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Introduction: When confronted with traumatic accidents and events that result in death, people are at risk of developing death anxiety. Due to their stressful job, emergency medical technicians (EMTs) will develop alexithymia and be unable to express and manage their emotions over time. Studies show that alexithymia causes physical and mental disorders in many people. The present study aimed to determine the relationship between death anxiety and alexithymia in EMTs.Methods: The convenience sampling method was used to select 400 EMTs in southeastern Iran who met the inclusion criteria for this descriptive-analytical study. The Templer Death Anxiety Scale and the Toronto Alexithymia Scale were used to collect data. SPSS version 20 was used to analyze the data, which included descriptive and analytical statistics (Independent t test, ANOVA, Pearson correlation, and regression). Results: The results of the study showed that the mean score of death anxiety in EMTs was 10.26 ± 3.69. It was revealed that 46.7% of the EMTs experienced severe death anxiety. Furthermore, the total mean score of alexithymia in EMTs was 59.65 ± 8.28, indicating the possibility of alexithymia. The Pearson correlation test showed a direct moderate relationship between death anxiety and alexithymia scores (r = .351, p < .001).Conclusion: According to the results, there is a direct significant relationship between death anxiety and alexithymia in EMTs. Therefore, it is suggested that EMTs be continuously taught effective methods to deal with death anxiety and reduce the physical and mental disorders caused by this problem.

HIV-related enacted stigma and social problems may increase risk for depression and/or behavioral problems among adolescents and young adults with perinatal HIV(AYA-PHIV), yet few studies have explored stigma in AYA-PHIV residing in low-to-middle income regions, including Southeast Asia. We assessed HIV-related enacted stigma and social problems in AYA-PHIV who participated in the RESILIENCE study (clinicaltrials.gov identification: U19AI53741) in Thailand and Cambodia using specific questions during structured in-person interviews. Depression was measured by the Child Depression Inventory for children

Research on predominantly male autistic samples has indicated that impairments in facial emotion recognition typically associated with autism spectrum conditions are instead due to co-occurring alexithymia. However, whether this could be demonstrated using more realistic facial emotion recognition stimuli and applied to autistic females was unclear. In all, 83 females diagnosed with autism spectrum condition completed online self-report measures of autism spectrum condition severity and alexithymia, and afacial emotion recognition deficit that assessed their ability to identify multimodal displays of complex emotions. Higher levels of alexithymia, but not autism spectrum condition severity, were associated with less accurate facial emotion recognition. Difficulty identifying one’s own feelings and externally oriented thinking were the components of alexithymia that were specifically related to facial emotion recognition accuracy. However, alexithymia (and autism spectrum condition severity) was not associated with speed of emotion processing. The findings are primarily discussed with the theoretical view that perceiving and experiencing emotions share the same neural networks, thus being able to recognise one’s own emotions may facilitate the ability to recognise others’. This study is in line with previous similar research on autistic males and suggests impairments in facial emotion recognition in autistic females should be attributed to co-occurring alexithymia. Lay abstract Research with autistic males has indicated that difficulties in recognising facial expressions of emotion, commonly associated with autism spectrum conditions, may instead be due to co-occurring alexithymia (a condition involving lack of emotional awareness, difficulty describing feelings and difficulty distinguishing feelings from physical bodily sensations) and not to do with autism. We wanted to explore if this would be true for autistic females, as well as to use more realistic stimuli for emotional expression. In all, 83 females diagnosed with autism spectrum condition completed self-report measures of autism spectrum condition traits and alexithymia and completed a visual test that assessed their ability to identify multimodal displays of complex emotions. Higher levels of alexithymia, but not autism spectrum condition features, were associated with less accuracy in identifying emotions. Difficulty identifying one’s own feelings and externally oriented thinking were the components of alexithymia that were specifically related to facial emotion recognition accuracy. However, alexithymia (and levels of autism spectrum condition traits) was not associated with speed of emotion processing. We discuss the findings in terms of possible underlying mechanisms and the implications for our understanding of emotion processing and recognition in autism.

High alexithymic traits and psychiatric comorbidities such as depression and social phobia are frequently observed among adults with autism spectrum disorder. In this study, we tested whether alexithymic and/or autistic traits are risk factors for depressive and social phobic symptoms in adults with autism spectrum disorder ( n = 122), patients with social interaction difficulties other than autism ( n = 62), and neurotypical participants ( n = 261). Multiple regression analyses of these three groups demonstrated that both traits explained considerable variance of depressive and social phobic symptoms. In adults with autism spectrum disorder, alexithymic traits were predictive of depressive symptoms, while autistic traits predicted social phobic symptoms. In patients with social interaction difficulties other than autism, alexithymic and autistic traits were identified as predictors of social phobic symptoms, while no variable predicted depressive symptoms. In neurotypicals, both alexithymic and autistic traits were predictive of depressive and social phobic symptoms. Our results, therefore, highlight the importance of assessing both alexithymic and autistic traits in patients with and without autism spectrum disorder for identifying comorbid psychopathology. Depending on the underlying core symptomatology, alexithymic and/or autistic traits increase the risk of depressive and social phobic symptoms calling for therapeutic strategies to prevent or at least reduce comorbid psychopathology. Lay abstract Adults with autism often develop mental health problems such as depression and social phobia. The reasons for this are still unclear. Many studies found that alexithymia plays an important role in mental health problems like depression. People with alexithymia have difficulties identifying and describing their emotions. Almost every second person with autism has alexithymia. Therefore, we explored in this study whether alexithymia is linked to worse mental health in autistic people. We looked at two common diagnoses, depression and social phobia. We found that alexithymia increased symptoms of depression, while autistic traits increased symptoms of social phobia. Our results suggest that alexithymia and autistic traits can increase the risk of mental health problems. An early assessment could help prevent mental health problems and improve quality of life.

In this study, we examined the relationships between prior trauma, alexithymia, and sexual aggression perpetration among 610 U.S. college students and 107 college students from the Philippines utilizing a cross-sectional retrospective design. We tested a moderated mediation model with alexithymia as the mediator between prior trauma and sexual aggression perpetration, and alcohol use as a moderator of the alexithymia–sexual aggression link. Moreover, given that cultural norms may influence these relationships, we also examined the structural invariance of the proposed moderated mediation model. Path analyses and multiple group analysis were used to examine the moderated mediation model, and examine model differences between samples. We did not find evidence for alexithymia as a mediator, but there was a significant interaction between alcohol use severity and alexithymia on sexual aggression perpetration across both samples. Alexithymia is a key variable in understanding the alcohol use–sexual aggression perpetration relationship. Clinical implications and recommendations for future research are also discussed.

The parent-report Mood and Feelings Questionnaire (MFQ-P) is one of the few well-established available measures specifically designed to assess childhood depression from the parent’s perspective. However, to date, few studies have analyzed the factorial structure of the MFQ-P. The aim of this study was to examine for the first time the psychometric properties of the scores and factorial structure of the Spanish-adapted version of the MFQ-P in a community sample of Spanish-speaking children. Parents of 181 children (54.1% boys) aged 6–8 years participated in this study. The MFQ-P was translated into Spanish and administered along with the Strengths and Difficulties Questionnaire-parent version (SDQ-P) and the Spence Children’s Anxiety Scale-parent version (SCAS-P). The scale showed high internal consistency (α = .92) and acceptable test–retest reliability, and factor analysis confirmed the original single-factor structure after removing one item. Convergent and divergent validity was supported. The findings provide initial support for the use of a 33-item version of the MFQ-P in the Spanish population, adding further international evidence for this promising scale.

With the growing number of individuals with Autism Spectrum Disorder (ASD) reaching the age of consent, health-care providers must be prepared to bridge gaps in their knowledge of ASD. This is especially true for clinicians who may have to determine if a person with ASD has the capacity to engage in end-of-life decision making, complete advance directives, or act as a surrogate decision maker for someone else. This paper provides an overview of the unique characteristics of autism as related to the communication, cognitive processing, and the capability to participate in advance care planning and, when acting as a surrogate decision maker, to consider the values and preferences of others. In addition, we examine the roles and responsibilities of clinician as facilitator of shared health-care decision making communication with the individual who has autism. Consideration is given to determining capacity, planning for atypical responses, the impact or lack of influence of the framing effect, and strategies for presenting information. Finally, we will offer health-care providers information and examples for adapting their existing end-of-life decision-making tools and conversation guides to meet the communication needs of persons with ASD.

Internationally, the most widely used self-report instrument to assess alexithymia (a clinical condition characterized by serious deficits in the cognitive processing of emotions) is the Toronto Alexithymia Scale (TAS-20). Because this measure has been poorly investigated in Brazil and emerging research suggests that TAS-20 scores might vary from one culture to another, we sought to: (1) investigate the psychometric properties of a Brazilian TAS-20; and (2) examine the degree to which Brazilian non-clinical TAS-20 scores differ from the scores of non-clinical samples from other cultures. A sample of 850 non-clinical Brazilian adults were administered a number of questionnaires and performance-based measures via online data collection. Data analyses inspected internal consistency and factor structure of the TAS-20, and tested the association of TAS-20 scores to emotional functioning and psychopathology. In line with previous international research, the Brazilian TAS-20 showed acceptable to adequate psychometric properties. Furthermore, TAS-20 scores associated negatively with empathy and emotional perception, and positively with emotion dysregulation and personality traits like dependency, abrupt changes in mood, and avoidance of criticism. Also noteworthy, our non-clinical Brazilian TAS-20 scores were very similar to those observed in other previously published non-clinical TAS-20 scores from seven non-Brazilian cultures.

Social skills interventions are critical for promoting social, emotional, and behavioral competence for students with or at risk of emotional and behavioral disorders (EBD) and autism spectrum disorders (ASD). This single-case meta-analysis examined the effects of social skills interventions (SSIs) for students with EBD and ASD. Effect sizes were calculated for 78 cases across 25 included studies using a nonparametric effect size, Baseline Corrected Tau. The overall weighted mean effect size of 0.54 suggested a moderate effect across the 25 studies. The overall weighted mean effects for studies reporting maintenance and generalization data were 0.68 and 0.37, respectively. Potential moderators examined (disability, intervention design, intervention delivery, methodological quality) were not significant. As such, they did not moderate the outcomes for participants. We conducted a post hoc analysis and hypothesized that between-study differences may be more meaningful than the similarities shared by participants in the same moderator groups. Implications are discussed on using SSIs to address the social, emotional, and behavioral challenges of students with or at risk of EBD and ASD.

There is some evidence that disordered self-processing in autism spectrum disorders is linked to the social impairments characteristic of the condition. To investigate whether bodily self-consciousness is altered in autism spectrum disorders as a result of multisensory processing differences, we tested responses to the full body illusion and measured peripersonal space in 22 adults with autism spectrum disorders and 29 neurotypical adults. In the full body illusion set-up, participants wore a head-mounted display showing a view of their ‘virtual body’ being stroked synchronously or asynchronously with respect to felt stroking on their back. After stroking, we measured the drift in perceived self-location and self-identification with the virtual body. To assess the peripersonal space boundary we employed an audiotactile reaction time task. The results showed that participants with autism spectrum disorders are markedly less susceptible to the full body illusion, not demonstrating the illusory self-identification and self-location drift. Strength of self-identification was negatively correlated with severity of autistic traits and contributed positively to empathy scores. The results also demonstrated a significantly smaller peripersonal space, with a sharper (steeper) boundary, in autism spectrum disorders participants. These results suggest that bodily self-consciousness is altered in participants with autism spectrum disorders due to differences in multisensory integration, and this may be linked to deficits in social functioning.

The Toronto Alexithymia Scale–20 is arguably the most utilized measure of alexithymia. Although a three-factor solution has been found by numerous studies, these findings are not universal. This article examined and compared 18 competing factor structures for the Toronto Alexithymia Scale–20, which included between one and four correlated latent factor structures, common methods models that accounts for negatively worded items, and bifactor models. Although the two-factor bifactor model with a common methods factor had the better model fit compared with the other 17 models examined, it still did not achieve the requisites of a good model fit across all model fit indices. Issues stemmed primarily from the externally oriented thinking factor and the negatively worded items. Post hoc analyses indicated that a two-factor bifactor model with the negatively worded items dropped achieved the requisites of a good model fit and can be treated as a unidimensional measure despite the presence of multidimensionality. Multiple-group analysis indicated that the factor loadings were invariant across U.S. and Philippines samples. After controlling for noninvariance at the item intercept level, the Philippines sample had a higher alexithymia general score compared with the U.S. sample.

It is often assumed that empathy impairments are common in individuals with \ud eating disorders (EDs), but empirical work has been limited and produced mixed \ud results, making the clinical features and treatment needs of this population \ud difficult to determine. Alexithymia, characterised by difficulties identifying and \ud describing one’s own emotions, frequently co-occurs with EDs, and is associated \ud with atypical recognition of, and empathy for, others’ emotions. The current \ud study used an existing empathy for pain paradigm to determine whether atypical \ud empathy in EDs stems from co-occurring alexithymia, rather than EDs \ud per \ud se. \ud Empathy (specifically personal distress in response to others’ pain) was \ud assessed in individuals with EDs (N = 21) and an alexithymia-matched control \ud group (N = 22). Participants were simultaneously members of a high alexithymia \ud (N = 16) or low alexithymia (N = 27) group, allowing the independent \ud contributions of alexithymia and EDs to be determined. Participants judged the \ud laterality of hands and feet in painful and non-painful situations, and the degree \ud of empathic interference on RTs was measured. Results indicated that \ud observation of painful stimuli impacted task performance in those with high \ud levels of alexithymia more than those with low levels, but no effect of ED \ud diagnosis was observed. These findings suggest that co-occurring alexithymia \ud explains increased empathic personal distress in ED populations. Atypical \ud empathy may therefore not be a core feature of EDs, and interventions aimed at \ud improving empathy-related social functioning may only be necessary for patients \ud who also have alexithymia. These findings emphasise the importance of \ud determining the influence of co-occurring alexithymia when assessing empathy \ud in clinical populations.

Objective: The aim of the study was to explore the range of psychiatric diagnoses seen in pregnant women who score above the ‘cut-off’ on the Edinburgh Postnatal Depression Scale when this is used as a routine screening instrument in the antenatal period. Method: Subjects were all pregnant women referred to and seen by the Perinatal Consultation-Liaison Psychiatry Team of a tertiary public hospital over a 14-month period. Edinburgh Postnatal Depression Scale score at maternity ‘booking-in’ visit, demographic and clinical data were recorded and diagnoses were made according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria following clinical interview(s) and review of documented past history. Data were analysed using descriptive statistics. Results: A total of 200 patients who had completed the Edinburgh Postnatal Depression Scale were seen for assessment; 86 (43%) scored ⩾13 on Edinburgh Postnatal Depression Scale. Of those scoring 13 or more on Edinburgh Postnatal Depression Scale, 22 (25.6%) had a depressive disorder. In total, 12 patients (14%) had an anxiety disorder, 14 (16.3%) had borderline personality disorder and 13 (15.1%) had a substance use disorder. An additional 23 women (26.7%) had two or more borderline personality traits. Conclusion: Psychiatric assessment of women who scored 13 or more on the Edinburgh Postnatal Depression Scale at routine antenatal screening identified a significant number with borderline personality disorder or borderline personality traits rather than depressive or anxiety disorders. Clinical Practice Guidelines note the importance of further assessment for all women who score 13 or more on the Edinburgh Postnatal Depression Scale. The findings here suggest that this assessment should be made by a clinician able to identify personality pathology and organise appropriate and timely interventions.

Objective The burnout syndrome represents a defence mechanism against stress and includes stages with decreased ability to experience feelings and emotional states. This finding suggests that burnout might be closely linked to emotional ‘blindness’ as a defence mechanism against negative and overwhelming emotions known as alexithymia. The aim of this study is to examine the relationships between burnout syndrome, alexithymia, depression and traumatic stress symptoms in healthcare professionals. Methods This empirical study assessed female healthcare professionals who work with a population of patients with diabetes, utilizing the Maslach Burnout Inventory (MBI-HSSMP), Burnout Measure (BM), Toronto Alexithymia Scale (TAS-20), Beck Depression Inventory (BDI-II) and Traumatic Stress Checklist (TSC-40). Data were analysed using Spearman’s correlation coefficient. Results A total of 114 female participants were included (age range, 31–60 years; mean age, 46.62 ± 8.71 years). Statistically significant associations were found between burnout syndrome (BM scores) and alexithymia (TAS-20) ( r = 0.41), and between BM scores and traumatic stress (TSC-40; r = 0.63). The MBI-HSSMP emotional exhaustion subscale also correlated with alexithymia (TAS-20) ( r = 0.37). Conclusion Findings of this study suggest that alexithymia and traumatic stress are related to burnout symptoms. This dynamic may be potentially useful for detecting and preventing burnout syndrome.

The Avoidance and Fusion Questionnaire for Youth (AFQ-Y8) was developed to measure psychological inflexibility. Although the questionnaire is a well-known tool in clinical practice, its psychometric properties have not been widely investigated in the target population of children and adolescents. The purpose of this study was to investigate the factor structure and validity of the AFQ-Y8 ( N = 1,572, mean age 15.39 years, girls 51%) on a Hungarian sample. We also tested the invariance of the measurement model across two age groups (11-14 and 15-20 years old). Results confirmed the single-factor structure of the AFQ-Y8. Psychological inflexibility was also found to be positively related to emotional instability, externalizing, and internalizing problems. Furthermore, psychological inflexibility explained the variance of life satisfaction when personality dimensions, emotional, and behavioral problems were accounted for. Measurement invariance across age groups was partially supported. These results suggest that the AFQ-Y8 is a reliable and valid instrument for assessing psychological inflexibility in children and adolescents.

Objective: To measure the provincial government cost of mental health–related activities for youth ages 12 to 17 in Alberta in 2014 to 2015. Methods: The target population was Alberta youth ages 12 to 17 (the federal justice definition) who received or were funded for mental health–related or complementary services from Alberta Health Services, Alberta Health, Alberta Human Services, Alberta Justice and Solicitor General, and Alberta Education (public schools). Data on services and expenditures were obtained from each source for the target youth population. Results: Costs for mental health–related services for all ministries were $175 million for 27,169 youth who used mental health services as defined by Policy Wise, $6460 per youth. Public school special education supplements for youth with emotional problems was the largest group, amounting to 30% of all costs. Other prominent sources of expenditures were hospital inpatient mental health services (18%), community mental health services (11%), physician mental health services (10%), and secure services with treatment requiring judicial approval (9%). Conclusion: Economists in several countries have developed countrywide measures of mental health expenditures and have used these to generate national benchmarks for mental health spending. We have estimated spending for Alberta provincial mental health and addiction services for a distinct and highly vulnerable group. This measure can be used to develop measures and benchmarks for other provinces, which will be valuable policy indicators.

The combination of shame, anxiety, and a history of childhood maltreatment can have devastating effects on self-esteem and on the morbidity and mortality of an individual. Shame is a natural emotion evoked in social evaluative settings. Without some degree of shame, goal attainment is less likely. However, high levels of shame may increase pathology and decrease performance. In this crosssectional study, pre-professional and professional dancers were divided into two shame groupings: low (N = 193) and high (N = 25). Chi square and multivariate analyses of covariance (age and gender as covariates) were conducted to determine group differences for cumulative adverse childhood experiences (ACEs), anxiety, self-esteem, and shame factors. The high shame group had a greater distribution of childhood adversity (especially emotional, physical and sexual abuse, and emotional neglect). They also had clinical levels of anxiety and low self-esteem. In the path analyses, the causal model demonstrated that childhood adversity had a direct effect on anxiety and shame and an indirect effect on self-esteem. Shame and anxiety had a direct effect on self-esteem. Helping dancers become resistant to shame may decrease anxiety and buffer the effects of a history of childhood adversity. As internalized shame decreases, dancers may enhance their self-esteem, wellbeing, and ability to pursue and achieve their career goals.

Objective: Functional remission represents an intermediate functional milestone toward recovery. Differential relationships of negative symptom sub-domains with functional remission in first-episode psychosis are understudied. We aimed to examine rate and predictors of functional remission in people with first-episode psychosis in the context of a 3-year follow-up of a randomized controlled trial comparing 1-year extension of early intervention (i.e. 3-year early intervention) with step-down psychiatric care (i.e. 2-year early intervention). Method: A total of 160 participants were recruited upon completion of a 2-year specialized early intervention program for first-episode psychosis in Hong Kong and underwent a 1-year randomized controlled trial comparing 1-year extended early intervention with step-down care. Participants were followed up and reassessed 3 years after inclusion to the trial (i.e. 3-year follow-up). Functional remission was operationalized as simultaneous fulfillment of attaining adequate functioning (measured by Social and Occupational Functioning Scale and Role Functioning Scale) at 3-year follow-up and sustained employment in the last 6 months of 3-year study period. Negative symptom measure was delineated into amotivation (i.e. motivational impairment) and diminished expression (i.e. reduced affect and speech output). Data analysis was based on 143 participants who completed follow-up functional assessments. Results: A total of 31 (21.7%) participants achieved functional remission status at 3-year follow-up. Multivariate regression analysis showed that lower levels of amotivation ( p = 0.010) and better functioning at study intake ( p = 0.004) independently predicted functional remission (Final model: Nagelkerke R2 = 0.40, χ2 = 42.9, p Conclusion: Only approximately one-fifths of early psychosis patients were found to achieve functional remission. Functional impairment remains an unmet treatment need in the early stage of psychotic illness. Our results further suggest that amotivation may represent a critical therapeutic target for functional remission attainment in early psychosis.

Objective Serum lipid levels may be associated with the affective severity of bipolar disorder, but data on lipid profiles in Asian patients with bipolar disorder and the lipid alterations in different states of opposite polarities are scant. We investigated the lipid profiles of patients in the acute affective, partial, and full remission state in bipolar mania and depression. Methods The physically healthy patients aged between 18 and 45 years with bipolar I disorder, as well as age-matched healthy normal controls were enrolled. We compared the fasting blood levels of glucose, cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein of manic or depressed patients in the acute phase and subsequent partial and full remission with those of their normal controls. Results A total of 32 bipolar manic patients (12 women and 20 men), 32 bipolar depressed participants (18 women and 14 men), and 64 healthy control participants took part in this study. The mean cholesterol level in acute mania was significantly lower than that in acute depression (p Conclusion Circulating lipid profiles may be easily affected by affective states. The acute manic state may be accompanied by state-dependent lower cholesterol and triglyceride levels relative to that in other mood states.

Objective: This study evaluated the concurrent validity of emotional lability (EL) in children with ADHD. Method: A total of 2,015 children with ADHD and 745 typically developed controls (TDCs) were assessed and compared on EL. Results: ADHD participants expressed higher EL scores than TDCs, not influenced by gender or IQ. Higher levels of EL symptoms were found in children with comorbid oppositional defiant disorder (ODD) and with ADHD-combined subtype. Receiver operating characteristic (ROC) analyses showed a strong screening efficacy of EL symptoms on ADHD. The effect of developmental age on EL showed a desisting pattern in TDCs, as opposed to a persisting pattern in ADHD (not influenced by ODD comorbid status). ODD symptoms in ADHD showed an ascending pattern. Conclusion: EL can potentially serve as a sentinel index for the presence of ADHD, especially when the ADHD presentation is atypical. ODD may embody a developmental entity distinct from EL.

Objective: A subset of children with ADHD experience more frequent, sudden, and intense shifts toward negative emotions. The current study utilized ecological momentary assessment (EMA) to provide a valid assessment of the impact of comorbid internalizing and externalizing disorders on negative emotional lability (EL) among children with ADHD. Method: Parents of 58, 8- to 12-year-old children with ADHD were administered a diagnostic interview to assess for ADHD and for the presence of comorbid disorders. Parents completed EMA-based ratings of their child’s negative emotions three times daily for a total of 28 days. Results: Children with a comorbid internalizing disorder or children with comorbid oppositional defiant disorder (ODD) experienced significantly greater EMA-derived negative EL than children without comorbid disorders over time. Children with multiple comorbidities experienced greater EL than children with single comorbidities. Conclusion: Overall, this study suggested that both comorbid ODD and comorbid internalizing disorders contribute to negative EL among children with ADHD.

Many pediatricians use a broad developmental screening test as part of well-child care, but do not specifically screen for behavioral and emotional disorders. Parents at 2 urban community agencies completed both the Ages and Stages Questionnaire (ASQ-3) and the Ages and Stages Questionnaire: Social Emotional (ASQ:SE) for 608 children, ages 2 to 60 months; 51.8% in Spanish. Less than half of the children with a positive screen on the ASQ:SE would have been identified as needing additional assessment or intervention if only the ASQ-3 had been administered. Younger children with positive ASQ:SE screens were significantly less likely to be referred for mental health services compared with older children. Physicians should consider screening all young children for social-emotional and behavioral needs, and referring those identified for infant and early childhood mental health services.

Difficulties in emotion perception are commonly observed in autism spectrum disorder. However, it is unclear whether these difficulties can be attributed to a general problem of relating to emotional states, or whether they specifically concern the perception of others’ expressions. This study addressed this question in the context of pain, a sensory and emotional state with strong social relevance. We investigated pain evaluation in self and others in 16 male individuals with autism spectrum disorder and 16 age- and gender-matched individuals without autism spectrum disorder. Both groups had at least average intelligence and comparable levels of alexithymia and pain catastrophizing. We assessed pain reactivity by administering suprathreshold electrical pain stimulation at four intensity levels. Pain evaluation in others was investigated using dynamic facial expressions of shoulder patients experiencing pain at the same four intensity levels. Participants with autism spectrum disorder evaluated their own pain as being more intense than the pain of others, showing an underestimation bias for others’ pain at all intensity levels. Conversely, in the control group, self- and other evaluations of pain intensity were comparable and positively associated. Results indicate that emotion perception difficulties in autism spectrum disorder concern the evaluation of others’ emotional expressions, with no evidence for atypical experience of own emotional states.

Purpose: To examine whether there is an association between students self-reported suicide attempts and non-suicidal self-injury and exposure to suicidal behaviour among friends, family members or within school communities. Methods: A cross-sectional analysis of a nationally representative health and well-being survey of 8500 New Zealand high school students conducted from March through November 2012. Students’ self-reported suicide attempts and repeated non-suicidal self-injury was examined in relation to student reports of self-harming behaviour among friends and family as well as data from school administrators of completed suicides within the school community. Results: Almost 1 in 20 (4.5%) students reported a suicide attempt in the last 12 months and 7.9% reported repeated non-suicidal self-injury in the last 12 months. The risk of both suicide attempts and repeated non-suicidal self-injury was highest among females, students from homes with economic deprivation and among students reporting an episode of low mood in the previous 12 months. Students exposed to suicide attempts or completed suicide among friends and/or family members were at increased risk of reporting attempted suicide and repeated non-suicidal self-injury in the last year. There was no association between completed suicide in school community and students self-reported suicide attempts or repeated non-suicidal self-injury. Conclusions: Low mood and exposure to suicide attempts of friends and family members are associated with suicide attempts and repeated non-suicidal self-injury in New Zealand high school students. This research highlights importance of supporting adolescents with low mood and exposed to suicide of friends and family.

Aim of this study was to investigate relationship between preoperative psychological factors and % total weight loss after gastric bypass. 76 adult patients scheduled for bariatric surgery were preoperatively asked to complete anxiety and depression Hamilton scales and Toronto Alexithymia Scale. At 3- and 6-month follow-up, body weight was assessed. At 6-month follow-up, alexithymic patients showed a poorer % total weight loss compared with non-alexithymic patients ( p = .017), and moderately depressed patients showed a lower % total weight loss compared with non-depressed patients ( p = .011). Focused pre- and postoperative psychological support could be useful in bariatric patients in order to improve surgical outcome.

This study examined the psychometric properties of the parent's versions of the Strengths and Difficulties Questionnaire (SDQ) and the Positive and Negative Affect Schedule-Extended Form (PANAS-X) in a community sample of Portuguese parents. A total of 1100 SDQ and PANAS-X were collected from an online sample of 761 parents, whose ages ranged from 23 to 65 years (M = 42, SD = 5). Confirmatory factor analyses provided evidence of the internal factor structure of both the SDQ and the PANAS-X and invariance of the factor structure across age and gender groups, with the exception of the SDQ, which failed to provide evidence of invariance between genders. Internal reliability and discriminant validity were confirmed for both measures, although convergent validity was only confirmed for the PANAS-X. Concurrent validity was also confirmed by comparing the results from the SDQ dimensions and the PANAS-X broad dimensions subscales. info:eu-repo/semantics/publishedVersion

Transdiagnostic cognitive-behavioral therapy for emotional disorders (ED) has proven to be effective. However, current transdiagnostic treatment protocols address only the regulation of negative affectivity, and they do not include treatment components to more directly target the regulation of positive affectivity. In this study, we propose to evaluate the preliminary efficacy and acceptability of a transdiagnostic treatment protocol for ED that includes, as an innovative feature, a specific treatment component to directly upregulate positive affectivity based on positive psychology interventions. A total of 24 participants were randomized to either a transdiagnostic treatment protocol ( n = 12) or a transdiagnostic treatment protocol with an additional component designed to regulate positive affectivity ( n = 12). Participants completed measures of anxiety, depression, positive and negative affectivity, and quality of life, as well as treatment acceptability at pre- and posttreatment and at the 3-month follow-up. Both interventions led to improvements in all measures at posttreatment, and these outcomes were maintained at the 3-month follow-up, with large effect sizes for all measures. The effect sizes for positive affect were larger in the condition that included the component to upregulate positive affectivity. Attrition rate was low, and both treatment protocols were well accepted by participants. The results obtained in this study indicate the feasibility of testing the treatment protocol in a larger, randomized, controlled trial, and they suggest the potential of including treatment components for directly upregulating positive affectivity in future research on transdiagnostic treatment protocols for ED.

Certain individuals who sexually offend may have difficulty differentiating, identifying, and articulating emotions. These clients may prove challenging for therapists when engaging with them in treatment. Such clients may suffer from alexithymia. There has been a dearth of research regarding specific psychotherapeutic interventions for alexithymia in both the clinical and forensic fields. The present study provides results from a pilot study on the efficacy of a brief, four-session, alexithymia-specific intervention with adults who have sexually offended. The intervention also aimed to increase emotional awareness and psychological mindedness. The intervention was comprised of both mindfulness and mentalization treatment components. Thirty-two men ( Mage = 41.8 years, SD = 11.9) convicted of sexual offences completed the intervention group. When compared with a matched control condition ( n = 27; Mage = 39, SD = 10.8), the intervention was effective in decreasing alexithymia characteristics and increasing psychological mindedness. Results suggest that the intervention was an effective means of increasing emotional awareness in this population. These provisional results must be tempered by the limitations of the study. However, the positive findings warrant future investigation. Clinical implications and ideas for future work are also discussed.

Alexithymia is a multifaceted personality construct associated with several medical illnesses. However, no studies have focused on food allergy. We investigated alexithymia among food-allergic youths, compared to a matched healthy sample. A total of 220 participants aged 9–25 years were assessed using the Toronto Alexithymia Scale and the Alexithymia Questionnaire for Children. Food-allergic patients reported higher levels of alexithymia compared to a matched healthy sample. Furthermore, an association between alexithymia and a clinical history of anaphylaxis was found among patients. Some possible hypotheses have been discussed considering physiological, psychological, developmental, and cognitive/behavioral factors.

This study evaluated the associations between depressive symptoms, emotion dysregulation and bulimic symptoms in youth with type 1 diabetes (T1D) in the context of the diagnosis and treatment of T1D. Study participants were 103 youth in 2 distinct groups: newly diagnosed (New) or transitioning to pump therapy (continuous subcutaneous insulin infusion [CSII]; “Pump”), who completed questionnaires regarding symptoms of depression, emotion dysregulation, and bulimia. Glycemic control (A1c), height, weight, and questionnaires were evaluated within 10 days of diagnosis (n = 58) or at education/clinic visit before starting insulin utilizing CSII (n = 45). In the newly diagnosed group, only depression accounted for significant variance in bulimia scores (β = .47, P < .01). For the group with disease treatment experience (Pump), but not for the newly diagnosed group (New), greater depressive symptoms and emotion dysregulation were associated with greater bulimic symptoms. Depressive symptoms and emotion dysregulation, an indicator of poor coping/behavioral control, could help explain adoption of disordered eating behaviors in youth with T1D who are transitioning to pump therapy.

The aim of the study was to calculate the cutoff scores on the Bermond-Vorst Alexithymia Questionnaire-20 Form B. 560 students completed the Bermond-Vorst Alexithymia Questionnaire-20 Form B and the 20-item Toronto Alexithymia Scale. Using cutoff scores of the French or the original version of the 20-item Toronto Alexithymia Scale as the standard, the participants were divided into alexithymic and non-alexithymic groups. The Bermond-Vorst Alexithymia Questionnaire-20 Form B cutoff scores selection was based on the sensitivity, specificity, receiver operating characteristic curve analysis, and the analyses of the clinical data. The most appropriate cutoff scores for determining the absence and presence of alexithymia ranged from 43 to 45 and from 50 to 53, respectively.

The effectiveness of evidence-based practice in the treatment of children with conduct disorder ( n = 186) or emotional disorders ( n = 490) in routine care was examined using naturalistic, previously collected data from 30 child and adolescent mental health services. Repeated measures analysis of covariance was used to compare the outcomes of children who received parent training for conduct disorder and cognitive behavioural therapy for emotional disorders (evidence-based practice) with children who did not receive these treatments (non-evidence-based practice). There was a relatively low occurrence of evidence-based practice, particularly for children with conduct disorder. Both the evidence-based practice and non-evidence-based practice groups improve over time, with moderate effect sizes, and there were greater improvements associated with evidence-based practice for children with emotional disorders, based on child self-reported symptoms but not on parent report. In the present sample, significant differences were not found for conduct disorder. Findings provide tentative support for evidence-based practice for the treatment of emotional disorders in routine care settings.

Objective In light of interpersonal difficulties and their relation to alexithymia in patients with somatoform disorder, the primary aim of this study was to explore the association between two insecure attachment strategies (deactivation and hyperactivation strategies), and affective and cognitive alexithymia in a sample of 128 patients with severe somatoform disorder, over and above the levels of negative affectivity and personality pathology. Method In a cross-sectional study among patients with somatoform disorder, self-report data were obtained using measures for alexithymia (Bermond-Vorst Alexithymia Questionnaire), attachment (Experiences in Close Relationships Questionnaire), personality pathology (Inventory of Personality Organization), and negative affectivity (Dutch Short Form of the MMPI). We used hierarchical regression analyses to test main effects of attachment deactivation and hyperactivation strategies in the prediction of both cognitive and affective alexithymia, while controlling for the levels of negative affectivity and personality pathology. Results Only cognitive alexithymia, i.e., the inability to analyze, identify, and verbalize emotions, was associated with personality dysfunction, in particular insecure attachment strategies. Affective alexithymia, i.e., the inability to fantasize and to experience emotions, was associated (negatively) with negative affectivity but not with the personality variables. Conclusions This study, therefore, indicates that both types of alexithymia are relevant for the assessment and treatment of severe somatoform disorder, yet each type may tap into different features of somatoform disorder.

Objective: The aim of this study was to examine occurrence of emotional lability (EL) in preschoolers with ADHD symptoms versus controls. Method: The study was part of the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. In the present study, 495 preschoolers were clinically examined. Symptoms of ADHD, anxiety, and oppositional defiant disorder (ODD) were measured with the Preschool Age Psychiatric Assessment Interview. An EL measure was obtained from the Emotional Control subscale of the Behavior Rating Inventory of Executive Function–Preschool Version (BRIEF-P), which parents and teachers completed. Results: EL was significantly more frequent in the ADHD group compared with controls (25% vs. 7%, p < .001). By parent report, EL correlated significantly with ADHD-, anxiety-, and ODD symptoms. By teacher report, EL was significantly correlated only with hyperactivity-impulsivity. Conclusion: EL appears identifiable in young preschoolers and was particularly associated with ODD in children with ADHD symptoms.

Background: Previous studies of endoscopic frontal sinus surgery have been primarily retrospective and focused on symptom relief only. Objectives: To prospectively assess the impact of endoscopic frontal sinus surgery on frontal sinus ostium patency and disease-specific quality of life as measured by the Rhinosinusitis Disability Index (RSDI). Study Design: A 60-patient cohort with chronic frontal sinusitis (100 diseased frontal sinuses) was prospectively evaluated using the RSDI, computed tomography (CT) imaging, and endoscopic examination. Image-guided endoscopic frontal sinusotomy (Draf 2a) was performed in each case. Patients were assessed with RSDI and endoscopic assessment at least 6 months postoperatively. Results: At a mean follow-up of 10 months, endoscopic assessment revealed patent frontal recesses in 90 of 100 frontal sinuses (90%), with significant improvement in the total RSDI score (41.98 ± 26.48 preoperatively to 17.15 ± 15.66 postoperatively) as well as each of its physical, emotional, and functional subscales from 16.3 ± 9.03, 12.23 ± 10.55, 13.45 ± 9.59 preoperatively to 5.95 ± 5.71, 5.55 ± 5.66, 5.65 ± 5.72 postoperatively, respectively. Similar improvement was seen in patients with asthma, polyps, and those undergoing revision sinus surgeries. Conclusions: With frontal recess mucosal preservation and meticulous postoperative endoscopic surveillance, endoscopic frontal sinusotomy results in high rates of frontal sinus ostium patency with significant improvement in quality of life.

We reviewed studies utilizing task sequencing to improve academic outcomes for children with emotional and/or behavioral disorders (EBD) in educational settings. Task sequencing interventions included high-probability, high-preference, and task interspersal interventions. Although task sequencing is commonly used in research, a synthesis of recent applications in educational settings for students with EBD is absent. Systematic searches of electronic databases and ancestral references identified 11 studies meeting inclusion criteria. These 11 studies were reviewed and analyzed for (a) participant characteristics, (b) experimental design, (c) type of academic outcome as the dependent variable, (d) intervention description, (e) certainty of evidence and research quality, and (f) reported student academic outcomes. Implications for continued applied practice and future research are discussed.

As awareness of the prevalence of NSSI and the risks associated with the behaviour have increased, interest in empirically supported treatments for NSSI has also increased. Empirical evidence has been strongest for interventions that have a specific focus on improving emotion regulation, such as DBT1 and emotion regulation group therapy,2,3 and emotion regulation has been implicated as an important treatment mechanism in these interventions (for example, Gratz,4 Gratz et al,5 and Slee et al6). In NSSI research more generally, our understanding of emotion regulation has focused predominantly on NSSI as a means of emotion regulation, and on trait emotion dysregulation among people who engage in NSSI. Much of this research has been guided by Linehan’s1 theory of emotion dysregulation in BPD, which focuses on emotional vulnerability and lack of emotion regulation skills. However, other models of emotion regulation may enhance and clarify our understanding of the difficulties experienced by people who engage in NSSI. The goal of this review is 3-fold. First, we will provide an overview of current research on emotion regulation and dysregulation in NSSI; for an in-depth review of these topics, please see Klonsky7 and Gratz.4 Second, we will discuss another model of emotion regulation8 that may provide a framework for building on existing work and for clarifying the process of, and deficits in, emotion regulation among self-injurers. We will then provide a review of NSSI research supporting the application of this model. Finally, we will suggest directions for future research to clarify and expand our understanding of emotion regulation in NSSI.

Many students with emotional and behavioral disorders (EBD) experience learning problems in reading at the middle and secondary school levels. Yet, the academic performance of students with EBD is often overlooked in the research literature. The purpose of this article was to provide a quantitative synthesis of the published, peer-reviewed, single-case research literature on reading interventions for students with or at-risk for EBD. An omnibus nonoverlap effect size of .59 with a 95% confidence interval (CI) = [.54, .64] was found consisting of 219 phase contrasts and 44 participants across the 11 studies included in the review. The findings are discussed in the context of improving the academic and behavioral outcomes of middle and secondary students with EBD.

Finasteride is a synthetic 5-α reductase inhibitor, which prevents the conversion of testosterone to dihydrotestosterone and has been used for more than 20 years in the treatment of male pattern hair loss. Randomized, controlled trials have associated finasteride with both reversible and persistent adverse effects. In this pilot study, we sought to characterize sexual and nonsexual adverse effects that men reported experiencing at least 3 months after stopping the medication. Based on previous research on persistent side effects of finasteride, we constructed an Internet survey targeting six domains: physical symptoms, sexual libido, ejaculatory disorders, disorders of the penis and testes, cognitive symptoms, and psychological symptoms and was e-mailed to patients who reported experiencing symptoms of side effects of finasteride. Responses from 131 generally healthy men (mean age, 24 years) who had taken finasteride for male pattern hair loss was included in the analysis. The most notable finding was that adverse effects persisted in each of the domains, indicating the possible presence of a “post-finasteride syndrome.”

Background: In routine clinical practice, the subcategories of various somatoform disorders are rarely used by the primary care physicians and there is lack of data to suggest any difference in the clinical manifestations of these subcategories. Aim: To compare the symptom profile, anxiety, depression, alexithymia, somato-sensory amplification and hypochondriasis of patients with persistent somatoform pain disorder with other subtypes of somatoform disorder. Method: A total of 119 patients diagnosed with somatoform disorders according to the International Classification of Diseases–10th Revision (ICD-10) were evaluated for prevalence of somatic symptoms, anxiety, depression, alexithymia, hypochondriacal worry and somato-sensory amplification. Results: No significant differences were found in the prevalence of various somatic complaints between those with persistent somatoform pain disorder group and those diagnosed with other somatoform disorders. Co-morbid anxiety and depression were seen in two-thirds of the patients, but again there was no difference in the prevalence of the same between the two groups. Similarly, no significant differences were found on alexithymia, hypochondriasis and somato-sensory amplification scales between the persistent somatoform pain disorder group and the group with other somatoform disorders. Conclusion: There are no significant differences between the various subcategories of somatoform disorders with regard to the prevalence of somatic symptoms, anxiety or depression and psychological correlates of alexithymia, hypochondriasis and somato-sensory amplification.

To support employees' work and health, organizations should help employees cope with common problems. Previous studies have focused primarily on work-related problems across multiple industries rather than on evaluating industry-specific issues. Here, two approaches identified common work and nonwork employee problems in the technology industry with the strongest correlations with psychosomatic health and life satisfaction. Study 1 used questionnaires to identify the problems that were perceived as the most frequent by lower-level employees ( N=355) working in the technology industry. Study 2 evaluated employees' coping behaviors by analyzing (with permission) counseling records collected from an employee assistance service company ( N=276). Employees reported a variety of problems; work problems were the only problems (of the top 5 problems) reported in both studies. Several problems emerged in the counseling records (e.g., legal issues, career development, family and marriage problems, and emotional problems) but not in the surveys. Future research should apply these observations to develop scales for measuring employee stressors.

Background. The Inventory of Callous-Unemotional Traits is a self- and other report questionnaire of callous-unemotional behaviors that is increasingly widely used in research and clinical settings. Nonetheless, questions about the factor structure and validity of scales remain. Method. This study provided the first large-scale ( N = 1,078) investigation of the parent report version of the Inventory of Callous-Unemotional Traits in a community sample of school-age (first-grade) children. Results. Confirmatory factor analysis indicated that a two-factor model that distinguished empathic-prosocial (EP) from callous-unemotional (CU) behaviors provided the best fit to the data. EP and CU were moderately to strongly correlated with each other (ϕ = −.67, p < .001) and with oppositional defiant disorder and conduct disorder (ODD/CD) behaviors (ϕODD/CD, EP = −.55; ϕODD/CD, CU = .71, ps < .001). Individual differences in EP and CU behaviors explained unique variation, beyond that attributable to ODD/CD behaviors, in peer-, teacher-, and parent relationship quality. Moreover, whereas EP moderated the effects of ODD/CD in the prediction of student–teacher relationship quality, CU moderated the effects of ODD/CD in the prediction of peer and parent relationship quality. Conclusions. Results are discussed with respect to the use of the ICU with school-age children.