Cesare Maffei

This perspective paper aims at discussing theoretical principles that could explain how emotion regulation and physical diseases mutually influence each other in the context of borderline personality disorder (BPD). Furthermore, this paper discusses the clinical implications of the functional relationships between emotion regulation, BPD and medical conditions considering dialectical behavior therapy (DBT) as a well-validated therapeutic intervention, which encompasses these issues. The inflexible use of maladaptive emotion regulation strategies (e.g., suppression, experiential avoidance, and rumination) might directly increase the probability of developing physical diseases through a physiological pathway, or indirectly through a behavioral pathway. Some metabolic and chronic medical conditions could significantly impact emotional functioning through biological alterations involved in emotion regulation. Several empirical studies have shown high co-occurrence rates between BPD and several chronic physical diseases, especially ones linked to emotion-based maladaptive behaviors. DBT addresses physical diseases reported by individuals with BPD reducing problematic behaviors functionally associated to emotion dysregulation and identifying physical health as a goal forBuilding a Life Worth Living.

Many experimental studies have evaluated Linehan’s biological emotional vulnerability in Borderline Personality Disorder (BPD). However, some inconsistencies were observed in operationalizing and supporting its components. This study aims at clarifying which aspects of Linehan’s model are altered in BPD, considering a multimodal evaluation of processes concerned with emotional responsiveness (self-report, psychophysiology and eye-tracking). Forty-eight socio-emotional pictures were administered to 28 participants (14 BPD, 14 Healthy Controls, HCs), gender- and age-matched, by employing two different lengths of stimuli exposure (5 s and 15 s). Our results supported the hypersensitivity hypothesis in terms of faster physiological responses and altered visual processing. Furthermore, hypersensitivity was associated with detailed socio-emotional contents. Hyperreactivity assumption was not experimentally sustained by physiological and self-report data. Ultimately, the slow return to emotional baseline was demonstrated as an impaired emotional modulation. Our data alternatively supported the hypersensitivity and the slow return to emotional baseline hypotheses, postulated by Linehan’s Biosocial model, rather than the hyperreactivity assumption. Results have been discussed in light of other BPD core psychopathological processes.

This paper examines the results of a systematic analysis, organised by the Italian Ministry of Education, University and Research, of private psychotherapy training in Italy. Since 1989, training in psychotherapy in Italy has been governed by a national law which recognises both public and private institutions. While the public system usually comprises approximately 150 students, the private system has grown significantly over time, registering thousands of students in hundreds of schools (for example, 19,123 students in 212 schools in 2011). Systematic analysis variables included geographical distribution, theoretical approaches, training methods, student and teacher characteristics, student’s personal psychotherapy, supervision and apprenticeships. Data were obtained from 92% of the schools. The primary issues discussed in this paper are as follows: the uneven geographical distribution of the schools; the disorderly amalgamation of traditional scientific paradigms; programmes which concentrate on theory and fail to meet international guidelines. One key issue is the excess supply with regard to demand, meaning that recently graduated psychotherapists (especially women) risk underemployment and financial hardship. Student enrolment is also increasingly problematic. This is the first paper to present an in-depth analysis of one European country’s situation in this field. The authors believe it will foster comparison and discussion internationally.

Gambling Disorder (GD) is an addictive disorder resulting in significant impairment in occupational and social functioning. The aim of the present study was to investigate the relationship of GD risk to adaptive and maladaptive personality dimensions in a sample of nonreferred Italian gamblers. The authors found the risk for GD to show significant associations with the Openness and Conscientiousness scales of the Big Five Inventory (BFI); however, these effects were not significant after controlling for alcohol and drug use. GD risk showed significant associations with the Detachment and Antagonism domains of the Personality Inventory for DSM-5 (PID-5), as well as with the PID-5 facet scales of Hostility, Callousness, Deceitfulness, Manipulativeness, Irresponsibility, and (low) Rigid Perfectionism, even when controlling for alcohol and drug use. Maladaptive personality dispositions may serve as risk factors for pathological gambling, even beyond their impact on frequently concomitant problems with alcohol...

To assess how the maladaptive personality domains and facets that were included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Alternative Model of Personality Disorders relate to adult attachment styles, 480 Italian nonclinical adults were administered the Personality Inventory for DSM-5 (PID-5) and the Attachment Style Questionnaire (ASQ). To evaluate the uniqueness of the associations between the PID-5 scales and the ASQ scales, the participants were also administered the Big Five Inventory (BFI). Multiple regression analyses showed that the ASQ scales significantly predicted both PID-5 domain scales and BFI scales; however, the relationships were different both qualitatively and quantitatively. With the exception of the PID-5 risk taking scale (adjusted R² = 0.02), all other PID-5 trait scales were significantly predicted by the ASQ scales, median adjusted R² value = 0.25, all ps < 0.001. Our findings suggest that the maladaptive personality domains and traits listed in the DSM-5 Alternative Model of Personality Disorders show meaningful associations with adult attachment styles.