Childhood adversities and psychopathological outcomes

Maltreatment of children by their parents or other caregivers is widely spread, and can cause serious injury and severe long-term consequences. Child maltreatment encompasses any acts of commission or omission by a parent or other caregiver that result in harm, potential for harm, or threat of harm to a child or adolescent (usually interpreted as up to 18 years of age), even if harm is not the intended result. In the past two decades, four forms of maltreatment have been increasingly recognised: physical abuse; sexual abuse; psychological abuse, sometimes referred to as emotional abuse; and neglect. Research from high-income countries revealed that 4–16% of children experienced severe parental violence, 15–30% of girls and 5–15% of boys experienced sexual abuse, and one in ten children was neglected. Self-report studies from the UK and the US showed that 8–9% of women and about 4% of men reported exposure to severe psychological abuse during childhood. Childhood maltreatment has unique and important implications since it can exert negative influences on sensitive developmental periods for emotional, behavioural, cognitive, and social domains; thereby, interrupt healthy development and lead to an increased risk for the development of psychopathology. Indeed, there is a large body of evidence that exposure to childhood maltreatment is a robust predictor of later psychiatric disorder, including mood disorders, anxiety disorders, eating disorders, substance use disorders, posttraumatic stress disorder (PTSD), and personality disorders. Thus, there is increasing interest in deepen the understanding on how and under which circumstances childhood adversity leads to psychiatric disorders; and in identifying different factors that may be associated with specific forms of mental suffering. Theoretical models have posited that specific types of childhood adversity, such as physical abuse, sexual abuse or psychological abuse, may be uniquely related to specific psychiatric outcomes. Unfortunately, studies among youth and adult samples suggest that, while exposure to early adversity is associated with increased risk for psychiatric disorder, the influence of specific types of childhood maltreatment on different mental disorder outcomes remains controversial. The aim of present thesis was a deep examination of the potential psychopathological outcomes related to childhood adversities. In particular, the specific role of different kinds of childhood maltreatment (e.g., physical, sexual, and emotional abuse) and of familial or social factors (e.g., parental bonding, family functioning, social support) on different mental disorders (e.g. borderline personality disorders, depression, etc.) was examined. For this purpose, the present work is articulated in three separate studies, each of which has analyzed specific aspects of the main topic. In particular, Study 1 has focused on the specific associations of childhood maltreatment, parental bonding and family functioning in female adolescents with borderline personality disorder (BPD) compared with female adolescents with others psychiatric conditions. Study 2 sought to investigate the specific effect of environmental factors on mental health outcomes of early-maltreated adults, by comparing a group of mixed clinical participants (CG) with childhood experiences of abuse and neglect with a healthy group (HG) with similar patterns of experiences. Finally, Study 3 used a meta-analytic approach to assess the specific influence of different types of maltreatment on depression outcome in adults and adolescents. In addition to the general topic, the recurrent theme of the three studies was the specific assessment measure that was used to detect and classify early experiences of childhood adversity: the Childhood Experiences of Care and Abuse (CECA), interview or questionnaire version (Bifulco, Bernazzani, Moran, & Jacobs, 2005; Bifulco, Brown, & Harris, 1994). This measure is considered the current ‘gold standard’ for the assessment of adverse childhood experiences in the international research field. The findings of the present three studies revealed interesting insights allowing better understanding of the specific influence of different types of childhood adversity on specific mental health outcomes. The results from Study 1 and 3 clearly showed that the more “silent” forms of maltreatment such as psychological abuse, antipathy and neglect might have a decisive role on development of psychopathological outcomes. Given that a broad range of experiences is subsumed under the term “adversity,” future research and clinical assessment needs to be comprehensive and assess a large range of early maltreatment forms. Exhaustive, complex, and reliable assessment tools that are able to detect the large variety of negative experiences and include key dimensions of these experiences such as type, severity, chronicity, and timing should support these assessments. Finally, those identified with a history of early adversity may be candidates for more intensive psychiatric and psychotherapeutic treatments. As our understanding of the differential effects of adversity develops, treatments may be individually tailored to the type and timing of exposure. As demonstrated in Study 2, psychological resilience derived from positive social support to those who were able to survive early life adversity without psychopathological development. In case of a critical family environment, support from outside may thus potentially attenuate the effect of adversity exposure on the subsequent risk for psychiatric disorder. Community-based preventive interventions that improve either the quality of children’s family life or alternatively the support of their respective neighbourhood environments may have substantial long-term benefits by reducing the incidence of psychiatric disorders in the general population. Some periods of vulnerability have also been highlighted in this research. Indeed, results from Study 3 showed that adolescents were more affected by childhood maltreatment than adults in terms of their risk for major depressive disorder. Theorists have argued that exposure to adversity during the critical developmental periods of late childhood and early adolescence may confer high vulnerability to particular forms of psychiatric disorders, perhaps owing to the rapid brain development that occurs during these ages. Thus, the transition to puberty may be a critical developmental period, which carries increased risk for particular forms of psychiatric disorders in case of a disturbing and non-supportive environment. Further research is needed to identify the precise critical periods and the forms of adversity most damaging at each period. Longitudinal designs might offer significant advantages for examining differential effects of early adversity by age of exposure, and thus for identifying critical periods in human development that confer heightened risk for psychiatric disorders in later life

Le piccole scuole nel contesto della Strategia Nazionale delle Aree Interne

The internal areas represent a large part of the country which, faced with a highavailability of cultural and environmental resources, is characterized by phenomenaof aging and population decline. These aspects determine an ever greaterdifficulty in the living conditions of the citizens who live there. The National Strategyfor Internal Areas (SNAI) is born for the revival and development of theseterritories and provides for two convergent lines of action: one concerns interventionsaimed at ensuring adequate levels of essential services to the population(health, education, and mobility) and another focuses on the promotion oflocal development in line with territorial vocations. The school represents forthese territories a civic and cultural garrison of great importance, however theschools of the municipalities of the Internal Areas present problems aswidespread as they are complex, with marked features of similarity from northto south. To cope with this, each area has identified diversified solutions that areconsistent with the social and territorial peculiarities of their communities. Thiscontribution presents the innovative and excellent choices that the internal areaGran Paradis (Valle d’Aosta) has decided to undertake to relaunch its territory.Le aree interne rappresentano una parte ampia del Paese, che a fronte di un’elevatadisponibilità di risorse culturali e ambientali è caratterizzata da fenomeni diinvecchiamento e calo della popolazione, che determinano una sempre maggioredifficoltà delle condizioni di vita dei cittadini che vi risiedono. La StrategiaNazionale per le Aree Interne (SNAI) nasce per il rilancio e lo sviluppo di questiterritori e prevede due linee di azione convergenti: una riguarda interventi voltiad assicurare livelli adeguati dei servizi essenziali alla popolazione (salute, istruzionee mobilità) e l’altra punta sulla promozione dello sviluppo locale in lineacon le vocazioni territoriali. La scuola rappresenta per questi territori un presidiocivico e culturale di grande importanza, tuttavia le scuole dei comuni delle AreeInterne presentano problematiche tanto diffuse quanto complesse, con marcatitratti di similarità da nord a sud. Ciascuna area per farvi fronte ha individuato soluzionidiversificate e coerenti con le peculiarità sociali e territoriali delle propriecomunità. In questo contributo vengono presentate le scelte innovative e di eccellenzache l’area interna Gran Paradis (Valle d’Aosta) ha deciso di intraprendereper il rilancio del proprio territorio

Influenze tra processo ed esiti: alleanza, coesione e cambiamento in un gruppo terapeutico a lungo termine

Research is currently moving in the direction of an integration between the outcome measures of the patients and the relational and/or structural factors that can facilitate their change. It is increasingly important to focus studies on the relationship between process and outcome, especially with regard to psychodynamic group therapy. These treatments, very complex and difficult to operationalize, still pose critical questions for research such as what are the main elements of the therapeutic process that are activated in these therapies?Many efforts are to be made in understanding which factors develop in groups and the conditions that positively influence the success of therapy. Important is, moreover, the work of conceptual and "operational" depth on the different constructs, to better understand their nature and differences and build tools to more easily detect their features. Therapeutic alliance and cohesion are among the most investigated process variables, because of their role on the results of therapy.This study investigates these two variables in a therapeutic group with severe patients and analyzes their associations with treatment outcomes in term of symptoms and defenses. A long-term, semi-open group meeting on a weekly basis was examined. The observation was carried out for a period of 18 months, for a total amount of 50 sessions; 11 patients with different diagnoses in Axis I and II DSM IV were examined. Outcome measures: SCL-90 - Symptom Check List; OQ-45 - Outcome Questionnaire 45.2; DSQ - Defense Style Questionnaire.Process measures: CALPAS-G: California Psychotherapy Alliance Scale-Group; GMLCS: Group/Member/Leader Cohesion Scale. The observation period was divided into 3 phases according to re-modulations of the setting (new entries, overcomes, dropout). Significant correlations between alliance, cohesion and outcomes were found in the three phases. During the phase of greater instability, the predominant role of cohesion and, more generally, dimensions related to group commitment emerge. Results offer interesting suggestions about the differentiation between Alliance and Cohesion and their different relationship with outcomes and process evolution

Linee guida per le comunita’ per minori. Uno strumento per la definizione di standard di funzionamento.

Le comunità e le strutture residenziali si possono connotare come “setting terapeutici”, capaci di generare un clima di spessore affettivo, sviluppare nuove, sicure e funzionali possibilità di esperienze interpersonali, assicurare un regolare svolgimento del percorso di crescita e la creazione di uno spazio mentale dedicato all’elaborazione di un progetto per il minore (Giannone, 2005; Brunori, Raggi, 2007; Bastianoni, Taurino, 2009). Il network della Community of Communities lavora ad un processo sistematico di miglioramento della qualità delle Comunità terapeutiche per bambini e adolescenti attraverso la formulazione di standard grazie ai quali le equipe e gli utenti delle comunità possono condividere le “migliori pratiche” ed utilizzarle come riferimento per l’autovalutazione, la valutazione tra pari e come aiuto, nello sviluppo dei propri servizi. In questo contributo sarà presentato l’adattamento italiano degli Standard per le Comunità per Minori della Community of Communities ed i primi dati relativi ad una ricerca condotta su un gruppo di operatori di comunità cui, a scopo esplorativo è stato proposto un self-report costruito sulla base degli Standard per le comunità per minori. I risultati consentono di evidenziare risorse ed aree critiche che caratterizzano il funzionamento delle strutture residenziali per minori, al fine di progettare meglio programmi di intervento e formazione funzionali ai reali bisogni delle comunità

Esperienze sfavorevoli infantili e dipendenza da sostanze: contesti di vita e narrazioni nella CECA interview

Introduzione: La letteratura internazionale sul ruolo delle esperienze infantili nella strutturazione della personalità adulta riconosce l’impatto a lungo termine di situazioni traumatiche precoci (Bifulco, Moran, 1998; Fonagy et al, 2002; Giannone et al, 2011). Le diverse tipologie di abuso (emotivo, fisico e sessuale) vissute nella prima infanzia possono aumentare lo strutturarsi in età adulta di problemi legati al consumo di sostanze stupefacenti e condizioni di dipendenza (Dube et al., 2003; Huang et al, 2011; Lansford et al., 2010; Pederson et al, 2008). Risulta pertanto importante l’approfondimento delle condizioni di sviluppo che sottostanno allo strutturarsi di tali patologie. La Childhood Experience of Care and Abuse (CECA) Interview (Bifulco et al., 1994; Giannone, Schimmenti et al., 2011) permette una accurata valutazione di tali condizioni, consentendo sia l’analisi in profondità dei contesti di sviluppo, sia la rilevazione di indicatori empirici delle esperienze infantili. Metodo: Un gruppo di 25 tossicodipendenti, in trattamento in Comunità, è stato intervistato con la CECA, che prevede la valutazione di 6 tipologie di maltrattamento/abuso e di variabili dei contesti di accudimento. Il contributo propone i primi risultati sulla presenza e qualità delle esperienze traumatiche rilevate nel gruppo e frammenti di narrazioni dalle interviste. Risultati: Non sono state rilevate categorie di maltrattamento/abuso prevalenti e ricorsive, ma la maggior parte dei soggetti ha esperito situazioni traumatiche infantili di grave intensità. La lettura clinica delle interviste ne fa cogliere l’impatto sulla vita dei soggetti e offre nuovi spunti per la comprensione del contesti maltrattanti e le loro ricadute. Conclusioni: Strumenti come la CECA, in grado di coniugare criteri empirici e approccio clinico, aprono la possibilità di percorsi di studio sempre più articolati e approfonditi, e sul piano dei dati empirici e su quello della riflessione teorico-clinica

Substance addiction and adverse childhood experiences: an empirical study with Childhood Experience of Care and Abuse

International audienceMany studies showed that adverse childhood experiences may increase the risk of substance abuse. Thirty-two male participants in treatment for substance abuse and thirty-two non clinical subjects were interviewed with Childhood Experience of Care and Abuse (CECA). Subjects with substance addiction had experienced more neglect, physical abuse, psychological abuse, inconsistent supervision and variable discipline compared with their non clinical control (p < 0.05). Furthermore, they were exposed during childhood to a greater number of adverse experiences (p = 0.01) than their control. The study suggests that specific types of adverse childhood experiences can play a key role in the onset of addictive disorders

Premesse teorico-epistemologiche per una ricerca/intervento attraverso il gruppo con genitori del Servizio Spazio Neutro

International audienc

Dipendenza da sostanze ed esperienze sfavorevoli infantili: uno studio empirico condotto con la Childhood Experiences of Care and Abuse Interview (CECA)

Backgroud: Numerose ricerche rilevano l’impatto che esperienze sfavorevoli infantili possono avere sulla dipendenza da sostanze. Metodo: 32 tossicodipendenti maschi in trattamento presso comunità e 32 soggetti appartenenti a un gruppo non clinico sono stai intervistati attraverso la Childhood Experience of Care and Abuse. Risultati: La maggior parte dei soggetti del gruppo clinico ha esperito maggiori esperienze (p<0,05) di negligenza, abuso fisico, abuso psicologico e ha ricevuto forme più inadeguate di supervisione e disciplina. Inoltre, i soggetti del gruppo clinico sono stati esposti a un numero più elevato (p=0,01) di esperienze sfavorevoli. Conclusioni: I risultati suggeriscono la presenza di specifiche forme di abuso e maltrattamento legate allo sviluppo di dipendenza da sostanze.Background: Many studies showed that adverse childhood experiences may increase the risk of substance abuse. Method: Thirty-two male participants in treatment for substance abuse and thirty-two non clinical subjects were interviewed with Childhood Experience of Care and Abuse (CECA). Results: Subjects with substance addiction had experienced more neglect, physical abuse, psychological abuse, inconsistent supervision and variable discipline compared with their non clinical control (p<0,05). Furthermore, they were exposed during childhood to a greater number of adverse experiences (p=0,01) than their control. Conclusion: The study suggests that specific types of adverse childhood experiences can play a key role in the onset of addictive disorders