Clinical psychology & psychotherapy最新文献

Identity diffusion, involving a lack of cohesive personal identity, is a vulnerability factor in affective states—psychache and hopelessness—that often precede suicidality. Traumatic experiences, such as childhood emotional abuse, may limit the capacity to form a stable and coherent sense of self, thereby indirectly heightening the vulnerability to psychache and hopelessness through diffuse identity. The present study examined the relationship between identity diffusion and psychache and hopelessness, along with the indirect effect of perceived childhood emotional abuse. The sample (n = 297) comprised UK-based help-seeking adults recruited online. Eligible participants completed measures of identity diffusion, unbearable psychache, hopelessness and childhood emotional abuse at baseline, with psychache and hopelessness reassessed two months later. Regression analyses revealed that identity diffusion was significantly associated with both psychache and hopelessness over time, even after controlling for baseline levels. Mediation analysis further indicated that identity diffusion had a significant mediating effect on the relationship between childhood emotional abuse and later experiences of psychache and hopelessness. These findings underscore the importance of clinically targeting identity diffusion to help reduce presuicidal affective states, particularly among individuals who experience childhood emotional maltreatment.

Intolerance of uncertainty (IU), cognitive avoidance (CA), positive beliefs about worry (PBW) and a tendency to view everyday problems as threats, termed negative problem orientation (NPO), are cognitive vulnerabilities associated with symptoms of anxiety and depression in adults, with fewer studies examining all four vulnerabilities in youth. In this study, validated measures of IU, CA, PBW and NPO were administered to clinically referred youth with a principal diagnosis of obsessive-compulsive disorder (OCD, n = 86), anxiety disorders (n = 80) or major depression (n = 18) and to non-clinical peers (n = 46). Group differences and the contribution of each vulnerability to internalizing symptom domains were examined. The OCD and anxiety groups did not differ significantly from each other on any vulnerability but had higher scores than non-clinical peers on all vulnerabilities except PBW. Alongside age and sex, IU, CA, PBW and NPO accounted for 52% of the variance in generalized anxiety symptoms, 51% in depression, 48% in panic, 31% in obsessions/compulsions, 29% in separation anxiety and 18% in social anxiety. Structural modelling revealed that IU was associated with all anxiety symptom domains and that NPO was most strongly associated with depression. These findings suggest that IU, CA, PBW and NPO are linked to various internalizing symptom domains in youth and that IU and NPO act as transdiagnostic vulnerabilities and may be important treatment targets.

Insecure attachment is a well-established risk factor for the emergence of borderline personality features (BPF), encompassing identity disturbance, affective instability, problematic interpersonal relationships and self-harming behaviours. From a mentalizing-based perspective, BPF may develop through the interplay of hypomentalizing, defined as a reduced capacity to understand and reflect on one's own and others' mental states, and epistemic mistrust (EM), the diminished capacity to trust communicated information. Both processes are shaped by attachment anxiety and avoidance. However, research investigating the mechanisms linking attachment to BPF remains limited. This study examined the parallel mediating roles of hypomentalizing and EM in the associations between attachment dimensions and BPF. Data were drawn from a large combined clinical and community sample of 1129 participants (291 men, 819 women, 17 transgender individuals and 2 categorized as ‘other’; mean age = 32.88 years, SD = 10.90). Participants completed the Experiences in Close Relationships—Revised (ECR-R); the Reflective Functioning Questionnaire–54 (RFQ-54); the Epistemic Trust, Mistrust and Credulity Questionnaire (ETMCQ); and the Borderline Features Scale of the Personality Assessment Inventory (PAI-BOR). Parallel multiple mediation analyses indicated that both hypomentalizing and EM significantly mediated the relationships between (a) attachment anxiety and BPF and (b) attachment avoidance and BPF. Supplementary analyses showed that these pathways did not differ across diagnostic groups, but EM was expressed most strongly in those participants who met criteria for borderline personality disorder (BPD), where it differentiated the group from clinical (depression and anxiety disorders) and community comparisons. These findings support the theoretical basis for mentalization-based interventions, highlighting the importance of improving mentalizing and reducing mistrust in communication to foster adaptive social learning. Nonetheless, the cross-sectional design and reliance on self-report measures limit causal inference and introduce potential bias. Future research should employ longitudinal designs to further evaluate the proposed model.

Narcissistic personality disorder (NPD) is a complex disorder that, given the variety of its manifestations and the significant challenges related to its treatment, has attracted considerable attention from international scientific research. The present research aimed to investigate the centrality and the dynamics among the symptoms of NPD, based on the mental health professionals' perceptions. The research involved 376 mental health professionals, which evaluated the relative importance of diagnostic criteria for NPD outlined in Section II of the DSM-5-TR and the significance of maladaptive personality trait domains encompassed by Criterion B of Section III. Network analysis was then employed to analyse the collected data. Analysis of the NPD criteria network revealed two distinct symptom clusters related to the self and interpersonal dimensions of functioning. The need for admiration criterion emerged as a central node within this network. Furthermore, the network analysis concerning the domains confirmed the centrality of the antagonism domain in NPD. The findings of this study systematise the perspectives of mental health professionals using a network analysis approach to deepen our understanding of the core characteristics of NPD. These insights may offer valuable practical applications for both research and clinical practice, enhancing diagnostic accuracy and informing effective treatment strategies.

Patients with schizophrenia (SZ) tend towards riskier decision-making (DM). Yet the specificity of these findings, as well as the impact of impairments in executive functions (EF), has not been sufficiently clarified. In a preregistered study (https://osf.io/n7z6y) 40 SZ, 50 patients with alcohol use disorder (AUD) and 36 healthy controls (HC) completed an n-back task (as EF challenge), the Game of Dice Task (GDT; DM under risk) and the Iowa Gambling Task (IGT; DM under ambiguity). AUD and SZ performed worse than HC in the n-back task and riskier in the GDT. In the IGT, only AUD performed riskier than HC and preferred disadvantageous Deck B compared to SZ. However, controlling for demographics and IQ abolished significance. Correlations of performance in the GDT and IGT with working memory differed between groups. Taken together, both patient groups show a deficit in the reflective system, whereas only AUD show impairments in the impulsive system. Thus, the direct comparison of DM in SZ and AUD reveals a differential DM profile of SZ and AUD. Our results suggest that both groups may benefit from EF training, especially in planning, categorization and cognitive flexibility, whereas AUD could additionally profit from impulse control and inhibition training. However, the findings need replication with well-matched samples, and the link between EF and DM in SZ should be examined more carefully with experimental approaches.