparison between PGs and croupiers revealed that the former obtained higher scores on measures of compulsivity, whereas the latter did not differ from HCs. However, both PGs and croupiers reported similar and higher self-reported impulsivity than HCs. As regards the cognitive tasks, no significant difference between groups emerged; nonetheless, IGT profiles of learning showed that PGs had a poor performance and croupiers differed from HCs in that they did not improve in the last block of the task. Several conclusions may be drawn from present results. First of all, data from self-report measures suggest that both the compulsive-impulsive spectrum hypothesis and the behavioural addiction one might be adequate for PG categorization, as compulsivity and impulsivity co-occur in PGs. Furthermore, the numerous analogies emerged between PGs, OCD patients and ADs further support to include the three of them in a common spectrum of disorders. On the other hand, IGT findings highlighted the presence of similar deficits in PGs and ADs. This result is in line with literature reporting dysfunctions in the brain circuitry underlying decision making ability, and therefore it supports the conceptualization of PG as an addictive disorder. Data emerged from the comparison between PGs and croupiers seem also to be consistent with this hypothesis, as probable vulnerability factors for addictions (i.e. impulsivity personality trait and potentially altered decision making processes) have been observed also in healthy individuals at risk for the development of PG. However, given the small samples sizes further studies are recommended. To conclude, results from the present dissertation indicate that both classifications are equally appropriate for PG, depending on the adopted indicators. Other studies are required to further clarify which is the best diagnostic category for PG

Revising the Intolerance of Uncertainty Model of Generalized Anxiety Disorder: Evidence from UK and Italian Undergraduate Samples

The Intolerance of Uncertainty Model (IUM) of Generalized Anxiety Disorder (GAD) attributes a key role to Intolerance of Uncertainty (IU), and additional roles to Positive Beliefs about Worry (PBW), Negative Problem Orientation (NPO), and Cognitive Avoidance (CA), in the development and maintenance of worry, the core feature of GAD. Despite the role of the IUM components in worry and GAD has been considerably demonstrated, to date no studies have explicitly assessed whether and how PBW, NPO, and CA might turn IU into worry and somatic anxiety. The current studies sought to re-examine the IUM by assessing the relationships between the model’s components on two different non-clinical samples made up of UK and Italian undergraduate students. One-hundred and seventy UK undergraduates and 488 Italian undergraduates completed measures assessing IU, worry, somatic anxiety, depression, and refined measures of PBW, NPO, and CA. In each sample, two mediation models were conducted in order to test whether PBW, NPO, and CA differentially mediate the path from IU to worry and the path from IU to somatic anxiety. Secondly, it was tested whether IU also moderates the mediations. Main findings showed that, in the UK sample, only NPO mediated the path from IU to worry; as far as concern the path to anxiety, none of the putative mediators was significant. Differently, in the Italian sample PBW and NPO were mediators in the path from IU to worry, whereas only CA played a mediational role in the path from IU to somatic anxiety. Lastly, IU was observed to moderate only the association between NPO and worry, and only in the Italian sample. Some important cross-cultural, conceptual, and methodological issues raised from main results are discussed

Profiles of intolerance of uncertainty, separation anxiety, and negative affectivity in emerging adulthood: A person-centered approach

Background: Although Intolerance of uncertainty (IU), separation anxiety, and negative affectivity seem theoretically interrelated, no empirical study has considered them jointly so far. However, deepening this topic is clinically relevant, especially during the delicate phase of emerging adulthood. This study aimed to pinpoint psychological profiles based on IU, separation anxiety symptoms, and negative affectivity in a group of Italian non-clinical emerging adults. Such profiles were then compared in terms of key psychological and psychosocial characteristics. Methods: 868 young adults (73 % women) aged 18-26 years entered the study. They completed a socio-demographic survey and self-report tools assessing IU, separation anxiety symptomatology, and personality traits. Subgroups exhibiting distinctive patterns of IU, separation anxiety symptoms, and negative affectivity were identified using latent profile analysis. To deepen disparities in psychological and psychosocial features by profile, analyses of variance and chi-square tests were performed. Results: Three profiles were detected, respectively with high, low, and moderate levels of the variables considered. In each profile, IU, separation anxiety symptoms, and negative affectivity had a consistent trend. The "High-level" profile had the greatest proportion of women and people who had not spent infancy with both parents. Limitations: The sample included mainly women and university students, and data were collected using self-report questionnaires only. Conclusions: IU, separation anxiety symptoms, and negative affectivity can co-occur, highlighting the importance of transdiagnostic interventions. Preventive efforts should be directed to emerging adult women and those who did not spend infancy with both parents, as they may be particularly vulnerable to internalizing distress

Seeking certainty about intolerance of uncertainty: Addressing old and new issues through the intolerance of uncertainty scale-revised

Intolerance of Uncertainty is a trans-diagnostic process that spans a range of emotional disorders and it is usually measured through the Intolerance of Uncertainty Scale-12. The current study aims at investigating some issues in the assessment of Intolerance of Uncertainty (IU) through the Italian Intolerance of Uncertainty Scale-Revised, a measure adapted from the Intolerance of Uncertainty Scale-12 to assess IU across the lifespan. In particular we address the factor structure among a large community sample, measurement invariance across gender, age, and over time, together with reliability and validity of the overall scale and its subscales. The questionnaire was administered to community (N = 761; mean age = 35.86 +/- 14.01 years) and undergraduate (N = 163; mean age = 21.16 +/- 2.64 years) participants, together with other self-report measures assessing constructs theoretically related to IU. The application of a bifactor model shows that the Italian Intolerance of Uncertainty Scale-Revised possesses a robust general factor, thus supporting the use of the unit-weighted total score of the questionnaire as a measure of the construct. Furthermore, measurement invariance across gender, age, and over time is supported. Finally, the Italian Intolerance of Uncertainty Scale-Revised appears to possess adequate reliability and validity. These findings support the unidimensionality of the measure, a conceptually reasonable result in line with the trans-diagnostic nature of Intolerance of Uncertainty. In addition, this study and comparison with published factor structures of the Intolerance of Uncertainty Scale-12 and of the Intolerance of Uncertainty Scale-Revised identify some issues for the internal structure of the measure. In particular, concern is expressed for the Prospective IU subscale. In light of the promising psychometric properties, the use of the Italian Intolerance of Uncertainty Scale-Revised as a univocal measure is encouraged in both research and clinical practice

Investigation of the Phenomenological and Psychopathological Features of Trichotillomania in an Italian Sample

Trichotillomania (TTM) is still a scarcely known and often inadequately treated disorder in Italian clinical settings, despite growing evidence about its severe and disabling consequences. The current study investigated the phenomenology of TTM in Italian individuals; in addition, we sought to examine patterns of self-esteem, anxiety, depression, and OCD-related symptoms in individuals with TTM compared to healthy participants. The current study represents the first attempt to investigate the phenomenological and psychopathological features of TTM in Italian hair pullers. One hundred and twenty-two individuals with TTM were enrolled: 24 were assessed face-to-face (face-to-face group) and 98 were recruited online (online group). An additional group of 22 face-to-face assessed healthy controls (HC group) was included in the study. The overall female to male ratio was 14:1, which is slightly higher favoring female than findings reported in literature. Main results revealed that a higher percentage of individuals in the online group reported pulling from the pubic region than did face-to-face participants; furthermore, the former engaged in examining the bulb and running the hair across the lips and reported pulling while lying in bed at higher frequencies than the latter. Interestingly, the online TTM group showed greater functional and psychological impairment, as well as more severe psychopathological characteristics (self-esteem, physiological and social anxiety, perfectionism, overestimation of threat, and control of thoughts), than the face-to-face one. Differences between the two TTM groups may be explained by the anonymity nature of the online group, which may have led to successful recruitment of more serious TTM cases, or fostered more open answers to questions. Overall, results revealed that many of the phenomenological features of Italian TTM participants matched those found in U.S. clinical settings, even though some notable differences were observed; therefore, cross-cultural invariance might represent a characteristic of OCD-related disorders

Measuring pandemic-related anxiety and confidence in care in chronic patients using the Psychological Consequences of a Pandemic Event (PCPE) questionnaire

: The COVID-19 pandemic has determined a considerable increase in psychological distress worldwide. Compared with the general population, patients with chronic conditions experience higher stress levels due to the increased risk of worse health outcomes from COVID-19 infection. Worries and fear of contagion could cause them to avoid going to their health facilities for medical examinations, which results in higher risks of morbidity and mortality. The present study aimed to develop and validate the Psychological Consequences of a Pandemic Event (PCPE) self-report questionnaire, and to assess the psychological effects of exposure to a pandemic on mood and on treatment adherence appropriate for patients with chronic diseases. Data were analysed with Rasch analysis after an Exploratory Factor Analysis and a Confirmatory Factor Analysis. We identified a final set of 10 items, divided into two independent factors labelled "pandemic-related anxiety" and "confidence in care". Finally, we transformed the raw scores of both factors into two interval scales (two rulers) that met the requirements of the fundamental measurement. The PCPE questionnaire has demonstrated to be a short and easy-to-administer measure, with valid and reliable psychometric properties, capable of assessing pandemic-related anxiety and confidence in care in patients with chronic clinical conditions