The Role of Attachment Trauma and Disintegrative Pathogenic Processes in the Traumatic-Dissociative Dimension

Epidemiological, clinical, and neurobiological studies of the last 30 years suggest that traumatic attachments during the early years of life are associated to specific psychopathological vulnerabilities based on dissociative pathogenic processes. It has been observed that the dissociative pathogenic processes caused by these traumatic attachments either may contribute to the genesis of well-defined mental disorders (e.g., dissociative disorders) or may variably occur in many other diagnostic categories, complicating their clinical pictures and worsening their prognosis. For this reason, we proposed to define the dimension of psychopathological outcomes linked to traumatic attachments and dissociative pathogenic processes as the “traumatic-dissociative” dimension (TDD). The clinical complexity of the TDD requires specific training to enable mental health professionals to recognize the signs of traumatic developments and to implement specific treatment strategies. The present article aims to review some crucial points about the clinical meaning and treatment strategies of the TDD, the dissociative pathogenic processes characterizing the TDD, as well as of the role of attachment trauma in the TDD. We also focused on the clinical and theoretical evidence suggesting that dissociation and dis-integration may be considered two different processes but highly correlated. The usefulness of clinical reasoning in terms of psychopathological dimensions, instead of distinct diagnostic categories, as well as several therapeutic implications of these issues was finally discussed

The Importance of Understanding Hierarchical Relations between High Order Mental Functions in Clinical Practice

Abstract: The state-of-the-art in studies on mentalization suggests that capacity to understand other minds (mindreading), self introspection and consciousness, mental time travel in the past and the present, linguistic communication, are different components of a hierarchical organization of several functions reflecting the evolutionary development of the specie and integrates increasingly complex, mutually coordinated brain levels. The understanding of the precise hierarchical relations between them, that reflect the phylo- and ontogenetic evolutionary pathway for adaptation to the complex interpersonal and socio-cultural environment, has an essential application in psychopathology and psychotherapy, in particular for those clinical conditions where the normal integration of high order mental functions is hampered by developmental relational trauma.Keywords: Hughlings Jackson; Developmental Trauma; Attachment Trauma; Mentalization; Body-centered Psychotherapies. L’importanza della comprensione delle relazioni gerarchiche tra le funzioni di ordine superiore nella pratica clinicaRiassunto: Lo stato dell’arte nell’ambito degli studi sulla mentalizzazione suggerisce che la capacità di comprendere le menti altrui (mindreading), l’introspezione e la coscienza di sé, la capacità di spostarsi temporalmente nel passato e nel presente, la comunicazione linguistica, sono componenti diverse di una organizzazione gerarchica di molte funzioni che riflettono lo sviluppo evolutivo della specie e che integra livelli cerebrali reciprocamente coordinati e di complessità crescente. La comprensione delle precise relazioni gerarchiche tra essi, che riflettono il percorso evolutivo filo- e ontogenetico verso l’adattamento al complesso ambiente interpersonal e socio-culturale, possiede un importante risvolto applicativo nel campo della psicopatologia e della psicoterapia, in particolare per quelle condizioni cliniche dove l’integrazione normale delle funzioni mentali di ordine superiore viene ostacolata da un trauma relazionale di carattere evolutivo.Parole chiave: Hughlings Jackson; Trauma evolutivo; Trauma da attaccamento; Mentalizzazione; Psicoterapie centrate sul corpo

Harmony of transitions in assessing interpersonal motivations in transcripts analysis can discriminate between Adult Attachment Interview secure and disorganized individuals

SUMMARY. Aim. Assessing Interpersonal Motivations in Transcripts (AIMIT) is a validated coding system to assess the activation of interpersonal motivational systems (IMS) in the transcripts of psychotherapy sessions. The Transition Index (TI) is an AIMIT measure that reflects the levels of organisation, synchronisation and harmony amongst two or more IMS when they are rapidly shifting or simultaneously in the clinical dialogue. It is supposed to be a measure of integration and coherence of the patient’s state of mind within the psychotherapeutic sessions. It has also been hypothesized that low TI could be a marker for disorganization of attachment of the patient leading to difficulties in the therapeutic relationships and ruptures in the therapeutic alliance. In order to assess this hypothesis we tested its capability to discriminate between Adult Attachment Interview (AAI) organized and disorganized individuals. Methods. Two groups of 15 transcriptions of AAI matched for age and sex, one classified as free-autonomous and one as disorganized, were analysed by the AIMIT method. Results. Compared to organized individuals, disorganized patients at AAI reported lower TI scores (3.7±0.63 vs 3.0±0.53; F=2.98, p=0.005). Furthermore, TI showed a good discriminant capability (Wilks’ Lambda=0.77, p=0.004). Discussion and Conclusion. This result seems to confirm the usefulness and reliability of AIMIT analysis in evaluating the interpersonal difficulties which often characterize the therapeutic relationship with disorganized attachment patient

Un'esplorazione neuroscientifica della dissociazione post-traumatica e la sua rilevanza per l'etica della psicoterapia

Riassunto: La prima parte dell’articolo riassume due ipotesi che connettono la dissociazione alle esperienze traumatiche: l’ipotesi della difesa intrapsichica contro il dolore mentale evocato dalle memorie traumatiche, e l’ipotesi dell’effetto disintegrante diretto delle esperienze traumatiche sulle funzioni mentali superiori. Nella seconda parte, l’articolo presenta sinteticamente i risultati di una ricerca in corso, che misura la connettività corticale (EEG Coherence) in una situazione sperimentale di evocazione di memorie di traumi cumulativi dell’infanzia avvenuti nel contesto delle relazioni di attaccamento. Tali risultati sembrano suffragare l’ipotesi dell’effetto disintegrante diretto, non dotato dei caratteri della difesa intrapsichica delle memorie traumatiche. Le possibili implicazioni dei contributi delle neuroscienze per l’etica della psicoterapia vengono infine discusse alla luce di questo esempio di ricerca.Parole chiave: Memorie traumatiche; Dissociazione; Etica della psicoterapia; Neuroscienza; Meccanismi di difesa.  A Neuroscientific Exploration of Post-Traumatic Dissociation and its Relevance for an Ethics of Psychotherapy Abstract: The first part of the paper presents two hypotheses linking dissociation to traumatic experiences: the idea that the link is an intrapsychic defensive process protecting an individual from the mental pain of traumatic memories, and the idea that traumatic experiences and memories directly disintegrate higher mental processes. The second part of the paper summarizes the findings of an ongoing research program assessing cortical connectivity (EEG coherence) in a situation of rehearsal of childhood cumulative traumas in the context of attachment relationships. These findings seem to support the hypothesis of a direct, non-defensive, dissociative influence of traumatic memories on cortical connectivity. This leads to a discussion on the possibility for neuroscientific contributions to the ethics of psychotherapy.Keywords: Traumatic Memories; Dissociation; Ethics of Psychotherapy; Neuroscience; Defensive Mechanisms

Default Mode Network alterations in alexithymia: An EEG power spectra and connectivity study

Recent neuroimaging studies have shown that alexithymia is characterized by functional alterations in different brain areas [e.g., posterior cingulate cortex (PCC)], during emotional/social tasks. However, only few data are available about alexithymic cortical networking features during resting state (RS). We have investigated the modifications of electroencephalographic (EEG) power spectra and EEG functional connectivity in the default mode network (DMN) in subjects with alexithymia. Eighteen subjects with alexithymia and eighteen subjects without alexithymia matched for age and gender were enrolled. EEG was recorded during 5 min of RS. EEG analyses were conducted by means of the exact Low Resolution Electric Tomography software (eLORETA). Compared to controls, alexithymic subjects showed a decrease of alpha power in the right PCC. In the connectivity analysis, compared to controls, alexithymic subjects showed a decrease of alpha connectivity between: (i) right anterior cingulate cortex and right PCC, (ii) right frontal lobe and right PCC, and (iii) right parietal lobe and right temporal lobe. Finally, mediation models showed that the association between alexithymia and EEG connectivity values was directed and was not mediated by psychopathology severity. Taken together, our results could reflect the neurophysiological substrate of some core features of alexithymia, such as the impairment in emotional awareness

A remark on an overdetermined problem in Riemannian Geometry

Let $(M,g)$ be a Riemannian manifold with a distinguished point $O$ and assume that the geodesic distance $d$ from $O$ is an isoparametric function. Let $\Omega\subset M$ be a bounded domain, with $O \in \Omega$, and consider the problem $\Delta_p u = -1$ in $\Omega$ with $u=0$ on $\partial \Omega$, where $\Delta_p$ is the $p$-Laplacian of $g$. We prove that if the normal derivative $\partial_{\nu}u$ of $u$ along the boundary of $\Omega$ is a function of $d$ satisfying suitable conditions, then $\Omega$ must be a geodesic ball. In particular, our result applies to open balls of $\mathbb{R}^n$ equipped with a rotationally symmetric metric of the form $g=dt^2+\rho^2(t)\,g_S$, where $g_S$ is the standard metric of the sphere.Comment: 8 pages. This paper has been written for possible publication in a special volume dedicated to the conference "Geometric Properties for Parabolic and Elliptic PDE's. 4th Italian-Japanese Workshop", organized in Palinuro in May 201

Problematic Use of the Internet Mediates the Association between Reduced Mentalization and Suicidal Ideation: A Cross-Sectional Study in Young Adults

© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Suicide is a major public health problem, and it is urgent to investigate its underlying clinical and psychological concomitants. It has been suggested that low mentalization skills and problematic use of the internet (PUI) are factors that can play a role in suicidal behaviors. It is possible that poor mentalization skills contribute to leading to forms of PUI, which, in turn, can represent triggers for suicidal ideation (SI). We tested this hypothesis through a quantitative and cross-sectional study on a sample (n = 623) of young adults (age range: 18−34). Self-report measures investigating symptoms related to Social Media Addiction (SMA), Internet Gaming Disorder (IGD), mentalization capacity, and SI were used. A single mediation analysis with two mediators was carried out to evaluate the direct and indirect effects of mentalization on SI through the mediating role of SMA- and IGD-related symptoms, controlling for potential confounding factors (e.g., socio-demographic and addiction-related variables). The four explored variables were significantly associated with each other (all p 0.001) across all subjects; the mediational model showed that the total effect of mentalization on SI was significant (B = −0.821, SE = 0.092 (95% CI: −1.001; −0.641)) and that both SMA- (B = −0.073, SE = 0.034 (95% CI: −0.145; −0.008)) and IGD-related symptoms (B = 0.046, SE = 0.027 (95% CI: −0.107; −0.001)) were significant mediators of such association. Our findings support the possibility that PUI severity plays a relevant role in mediating the association between low mentalization skills and levels of SI.Peer reviewedFinal Published versio

Refractory and 17p-deleted chronic lymphocytic leukemia: improving survival with pathway inhibitors and allogeneic stem cell transplantation.

ABSTRACT Refractory/early relapsed and 17p deletion/p53 mutation (del(17p)/TP53mut)-positive chronic lymphocytic leukemia (CLL) has been conventionally considered a high-risk disease, potentially eligible for treatment with allogeneic stem cell transplantation (alloSCT). In this multicenter retrospective analysis of 157 patients, we compared the outcomes of patients with high-risk CLL treated with alloSCT, a B-cell receptor pathway inhibitor (BCRi), and both. Seventy-one patients were treated with BCRis, 67 patients underwent reduced-intensity conditioning alloSCT, and 19 received alloSCT with a BCRi before and/or after transplantation. Inverse probability of treatment weighting analyses were performed to compare the alloSCT and no-alloSCT groups; in the 2 groups, 5-year OS, PFS, and cumulative incidence of nonrelapse mortality (NRM) and relapse were 40% versus 60% (P = .096), 34% versus 17% (P = .638), 28% versus 5% (P = .016), and 38% versus 83% (P = .005), respectively. Patients treated with alloSCT plus BCRi had a 3-year OS of 83%. The 3-year OS and NRM by year of alloSCT, including patients treated with BCRi, were 53% and 17% in 2000 to 2007, 55% and 30% in 2008 to 2012, and 72% and 18% in 2013 to 2018. In conclusion, the combination of pathway inhibitors and alloSCT is feasible and may further improve the outcome of high-risk CLL patients