Binge eating disorder (BED) and psychopathological symptoms in adolescence: preliminary report from a study in Liguria.

The prevalence of Binge Eating Disorder (BED), added in the new DSM-5, is increasing among teenagers and young adults of Western Countries (Goldschmidt et al., 2016). Despite is well-known the prevalence of eating disorders in adolescence, little of specific is known about the BED, which could show comorbidity both with internalizing and externalizing symptoms in adolescents (Forrest et al., 2017; Pace, Guiducci & Cavanna, 2016; Swanson et al., 2011). This preliminary study involved a non-clinical sample of Italian adolescents. We aimed to investigate: 1) the prevalence of BED and psychopathological symptoms; 2) the associations between BED and internalizing and externalizing symptoms. This report is the first screening wave of a larger study that aims to explore the psychological variables which can be associated with the risk of BED in adolescence, such as attachment representations and emotional functioning. The participants were 382 adolescents (aged 13-18 years, M= 15.59, SD=1.1; 38.5% males 61.5% females), enrolled from high-schools in Liguria. The measures were: 1) demographic and anamnestic data set; 2) the Binge Eating Scale (BES) to assess the risk or presence of Binge Eating Disorder (cut off >= 17); 3) the Youth Self Report 11/18 (YSR 11/18) to assess internalizing (cut-off M>29, F>35) and externalizing (cut-off M>31, F>26) problems. We found the 6% of adolescents resulting as at-risk on BES scale (22 girls and 1 boy); 8 boys and 19 girls showed internalizing symptoms (7.07%), while 3 boys and 11 girls externalizing symptoms (3.66%). Correlations were found between BES and YSR scores in internalizing (r = .424; p = .000) and externalizing (r = .153; p = .003) symptoms. These results suggest to deepen investigate comorbidities between BED and other psychopathological problems in adolescence

Relationships among internalizing and externalizing problems, attachment and alexithymia in high-risk and community adolescents: a multi-method comparative study.

Late-adopted (i.e. adopted after 12months) and residential-care adolescents, due to higher rates of adverse childhood experiences, show high rates of internalizing-externalizing problems and they are at high-risk to show attachment insecurity and alexithymia, which are risk-factors that may increase psychopathological vulnerability during adolescence. However, no studies before compare in the same occasion these two high-risk groups of adolescents with community peers in internalizing-externalizing problems, attachment and alexithymia, which were never assessed simultaneously in these groups. This mixed-method comparative research involved 174 non-clinical adolescents aged 10-19 years (M = 15.55, SD = 2.02, 53% boys) matched for age and gender in 3 groups: two "high-risk groups" of 33 late-adoptees (LA, i.e. adopted after 12 months) and 50 in residential-care (RC), and 91 community teens as low-risk control group (C), with two main aims: 1) to compare groups in internalizing-externalizing problems, attachment and alexithymia with a mixed-method, multi-informant approach, in order to check the assumed vulnerability of high-risk adolescents in these variables. 2) to explore relationships between internalizing-externalizing problems, attachment and alexithymia through groups, exploring the cumulative and interactive effects of attachment and alexithymia as possible risk factors for more internalizing-externalizing problems during adolescence. After the approval of the University's Research Ethic Commitee, formal agreements with the Social and Health Services for adoption and residential-care and high-school for the recruitment of participants,and the signature by legal care-takers of an informed consent for the voluntarly participation of the adolescent in the research, each participant was assessed in two meetings in home visiting. Measures were: The Child Behavior Check List 6-18 years (CBCL, filled by a biological or adoptive parent and by the educator in the RC group) and the Youth Self Report 11-18 years (YSR) to assess internalizing-externalizing problems; the Friends and Family Interview (FFI) and the Inventory for Parent and Peer Attachment (IPPA) to assess attachment representations and relationships; the Toronto Alexithymia Scale 20 item (TAS-20) and the Toronto Structured Interview for Alexithymia (TSIA) to assess alexithymia; the verbal comprehension index of the Weschler Intelligence Scale for Children 4th edition (ICV-WISC-IV) to control the confounding effect of participant's verbal skills in the interview, plus a socio-demographic data form to collect demographic and anamnestic data (e.g. age and lenght of adoption or institituionalization, reasons). Main results were: 1) Residential-care adolescents were confirmed the group more vulnerable to internalizing-externalizing problems, attachment insecurity and higher alexithymia, while late-adopted and community adolescents did not show differences each other. 2) Attachment insecurity and higher alexithymia were related to total and internalizing problems in all groups, while no relations with externalizing problems were found. 3) Alexithymia was a common risk-factors for more total and internalizing problems through groups, while attachment patterns had different group-specific roles. Overall, models of prediction inclusive of attachment and alexithymia allowed the prediction of 4%-39% of total problems and 20%-66% of internalizing problems through groups, with higher vulnerability for girls and a certain variability related to the problem's informant (care-giver or adolescent). In the discussion, shared and specific vulnerabilities of each group from a clinical point of view were discussed, commenting on the practical implications and suggesting ways of using these risk prediction models in clinical practice. In the conclusion, the utility of a mixed-method multi-informant approach was highlighted

Externalizing problems and delinquent behaviors in residential-care male adolescents: associations with peer attachment and alexithymia

Male teenagers in residential-care (RC) show high rates of externalizing problems, such delinquent behaviors. Research findings underlined that peer attachment may have a protective role on the social adjustment of adolescents, while higher levels of alexithymia \u2014defined as an emotional regulation disorder (Taylor, 2004)\u2014 may be a risk factors for externalizing problems. Due to their previous adverse experiences, RC adolescents may show difficulties in both, although they live with peers. As no study done it before, this pilot study investigated the associations among peer attachment, alexithymia and externalizing and delinquent problems in 21 boys aged 13-18 years (M = 16.33, SD = 1.4) placed in residential-care. Measures were: 1) the Youth Self Report 11/18 (YSR) to measure Externalizing problems and delinquent behaviors; 2) the Inventory of Peer and Parent Attachment (IPPA) to assess the levels of Peer attachment, and 3) The Toronto Alexithymia Scale (TAS-20) to detect alexithymia. Results showed expected associations among higher levels of alexithymia and Externalizing (rs = .447, p = .04) and delinquent (rs = .464, p = .03) problems, which show unexpected positive correlations also with peer attachment (Externalizing: rs = .600, p = .009; delinquent: rs = .629, p = .005). In addition, a multiple regression accounted only peer attachment as predictor of higher levels of externalizing problems (adjusted-R2 = .36 p = .005) and delinquent behaviors (adjusted-R2 = .32 p = .009). Authors discussed the potential utility to monitoring the quality of peer-attachment in potentially high-risk contexts like residential ones, whereas it may elicit or perpetuate delinquent conducts among adolescents instead of promoting social adjustment. The role of attachment and emotional regulation for residential adolescents psychopathology is deepen investigate into this larger study, using also clinical interviews such FFI and TSIA

Emotional and behavioral problems in residential-care adolescents: links with attachment and alexithymia

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Risk factors for emotional- behavioral problems in residential-care and late-adopted adolescents: a pilot study with narrative interviews for attachment and alexithymia

Adolescents in residential-care and late-adopted ones resulted high-risk to emotional-behavioural problems, showing vulnerability to risk-factors as insecure/disorganized attachments and difficulties in emotional regulation, such alexithymia. Moreover, findings suggested higher risk for residential adolescents. However, there are no studies that investigated jointly the role of attachment and alexithymia with respect to emotional-behavioural problems displayed by adolescents in those high-risk groups, as we aim to do in a larger pilot study with a multi-method approach. In this preliminary report, we subsampled 20 adolescents (aged 13-17, M = 14.95, SD = 1.4; 80% boys) with traumatic past experiences, dividing 10 late-adoptees and 10 residential-care, equalling for age and gender. We used the Child Behavior Checklist (CBCL 6-18) to assess emotional-behavioral problems; the Friends & Family Interview (FFI) to assess attachment representations, in terms of classifications and scales; the Toronto Structured Interview for Alexithymia (TSIA) to detect the levels of alexithymia. U-Mann Whitney confirmed that residential showed higher levels of emotional-behavioral problems - especially externalizing ones (p = .03) - less security (p = .003) and more avoidance (p = .03) in attachment and higher levels of alexithymia (p = .009) than adoptees. In the total group, correlations were found between psychopathology, less security in attachment and higher alexithymia, which also showed associations each other (p =.029). However, a stepwise regression only accounted the poor attachment\u2019 security as predictor of 29.9% of the variance in externalizing problems (adjusted-R2 = .255, p = .019). Larger samples are needed, but both variables seem correlated to high-risk adolescent\u2019s adjustment: in particular, attachment security resulted a key-feature to promote especially in residential-care contexts, where the adolescents seem more vulnerable than in adoptive families

Attachment in late-adopted, residential-care and community adolescents: a multi-method comparative study.

Introduction. Late-adopted and residential-care adolescents are supposed to be more at risk of insecurity or disorganization in attachment than their community peers, due to the higher adverse childhood experiences (Vorria et al., 2015). However, some studies suggested no differences in attachment between late-adoptees and community adolescents (Pace et al., 2018), while residential-care adolescents showed less security and more disorganization in attachment compared with peers (Bifulco et al., 2016; Vorria et al., 2015). Nevertheless, findings are controversial because few studies compared these high-risk groups during adolescence and results obtained with interviews and self-reports often diverge (McSherry et al., 2016). In this multi-method study, we compared the attachment in late-adopted, residential-care and community adolescents, using both semi-structured interviews and self-reports. Methods. Participants were 75 adolescents (aged 11-19y, M=15.5, 53% boys), 25 each group (late-adopted, residential-care and community). Measures were: 1) the Friends and Family Interview (FFI, Steele and Steele, 2005), a semi-structured interview to assess adolescents\u2019 attachment representations as Secure-Autonomous, Insecure-Dismissing, Insecure-Preoccupied, Disorganized-Disoriented, both in terms of classifications and scores, focusing on narrative\u2019s coherence; 2) the Inventory of Parent and Peer Attachment (IPPA, Armsden and Greenberg, 1987), a well-known self-report used to measure attachment\u2019 security towards mother, father and peers. Results. There were no differences among groups in FFI\u2019s attachment classifications (Table1, p>.09). Comparing the scales (Table2), the residential group showed scores significantly lower in security, and higher in disorganization and dismissing on FFI (p<.04), showing also poorest coherence (p=.005). Using the IPPA, both late-adoptees and residential adolescents reported lower scores only in attachment to mother (p<.01). Discussion. Residential-care adolescents are confirmed to be more at risk of insecurity or disorganization in attachment, while late-adoptees overlapped with community peers. Authors discussed the differences among groups, highlighting the utility of a multi-method approach

What predict binge eating disorder in non-clinical female adolescents? Exploring peer attachment and emotional regulation

The Binge Eating Disorder [BED] is the prevalent eating disorder among community adolescents, but little is known about its specific correlates in this developmental stage. Clinical research underlined associations between ED in adolescence and the peer attachment, as well as higher use of potentially disadaptive Emotional Regulation (ER) strategies, such Expressive Suppression (ES; Gross & John, 2003). This is the preliminary report of a larger pilot study \u2014including narrative measures such Friends and Family Interview [FFI]\u2014 that aim to investigate the role of these variables with respect to the level of BED symptoms showed by non-clinical adolescents, as to our knowledge there are no studies that have done it before. Participants were 44 girls, aged 14-18 (M = 15.68, SD = 1.1), came from Italian intact families with medium-higher SES. Measures were: 1) the Binge Eating Scale (BES) to measure the levels of BED; 2) the Inventory of Peer and Parent Attachment (IPPA) to assess the levels of Peer attachment, also in terms of Trust, Communication and Alienation, and 3) The Emotional Regulation Questionnaire for Children and Adolescents (ERQ-CA) to assess the use of ER strategies (Expressive Suppression and Cognitive Reappraisal). Main results showed that higher levels of BED symptoms correlated with lower levels of Peer attachment (rs = \u2013.370, p = .14), higher Alienation to peers (rs = .476, p = .001) and use of ES (rs = .424, p = .004). However, the multiple regression accounted only the Alienation to Peer and the ES as predictor of BED symptoms (adjusted-R2 = .27 p = .01), excluding Peer Attachment (p > .78). Discussing the implications in terms of prevention and health promotion, the authors underline the utility to foster in community female teenagers positive peer relationships, social competences and the reduction of disadaptive ER strategies, such Expressive Suppression

Peer Power! Secure Peer Attachment Mediates the Effect of Parental Attachment on Depressive Withdrawal of Teenagers

Adolescents\u2019 depressive social withdrawal is a relevant concern for mental health professionals, and it is widespread among community teenagers in form of subclinical symptoms. Different studies suggest that insecure attachment representations increase the adolescents\u2019 likelihood to show symptoms of withdrawal (e.g., loneliness). This study explored the effect of the general attachment internal working model (IWM) and the independent and cumulative effects of the specific attachment representations of parents\u2014in terms of secure base/safe haven\u2014and peers on adolescents\u2019 withdrawal. Additionally, the mediation of peer attachment on the effect of parental attachment on symptoms was explored. All analyses were conducted controlling for the difference between teenagers living with parents together or divorced/separated, as children of divorcees are considered more exposed to stressors. Ninety-one adolescents aged 12\u201317 years old were assessed online during the COVID pandemic period, employing the Youth Self-Report to assess withdrawal and the Friends and Family Interview to assess attachment-general IWM and attachment-specific representations. Results show no influence of parents together/separated or of the general IWM on withdrawal, but higher parent secure base/safe haven and peer attachment cumulatively predicted 10\u201321% less withdrawal. Moreover, more positive peer attachment mediated 61% of the effect of the parental secure attachment on withdrawal, revealing an indirect effect of parental attachment on withdrawal through peer attachment. In conclusion, both parents and peers are influential on adolescent mental health, and fostering positive peer relationships can buffer the effect of dysfunctional family relationships on teenagers\u2019 withdrawal

Self-criticism and attachment: A systematic review and meta-analysis

Several contributions argue that insecure attachment accounts for the development of self-criticism. However, advances in the field are replete with theoretical issues that limit the integration of past results. This work estimates the strength of the associations between attachment and self-criticism and examines which theoretical and methodological features impact these estimations. A PRISMA systematic search was conducted. A three-level meta-analytic approach has been used to estimate effect sizes and the role of theoretical and methodological moderators. Low levels of secure attachment and high levels of insecure attachment were both positively associated with self-criticism. The type of insecure attachment significantly moderated this result, with attachment anxiety being more strongly associated with self-criticism than avoidant attachment. In some cases, the conceptualization and operationalization of both attachment and self-criticism were significant moderators. Self-criticism is likely to be rooted in insecure attachment, supporting most theoretical models and clinical indications. However, results regarding anxious attachment call for an additional theoretical effort to extend the current model. Furthermore, the bi-dimensional conceptualization of insecure attachment may lead to an overestimation of the association between avoidant attachment and self-criticism. The different nature of the emotional components involved may impact observations, suggesting the need to use multidimensional measures

Late-adopted children grown up:A long-term longitudinal study on attachment patterns of adolescent adoptees and their adoptive mothers

This paper reports on a long-term follow-up of a longitudinal study conducted in Italy that assessed attachment patterns of late-adopted children (placed between 4 and 8 years old) and their adoptive mothers, in three phases: T1, at placement; T2, in childhood (7\u20138 months after adoption); and T3, in adolescence (current study). The following hypotheses were tested: 1) children\u2019 IWMs will shift from insecurity towards security in a long-term follow-up; and 2) there will be a significant association between adoptees\u2019 and adoptive mothers\u2019 IWMs in adolescence. Participants were 22 late-adopted adolescents (aged 11\u201316) and their adoptive mothers, all assessed in previous phases. Participants completed several measures of attachment, including the Separation-Reunion Procedure (T1, T2), Manchester Child Attachment Story Task (T2), Friends and Family Interview (T3), and Adult Attachment Interview (T1, T3). Late-adopted adolescents showed both an increase in attachment security and a decrease in disorganized attachment from childhood to adolescence. Adoptive mothers\u2019 (T3) secure states of mind were associated significantly to their adopted children attachment security in adolescence. These findings reinforce the importance of taking attachment into account for adoptive families from the beginning of adoption