Single fathers by choice using surrogacy. Why men decide to have a child as a single parent

STUDY QUESTION: Why do men decide to have a child by surrogacy as a single parent? SUMMARY ANSWER: Reasons included feeling that it was the right time (i.e. having 'worked through' concerns about single parenthood; career and financial stability; a fear of getting older; no longer wanting to wait for the 'right' relationship), external encouragement, a desire to reproduce and a fear of separation/divorce. WHAT IS KNOWN ALREADY: Because no research has been conducted on single fathers who used surrogacy, their characteristics, motivations and experiences are unknown. STUDY DESIGN, SIZE, DURATION: This study used a cross-sectional design as part of a larger, multi-method, multi-informant investigation of single father families created by surrogacy. Multiple strategies were used to recruit participants (i.e. from an association of gay parents, Facebook groups of single parents and snowballing) between November 2016 and April 2017. Data were obtained from 33 Italian single fathers (Meanage = 47.33 years, SD = 4.63), most of whom self-identified as gay (n = 24, 72.7%). PARTICIPANTS/MATERIALS, SETTING, METHODS: In-depth semi-structured interviews were conducted in family homes (n = 20, 60.6%) or over Skype (n = 13, 39.4%). Each interview lasted approximately 40 min and was audio recorded, transcribed verbatim and analyzed using thematic and qualitative content analysis, with the aid of the software package MAXQDA. Where appropriate, a two-sided Fisher's exact test was used to compare the gay and heterosexual fathers, and illustrative quotations were reported. MAIN RESULTS AND THE ROLE OF CHANCE: Although all of the single men had experienced mature relationships, about one-third of the fathers (n = 10, 30.3%) had never thought of having a child and the majority of the heterosexual men (n = 7, 77.8%, P = 0.05) had tried to conceive in previous relationships. The gay and heterosexual men differed in their preferred path to parenthood (P = 0.01), with the former (n = 17, 70.8%) having always preferred surrogacy and the latter (n = 6, 66.7%) having considered or attempted conception via casual sex with women. Irrespective of their sexual orientation, most of the fathers chose surrogacy because they wanted a genetic relation to their child (n = 28, 84.8%) and because they felt that surrogacy would be more secure compared to adoption, upon their return to Italy due to Italian laws (n = 26, 78.7%). The majority (n = 20, 60.6%) were satisfied with their decision to 'go it alone', although nearly all (n = 16, 80%) would have preferred to have a child within the context of a relationship. After their child's birth, the majority received support from both their parents/siblings (n = 21, 63.7%) and friends (n = 24, 72.7%). LIMITATIONS, REASONS FOR CAUTION: The risk of socially desirable responding should be taken into account when interpreting the findings, given the ethical concerns surrounding single fatherhood and surrogacy. Furthermore, fathers with a negative surrogacy experience were less likely to participate in this research. The small sample and participant characteristics of older age, an Italian nationality, a mainly gay sexual orientation and high income may limit the generalizability of the findings. WIDER IMPLICATIONS OF THE FINDINGS: This study is the first to provide insight into the reproductive experience of single men seeking surrogacy. The findings warn practitioners and policy-makers against making assumptions about people with access to fertility treatments on the basis of marital status, gender or sexual orientation. STUDY FUNDING/COMPETING INTEREST(S): None

Surrogacy families headed by gay men: Children’s psychological adjustment, gender-typed play behavior, attachment security, and views on their surrogacy origins

Il presente progetto di dottorato si è posto l’obiettivo di indagare il benessere dei bambini nati da gestazione per altri in famiglie composte da padri gay. Nello specifico, utilizzando una procedura multi-metodo (questionari standardizzati, interviste semi-strutturate, interazioni di gioco video-registrate) e multi-informante (genitori, bambini, insegnanti, neuropsichiatra infantile, altre figure significative), sono state indagate le quattro seguenti domande di ricerca: 1. I bambini concepiti con gestazione per altri e cresciuti in famiglie con padri gay sono a rischio di sviluppare problemi psicologici data la modalità del loro concepimento e la mancanza di una figura materna? 2. I bambini con padri gay mostrano comportamenti di genere adeguati nonostante la mancanza di una figura femminile in casa? 3. Il concepimento con gestazione per altri e l’orientamento omosessuale dei genitori influenzano la qualità dell’attaccamento dei bambini? 4. Quali sono i vissuti e i pensieri dei bambini nati con gestazione per altri nei confronti della propria gestante e della propria donatrice d’ovulo? Nel primo e nel secondo studio sono state confrontate 40 famiglie di padri gay ricorsi a gestazione per altri con 40 famiglie di madri lesbiche ricorse a donazione di seme, tutte con figli tra i 3 e i 9 anni (età media = 6.1 anni). Le famiglie con madri lesbiche sono state scelte come gruppo di controllo sia alla luce dei risultati di 40 anni di ricerche che hanno dimostrato che i bambini con madri lesbiche non presentano livelli più elevati di problemi psicologici in confronto a bambini con genitori eterosessuali, sia per controllare l’orientamento non eterosessuale dei genitori e la modalità di concepimento con procreazione medicalmente assistita. In merito al primo quesito di ricerca, i padri gay hanno riferito livelli inferiori di problemi internalizzanti dei loro figli rispetto alle madri lesbiche, sebbene in entrambi i gruppi i livelli di problemi internalizzanti fossero ben al di sotto della soglia di significatività clinica. Differenze nei livelli di problemi internalizzanti nelle due tipologie familiari non sono comunque state confermate né dalla valutazione degli insegnanti né da quella del neuropsichiatra infantile. Non sono emerse nemmeno differenze nei livelli di problemi esternalizzanti. Piuttosto, fattori associati a maggiori problemi emotivi sono emersi l’aver subito episodi di stigmatizzazione familiare, il basso reddito familiare e l’appartenere a una famiglia con due madri lesbiche; d’altra parte, il genere maschile del bambino, l’aver subito episodi di stigmatizzazione familiare e una genitorialità caratterizzata da frequente e elevata conflittualità, criticismo nei confronti del bambino e aggressività predicono problemi comportamentali nei bambini. In merito al secondo quesito di ricerca, è emerso che, indipendentemente dal tipo di famiglia, i bambini mostrano preferenze per attività di gioco più mascoline rispetto alle bambine. Inoltre, nelle famiglie di padri gay i bambini e le bambine mostrano comportamenti di gioco maggiormente stereotipati rispetto ai bambini e alle bambine con madri lesbiche. Infine, i bambini con padri gay preferiscono attività di gioco più mascoline rispetto ai bambini con madri lesbiche, mentre le bambine con padri gay preferiscono attività di gioco più femminili rispetto alle bambine con madri lesbiche. Nel terzo studio sono stati confrontati 33 figli di padri gay con 37 figli di madri lesbiche di età tra i 6 e i 12 anni (età media = 8.3 anni) rispetto alla qualità dell’attaccamento e alla modalità con cui utilizzano i propri genitori nei momenti di pericolo o turbamento (rifugio emotivo) e per allontanarsi ed esplorare l’ambiente circostante (base sicura). I risultati non hanno mostrato differenze significative tra i due gruppi rispetto alla qualità dell’attaccamento, con il 45.5% dei figli di padri gay con attaccamento sicuro, il 39.4% con attaccamento insicuro distanziante, il 12.1% con attaccamento insicuro preoccupato e il 3% con attaccamento disorientato-disorganizzato. A prescindere dalla tipologia familiare, elevati livelli di calore e responsività genitoriale, disponibilità a fungere da figura di attaccamento, bassi livelli di rifiuto e controllo genitoriale, e la più giovane età del bambino si associano a più alti livelli di sicurezza dell’attaccamento nel bambino. In entrambe le tipologie familiari il caregiver primario viene più utilizzato come rifugio emotivo, mentre il caregiver secondario viene utilizzato più come base sicura. Nel quarto studio sono stati intervistati 31 bambini di età tra i 6 e 12 anni (età media = 8.3 anni) sulla loro esperienza del concepimento. La maggior parte (n = 17, 54.8%) ha mostrato una chiara comprensione della modalità del proprio concepimento, spiegando i differenti ruoli svolti dalla gestante e dalla donatrice d’ovulo. La maggior parte di loro (n = 19, 61.3%) ha dichiarato un limitato interesse nei confronti del proprio concepimento, 11 (35.5%) hanno espresso sentimenti positivi, mentre 1 (3.2%) non era certo di cosa provasse. I bambini hanno espresso differenti sentimenti nei confronti della gestante e della donatrice: più bambini hanno espresso gratitudine verso la propria gestante, considerandola anche come una “zia”; mentre più bambini si sono dichiarati indifferenti o poco interessati alla propria donatrice, definendola “signora gentile” o semplicemente “donatrice”. Il presente progetto di ricerca è il primo a livello nazionale e uno dei primi a livello internazionale ad aver indagato empiricamente le principali obiezioni rivolte alle famiglie con padri gay che concepiscono con gestazione per altri. I risultati hanno importanti implicazioni per i chi si occupa di politiche sociali, poiché evidenziano che l’orientamento omosessuale dei genitori e il concepimento con gestazione per altri non sono di per sé predittivi di problemi psicologici nei bambini. Da un punto di vista teorico, si allineano alla letteratura sul parenting, mostrando che è la qualità dei processi familiari, e non la struttura familiare, a determinare il benessere psicologico dei bambini

Il benessere dei bambini e delle bambine con genitori gay e lesbiche

La finalità di questo documento è quella di chiarire parole e dimensioni concettuali legate al genere, con specifico riferimento alle famiglie omogenitoriali, mirando a fornire informazioni basate sulla competenza e la ricerca di esperti del settore. Le famiglie omogenitoriali, specie quelle visibili, in cui i figli sono cresciuti da due madri o due padri, sono infatti considerate da alcuni quasi “la somma di tutti i mali” perché rimettono in discussione concetti chiave della nostra storia culturale (come la filiazione e i ruoli di genere all’interno della copia genitoriale). In effetti, chi fomenta paura rifacendosi alla spaventosa “teoria del gender” sogna un mondo immutabile e immutato, in cui le donne e gli uomini hanno ruoli ben definiti, in cui c’è un solo modo di essere e un solo modo di comportarsi e le donne devono rimanere al loro posto. I cambiamenti terrorizzano chi non vuole cambiare, non chi aspira a più libertà e più diritti per tutti e lavora alla convivenza civile, al superamento delle disuguaglianze, al miglioramento delle relazioni fra le persone al di là del loro genere, orientamento sessuale, sesso biologico

Gay father surrogacy families: relationships with surrogates and egg donors and parental disclosure of children's origins.

OBJECTIVE: To study the nature and quality of relationships between gay father families and their surrogates and egg donors and parental disclosure of children's origins. DESIGN: Cross-sectional study. SETTING: Family homes. PATIENT(S): Parents in 40 gay father families with 3-9-year-old children born through surrogacy. INTERVENTION(S): Administration of a semistructured interview. MAIN OUTCOME MEASURE(S): Relationships between parents, children, surrogates, and egg donors and parental disclosure of children's origins were examined using a semistructured interview. RESULT(S): The majority of fathers were content with the level of contact they had with the surrogate, with those who were discontent wanting more contact. Fathers were more likely to maintain relationships with surrogates than egg donors, and almost all families had started the process of talking to their children about their origins, with the level of detail and children's understanding increasing with the age of the child. CONCLUSION(S): In gay father surrogacy families with young children, relationships between parents, children, surrogates, and egg donors are generally positive.Wellcome Trust (Grant ID:097857/Z/11/Z)This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.fertnstert.2016.08.01

Therapist reactions to patient personality: A pilot study of clinicians’ emotional and neural responses using three clinical vignettes from "In Treatment" series

Introduction: Therapists’ responses to patients play a crucial role in psychotherapy and are considered a key component of the patient–clinician relationship, which promotes successful treatment outcomes. To date, no empirical research has ever investigated therapist response patterns to patients with different personality disorders from a neuroscience perspective. Methods: In the present study, psychodynamic therapists (N = 14) were asked to complete a battery of instruments (including the Therapist Response Questionnaire) after watching three videos showing clinical interactions between a therapist and three patients with narcissistic, histrionic/borderline, and depressive personality disorders, respectively. Subsequently, participants’ high-density electroencephalography (hdEEG) was recorded as they passively viewed pictures of the patients’ faces, which were selected from the still images of the previously shown videos. Supervised machine learning (ML) was used to evaluate whether: (1) therapists’ responses predicted which patient they observed during the EEG task and whether specific clinician reactions were involved in distinguishing between patients with different personality disorders (using pairwise comparisons); and (2) therapists’ event-related potentials (ERPs) predicted which patient they observed during the laboratory experiment and whether distinct ERP components allowed this forecast. Results: The results indicated that therapists showed distinct patterns of criticized/devalued and sexualized reactions to visual depictions of patients with different personality disorders, at statistically systematic and clinically meaningful levels. Moreover, therapists’ late positive potentials (LPPs) in the hippocampus were able to determine which patient they observed during the EEG task, with high accuracy. Discussion: These results, albeit preliminary, shed light on the role played by therapists’ memory processes in psychotherapy. Clinical and neuroscience implications of the empirical investigation of therapist responses are discussed

The intergenerational transmission of attachment during middle childhood in lesbian, gay, and heterosexual parent families through assisted reproduction: The mediating role of reflective functioning

the present study examined the attachment patterns distribution of 60 lesbian mothers, 50 gay fathers, and 42 heterosexual parents through assisted reproduction and their 76 children, using the Adult Attachment Interview (AAI) and the Friends and Family Interview (FFI), respectively. the study also explored the intergenerational transmission of attachment through reflective functioning (AAI-RF). all families lived in italy and children were aged 6-12 years (Myears = 8.11, SD = 2.17; 48.68% assigned female at birth). the AAI patterns distribution was similar across family types and did not significantly differ from international and national normative data. similarly, children's FFI attachment patterns were evenly distributed between family types, and no significant differences emerged in comparison to international and national normative data referring to middle childhood samples. mediational models revealed that, in all three family types, parents with greater AAI coherence of mind exhibited higher AAI-RF, which, in turn, was associated with increased FFI attachment security in children. Furthermore, parents' AAI coherence of mind directly influenced children's FFI attachment security. the results support and expand hypotheses regarding the intergenerational transmission of attachment in lesbian, gay, and heterosexual parent families through assisted reproduction, while offering unique indications to support these families during middle childhood

Disease awareness in patients with COPD: measurement and extent

Background: Patient awareness of COPD refers to knowledge and acceptance of the disease and its treatment. Although it is relevant to management and outcomes, the disease awareness of patients is poorly investigated, and no validated questionnaires are currently available. We aimed to develop the novel Disease Awareness in COPD Questionnaire (DACQ), which was validated in relation to demographic and clinical features, in patients participating in the SATisfaction and Adherence to COPD Treatment (SAT) study. Methods: DACQ was developed according to a list of items regarding the patient's knowledge, acceptance, and perception of COPD as well as of treatment needs. The questionnaire was validated by assessing internal structure and consistency, correlations with other patient-reported outcomes, and stability over time. Furthermore, the extent of disease awareness of patients enrolled in the SAT study was assessed by using DACQ, and correlations with demographic and clinical features were evaluated. Results: DACQ was composed of four domains. Overall reliability and stability over time were adequate; correlations between DACQ and other tools measuring different constructs (ie, treatment satisfaction, illness perception, impact of COPD symptoms on daily life, and dyspnea severity) were, as expected, more limited. In the enrolled patient sample, a suboptimal level of disease awareness (<70%) was detected, especially in terms of disease acceptance and perception. Disease knowledge was positively associated with COPD severity, while the impact of symptoms on daily life was negatively associated with disease acceptance, awareness of treatment needs, and overall awareness. Conclusion: DACQ proved to be a reliable tool to assess awareness in COPD patients. Awareness of COPD patients need to be improved. Clinical trial registration: ClinicalTrials.gov ID# NCT02689492

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

In origine è il dono. Donatori e portatrici nell'immaginario delle famiglie omogenitoriali

Negli ultimi quarant’anni il panorama della genitorialità si è declinato in combinazioni sempre più complesse e la riproduzione (etero)sessuale è diventata una tra le molte possibilità per avere figli. Questo cambiamento, già sancito dal sistema delle adozioni, è stato reso ancora più manifesto dagli sviluppi delle biotecnologie e dall’omogenitorialità. Tuttavia, per quanto le tecniche di procreazione medicalmente assistita consentano di diventare genitori senza il vincolo dell’accoppiamento sessuale, è impossibile non fare i conti con la differenza tra i sessi e il ruolo che questa ha nella riproduzione e nel tema della propria origine, così strettamente legato a quello dell’identità. «E l’affetto immenso, per un dono da straniera mano?» domanda Edipo al Messaggero. Quando il dono del seme, dell’ovulo o dell’utero sono all’origine della filiazione, quali pensieri, affetti e immagini i genitori gay e lesbiche maturano verso i donatori e le donatrici di gameti e verso la portatrice? Possiamo parlare di «dono» se è prevista una ricompensa economica? E qual è il destino delle identificazioni sessuali se vengono a mancare le figure «concrete» del padre e della madre e la figura simbolica dell’accoppiamento sessuale maschio-femmina? In origine è il dono racconta e chiarisce, approfondendoli, i risultati di anni di ricerche sulla genitorialità tramite procreazione assistita – argomento di numerosi dibattiti, di cui però molti e molte hanno ancora una conoscenza approssimativa – e interroga sul campo le esperienze di coloro che hanno vissuto in prima persona questa nuova e sorprendente possibilità: la presenza/assenza di un «terzo» nella propria vita, l’introduzione di un estraneo necessario al concepimento che, donando la propria biologia, aiuta a creare una nuova famiglia, entrando a far parte, in alcuni casi, della sua storia affettiva. Nicola Carone mette in dialogo medicina e psicologia, sociologia e mito, dando vita a un’indagine rigorosa che approfondisce scientificamente ciò che troppo spesso è affidato a conoscenze superficiali e a reazioni ideologiche e viscerali