Clinical Neuropsychiatry最新文献

Farina and Schimmenti's model of attachment trauma offers a robust, transdiagnostic framework linking early relational trauma to complex psychopathological phenomena. This commentary expands upon their clinical conceptualization through a dialogue with neuropsychodynamic model of the self, as proposed by Scalabrini, and Mucci's psychoanalytic theory of trauma, affect regulation and intergenerational transmission. Integrating different perspective from developmental psychopathology, affective neuroscience, and relational psychoanalysis, we further consider the therapeutic implications of restoring self-integration vs. traumatic disintegration, affective relationality vs. detachment reactions and mentalization vs. dysregulation of arousal and impulses across brain, body, mind and intergenerational systems.

This article offers commentary on the featured article on attachment trauma by Farina and Schimmenti (2025). Attachment trauma is often not recognized by clinicians. Hence, the presentation of a comprehensive definition of attachment trauma, together with a discussion of pathological processes and components of treatment, is timely. Case examples involving traumatic attachment to a perpetrator illustrate the importance of recognizing and treating attachment trauma, which creates vulnerability to perpetrators who exploit the need for connection.

Benedetto Farina and Adriano Schimmenti have synthesized the burgeoning literature on attachment trauma to draw attention to its prevalence and pervasive role in the development of diverse forms of severe and chronic psychopathology. These sequelae call for a multidimensional approach to treatment that is evidenced by a spate of trauma-related psychotherapies as well as biological interventions. While respecting the sheer complexity of attachment trauma, this commentary offers an integrative perspective for therapists of different orientations. Relying on decades of research on contributors to the effectiveness of psychotherapy, the author provides a distinctive view of the role of common factors that cut across the wide varieties of therapy. These factors pertain largely to qualities of patient-therapist relationships that are especially crucial in the treatment of attachment trauma. This commentary highlights five such common factors: attachment, mentalizing, trust, care, and-not least-the therapist. As Farina and Schimmenti's review attests, understanding the complexity and severity of illness associated with trauma requires a great deal of knowledge; concomitantly, establishing therapeutic relationships requires an exceptional level of interpersonal skill: skill in being human, to put it simply.

Farina and Schimmenti's (2025) model of Attachment Trauma (AT) reframes early relational adversity as a transdiagnostic, developmentally rooted process that disrupts emotional regulation, identity formation, and relational functioning. Rather than viewing trauma as a single catastrophic event, their model emphasizes chronic, inescapable relational disruptions, particularly in protection, attunement, and repair as core pathogenic mechanisms. This relationally situated view positions AT as a primary etiological force behind a range of clinical conditions, including complex PTSD, borderline personality disorder, and dissociative disorders. To strengthen this compelling framework, the current paper proposes the integration of somatosensory processing models, which offer neurobiologically grounded mechanisms for how AT becomes embedded neurobiologically. Dysregulation in vestibular and somatosensory systems, critical to bodily orientation, interoception, affect regulation, and social connection, may underlie the fragmentation and dissociation central to AT. A hierarchical neurobiological model is proposed, mapping disruptions from brainstem sensory circuits through limbic and cortical systems. A key implication of this model is the need to prioritize physiological regulation before initiating higher-order cognitive or relational interventions. Bottom-up approaches, including sensorimotor psychotherapy, somatic experiencing, and Deep Brain Reorienting (DBR) target shock, autonomic dysregulation and sensory fragmentation that can compromise traditional talk-based therapy. By stabilizing the nervous system and restoring sensorimotor integration, these methods prepare clients for deeper therapeutic work and support the reorganization of disrupted self and relational patterns inherent in attachment trauma.

Farina and Schimmenti (2025a) have made a major contribution to furthering our understanding of early developmental trauma and its serious, long-term, psychosocial effects, while pointing toward therapeutic approaches deeply informed by their rich conceptualization of attachment trauma (AT) and clinical acumen. The authors' impressive review and integration of a wealth of developmental and clinical research has led them to propose a sophisticated yet clear definition of AT, as well as important notions on its relationship with disorganized attachment (DA) and a helicopter view on its treatment. We identify several appreciations of the authors' conceptualization and applications to clinical practice; offer suggestions for further clarification and expansion of ideas; and finally propose how we might "continue the conversation" with an emphasis on clinical theory and practice, past, present, and future. Farina and Schimmenti are to be strongly commended for providing a solid foundation from which to pursue, with greater clarity and intention, our field's ever-deepening and hope-engendering understanding and treatment of survivors of AT, for patients, therapists, and concerned loved ones.

This paper responds to expert commentaries on our original formulation of attachment trauma. By synthesizing the commentators' critical perspectives, we refine the conceptual boundaries of attachment trauma, elaborate the mechanisms of therapeutic change, and discuss the need for an integrated model that spans phenomenology, neuro‑somatic dynamics, narrative emergence, existential motivation, and ethical co‑presence in clinical settings. We examine how rupture and repair manifest in clinical interaction, the role of somatic co‑regulation in reshaping neural attractors, the emergence of patient narratives as both symptom and remedy, the existential motivations driving attachment and defense, and the ethical imperative of clinical presence with individuals exposed to child maltreatment. We believe that further developing this dialogue may advance a scientifically rigorous yet deeply human approach to assessment and intervention for attachment trauma.

Objective: This study aims to evaluate the effectiveness of RehaCom cognitive rehabilitation in improving neurocognitive functions in patients with temporal lobe epilepsy (TLE) following anterior temporal lobectomy (ATL), a common surgical intervention for medically refractory epilepsy.

Method: A total of 12 patients who had undergone ATL participated in a 10-session RehaCom rehabilitation program. Cognitive assessments were conducted pre- and post-intervention, measuring verbal memory, figural memory, attention, and executive function. Cognitive improvements were analyzed using repeated measures ANOVA and non-parametric tests to evaluate changes in performance and the effect of the surgery side on outcomes.

Results: Significant improvements were observed in verbal memory, working memory, and learning ability, especially in patients who underwent left anterior temporal lobectomy. Overall, cognitive improvements were evident across both groups, though specific patterns of recovery differed depending on the side of the surgery.

Conclusions: RehaCom cognitive rehabilitation significantly improves cognitive functions, particularly in memory, attention, and executive function, following ATL. The side of surgery plays a role in determining specific outcomes, with left ATL patients benefiting more in verbal memory. These findings support the use of RehaCom as a multi-domain, adaptive rehabilitation tool for enhancing cognitive recovery in TLE patients post-ATL.

Objective: Sensitive alterations in the balance between physiological changes may be a relevant factor in the expression of social behavior and are systematically reported in a broad spectrum of psychopathological conditions. Among these, psychopathy, compassion and theory of mind hold a prominent role in social interaction. Biomarkers associated with such individual characteristics could represent an ambitious breakthrough in clinical practice, both diagnostically and therapeutically. The aim of this work is to evaluate the available evidence published in the past 20 years in order to investigate the relationship between the autonomic nervous system and the aforementioned individual characteristics.

Method: A literature search was conducted using dedicated search engines, including Pubmed, Scopus, and Google Scholar. The review focused on evidence published over the last two decades, from 2003 to 2024.

Results: Individuals with high trait psychopathy show reduced activation in skin conductance. This attenuation results in lower sensitivity to learning through fear conditioning mechanisms and an impaired ability to process affective stimuli. Studies focusing on compassion, while showing less variability in measures and proposed tasks, have revealed a possible effect of time in terms of efficacy, with therapeutic intervention programs (of at least 2 weeks' duration) also showing an impact on autonomic indices. Studies focused on theory of mind highlighted mixed findings and may require further investigation.

Conclusions: Interpretation of results may be limited by the numerosity and demographic characteristics of the participants, the plurality of autonomic indices used, and the heterogeneity of the proposed tasks. The ability to modify sensitivity to autonomic changes intentionally through possible specific therapeutic interventions could be a potential clinical goal.

Objective: Youth violence, often linked to drug offenses, is a major concern in socially and politically unstable regions worldwide. Early attachment and stressors influence behavioral development, highlighting the importance of addressing underlying psychopathology. This study examined clinical, psychopathological, and cognitive profiles in incarcerated young adults with substance use issues, considering social, familial, and environmental factors.

Method: This cross-sectional study enrolled 40 male young adults (mean age 21.05 ± 1.15 years) with SUD, participating in a resocialization program in Medellin. Participants completed questionnaires assessing affective lability (ALS-SF), emotion dysregulation (DERS), executive functions (BRIEF-A), ADHD symptoms (ASRS), attachment styles (CA-MI-R), and stressful life events (SRRS). Data were analyzed using non-parametric tests, Spearman's rank correlations, and multiple linear regressions.

Results: Multiple linear regression analyses revealed significant predictive relationships. The number of substances used was predicted by poorer emotional control (β = -0.440, p = .007), greater executive dysfunction (β = 0.060, p = .015), higher childhood trauma (β = -0.360, p = .006), and a higher CA-MI-R score (β = 2.316, p = .017). Childhood trauma reported was predicted by greater executive dysfunction (β = 0.536, p = .013), lower socioeconomic status (β = -0.119, p = .035), a greater number of substances used (β = -0.256, p = .006), benzodiazepine use (β = -0.299, p = .014), and poorer emotional control (β = -0.331, p = .016). Affective lability, emotion dysregulation, and executive dysfunction were significantly intertwined with ADHD traits.

Conclusions: This study provides evidence for the complex interplay of attachment, executive function, emotion regulation, and ADHD symptoms in incarcerated young adults with SUD. Executive dysfunction, impulsivity, emotional dysregulation, and attachment insecurity significantly contribute to substance use and childhood trauma, fueling a vicious cycle. Interventions addressing relational trauma, deficits, and broader factors are needed to disrupt this cycle, promote rehabilitation, and reduce recidivism.

Objective: The decision to pursue a career as a psychotherapist may be influenced by various psychological dispositions or self-healing motivations. The current study aimed to investigate differences in empathy, personality traits, and psychopathology between psychology students who intend to pursue psychotherapy training and those who do not.

Method: The study involved 1978 psychology students (1764 women, 89.2%), aged between 18 and 30 years (M = 22.72, SD = 2.59), who were attending a Bachelor's or a Master's degree program at Italian universities. Each participant completed self-report instruments assessing dispositional empathy domains, personality traits, and clinical symptoms, as well as a sociodemographic questionnaire. A Multivariate Analysis of Covariance was performed to examine the significant differences on the examined variables between psychology students intending to pursue psychotherapy training (n = 1309) and those without such intentions (n = 669).

Results: Both groups of psychology students reported clinically relevant symptoms across various domains of psychopathology. However, students who expressed an intention to pursue psychotherapy training reported higher levels of empathetic concern, conscientiousness, and openness compared to their peers without such intentions.

Conclusions: These findings suggest that individuals may choose to enroll in a university psychology program for self-healing purposes, and that individual differences in empathy and personality traits may play a role in the decision to pursue a career as a psychotherapist. Universities and psychotherapy training institutes should promote psychology students' access to psychotherapy services. Also, psychotherapy training institutes should consider individual differences in empathy and personality traits within their educational programs.