Transdiagnostic Factor Research Articles

The relationship between sleep difficulties and externalizing and internalizing problems in children and adolescents with mental illness.

Sleep difficulties are presumably a transdiagnostic factor in the complex aetiology of psychiatric disorders in youth. This study assessed the prevalence of sleep difficulties in children and adolescents seeking specialized psychiatric care, examined the relationships of internalizing and externalizing problems, and considered the moderating role of sex and age on these relationships. Parent-reported data on difficulties initiating sleep, difficulties maintaining sleep, early morning awakenings and daytime fatigue from a large sample of children and adolescents referred for specialized psychiatric care (n = 4638; < 18 years) were used to estimate prevalence rates. To examine associations between these sleep difficulties and internalizing/externalizing problems, multiple linear regression analyses were conducted on available data (n = 3768) stratified in three age groups (1.5-5 years; 6-11 years; 12-18 years). Overall prevalence, i.e. at least one sleep difficulty was reported to be often or always present, was 65%. Difficulties initiating sleep occurred the most, closely followed by daytime fatigue. In all age groups, sleep difficulties were positively related to internalizing and externalizing problems. In young children and school-age children, age moderated the interaction between sleep difficulties and internalizing problems. To conclude, prevalence rates of sleep difficulties in children with mental illness appear higher than it has been reported in the general youth population, especially difficulties initiating sleep and daytime fatigue. We observed that the associations between internalizing problems and sleep difficulties in young children and school-age children seemed to be amplified with age, suggesting a negative, bidirectional, spiral in development.

Emotional Disorders, Distress Tolerance and Suicide Risk: A Mediation Model.

Background: Suicide has been linked to psychopathology, particularly emotional disorders. This study seeks to investigate the mediating role of distress tolerance in the relationship between emotional symptoms and suicide risk. Method: The sample included 1014 adults (33.82% male; M = 33.0, SD = 15.15). Four mediation analyses were performed, controlling for sex, for depressive, anxious, somatizing and obsessive symptoms measured with the Brief Symptom Checklist as the independent variable, distress tolerance, measured with the Distress Tolerance Scale as the mediating variable, and the risk of making a suicide attempt, measured with Risk of Suicide, as the dependent variable. Results: Distress tolerance partially mediated the relationship between emotional symptoms and suicide risk, with Appraisal and Absorption scales positively mediating, and Tolerance negatively mediating. Conclusions: Tolerance of distress plays a role in risk of suicide attempts. Distress tolerance needs to be addressed as a key transdiagnostic factor in reducing suicidal risk.

Emotion regulation mediates the relation between intolerance of uncertainty and emotion difficulties: A longitudinal investigation.

Intolerance of uncertainty has been proposed as a transdiagnostic factor in emotional disorders. Despite comprehensive empirical evidence demonstrating the association between intolerance of uncertainty and emotional disorders, the underlying mechanism remains elusive. Drawing on theoretical frameworks and empirical studies, the current study proposed that emotion regulation emerges as a potential mechanism. We explored the connections among intolerance of uncertainty, eight emotion regulation strategies (both adaptive and maladaptive), and emotional difficulties (specifically anxiety and depression) using a three-wave longitudinal approach (N = 341). Our findings revealed that heightened intolerance of uncertainty predicted increased anxiety but not depression over time. Greater intolerance of uncertainty significantly predicted elevated levels of maladaptive emotion regulation strategies including experiential avoidance, thought suppression, rumination, and reassurance-seeking. Adaptive strategies (i.e., mindfulness, cognitive reappraisal, problem-solving) predicted lower anxiety and/or depression whereas maladaptive emotion regulation strategy rumination predicted greater levels of anxiety and depression. Surprisingly, thought suppression predicted lower levels of anxiety and depression. More importantly, our analysis showed that both rumination and thought suppression served as significant mediators in the relationship between intolerance of uncertainty and both anxiety and depression. These results hold implications for future interventions, emphasising rumination and thought suppression as potential targets for interventions aimed at alleviating emotional difficulties in individuals with intolerance of uncertainty.

Emotion dysregulation in misophonia: Findings from a nationally representative sample

A core feature of misophonia is the emotional distress that occurs in response to specific sounds (e.g., slurping, pen clicking). Despite the theorized connection between emotion dysregulation and misophonia, there is very little research on this topic. Examining emotion dysregulation and identifying the specific emotion regulation deficits that are associated with worse misophonia symptoms would advance our understanding of potential transdiagnostic factors central to misophonia symptoms; thereby informing the development of more targeted interventions. The current study sought to: 1) characterize emotion dysregulation among individuals with misophonia, 2) compare emotion dysregulation between individuals with clinical and subclinical misophonia, and 3) examine the unique role of emotion dysregulation across three domains of misophonia symptoms. This study included a large, nationally representative sample of U.S. adults (N = 4005; 51.5% female; 62.5% White, non-Hispanic). Participants completed self-report questionnaires to assess misophonia symptoms (i.e., misophonia sounds, emotional and behavioral reactions to misophonia sounds, and misophonia-related impairment), stress, and emotion dysregulation. The results revealed participants with misophonia reported significantly worse emotion regulation abilities compared to individuals with subclinical levels of misophonia. In addition, emotion dysregulation was significantly associated with sensitivity to misophonia sounds, reactions to misophonia sounds, and misophonia-related impairment, even after accounting for covariates. Results support emotion dysregulation as an important element in misophonia and suggest certain dimensions of emotion dysregulation should be considered in future research and in the evaluation of treatment strategies used to reduce misophonia symptoms.

Deconstructing Cognitive Impairment in Psychosis With a Machine Learning Approach

Cognitive functioning is associated with various factors, such as age, sex, education, and childhood adversity, and is impaired in people with psychosis. In addition to specific effects of the disorder, cognitive impairments may reflect a greater exposure to general risk factors for poor cognition. To determine the extent that impairments in cognition in psychosis reflect risk factor exposures. This cross-sectional study examined the relationship between exposures and cognitive function using data from the Bipolar-Schizophrenia Network on Intermediate Phenotypes studies 1 and 2 across 6 sites. Participants included healthy controls; patients with schizophrenia, schizoaffective disorder, or bipolar I disorder with psychosis; and relatives of patients. Predictive modeling was performed using extreme gradient boosting regression to train a composite cognitive score prediction model with nested cross-validation. Shapley additive explanations values were used to examine the relationship between exposures and cognitive function. Exposures were chosen based on associations with cognition previously identified: age, sex, race and ethnicity, childhood adversity, education, parental education, parental socioeconomic status, parental age at birth, substance use, antipsychotic dose, and diagnosis. Cognition was assessed using the Brief Assessment of Cognition in Schizophrenia. A total of 3370 participants were included: 840 healthy controls, 709 patients with schizophrenia, 541 with schizoaffective disorder, 457 with bipolar I disorder with psychosis, and 823 relatives of patients. The mean (SD) age was 37.9 (13.3) years; 1887 were female (56%) and 1483 male (44%). The model predicted cognitive scores with high accuracy: out-of-sample Pearson correlation between predicted and observed cognitive composite score was r = 0.72 (SD = 0.03). Individuals with schizophrenia (z = -1.4), schizoaffective disorder (z = -1.2), and bipolar I disorder with psychosis (z = -0.5) all had significantly worse cognitive composite scores than controls. Factors other than diagnosis and medication accounted for much of this impairment (schizophrenia z = -0.73, schizoaffective disorder z = -0.64, bipolar I disorder with psychosis z = -0.13). Diagnosis accounted for a lesser proportion of this deficit (schizophrenia z = -0.29, schizoaffective disorder z = -0.15, bipolar I disorder with psychosis z = -0.13), and antipsychotic use accounted for a similar deficit across diagnostic groups (schizophrenia z = -0.37, schizoaffective disorder z = -0.33, bipolar I disorder with psychosis z = -0.26). This study found that transdiagnostic factors accounted for a meaningful share of the variance in cognitive functioning in psychosis. A significant proportion of the cognitive impairment in psychosis may reflect factors relevant to cognitive functioning in the general population. When considering interventions, a diagnosis-agnostic, symptom-targeted approach may therefore be appropriate.

Fear of positive evaluation and social affiliation in social anxiety disorder and major depression

Fear of positive evaluation (FPE) is posited as a core feature of social anxiety disorder (SAD); however, little is known about its role in interpersonal functioning. We examined relationships between FPE and responses to a standardized social affiliation paradigm designed to facilitate positive social connection with an unacquainted conversation partner (trained confederate). The sample included adults with SAD (N = 52), major depressive disorder (MDD; N = 23), comorbid SAD and MDD (N = 36), and non-psychiatric controls (N = 33). Participants completed measures assessing FPE, affect, safety behaviors, and desire for future interaction. Confederates and observers rated participant behavior and their own desire for future interaction. FPE was most elevated in the SAD and comorbid groups, followed by the MDD group, and then non-psychiatric controls. In the full sample, FPE was associated with greater self-reported anxiety and safety behavior use, lower self-reported positive affect and desire for future interaction, lower observer-rated desire for future interaction and approach behaviors, and greater observer-rated anxious behaviors. Within-group correlations revealed that associations were weaker in the SAD only and comorbid groups (cf. control and MDD only groups); however, post-hoc moderation analyses indicated that the relationships between FPE and the outcomes of interest largely held across varying levels of social anxiety and depression severity. Findings underscore the potential role of FPE as a transdiagnostic factor relevant to understanding interpersonal functioning in social anxiety and depression.

“You’re Ugly and Bad!“: a path analysis of the interplay between self-criticism, alexithymia, and specific symptoms

AbstractSelf-criticism is a transdiagnostic factor of significant clinical relevance. Research has studied its detrimental role on mental health without discriminating how this differs based on individual psychological functioning. Furthermore, little research has considered the lack of emotional awareness as an essential competence that contributes to dysfunctional self-critical processes and, consequently, to psychopathological outcomes. The objective of the study was to investigate how different forms of self-criticism are associated with specific symptoms, considering social anxiety, obsessive-compulsive, and eating disorder symptoms. Furthermore, we wanted to explore the role of alexithymia in this relationship. The sample comprised 564 subjects (M = 35.12, SD = 12.8), 389 females and 175 males. Participants completed online questionnaires to investigate levels of self-criticism, alexithymia, and specific symptoms. Hierarchical regression and path analyses showed that aspects of self-criticism have different importance in psychopathological features. Furthermore, the subscales of alexithymia differently mediate the relationship between self-criticism and symptomatological features, depending on the type of feature considered (social anxiety, eating or obsessive-compulsive). In light of the results, since self-criticism is a contributing factor to the onset and maintenance of many mental disorders, it becomes important to distinguish its specific characteristics and how they are linked to the disorders. A better understanding of these processes would help to prepare more targeted interventions.

Early emotion regulation developmental trajectories and ADHD, internalizing, and conduct problems symptoms in childhood.

Emotion dysregulation is considered a transdiagnostic factor with importance for a range of neurodevelopmental and mental health issues, including attention deficit hyperactivity disorder (ADHD) symptoms, internalizing problems, and conduct problems. Emotion regulation skills are acquired from early in life and are thought to strengthen gradually over childhood. Children, however, acquire these skills at different rates and slower acquisition may serve as a marker for neurodevelopmental and mental health issues. The current study uses the UK Millennium Cohort Study, a large longitudinal study to evaluate whether developmental trajectories of emotion regulation across ages 3, 5, and 7 predict levels of ADHD symptoms, internalizing problems, and conduct problems at age 7. Both higher initial levels of and slower reductions in emotion dysregulation across ages 3, 5, and 7 predicted higher ADHD symptoms, conduct problems, and internalizing problems at age 7 in both male and female children. Our findings suggest that monitoring trajectories of emotion regulation over development could help flag at-risk children. Additionally, supporting the acquisition of emotion regulation skills in this critical period could be a promising transdiagnostic preventive intervention.

On the effects of impulsivity and compulsivity on neural correlates of model-based performance

Impaired goal-directed behavior is associated with a range of mental disorders, implicating underlying transdiagnostic factors. While compulsivity has been linked to reduced model-based (MB) control, impulsivity has rarely been studied in the context of reinforcement learning despite its links to reward processing and cognitive control. This study investigated the neural mechanisms underlying MB control and the influence of impulsivity and compulsivity, using EEG data from 238 individuals during a two-step decision making task. Single-trial analyses revealed a modulation of the feedback-related negativity (FRN), where amplitudes were higher after common transitions and positive reward prediction error (RPE), indicating a valence effect. Meanwhile, enhanced P3 amplitudes after rare transitions and both positive and negative RPE possibly reflect surprise. In a second step, we regressed the mean b values of the effect of RPE on the EEG signals onto self-reported impulsivity and compulsivity and behavioral MB control (w). The effect of RPE on FRN-related activity was mainly associated with higher w scores, linking the FRN to MB control. Crucially, the modulation of the P3 by RPE was negatively associated with compulsivity, pointing to a deficient mental model in highly compulsive individuals.

A Study of Psychometric Properties of Difficulty in Emotion Regulation Scale – Thai Version among Thai Population

Objective: Individuals with psychiatric disorders are found to struggle with emotion regulation, which is considered a transdiagnostic factor. However, due to a limitation in the assessment of emotion regulation in Thailand, this study aimed to translate the Difficulty in Emotion Regulation Scale (DERS) into Thai (DERS-Thai) and evaluate its psychometric properties. Materials and Methods: The DERS-Thai was initially translated by one of the researchers before being re-reviewed. A pre-testing phase was then conducted to preliminarily evaluate the psychometric properties of the DERS-Thai. Subsequently, the testing phase involved 446 participants who completed an online questionnaire platform containing demographic data, DERS-Thai, the Emotion Regulation Scale (ERQ), and the Depression Anxiety Stress Scale 21 (DASS-21). The factor structure was then evaluated, along with its concurrent and criterion validity, as well as its internal consistency. Results: DERS-Thai demonstrated acceptable content validity (I-CVI = 0.8 to 1.0, S-CVI/Ave = 0.85). In the testing phase with 446 participants (mean age = 29.19, SD = 8.50), predominantly female (81.8%), and mostly residing in central Thailand (81.31%), the original model did not fit well. After modification, fit indices were improved. DERS-Thai showed a negative correlation with ERQ and a moderate to strong correlation with DASS-21. Known-group analysis revealed significant differences in DERS-Thai scores between DASS-21 groups (p-value &lt; 0.001). The scale exhibited excellent internal consistency (α = 0.94, ω = 0.96). Conclusion: The DERS-Thai has demonstrated appropriate psychometric properties for assessing emotion regulationskills in individuals.

The dynamics of emotion-related impulsivity: An analysis of momentary self-efficacy and daily emotion-driven urges and actions via ecological momentary assessment.

Emotion-related impulsivity-the engagement in impulsive reactions specifically in response to emotions-is considered a transdiagnostic factor underlying psychopathology. The reflexive responding to emotion (RRE) model of emotion-related impulsivity (Carver et al., 2008) suggests that sensitivities to reward and threat in combination with control over emotion are factors that result in internalizing and externalizing psychopathology. In the current study, we adapt the trait-based RRE model to momentary states by evaluating how within-person fluctuations in affect combine with perceptions of momentary emotional control to predict impulsive, rash action and inaction in daily life. Participants (college students and adults recruited from the community: N = 197) completed 8 days of ecological momentary assessment, where we assessed current affect, perceptions of momentary emotional control (via distress intolerance and willpower), and urges for rash action and inaction (5,353 momentary prompts completed). We also assessed subsequent engagement in rash action and inaction. Using multilevel modeling, we found that when people feel greater positive affect and lower negative affect, they also report greater subjective willpower and lower distress intolerance, replicating past ecological momentary assessment findings. Furthermore, we found that momentary perceptions of momentary emotional control moderated the relationship between (a) affect and urges for rash action and (b) affect and engagement in rash action at follow-up. Findings support a dynamic model of the RRE model, confirming that perceptions of momentary emotional control are relevant for both rash action and inaction, particularly when occurring alongside shifts in affect. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The relationship between distress tolerance and behavioral activation on anxiety and depression symptomatology in autistic youth: Leveraging self and caregiver perspectives.

Anxiety and depression are prevalent among autistic adolescents and may be difficult to accurately diagnose and treat given various factors (e.g., diagnostic overshadowing, heterogeneity). Therefore, efforts to examine transdiagnostic factors (i.e., distress tolerance, behavioral activation) may afford more parsimonious means for assessment and treatment. To our knowledge, there has been little research on distress tolerance, behavioral activation, and depressive and anxiety symptoms in autistic adolescents to guide diagnostic practices and treatment planning. In the current study, we examined the interrelationships between these transdiagnostic factors and depressive and anxiety symptoms using ratings from 100 verbally fluent autistic adolescents without intellectual disability (Mage = 13.70, SDage = 2.23, Range: 11:00-17:11 years) and 100 of their caregivers. Many adolescents reported male sex assigned at birth (61%), cisgender (87%), not Hispanic/Latinx (90%), and White (80%) identities. A series of correlational analyses were employed to examine associations between these constructs from youth and caregiver perspectives, and multiple linear regression analyses were conducted to explore the mediating roles of distress tolerance and behavioral activation. Preliminary results show that low distress tolerance and behavioral activation were associated with more severe internalizing symptoms per self- and caregiver-report. Some differences by rater emerged, which highlight the importance of multi-informant ratings in autism. Results from mediation analyses may show that behavioral activation may be more salient to assessments and treatment planning for depression than distress tolerance, while distress tolerance may be important for both anxiety and depression; however, findings are preliminary given the cross-sectional nature of the data. Findings suggest that these transdiagnostic concepts may be important to individualizing treatment approaches, including the timing of certain approaches, for anxiety and/or depression in autistic adolescents.

Examining emotion regulation and inflammation as predictors of maternal mental health after fetal anomaly diagnosis

ObjectiveFetal anomalies occur in approximately 3% of pregnancies and receiving the diagnosis may be a potentially traumatic experience for families. The mental health of mothers receiving diagnoses and what predicts resilience or poor mental health is understudied. Emotion regulation is an important, modifiable, transdiagnostic factor of mental health, and may be protective post-diagnosis. Evaluating biomarkers of stress, including IL-6 and Allostatic Load (AL), can also serve as early indicators of risk, indicative of early intervention. This study assessed whether reappraisal, suppression, IL-6, and AL was associated with mental health outcomes and resilience in women after receiving a fetal anomaly diagnosis. MethodsPregnant women (N=108) presenting to a fetal concerns clinic for initial consultation completed measures of emotion regulation (i.e., reappraisal and suppression), depression, anxiety, posttraumatic stress symptoms, and resilience between 2019–2022. A blood draw was used to assess IL-6 and create composite allostatic load measure including: IL-6, blood pressure, heart rate, glucose, cortisol, and body mass index. ResultsLinear regressions controlling for age, gestational age, and perceived fetal diagnosis severity, demonstrated that IL-6 was negatively associated with resilience and positively associated with depression. Reappraisal was positively associated to resilience and negatively associated with depression, anxiety, and PTSD, whereas state insurance status was positively associated to anxiety and PTS symptoms. Suppression and allostatic load were not significant. ConclusionsWomen experiencing fetal anomaly diagnosis represent an understudied population with unaddressed mental health needs. Reappraisal serves as not only a protective factor, but one that can be enhanced to promote maternal resilience and mental health. Furthermore, elevated IL-6 may be a critical early indicator of potential intervention needs among women who are pregnant, to mitigate negative psychological states and enhance resilience.

The relations of difficulties in emotion regulation and distress intolerance with cannabis problems: The role of protective behavioral strategies underutilization

IntroductionDifficulties with emotion regulation and distress tolerance are related to more cannabis problems, yet little research has identified why this is the case. Cannabis-related protective behavioral strategies (PBS; behaviors used to mitigate cannabis related problems) are related to less cannabis consumption and related problems. Potentially, these individuals may use cannabis to alleviate the distress and/or in an attempt to regulate their emotions. Thus, the present study aimed to examine the mediational role of PBS on the relations of emotion dysregulation and distress intolerance with cannabis problems. MethodsUndergraduate students who endorsed past-month cannabis use (N = 339, Mage = 19.33, SDage = 1.37; 77.9 % female) at a southern United States university completed a survey online via Qualtrics. ResultsMore emotion dysregulation and less distress tolerance predicted less PBS use and more cannabis problems, but not cannabis use frequency. After statistically controlling for sex, the relation of each transdiagnostic factor with cannabis problems occurred indirectly via the relations of less PBS use and greater cannabis use frequency ConclusionsThe present study supports previous claims that emotion dysregulation and distress intolerance are related to more cannabis problems. Additionally, results suggest that individuals with high levels of these problems underutilize PBS which, in turn, is associated with more frequent cannabis use and use-related problems. Clinical implications are discussed.

Evidence for post-decisional conflict monitoring in delay discounting

Choice impulsivity can be measured by offering a sequence of various binary choices between smaller, immediately available rewards and larger, later available rewards. An individual’s delay discount (DD) rate reflects the aggregate decision-making tendency. Given the broad spectrum of disorders associated with a high DD rate, this may be an important transdiagnostic factor. This study aimed to establish whether post-decisional neurophysiological processes reflecting the presence of error monitoring are involved in delay discounting. A large sample (N = 97) was investigated, including 46 females and 51 males. The electroencephalogram (EEG) was recorded during the classic monetary choice questionnaire (MCQ-27). Error-related event-related potentials (ERPs) and event-related oscillations (EROs) following responses were analyzed. A modest relationship between error positivity (Pe) and DD rate was seen centro-parietal, with higher amplitude for low DD individuals after choosing immediate rewards. A robust association was found between DD rate and theta oscillation power increases. This was most prominent in low DD individuals after making an immediate reward choice. Theta power was positively associated with decision (reaction) time, suggesting an association between pre- and post-decisional conflict. No evidence was found for an error-related negativity (ERN) and delta oscillations. This study provides clear evidence for conflict monitoring as a post-decision process in delay discounting. Findings suggest that diminished theta band power bursts and lower Pe amplitude, observed after choosing an immediate reward, reflect the neurophysiological consequence and possibly the cause of steep delay discounting. High DD was characterized by prefrontal hypoactivation and appears to result from affective decision-making.

Understanding the role of cannabis use on cigarette dependence severity among individuals with e-cigarette and combustible tobacco dual use.

The use of both electronic and combustible cigarettes is related to greater rates of cannabis use. Further, cannabis use is associated with worse combustible smoking-related outcomes, yet little research has identified mechanisms underlying such relations. It may be that negative-affect-related transdiagnostic factors such as emotion dysregulation, anxiety sensitivity, and/or distress intolerance play a mechanistic role in the cannabis-tobacco interrelations. The current study tested this hypothesis among 400 adults who endorsed dual use, 33% of whom endorsed current (past 3 months) cannabis use. We conducted analyses of variance and indirect effects model using the PROCESS v4.1 macro in SPSS version 29. Results indicated that participants who use cannabis reported greater difficulty with emotion regulation, anxiety sensitivity, and cigarette dependence severity. Cannabis use was related to cigarette dependence severity indirectly via difficulty with emotion regulation and anxiety sensitivity. These results indicate that specific transdiagnostic negative-affect-related factors of difficulty with emotion regulation and anxiety sensitivity are associated with cannabis use among adults who smoke combustible and electronic cigarettes. Given that these transdiagnostic factors are malleable, these findings suggest targeting and engaging such mechanisms may offer novel behavioral change strategies for this high-risk population.

"Too much of a burden": Lived experiences of depressive rumination in early adulthood.

Rumination is an established transdiagnostic factor in mental illness, but there remains a significant gap in understanding the subjective experiences of those affected by it. This study explored the lived experiences of depressive rumination in early adulthood, a population notably susceptible to its effects. We interviewed 20 participants aged between 18 and 35 years using a semistructured approach and generated five distinct but interconnected themes using reflective thematic analysis. The first theme delved into recurrent narratives of past traumas and unresolved pain, with participants unable to move on from their past. The second theme illustrated how participants, due to real or perceived pressure, often equated their self-worth with their ability to meet expectations, leading to a distorted self-view and diminished self-esteem. The third theme captured the relentless pursuit of mental peace, with tranquility remaining ever elusive despite the frequent use of distraction. The fourth theme highlighted the profound isolation stemming from internalized mental health stigma, with participants grappling with fears of being perceived as burdensome and facing rejection from their close ones. Finally, the fifth theme underscored the far-reaching and interconnected repercussions of rumination on mental, emotional, and physical health and individuals' ability to achieve their life goals. These findings emphasize the intertwined nature of psychological, physiological, and social risk factors for the development and maintenance of rumination, advocating for a holistic treatment approach to rumination and paving the way for more timely, tailored care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Metacognition as a transdiagnostic factor across eating disorders: a latent profile analysis study.

Metacognition is a crucial aspect of understanding and attributing mental states, playing a key role in the psychopathology of eating disorders (EDs). This study aims to explore the diverse clinical profiles of metacognition among patients with EDs using latent profile analysis (LPA). A total of 395 patients with a DSM-5 diagnosis of ED (116 AN-R, 30 AN/BP, 100 BN, 149 BED) participated in this study. They completed self-report measures assessing metacognition, eating psychopathology, depression, emotional dysregulation, personality traits, and childhood adversities. LPA and Welch ANOVAs were conducted to identify profiles based on metacognition scores and examine psychological differences between them. Logistic regression models were employed to explore associations between personal characteristics and different profiles. A 3-class solution had a good fit to the data, revealing profiles of high functioning (HF), intermediate functioning (IF), and low functioning (LF) based on levels of metacognitive impairments. Participants in the IF group were older and had a higher BMI than those in the HF and LF groups. Individuals with BN were largely categorized into HF and LF profiles, whereas participants with BED were mainly included in the IF profile. Participants in the LF group reported an impaired psychological profile, with high levels of depression, emotional dysregulation, childhood adversity, and personality dysfunction. Multinomial logistic regression analyses showed significant associations between metacognitive profiles and emotional and neglect abuse, emotion dysregulation, and detachment. This exploratory study unveils distinct metacognitive profiles in EDs, providing a foundation for future research and targeted interventions. In this light, metacognitive interpersonal therapy could be a valid and effective treatment for EDs, as suggested by the initial promising results for these patients.

Understanding the relationship between narrative identity, transdiagnostic factors and psychological functioning in a young adult community sample

Understanding the relationship between narrative identity, transdiagnostic factors and psychological functioning in a young adult community sample

Treatment adherence rates across different psychiatric disorders and settings: findings from a large patient cohort.

Approximately 50% of patients with psychiatric disorders do not fully adhere to the prescribed psychopharmacological therapy, significantly impacting the progression of the disorder and the patient's quality of life. The present study aimed to assess potential differences in terms of rates and clinical features of treatment adherence in a large cohort of psychiatric patients with different diagnoses attending various psychiatric services. The study included 307 psychiatric patients diagnosed with a primary major depressive disorder, bipolar disorder, anxiety disorder, schizophrenic spectrum disorder, or personality disorder. Patient's adherence to treatment was evaluated using the Clinician Rating Scale, with a cutoff of at least five defining adherence subgroups. One-third of the sample reported poor medication adherence. A lower rate of adherence emerged among patients with schizophrenic spectrum disorder and bipolar disorder. Subjects with poor adherence were more frequently inpatients and showed higher current substance use, a greater number of previous hospitalizations, and more severe scores at psychopathological assessment compared with patients with positive adherence. Poor adherence was associated with symptom severity and increased rates of relapses and rehospitalizations. In addition, substance use appears to be an unfavorable transdiagnostic factor for treatment adherence.