A longitudinal examination of the interpersonal fear avoidance model of pain:the role of intolerance of uncertainty

Youth with chronic pain and their parents face uncertainty regarding their diagnosis, treatment, and prognosis. Given the uncertain nature of chronic pain and high comorbidity of anxiety among youth, intolerance of uncertainty (IU) may be critical to the experience of pediatric chronic pain. This study longitudinally examined major tenets of the Interpersonal Fear Avoidance Model of Pain and included parent and youth IU as key factors in the model. Participants included 152 youth with chronic pain (Mage = 14.23 years; 72% female) and their parents (93% female). At baseline, parents and youth reported on their IU and catastrophic thinking about youth pain; youth reported on their fear of pain, pain intensity, and pain interference; and parents reported on their protective responses to child pain. Youth reported on their pain interference 3 months later. Cross-lagged panel models, controlling for baseline pain interference, showed that greater parent IU predicted greater parent pain catastrophizing, which, in turn, predicted greater parent protectiveness, greater youth fear of pain, and subsequently greater youth 3-month pain interference. Youth IU had a significant indirect effect on 3-month pain interference through youth pain catastrophizing and fear of pain. The results suggest that parent and youth IU contribute to increases in youth pain interference over time through increased pain catastrophizing, parent protectiveness, and youth fear of pain. Thus, parent and youth IU play important roles as risk factors in the maintenance of pediatric chronic pain over time and may be important targets for intervention.</p

The Italian version of the Depressive Experiences Questionnaire: psychometric properties and validation in students, community, and clinical groups

The current study evaluated the psychometric properties of the Italian validation of the Depressive Experiences Questionnaire (DEQ), conceived as a measure of self-criticism and dependency, i.e. two personality factors acting, according to Blatt (2004), as risk factors for depression in particular and psychopathology in general. A series of standardized measures [Beck Depression Inventory-II (BDI-II), DEQ, Symptom Checklist-90-R (SCL-90-R), Millon Clinical Multiaxial Inventory, 3rd edition (MCMI-III)] was administered to three samples (i.e., students, community and clinical). Factorial validity was evaluated along with convergent and predictive validity. In order to evaluate the reliability and internal consistency, a specific subgroup of participants was retested on the DEQ and BDI-II. Results showed correlations between DEQ dimensions and some personality traits of the MCMI-III. The traditional three-factor model of the DEQ structure as identified by principal component analysis appears to be as stable factors as typically found in American samples, although some items showed elevated cross-loading or low loadings on any factor. Clinical and diagnostic implications of the findings will be discussed

The development of self-definition and relatedness from adolescence through adulthood

Self-definition and relatedness are fundamental personality developmental tasks that engage individuals across the entire lifespan (Blatt, 1974, Blatt & Luyten, 2009; Luyten & Blatt, 2013). Healthy psychological maturation requires the development of a sense of self that is differentiated, integrated, and positive, and the ability to form close interpersonal relationships that are mature, intimate, mutually satisfying, and reciprocal. A failure or delay in the development of self-definition contributes to the development of a personality trait labelled self-criticism, whereas a failure or delay in the development of relatedness contributes to the development of a personality style labelled dependency. This thesis expands contributes to our knowledge of personality development across the lifespan. In articles 1 and 2, 200 young adults completed measures of recalled parenting and peer relationships as well as a measure of their current levels of self-criticism and dependency. In article 1, I provide the first evidence that highly self-critical young adults recall higher levels of peer victimization in adolescence, over and above their recalled parenting experiences. In article 2, I extend this to dependency by showing that highly dependent young adults recall poorer quality attachments to their peers during adolescence, again over and above their experiences with their parents. In order to longitudinally confirm the effects of a variety of experiences (e.g., parents, peers, romantic partners, siblings, and academic achievement) on dependency and self-criticism in adolescence, I then examine the effects of these experiences on change in dependency and self-criticism, and the role these two personality factors play in the development of depressive and anxiety symptoms. In article 3, 276 early adolescents completed a measure of self-criticism and dependency as well as measures of depressive and anxiety symptoms at baseline and again two years later. Every three months during the study interval, they completed measures of common negative life events and hassles. Results showed that events coded as self-definitional uniquely predicted increases in self-criticism, which in turn predicted increases in depressive symptoms. In contrast, events coded as relatedness-oriented uniquely predicted increases in dependency, which in turn uniquely predicted the development of anxiety symptoms.Finally, in study 4, I provide the first test of lifespan developmental hypotheses of self-definition and relatedness. One Canadian sample and one multicultural sample ranging in age from 18 to 59 completed measures of self-criticism, dependency, neuroticism, agreeableness, and depressive symptoms. Results showed that, adjusting for depressive symptoms as well as neuroticism and agreeableness, older age was linearly associated with improvements in both self-definition and relatedness from age 18 to 59. This pattern of age-related differences was seen in both Western and Eastern cultural samples, suggesting that effects are due to change over time, rather than cohort effects. I then discuss the contributions of these studies to our understanding of personality development across the lifespan. In particular, results suggest that that a variety of developmental experiences, including peers, parents, romantic partners, and academic accomplishments, affect personality development. Furthermore, personality development may affected by experiences that are congruent with specific personality factors. Finally, results suggest that personality is not set by a certain age, but rather continues to evolve across adulthood. I also propose potential explanations for the variety of effects shown. I address the limitations to these studies, and conclude by outlining avenues for future research, as well as the implications of these findings for clinical interventions.La définition de soi et l’affiliation sociale représentent des tâches développementales de la personnalité qui sont fondamentales à travers la vie (Blatt, 1974; 2004, 2007, 2008; Blatt & Luyten 2009, 2013). Pour que la maturation psychologique saine ait lieu, ces tâches nécessitent le développement d'un sens de soi qui est différencié, intégré et positif, ainsi que la capacité d’établir des relations interpersonnelles rapprochées qui sont matures, intimes, mutuellement satisfaisantes et réciproques. Une défaillance ou un retard dans le développement d’une définition de soi mène au développement d’un trait de personnalité dénommé l’autocritique, alors qu'un retard dans le développement de l’affiliation sociale peut mener au développent d’un style de personnalité dénommé la dépendance. Cette thèse contribue ainsi à notre connaissance du développement de la personnalité à travers la vie. Dans les articles numéro 1 et 2, 200 jeunes adultes ont complété des mesures de leurs expériences passées avec leurs parents et de leurs relations avec leurs pairs, ainsi qu’une mesure de leurs niveaux actuels d’autocritique et de dépendance. Dans l’article numéro 1, je fournis les premiers indices que les jeunes adultes très autocritiques se souviennent de niveaux plus élevés de victimisation par les pairs à l'adolescence, au-dessus des effets attribuables à leurs expériences parentales évoquées. Dans l'article numéro 2, j’adresse ceci par rapport à la dépendance, en démontrant que les jeunes adultes très dépendants se souviennent d’avoir formé des attachements de moins bonne qualité avec leurs pairs, une fois encore après avoir contrôlé pour les effets de leurs expériences avec leurs parents. Dans l’article numéro 3, 276 jeunes adolescents on complété une mesure d’autocritique et de dépendance ainsi que des mesures de symptômes de dépression et d’anxiété au départ et deux ans plus tard. Tous les trois mois pendant la durée de l'étude, ils ont rempli des mesures d'événements de la vie négatifs communs et de tracas. Les résultats ont démontré que les événements codés en tant qu’autodéfinitionels pouvaient prédire de façon unique des augmentations de l'autocritique, qui prédisaient conséquemment des augmentations en symptômes dépressifs. En contraste, les événements codés comme étant reliés à l’affiliation sociale prédisaient uniquement des augmentations en dépendance, qui, à leurs tours, démontraient des effets uniques sur le développement des symptômes d'anxiété.Finalement, dans l'étude numéro 4, un échantillon canadien et un échantillon multiculturel composé d’individus âgés de 18 à 59 ans ont complété des mesures d’autocritique, de dépendance, de névrosisme, d’agréabilité et de symptômes dépressifs. Les résultats ont montré que, en ajustant pour les symptômes dépressifs ainsi que pour la névrose et l’agréabilité, l’âge est positivement et linéairement associé à une amélioration de la définition de soi ainsi qu’en l’affiliation sociale entre 18 et 59 ans. Ce motif de différences reliées à l'âge est retrouvé dans les échantillons de culture occidentale ainsi qu’orientale, ce qui suggère que les effets sont dus à des changements au fil du temps, plutôt qu’à des effets de cohorte.Les résultats suggèrent qu'une variété d'expériences de développement affectent le développement de la personnalité. De plus, les expériences associées à la définition de soi et à l’affiliation sociale pourraient être particulièrement importantes au développement de facteurs de personnalité reliés à ces domaines. Finalement, les résultats suggèrent que la personnalité n'est pas définie par un certain âge, mais continuent plutôt à évoluer à travers l'âge adulte. Je propose également des explications potentielles pour les nombreux effets observés. J'adresse les limites de ces études, et je conclus en soulignant des pistes pour de futures recherches, ainsi que les implications de ces résultats pour les interventions cliniques

Childhood Maltreatment, Pathological Personality Dimensions, and Suicide Risk in Young Adults

Several studies have demonstrated that child maltreatment (psychological, physical, and sexual abuse, and neglect) may be a significant factor in the development of pathological personality traits that increase the risk for suicidal ideation and behavior from adolescence to adulthood. Currently, the challenge is to understand how different forms of early negative experiences render an individual prone to develop specific personality traits and, in turn, be more vulnerable to suicide risk. To understand the relationship between childhood maltreatment and personality dimensions in suicide risk, our study aims to explore the role of self-criticism and dependency, two different pathological personality traits, as potential mediators of the link between different types of childhood maltreatment and suicide risk in young adults. For this purpose, 306 students from three Italian public universities were recruited. We used the Italian version of the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) to assess experiences of lack of care by parents (i.e., antipathy and neglect) as well as psychological and physical abuse before the age of 17 years. The Depressive Experiences Questionnaire (DEQ) was used to assess the personality dimensions of self-criticism and dependency, and the Suicide History Self-Rating Screening Scale was administered to assess suicide risk. Results revealed that lack of care and psychological abuse were significantly associated with suicide risk and this association was partially mediated by the maladaptive personality dimension of self-criticism. These findings suggest that the combined effect of specific forms of dysfunctional parental behavior during childhood and the development of rigid and dysfunctional negative personality traits may increase the risk for suicidal ideation and behavior during adulthood

The moderating effect of attachment styles on the relationships between maltreatment experiences and internalizing and externalizing problems among adolescents: Implications for custody issues

Multiple studies have documented the relationship between child maltreatment and internalizing and externalizing problems. Evidence suggests that the link between child maltreatment and these psychopathological outcomes may be moderated by various factors. Attachment styles may be one such moderating factor in this relationship. This study seeks to explore whether different attachment style profiles are associated with different forms of maltreatment as well as internalizing and externalizing symptoms, and whether attachment styles may moderate the link between different forms of maltreatment and internalizing and externalizing problems. For this purpose, 387 students from Italian public high schools were recruited. We used the Italian version of the Attachment Style Questionnaire (ASQ) to assess different dimensions of attachment, the Italian version of the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) to assess experiences of maltreatment, and the Italian version of the Youth Self-Report (YSR) to assess internalizing and externalizing problems. Results showed that different types of attachment style profiles were specifically associated with maltreatment variables and internalizing/externalizing problems as well as attachment style profiles moderated the relationships between maltreatment and internalizing problems. The findings are discussed in light of the theoretical framework and limitations, and implications for practice and child custody are presented

Psychometric Aspects of the Depressive Experiences Questionnaire: Implications for Clinical Assessment and Research

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The Predictive Role of Ideological, Personality and Psychopathological Factors in Homonegative Attitudes in Italy

Homonegativity refers to a series of prejudicial and discriminatory attitudes towards individuals perceived as homosexuals. Previous studies indicated that some person- ality traits (i.e., neuroticism, low openness to experience), as well as specific ideo- logical attitudes (i.e., conservatism, authoritarianism) and higher levels of psychopa- thology make individuals more prone to show homonegative attitudes. However, no studies have compared these three dimensions in order to identify their different role in homonegativity. For this reason, the aim of this study was to simultaneously eval- uate the association of ideological, personality, and psychopathological factors with homonegativity in adults living in Italy. Participants were 307 heterosexual adults (males = 46%) ranging in age between 19 and 66 years (M = 28.74, SD = 10.65), who completed four self-report questionnaires: Modern Homophobia Scale, Right-Wing Authoritarianism Scale, NEO Five-Factor Inventory 3, and Symptom Check List- 90-R. A structural equation model was computed to examine the relation between ideological, personality, and psychopathological factors and homonegativity. Results showed that ideological factors, particularly authoritarian attitudes and religiosity, were mostly related with homonegativity, while lower agreeableness and lower psy- chopathology were significantly albeit more weakly associated with homonegativity in adults living in Italy. Methodological limitations and implications for interven- tions are discussed