A Pilot Study of Gender Differences in Sexual Arousal of Patients With OCD: The Moderator Roles of Attachment and Contamination Symptoms

Sexual arousal is often impaired in patients with obsessive–compulsive disorder (OCD). However, little is known about the factors related to this impairment: no study focused on the role of gender-based effects of attachment styles and contamination symptoms. The Dual Control Model assumes three processes driving sexual arousal: sexual excitation (SE), sexual inhibition (SI) due to threat of performance failure, and SI due to threat of performance consequences (e.g., getting contaminated with sexually transmitted diseases). In a group of OCD patients, we hypothesized that (a) women report lower SE and higher SI thanmen; (b) patients with insecure (both anxious and avoidant) attachment styles show lower SE and higher SI; (c) attachment styles moderate the relation between gender and sexual arousal (respectively, for women, higher attachment anxiety, and for men higher attachment avoidance were related to impaired sexual arousal (higher SE and SI) controlling for OCD severity); and (d) contamination symptoms moderate the relation between gender and sexual impairment (women with contamination symptoms show impaired sexual arousal). Seventy-two OCD patients (37.50% women) completed the Obsessive–Compulsive Inventory-Revised, Attachment Styles Questionnaire and Sexual Inhibition/Sexual Excitation Scales. In contrast with our hypotheses, women reported higher SE and lower SI due to threat of performance consequences than men. Patients with higher attachment avoidance (discomfort with intimacy) but also confidence in self and others had higher SE. Women with attachment avoidance (i.e., discomfort with intimacy) had lower SE, while women with attachment anxiety (i.e., preoccupations with relationships) had higher SI due to negative performance consequences. Women with contamination symptoms had higher SI due to performance failure but lower SI due to performance consequences. The present preliminary findings suggest that sexual arousal impairment should be evaluated during the assessment of OCD patients, and gender-based effects of attachment styles and contamination symptoms should be considered during personalized treatment planning

PERFECTIONISM AND INTOLERANCE OF UNCERTAINTY ARE PREDICTORS OF OCD SYMPTOMS IN CHILDREN AND EARLY ADOLESCENTS: A PROSPECTIVE. COHORT, ONE-YEAR. FOLLOW-UP STUDY

Objective: Cognitive models of Obsessive-Compulsive Disorder (OCD) identified four types of beliefs, which would develop during childhood and play a role in the aetiology and maintenance of OCD: Inflated Responsibility, Threat Overestimation, Importance/Control of Thoughts, Perfectionism/Intolerance of Uncertainty. Whereas research produced consistent evidence in adults that these beliefs constitute vulnerability factors for OCD, no study examined whether the obsessive beliefs prospectively predict OCD symptoms over time in youth. The current study investigated the role of the obsessive beliefs as predictors of OCD symptoms after one year in a large cohort sample of community children and early adolescents prospectively followed-up.Method: Seven hundred and fifty-four children and early adolescents recruited from the community (mean age=10.87 years, 51.46% females) completed the Obsessive Belief Questionnaire-Child Version (OBQ-CV) as a measure of obsessive beliefs, the Obsessive-Compulsive Inventory-Child Version (OCI-CV) as a measure of OCD symptoms, the Children's Depression Inventory for depression (CDI) at baseline (tO) and at one-vear follow -up (t1). A multiple linear regression analysis was run entering the scores on the OBQ-CV and the CDI as predictors and the scores on the OCI-CV at t1 as dimensional outcome.Results: More intense Perfectionism/Intolerance of Uncertainly at t0 (beta= 0.17, t= 4.33, p<0.001) and to a lesser extent more intense Threat Overestimation at t0 (beta= 0.08, t= 1.97, p<0.05) predicted more severe OCD symptoms at t1 controlling for the effects of depression at t0 (beta= 0.19, t= 5.53, p<0.001). Evidence of the predictive effects of the other cognitions at t0 on OCD symptoms at t1 was not found.Conclusions: Perfectionism/Intolerance for Uncertainty and to a lesser Threat Overestimation may be early predictors of OCD symptoms in youth. Early detection and prevention of OCD in children and adolescents could focus on these cognitive vulnerability factors. The current findings appear to raise some doubts about the role of Inflated Responsibility and Importance/Control of Thoughts as cognitive vulnerability factors specific to OCD among youth. Future studies should use clinical interviews to assess the presence of an OCD diagnosis

Effect of intra-articular injection of intermediate-weight hyaluronic acid on hip and knee cartilage : in-vivo evaluation using T2 mapping

Objectives: We used T2 mapping to quantify the effect of intra-articular hyaluronic acid administration (IAHAA) on cartilage with correlation to clinical symptoms. Methods: One hundred two patients with clinical and MRI diagnosis of hip or knee grade I-III chondropathy were prospectively included. All patients received a standard MRI examination of the affected hip/knee (one joint/patient) and T2-mapping multiecho sequence for cartilage evaluation. T2 values of all slices were averaged and used for analysis. One month after MR evaluation 72 patients (38 males; mean age 51\ub110 years) underwent IAHAA. As a control group, 30 subjects (15 males; 51 \ub1 9 years) were not treated. MR and WOMAC evaluation was performed at baseline and after 3, 9, and 15 months in all patients. Results: T2 mapping in hyaluronic acid (HA) patients showed a significant increase in T2 relaxation times from baseline to the first time point after therapy in knees (40.7 \ub1 9.8 ms vs. 45.8 \ub1 8.6 ms) and hips (40.9 \ub1 9.7 ms; 45.9 \ub1 9.5 ms) (p < 0.001). At the 9- and 15-month evaluations, T2 relaxation dropped to values similar to the baseline ones (p < 0.001 vs. 3 month). The correlation between T2 increase and pain reduction after IAHAA was statistically significant (r = 0.54, p < 0.01) in patients with grade III chondropathy. Conclusions: T2 mapping can be used to evaluate the effect over time of IAHAA in patients with hip and knee chondropathy. Key points: \u2022 T2 relaxation times change over time after hyaluronic acid intra-articular administration\u2022 T2 relaxation times of the medial femoral condyle correlate with WOMAC variation\u2022 T2 relaxation times are different between Outerbridge I and II-II

Gender identity disorder and eating disorders: similarities and differences in terms of body uneasiness.

INTRODUCTION: Subjects with gender identity disorder (GID) have been reported to be highly dissatisfied with their body, and it has been suggested that the body is their primary source of suffering. AIMS.: To evaluate quality and intensity of body uneasiness in GID subjects, comparing them with a sample of eating disorder patients and a control group. To detect similarities and differences between subgroups of GID subjects, on the basis of genotypic sex and transitional stage. METHODS: Fifty male-to-female (MtF) GID (25 without and 25 with genital reassignment surgery performed), 50 female-to-male (FtM) GID (28 without and 22 with genital reassignment surgery performed), 88 eating disorder subjects (26 anorexia nervosa, 26 bulimia nervosa, and 36 binge eating disorder), and 107 healthy subjects were evaluated. MAIN OUTCOME MEASURES: Subjects were studied by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, the Symptom Checklist (SCL-90), and the Body Uneasiness Test (BUT). RESULTS: GID and controls reported lower psychiatric comorbidity and lower SCL-90 General Severity Index (GSI) scores than eating disorder subjects. GID MtF without genital reassignment surgery showed the highest BUT values, whereas GID FtM without genital reassignment surgery and eating disorder subjects showed higher values compared with both GID MtF and FtM who underwent genital reassignment surgery and controls. Considering BUT subscales, a different pattern of body uneasiness was observed in GID and eating disorder subjects. GID MtF and FtM without genital reassignment surgery showed the highest BUT GSI/SCL-90 GSI ratio compared with all the eating disorder groups. CONCLUSIONS: GID and eating disorders are characterized by a severe body uneasiness, which represents the core of distress in both conditions. Different dimensions of body uneasiness seem to be involved in GID subsamples, depending on reassignment stage and genotypic sex. In eating disorder subjects body uneasiness is primarily linked to general psychopathology, whereas in GID such a relationship is lacking

Medical treatment in gender dysphoric adolescents endorsed by SIAMS-SIE-SIEDP-ONIG

Despite international guidelines being available, not all gender clinics are able to face gender dysphoric (GD) youth population needs specifically. This is particularly true in Italy. Centers offering specialized support are relatively few and a commonly accepted Italian approach to GD youth has still not been defined. The aim of the present Position Statement is to develop and adhere to Italian guidelines for treatment of GD adolescents, in line with the "Dutch Approach", the Endocrine Society (ES), and the World Professional Association for Transgender Health (WPATH) guidelines

La clinica psicologica. Fondamenti e linee di sviluppo

none20mixedFAVA G.A.; RAFANELLI C.; BALDARO B.; BATTAGLIA M.; CARACCIOLO S.; CARLOMAGNO S.; CASARI E.; DETTORE D.; FULCHERI M.; GRANDI S.; MENONI E.; MICHIELIN P.; PALOMBA D.; PRUNETI C.; REDA M.A.; REZZONICO G.; STREPPARAVA M.G.; UGUZZONI U.; VIOLANI C.; SIRIGATTI S.Fava, G. A.; Rafanelli, C.; Baldaro, B.; Battaglia, M.; Caracciolo, S.; Carlomagno, S.; Casari, E.; Dettore, D.; Fulcheri, M.; Grandi, S.; Menoni, E.; Michielin, Paolo; Palomba, Daniela; Pruneti, C.; Reda, M. A.; Rezzonico, G.; Strepparava, M. G.; Uguzzoni, U.; Violani, C.; Sirigatti, S

La clinica psicologica. Fondamenti e linee di sviluppo

La clinica psicologica pu\uf2 essere definita come l\u2019applicazione di strumenti psicologici alla valutazione, con un approccio clinimetrico, anzich\ue9 psicometrico. La clinica psicologica utilizza l\u2019osservazione, la descrizione e la classificazione; confronta le varie metodiche di registrazione delle osservazioni (etero, auto-valutative, psicofisiologiche, ecc.); formula e testa ipotesi esplicative di natura pragmatica (l\u2019articolazione delle componenti terapeutiche). \uc8 legata ad una concezione realistica, e non idealistica della clinica, e ad un concetto dinamico della salute e della malattia. Richiede una profonda conoscenza della clinica, della psicopatologia, della ricerca e della pratica in psicoterapia. Prescinde da rigidi steccati determinati da gruppi di potere ed influenza. Costituisce il naturale presupposto per l\u2019accesso a trattamenti psicoterapeutici basati sull\u2019evidenza nell\u2019ambito della medicina generale e di quella specialistica. \uc8 in grado di operare un profondo rinnovamento nella psicologia clinica, che pu\uf2 esercitare importanti influenze anche in altre aree psicologiche, nella psichiatria e nella medicina clinica