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IntroductionMental health problems seemed to have increased among university students during the COVID-19 pandemic. To deepen our understanding of the pandemic's effects in this population, we conducted qualitative research to investigate any perceived changes in students during the pandemic, differentiating the sample based on the presence or absence of current suicidal ideation (SI).MethodsA wide sample of Italian university students (n = 1,214) completed an online questionnaire during the COVID-19 pandemic, March 2020-June 2021. We conducted a computer-assisted content analysis of an open-ended question about the perceived changes that occurred to them during the pandemic.Results(1) Four thematic clusters were identified: "The psychological impact of the pandemic," "New ties and new loneliness," "An uncertain forethought" and "Discovering the value of relationships." (2) In subjects characterized by severe SI, the state of confinement at home was related to the most intense emotional states and worries. (3) Students with severe SI were different from the others, in particular using the lemma "panic," which was the only psychological state specifically associated with this group.ConclusionsStudents with current severe SI experienced higher level of psychological distress and suffering compared to the other groups during the pandemic.

Background. Suicide constitutes a significant global health concern. Joiner’s interpersonal-psychological theory of suicide focuses on three variables: Thwarted Belongingness (TB), Perceived Burdensomeness (PB) and Acquired Capability for Suicide. Methods. A sample of 90 psychiatric patients, comprising outpatients, inpatients and individuals residing in therapeutic communities, was recruited between 2021 and 2022. Scales measuring anxiety, depression, mental pain, reasons for living, TB, PB and fearlessness about death were administered. Patients with and without suicidal ideation (SI), as well as those with and without history of suicide attempt (SA) were compared and two stepwise logistic regression models were performed. Results. Both patients with SI and with SA had higher anxiety, depression, mental pain, PB, fearlessness about death and lower self-esteem. Notably, depression, PB and beliefs about coping strategies were strongly associated with SI, while higher fearlessness about death and PB were strongly linked to history of SA. Additionally, inpatients and therapeutic community patients were at higher risk of suicide and had higher levels of depression compared to outpatients. Limitations. The small sample size and the inclusion of patients with mixed psychiatric diagnoses limit the generalizability of the findings. The cross-sectional design hinders causal hypotheses about the relationship between current SI or past SA and potential risk factors. The use of self-report measures entails biases. The analyses did not include details about pharmacological treatments. Conclusions. SA history could be explained by fearlessness about death. Improving the ability to cope with suicidal thoughts constitutes a pivotal component of therapeutic interventions with suicidal patients.

Background: Clinical and subclinical forms of narcissism may increase suicide risk. However, little is known and there are controversies on this topic. This systematic review aims at providing an overview of studies investigating this association. Methods: We used PubMed, Scopus, and PsycInfo databases and followed PRISMA. We focused on cohort, case-control, cross-sectional and case series studies. We referred to both clinical (i.e., narcissistic personality disorder (NPD) and/or NPD criteria) and subclinical forms (i.e., grandiose and vulnerable narcissistic traits) of narcissism. Moreover, we considered: Suicidal Ideation (SI), Non-Suicidal Self-Injury(s) (NSSI), Deliberate Self-Harm (DSH), Suicide Attempt(s) (SA), Suicide Risk (SR), and Capability for Suicide. Results: We included 47 studies. Lack of association between NPD diagnosis/criteria and suicide-related outcomes (SI) or mixed results (SA) were found. Higher homogeneity emerged when considering narcissistic traits. Vulnerable narcissism was associated with SI, less impulsive NSSI, and DSH. Grandiose narcissism was associated with severe NSSI and multiple SA with high intent to die, but it was protective against SI and SR. Vulnerable narcissism seemed to be associated with suicide-related outcomes characterized by low intent to die, while grandiose narcissism seemed to be a risk factor for outcomes with high planning and severity. Limitations: Between-study heterogeneity and lack of longitudinal studies. Conclusions: Assessing suicide risk in subjects with clinical or subclinical forms of narcissism may be useful. Moreover, considering the most vulnerable form of narcissism, and not just the grandiose one, may contribute to a more nuanced risk stratification and to the identification of distinct therapeutic approaches.

Shame may be a transdiagnostic marker of psychopathology and might potentially have a negative impact on treatment outcome. This scoping review maps the empirical literature on shame and psychotherapy, with a focus on individual therapy. Searching the terms shame and psychotherapy in PubMed and PsycInfo, we identified 2,520 unique records. After screening and selection, 46 empirical studies were included in the review and three themes were extracted from them: the impact of psychotherapy on shame, the impact of shame on psychotherapy, and additional shame-related themes. Narrative synthesis suggested that shame decreases after psychotherapy. In a subset of quantitative treatment evaluation studies, a preliminary meta-analysis indicated a medium size decrease in shame. The impact of shame on individual psychotherapy was more nuanced. Additional themes included but were not limited to shame-appropriate versus nonappropriate therapeutic interventions or investigations of therapists’ reactions to patients’ shame. Research gaps and recommendations for future investigations are outlined.

Introduction: The hypothesis of a diminshed pain sensitivity trait as one key contributor to suicidal behavior is recurring across most contemporary theoretical frameworks of suicide. In Joiner's Interpersonal-Psychological Theory, increased pain tolerance, alongside fearlessness about death, is thought to specifically contribute to the acquiring of a capability for suicide. Methods: A critical overview of clinical and neurobiological theoretical, meta-analytical and empirical contributions has been performed, after targeted and in-depth research on electronic databases, leading to the proposition of two different subtypes of patients at risk of suicide. Results: Pain insensitivity as a trait does not seem to effectively distinguish suicide attempters from ideators, and literature does not always suggest such a linear relationship between suicide risk and pain perception. On one hand, building upon Orbach's insights into dissociation, interoception, and pain sensitivity, and incorporating recent meta-analytical and neurobiological research, the presence of a dissociative subtype of individuals at risk of suicide is hypothesized. As possessing higher dissociative traits, some individuals may encounter frequent disruptions in conscious appraisal of pain and disconnections between the processing of interoceptive stimuli and subjective emotional experience, which expose them to a higher risk of suicide attempting. On the other hand, some lines of evidence suggest an opposite pattern of associations between a greater suicide risk and heightened sensitivity to both physical and psychological pain, at least among individuals characterized by chronic inflammation, like depressed patients and people living with chronic pain syndromes. Such findings converge in the hypothesis of a hypersensitive subtype, marked by chronic inflammatory processes, heightened interoceptive vigilance, sensitivity to both physical and psychological pain, and increased suicidal ideation. Discussion

The concept of personality organization, proposed by Kernberg and colleagues, has extensively contributed to the understanding and treatment of personality disorders, facilitating a paradigm shift in clinical practice. The Structured Interview for Personality Organization (STIPO-R) is a semi-structured interview designed for the dimensional assessment of personality organization as elaborated by Kernberg. In the present contribution, we tested the applicability and psychometric properties of the revised version of the Structured Interview for Personality Organization (STIPO-R) in the Italian population. In the first study, the STIPO-R was administered to 350 Italian participants, divided into 170 nonclinical participants and 180 clinical individuals. The theoretical dimensionality of the STIPO-R and the internal consistency of each scale were tested through Confirmatory Factor Analysis. Convergent validity was established using both criterion measures of maladaptive personality (Inventory of Personality Organization, IPO; Personality Inventory for DSM-5, PID-5) and general psychopathology (Symptom Checklist 90-R, SCL-90-R; Pathological Narcissism Inventory, PNI). Subsequently, a network analysis was conducted on the STIPO-R domains and subdomains to elucidate the interrelationships among personality organization components and investigate differences in their underlying structure in the community versus clinical sample. In a second study, we tested how STIPO-R performed in evaluating the personality structure in three different samples: 60 participants from the community, 45 outpatients with SUDs, and 42 inpatients with DD of SUDs and co-occurring PD. Analysis of variance (ANOVA) revealed that SUD and DD patients shared poorly integrated identity and object relations, rigid and primitive defenses, poorly integrated moral values, and higher self-directed aggression levels compared to individuals from the community sample. Moreover, DD patients were characterized by a

Withdrawal into fantasy can be a way to avoid conflicts and difficulties in real life and, as such, can represent a defense mechanism, which is traditionally traced back to schizoid/autistic phenomena. At the same time, fantasies of power, success, and ideal love are included among the criteria for Narcissistic Personality Disorder and represent a central feature of narcissistic pathology when assessed dimensionally. Clinically, grandiose fantasies are believed to compensate for deeper feelings of inadequacy and vulnerability, indicating that they may as well serve defensive purposes. To date, similarities and differences between autistic/schizoid and grandiose fantasies fall short of theoretical coordinates and have not been investigated empirically, nor has the relative role of schizoid and narcissistic traits been addressed in these defenses. The present contribution offers a theoretical discussion on the topic, investigating the role of fantasy in relation to both narcissistic and schizoid functioning. Preliminary empirical data from a nonclinical sample will be also used to investigate the link between maladaptive personality traits and different measures of fantasy. The assessment of fantasy in daily life with an intensive longitudinal design will allow detecting both trait-level and state-level dynamic processes. A specific focus will be on the relative contribution of narcissistic (both grandiose and vulnerable) and schizoid traits in the prediction of fantasy, and on the possibility to empirically discriminate between autistic/schizoid fantasy and fantasies with an explicitly grandiose content. Clinical and research implications will be discussed.

The COVID-19 pandemic has negatively impacted adults’ mental health around the world. Various studies highlighted the role of socio-demographic risk factors, including age, gender, and level of education, in increasing this impact. Although insecure attachment styles are considered a vulnerability factor for psychopathology and difficulties in coping with stressful situations, few studies have examined the role of attachment styles in relation to psychological responses to the COVID-19 pandemic. This study aims to investigate the role of attachment styles in affecting psychopathological problems and post-traumatic symptoms during the COVID-19 pandemic in a sample of Italian adults (N=1548). During the first lockdown in Italy, the Attachment Style Questionnaire, the Impact of Event Scale-Revised, and Symptom Checklist 90-Revised were administered to the participants to assess attachment styles, trauma-related symptoms, and psychopathological problems. The results showed that 41% of the participants had symptoms of clinical and subclinical relevance during the pandemic. Anxious and avoidant insecure attachment styles predicted psychopathological problems and post-traumatic symptoms, whereas secure attachment style was a protective factor. Our results highlighted the significant role played by the quality of attachment styles on adult mental health during the pandemic, providing valuable elements for targeted psychological support interventions.

Tools for assessing object relations (ORs) are fundamental for psychodynamic theory, research, and practice. ORs play an important role in diagnostic and therapeutic processes, helping therapists to better understand and manage complex relational functioning in their patients. The clinical relevance of OR is also recognized by the first criterion of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition Alternative Model for Personality Disorders. Our goal is to provide clinicians and researchers with an updated review of the available empirical tools to assess OR. We conducted a systematic search on APA PsycInfo and Pubmed and retrieved 42 instruments from the existing literature. Some of these assessment tools are well established in the scientific community. Among the less popular ones, we identified some instruments that show good potential and may be granted a further round of validation. We encourage the development of existing and new instruments within the framework of Kernberg’s theory of personality organization, and a further inquiry into qualitative aspects of ORs dyads, which may help therapists obtain more sophisticated information on their patients’ relational functioning.

In the frame of the interpersonal psychological theory of suicide (IPTS), Interpersonal Needs Questionnaire (INQ-15) assesses thwarted belongingness (TB) and perceived burdensomeness (PB), related to suicidal ideation (SI); Acquired Capability for Suicide Scale–Fearlessness About Death (ACSS-FAD) measures this component which contributes to lethal self-harm. The objective was to evaluate the psychometric properties of INQ-15 and ACSS-FAD in a population of Italian university students. Since the Italian INQ-15 was already validated, we translated ACSS-FAD through a multistage procedure and administered both to 1,665 Italian university students. Factor analysis confirmed a two-factor-related model of INQ-15, one factor of ACSS-FAD, and good reliability for both. We proved the association between INQ-15 and current SI and between ACSS-FAD and lifetime suicidal planning and/or suicide attempt. The convergent and discriminant validities were in line with those of previous studies. Both tools are valid and reliable to assess the constructs associated with suicide outcomes according to IPTS.

INTRODUCTION: Suicide is a major public health issue among adolescents, the fourth leading cause of death among 15-19-year-olds. Ambulatory Assessment (AA), or real-time monitoring, refers to a range of techniques (e.g., ecological momentary assessment (EMA), daily diaries) designed to assess individuals’ thoughts, feelings, and behaviors in their natural environment, intensively and repeatedly over time. It represents a suitable approach for capturing these fluctuations and dynamics. EVIDENCE ACQUISITION: The present narrative review aimed to describe all the published studies evaluating AA and suicide-related outcomes in adolescents and to critically evaluate the reported dynamic processes. A PubMed search was performed up to March 2022 to include studies focused on 1) adolescents; 2) any suicide-related outcome; and 3) AA and dynamic processes. EVIDENCE SYNTHESIS: We included 27 studies based on EMA (multiple assessments per day) (k=17), daily diary (one assessment per day) (k=9), or both (k=1). Among EMA studies, different types of sampling strategies were used: signal-contingent (self-report after a notification) (k=11), event-contingent (self-report after the event) (k=1), and mixed-based (k=4) sampling strategies. Nearly half of the studies measured positive and negative affects, while most studies measured suicidal ideation (SI), self-injurious thoughts and non-suicidal self-injury (NSSI). Nineteen studies yielded a dynamic aim, using a nomothetic (k=5) or an idiographic approach (k=22), respectively, a group-based and an individual-based approach. CONCLUSIONS: The shortness of NSSI episodes (from 1 to 30 minutes) and the high SI fluctuation over time suggest the importance of a real-time assessment of these phenomena. However, an idiographic approach to data analysis should accompany this type of monitoring. This approach captures the dynamics underlying these phenomena. It considers their intimate and individual nature, gaining a basic understanding of the

The “Healthcare workers’ wellbeing [Benessere Operatori]” project is an exploratory longitudinal study assessing healthcare workers’ mental health at three different time points over a 14-month period during the COVID-19 pandemic. We collected socio-demographic and work-related information and assessed the perceived social support, coping strategies, and levels of depression, anxiety, insomnia, anger, burnout, and PTSD symptoms. In total, 325 Italian healthcare workers (i.e. physicians, nurses, other healthcare workers, and clerks) participated in the first initial survey and either the second or third subsequent survey. Participants reported subclinical levels of psychiatric symptoms that remained mostly unchanged across time, except for an increase in stress, depression, state anger, and emotional exhaustion symptoms. Despite subclinical levels, healthcare workers’ distress can adversely affect the quality of care, patient satisfaction, and medical error rates. Therefore, implementing interventions to improve healthcare workers’ wellbeing is required.

Background: The COVID-19 pandemic has been postulated to account for inflated rates of either suicides or homicides. Nonetheless, results are discordant, in particular concerning suicide. We aimed to perform a retrospective analysis of suicides and homicides in the region of Lombardy, Northern Italy (districts of Milan and Monza Brianza), the Italian region most seriously impacted by the pandemic outbreak. Methods: Data were collected during the autopsies performed at the Institute of Forensic Medicine in Milan. We presented suicides and homicides in the years 2015-2021 and compared the year 2021 to 2019, a pre-COVID-19 year. Results: Data may allow us to cautiously hypothesize a normalization of trends ("regression" to the mean effect) as time passes from the COVID-19 outbreak. Limitations: Limited number of events, in particular, homicides. Conclusions: Recording historical reports from the same region is warranted besides the comparisons across different countries.

The Pathological Narcissism Inventory (PNI) is extensively used in recent empirical literature on pathological narcissism. However, most studies using the PNI are community-based, and no studies have used the PNI to investigate narcissistic presentations in personality disordered patients. This study investigates measurement invariance of the PNI in community participants and patients with personality disorders, and examines differences of narcissistic presentations in these samples through a multimethod approach. Results show that the PNI can be used reliably to measure and compare traits of pathological narcissism in community participants and patients with personality disorders. Personality disordered patients show higher traits reflecting vulnerable narcissism and overt manifestations of grandiose narcissism, compared with controls. Finally, network analysis indicates that traits of grandiose fantasies and entitlement rage have a central role in defining manifestations of PNI pathological narcissism, regardless of the presence of an underlying personality disorder. Research and clinical implications are discussed.

Introduction Prevalence of suicidal thoughts and behaviours is higher among patients with borderline personality disorder than the general population. However, evidence concerning the role of specific borderline symptoms for predicting suicide-related outcomes is lacking and no systematic review/meta-analysis (SR/MA) investigated this topic. Our aim will be to investigate the relationship between any borderline symptom (except criterion 5) and suicide-related outcomes both through an SR/MA and an individual patient data meta-analysis (IPD-MA). Methods We will search PubMed/MEDLINE, Scopus, Web of Science, Embase, PsycINFO, CINAHL and Cochrane Library databases from 1974 until September 2021. Both published and unpublished studies showing the association between any borderline symptom (except criterion 5) and suicide-related outcomes (death wish, suicidal ideation, suicidal plan, non-suicidal self-injury, deliberate self-harm, suicide attempt, suicidal behaviour disorder, suicide) will be included. Two team members will independently perform the selection of the studies and data extraction, with the supervision of two other members in case of discrepancies; and assess each study with study quality assessment tools by National Institutes of Health and Grading of Recommendations Assessment, Development and Evaluation. Each author will be contacted. If possible, we will perform both random-effect meta-analyses on the collected data (odds, risk, rate ratios or correlations) and an IPD-MA on collected databases. Ethics and dissemination This study does not require an ethical approval. Results will be publicly disseminated, included in research presentations and published in peer-review journals. PROSPERO registration number CRD42018078696.

Introduction: Among the most investigated theories explaining suicidal behavior there are the interpersonal-psychological theory of suicide (IPTS) by Thomas E. Joiner and the one focused on the construct of psychological pain (or psychache, or mental pain). Objective: Since it remains unclear whether these two different theories correlate with each other in the explanation of suicidal risk, we used a network analysis approach to investigate the complex interplay between both IPTS and psychological pain theories and history of suicidal planning and/or suicide attempt (SP/SA). Methods: A sample of 1,586 university students from various Italian universities was recruited between April 24th, 2020 and February 23rd, 2021, hence during the COVID-19 pandemic. To be included subjects should have been university students and aged between 18 and 35 years old. Results: Within a network that included the core factors from both models (IPTS and psychological pain), higher fearlessness about death (Acquired Capability for Suicide Scale-Fearlessness About Death, ACSS-FAD) and higher psychological pain (Psychache Scale) were the variables most strongly associated with history of SP/SA. Conclusions: Considering a large number of variables, history of SP/SA was explained in particular by fearlessness about death and psychological pain in university students. Hence these aspects should be targeted in the treatment for suicide prevention.

Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries’ COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries’ income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well

Despite the widespread prevalence of mental health problems, most psychological distress remains untreated. Internet-based psychological interventions can be an essential tool for increasing treatment availability and accessibility. The main objective of the MindBlooming project is to design and implement an innovative Internet-based multi-approach treatment for university students suffering from psychological or physical problems. The intervention will focus on symptoms of depression, anxiety, sleep problems, self-destructive thoughts, job-and study-related stress and burnout, and chronic pain. It will be based on different approaches, primarily psychoeducation, Cognitive-Behavioral Treatment (CBT), and third-wave CBT. At the end of the treatment, user satisfaction and usability will be assessed. In addition, two further aims will be evaluating the treatment efficacy through a randomized controlled trial and tuning a predictive model through Machine Learning techniques. The intervention consists of a 7-week treatment on two problematic areas according to each students’ personal needs, identified through an initial assessment. Besides the treatment assigned following the initial screening, participants will also be assigned to a different module to improve their relational skills. The treatment, which can be accessed through a mobile app, consists of psychoeducational videos followed by related exercises. We expect MindBlooming to be a remarkable tool for promoting the mental health of university students.

Adolescence is a crucial period for the development of personality and its dysfunctions. In this regard, it is essential to evaluate the nature and degree of maladaptive personality functioning. However, measures currently available present some limitations, mainly being adaptations from adult’s tailored instruments and length. Moreover, no instrument considers the crucial dimensions related to body development and sexuality. This contribution presents data on the Adolescent Personality Structure Questionnaire (APS-Q) development, a self-report measure to capture core aspects of personality functioning in adolescence while being agile and reliable. On two large samples of adolescents (total N = 1,664), we investigated the psychometric properties of the APS-Q. We explored its factor structure and construct and incremental validity in the first sample, testing specific associations with existing measures of severity of personality pathology, maladaptive personality traits, and psychological distress. In the second sample, we confirmed its factor structure, assessing gender and age invariance. Overall, our findings support the APS-Q’s validity as a reliable and useful measure to assess personality functioning. Moreover, the APS-Q highlighted developmentally vital dimensions such as self-functioning (encompassing mental and bodily changes and considering the dimension of sexuality), interpersonal functioning (discriminating the dimensions of family and peers), and emotion regulation.

Molte persone a rischio suicidario non ricevono assistenza professionale per problemi economici, per il desiderio di risolvere il problema in autonomia o per via dello stigma. Gli Interventi Internet- e Mobile-based (o Internet and Mobile-based Interventions - IMI) sono in grado di superare molti di questi ostacoli, offrendo interventi flessibili e facilmente accessibili. Abbiamo condotto una revisione narrativa della letteratura riguardo le caratteristiche degli IMI rivolti al rischio suicidario, la loro efficacia e alcuni esempi di applicazioni e siti utilizzati per prevenire e trattare il rischio suicidario. Metodo. La ricerca della letteratura è stata condotta sui database PubMed e PsycINFO. Risultati. Gli IMI rappresentano una valida alternativa ai tradizionali trattamenti e diverse ricerche ne dimostrano l’efficacia nel ridurre l’ideazione e i comportamenti suicidari. La maggior parte degli IMI si basa sulla terapia cognitivo-comportamentale, un trattamento molto strutturato e facilmente trasferibile in formato digitale. L’auto-potenziamento, i meccanismi di rinforzo e il supporto umano sono i principali aspetti che promuovono il cambiamento dell’individuo e la sua aderenza al trattamento. Alcuni IMI sviluppati per la prevenzione del suicidio sono Stay Alive (Regno Unito), Virtual Hope Box (USA), This way up (Australia) e Jaspr Health (USA). Conclusioni. Gli IMI sembrano essere un valido aiuto nella prevenzione del suicidio. Riteniamo importante continuare le ricerche che ne supportino l’efficacia e implementare questo tipo di interventi in Italia., Many suicidal people do not receive professional assistance due to economic problems, the desire to autonomously solve the problem, or the stigma. Internet and Mobile-based Interventions (IMIs) can overcome many of these obstacles, offering flexible and accessible interventions. We conducted a narrative literature review about the characteristics of IMIs focused on suicide risks. We studied their efficacy and some examples of applications and websites used to prevent and treat suicide risk. METHOD: Literature research was conducted on Pub Med and PsycINFO databases. RESULTS: IMIs are a viable alternative to traditional treatments and several studies supported their effectiveness in reducing suicidal ideation and behaviors. Most IMIs are based on cognitive-behavioral therapy, which is very structured and easily transferable to digital format. Empowerment, reinforcement mechanisms and human support are the main features that promote the change of the individual and her or his adherence to the treatment. Some IMIs developed for suicide prevention are Stay Alive (UK), Virtual Hope Box (USA), This way up (Australia), and Jaspr Health (USA). CONCLUSIONS: IMIs can be considered a valid aid in suicide prevention. It is necessary to continue the research supporting their effectiveness and implement their interventions in Italy.

La pandemia da Coronavirus (Covid-19) ha richiesto l’adattamento di pazienti e psicoterapeuti a un’evoluzione del tradizionale setting “in presenza” alla videoterapia (VT). La VT ha visto una progressiva diffusione prima come passaggio obbligato e, poi, come nuova modalità alternativa o integrabile. L’obiettivo di questo lavoro è indagare il grado di soddisfazione dei pazienti nel passaggio alla VT, unitamente all’impatto di attitudini/esperienze pregresse e attuali riguardo alla VT stessa. A tal fine, è stato sviluppato un questionario ad hoc, inviato via e-mail a tutti i pazienti seguiti in psicoterapia, tra marzo e giugno 2020, presso il servizio di Psicologia,Psicoterapia e Psichiatria del Centro Medico Santagostino. È stata condotta un’analisi della distribuzione delle risposte nel campione (n = 111) e un modello di regressione multipla per valutare l’effetto di specifiche variabili sul grado di soddisfazione espresso dai pazienti. Le difficoltà nell’uso dei sistemi di video-comunicazione e di postazione predicono una minore soddisfazione per la VT. Nell’esperienza di VT, un senso di maggiore spontaneità con il terapeuta e la percezione di impatto sul modo di comunicare correlano, rispettivamente positivamente enegativamente, con la soddisfazione per la VT. Al fine di una migliore esperienza di VT, proponiamo di considerare diverse variabili contestuali e specifiche che ne caratterizzano il setting.

Background: Suicide methods chosen by victims are particularly critical in suicide risk research. To differentiate suicide deaths, it is usual to categorize them as violent and nonviolent depending on the detrimental method chosen by the victims. Caustic ingestion, for example, is traditionally considered as a nonviolent suicide method. It results in severe consequences for the human body and it is associated with high levels of lethality. Methods: In this study, we retrospectively analyzed suicides that occurred between 1993 and 2021 in Milan (Italy) and that underwent autopsy. We compared a sample of 40 victims that ingested caustic substances with a sample of 460 victims of other chemical ingestion, and a sample of 3962 victims from violent suicide. Univariate analyses and univariate logistic regression models were performed. Suicides from caustic poisoning were significantly older, had a higher mean number of diseases and were more affected by psychiatric diseases compared to other chemical ingestion victims. By contrast, caustic suicides, compared to violent suicides, had a more balanced gender ratio, a higher mean number of diseases, were more affected by psychiatric diseases, had a higher rate of complex suicides (more than one modality), and had victims who died more frequently inside instead of outside. In logistic regression models, age was the only feature differentiating caustic from other chemical ingestion suicides while the features differentiating caustic from violent suicides were gender, mean number of diseases and suicide place. Conclusions: Suicides by caustic ingestion showed substantial differences compared to violent suicides, with a higher severe profile. However, some differences were reported comparing caustic ingestion to other chemical ingestion as well. Thus, we argue whether it is more appropriate to differentiate the suicidal ingestion of caustics from both violent and nonviolent suicide methods.

Introduction: Both variable- and person-centered approaches identify grandiose and vulnerable themes in pathological narcissism (PN). However, person-centered results rely on cross-sectional data, preventing identification of subtypes of individuals through transitory self-states. Methods: We perform a cluster analysis on the joint trajectory of daily ratings of grandiose narcissism (GN) and vulnerable narcissism (VN), collected during a 28-day experience sampling (N = 196 participants). Results: The best partition—identified by multiple criteria—includes three clusters: a “low PN” cluster displays below-average levels of both daily GN and VN; a “high VN” cluster displays average daily GN and above-average levels of daily VN; a “high GN” cluster shows above-average levels of daily GN and below-average levels of daily VN. Significant inter-cluster differences emerge on both daily and trait measures of narcissism, and on trait measures of self-esteem and shame, but less sharply on impairment in personality structure. There is no inter-cluster difference on the variability and instability of daily narcissism. Discussion: We conclude that the constructs of daily GN and VN define corresponding groups of individuals with either high GN or VN, the latter group being more distressed. Yet, this group is also less “pure” in its narcissistic characterization, showing at least some levels of trait and state GN.

Introduction: Pathological narcissism (PN) entails both grandiose (GN) and vulnerable narcissism (VN). These can be studied both at the variable-level – focusing on the constructs, such as on their covariation – and at the person-level, focusing on subjects and grouping individuals on the basis of their similarities and differences in grandiose and vulnerable manifestations. While there is emerging agreement on the defining features of GN and VN at the variable-level, controversies still exist when looking at the person level. For instance, there is no definitive understanding of the nature of grandiose and vulnerable narcissism as subtypes or rather as fluctuating/coexisting dimensions. Methods: In this work, we perform a cluster analysis on the joint trajectory of daily ratings of grandiose (GN) and vulnerable narcissism (GN), collected during a 28-day experience sampling study (N = 196 participants). Results: We use multiple criteria to find the best partition, which identifies three discrete clusters of individuals: a “low PN” cluster with below-average levels of both grandiose and vulnerable daily manifestations; a “high VN” cluster, displaying average daily GN and above-average levels of daily VN; a “high GN” cluster, with above-average levels of daily GN but below-average levels of daily VN. The three clusters differ on several trait measures of maladaptive narcissism, as well as on measures of trait self-esteem and shame. Non-significant or less sharp inter-group differences emerge regarding impairment in personality organization and stability/variability of daily narcissism. Discussion: We conclude that the constructs of daily GN and VN define corresponding groups of individuals with either high GN or VN, the latter group being more emotionally distressed. Yet, this group also shows at least some levels of trait and state GN. To the best of our knowledge, this is the first study that applies person-centered analyses to longitudinally assessed manifestations

Objective: Evidence suggests that pathological narcissism impacts psychotherapy process and outcome. This study investigates whether traits of pathological narcissism account for distinctiveness (construal) of patients' interpersonal perceptions in treatment settings. Methods: Patients enrolled in psychological/psychotherapeutic treatment (N = 150) described a segment of a session in a written format and subsequently assessed both self- and clinician's behavior on the dimensions of dominance and hostility (patient-reported ratings), along with their pathological narcissistic traits. Three independent raters also assessed interpersonal behaviors (observer-reported ratings) based on the written session descriptions. Indices of construal were defined by the residuals of self-reported (net of observer-reported) ratings and were regressed onto pathological narcissistic traits. Results: No association emerged between pathological narcissism and construal in patients' perceptions of their clinicians. However, grandiose traits of pathological narcissism were related to distinctively perceiving oneself as more dominant, while vulnerable traits were related to distinctively perceiving oneself as more hostile. The former association (but not the latter) also held after incorporating additional observer ratings to investigate the robustness of the results. Conclusion: Findings are discussed in light of treatment-related self-enhancement and self-concealment processes.

Pathological narcissism implies a fragile self-view. The psychological effects of ego-relevant events in people high in pathological narcissism, however, are still uncertain. The study examined the effects of pathological narcissism on psychological reactions to ego-relevant events occurring in private or public settings. Participants (N = 410) completed measures of pathological narcissistic traits, and then they took part in a scenario-based experimental session. They were randomly assigned to four conditions: ego-threatening vs. ego-fostering events in public vs. private settings. Self-esteem and affective states before and after the experimental manipulation were measured. Results showed that vulnerable and grandiose manifestations of pathological narcissism affect differently psychological reactions to ego-relevant events. Vulnerable narcissism made people particularly sensitive to ego-threatening and ego-fostering events, especially when occurring in public settings. Grandiose narcissism was linked to a reduction in emotional responses to ego-relevant events. Findings suggest that self- and affective reactions to ego-relevant events depend on narcissistic prevailing manifestations, and that public exposure has a key role in vulnerable narcissism.

Suicide is a major cause of death in Eating Disorders (EDs) and particularly in anorexia nervosa (AN). The aim of the present mini-review was to summarize the literature focusing on the interpersonal-psychological theory of suicide (IPTS) by Thomas E. Joiner, as applied to explain suicidal risk in EDs. PubMed database was used to search articles focused on IPTS in EDs; 10 studies were eventually included. The majority of the included studies reported data from the same sample, even though the hypotheses and analyses for each study were unique. The investigated suicidal outcomes were suicidal ideation (SI) (40%), non-suicidal self-injury (10%), suicide attempt (40%) and suicide (10%). In ED patients Perceived Burdensomeness (PB) may play an important role, especially regarding SI risk. ED patients may feel like a burden to their close ones, and actually some of the ED symptoms may be an expression of anger and hate against the self. Overall, currently available research has supported some IPTS derived predictions (i.e., ED symptoms may increase PB and thereby SI), but not others (i.e., the elevated suicide rate in AN may be due to higher acquired capability for suicide). Further research on IPTS tenets as well as on other theoretical perspectives and constructs (e.g., interoceptive awareness), hopefully with a longitudinal design and adequate follow-up duration, might allow a more thorough understanding of the complex topic of suicidal behavior in ED patients.

Introduction Multiple epidemiologic and clinical studies have explored the relationship between physical pain and suicidal thoughts and behaviours. Objectives The aim of this meta-analysis was to provide an update of the data already present in literature about this specific association in adults. Methods Starting from a meta-analysis published by Calati and colleagues in 2015, 28 studies were included in this work. After searching on Pubmed (until March 2020), data were extracted from articles comparing the rates of current and lifetime suicidal thoughts and behaviours (death wish, suicidal ideation, suicidal planning, suicide attempt and suicide death: DW, SI, SP, SA, and SD) in adults with any type of physical pain and in individuals who did not report this condition. Data were analysed using Cochrane Collaboration Review Manager software (RevMan, version 5.4). Results Although high between-study heterogeneity was detected in most analyses, results suggested that adults with physical pain are more likely to report any form of suicidal outcome, except for death by suicide, compared to individuals not affected by pain. No evidence of publication bias was reported in the main analysis (lifetime SA). Conclusions Collected data are therefore in line with previous literature on this topic, which considered physical pain an extremely relevant risk factor for suicidal thoughts and behaviours. Future studies should specifically focus on alternative types of physical pain (such as medically unexplained pain or psychogenic pain) or explore the different impact of acute versus chronic pain in terms of increased suicide risk.

Introduction Suicide is the third leading cause of death in adolescents (15-19 years). Physical pain is an important risk factor for suicidal thoughts and behaviors, especially in a delicate phase as adolescence. Objectives Several studies investigated this association and the aim of this meta-analysis was to synthesize data in literature about this topic in adolescents (11-20 years). Methods We started from a systematic review published by Hinze and colleagues in 2019 and we searched on PubMed (January 2019-June 2020) studies comparing rates of suicidal outcomes (Suicidal Ideation, Suicide Plan, Attempt, Self-Harm: SI, SP, SA, SH) in individuals with any type of physical pain (head, back, neck, chest, stomach, abdomen, muscle, joint, arthritis) vs. those without it. Data were analyzed with Comprehensive Meta-Analysis software (CMA, version 3). Results Of the 16 included studies, eleven focused on SI (68.8%), six (37.5%) on SA, four (25%) on SH and two (12.5%) on SP. Adolescents with physical pain were more likely to report SI (p < .001), SH (p < .001), SA (p = .004) and SP (p = .006). In all analyses, the between study heterogeneity was high. The presence of publication bias has been detected in SI (k≥10). Conclusions Results are in line with previous literature on this topic. Future research should investigate the specific impact of: acute vs. chronic pain; different types and intensities of pain; planned vs. impulsive action and therefore suicidal intent; role of psychological factors (in particular sensitivity and tolerance to physical pain).