Abstract Child and adolescent externalizing problems have often been conceptualized broadly with imprecise language (e.g., “disruptive behavior”) or inconsistently across varying taxonomies (e.g., oppositional defiant and conduct disorder symptoms, aggressive and rule-breaking behaviors). Establishing clarity around dimensions of externalizing problems is an essential step toward more accurate measurement and construct validity across the externalizing domain. To that end, the current study investigated fine-grained dimensions in the structure of youth externalizing psychopathology. Caregiver-report survey data were collected for a national community sample of 576 youth (ages 6–14; 45% female, 25% Hispanic), including measures of irritability, oppositionality, reactive and proactive aggression, conduct problems, hyperactivity/impulsivity, and inattention. We used exploratory factor analysis (EFA) to examine relations among externalizing dimensions at the item-level followed by confirmatory factor analysis (CFA) to examine relations at the construct-level. EFA results suggested that a 3-factor model best fit the data, including factors characterized by externalizing affect (e.g., “felt mad”), externalizing behavior (e.g., “bullies, threatens, or intimidates others”), and ADHD symptoms (e.g., “talks excessively”), with a few cross-loadings. Similarly, confirmatory models indicated that a 3-factor, non-hierarchical structure fit the data best when compared to three other models. Results provide support for distinct facets of the externalizing spectrum in child psychopathology, suggesting a preliminary direction for a unifying framework. These findings highlight the potential for future measurement research to further disentangle the distinct and overlapping facets of externalizing constructs, particularly using multiple methods and informants and with replication across samples.
Psychological distress during young adulthood may be influenced by early emotional experiences and current interpersonal relationships. The current study investigates the relationship between childhood emotional neglect, peer support and psychological distress in young adults. A quantitative research design was used with 200 participants aged 18-25 years selected through purposive sampling from educational institutions of Lahore. Childhood emotional neglect, peer support and psychological distress were measured with the Childhood Emotional Neglect Questionnaire (CENQ), Multidimensional Scale of Perceived social support (MSPSS), and Kessler Psychological Distress Scale (K10), respectively. Data were analyzed using Pearson- product moment correlation, hierarchical regression, PROCESS moderation analysis and one way ANOVA. Childhood emotional neglect was significantly and positively associated with psychological distress while peer support was not significantly and directly associated with psychological distress. Hierarchical regression indicates that psychological distress was significantly predicted by childhood emotional neglect, while peer support was not a significant direct predictor. The regression model explained 12.5% of variance in psychological distress. Moderation analysis showed significant interaction effects of friends’ support (P= .017) and family support (P= .032), indicating that these sources of support moderated the relationship between childhood emotional neglect and psychological distress. There were significant socio-economic differences for childhood emotional and peer support, but not for psychological distress. The findings highlight the importance of considering childhood emotional experiences and interpersonal resources when understanding psychological distress among young adults.
This study examined the association between intolerance of uncertainty and psychological distress among emerging adults aged 18-29 years. A quantitative, cross-sectional correlational design was used with online convenience sampling. Of 181 survey submissions, one record was excluded because age was missing and one because the respondent was aged 17 years; a further 18 respondents who reported a previous mental-health diagnosis were excluded. The final analytical sample comprised 161 participants (M age = 23.60, SD = 3.09; 67.1% women). Intolerance of uncertainty was measured with the 12-item Intolerance of Uncertainty Scale (IUS-12), and nonspecific psychological distress with the Kessler Psychological Distress Scale (K10). Mean IUS-12 and K10 scores were 32.11 (SD = 9.44) and 24.31 (SD = 8.09), respectively. Internal consistency estimates were .887 and .913. Pearson's correlation indicated a positive association between IUS-12 and K10 scores, r(159) = .632, p < .001, 95% CI [.529, .717]. Spearman's correlation was also positive and significant (rs = .595, p < .001, 95% bootstrap CI [.475, .699]). Higher intolerance of uncertainty was associated with greater self-reported psychological distress in this sample. The cross-sectional design, convenience sampling, self-report measures, and diagnosis-based screening limit causal inference and generalisability.
The number of depressed Malaysian university students has sharply increased over the past ten years. What started as a localized academic issue has now become a major national mental health crisis, but the true experiences of those affected remain elusive. Therefore, the purpose of the research is to comprehend the authentic experiences of students in Malaysian universities who are experiencing depression. This research employed a qualitative methodology via a phenomenological framework involving five participants female university students who are diagnosed clinically with depression. Information was accessed via semi-structured interviews that were digitally audiotaped, transcribed verbatim and translated to English to analyse the information. The results indicate that there are six major themes that describe the experience of having depression. They are high-achieving students losing their academic identity because they entered the survival mode, a bitter fight between seeking the help of professional assistance and turning to drug use or self-harm in order to cope, the pressure of being a normal, fearing to be seen as a burden, the contradiction between familial beliefs and attributing depression to lack of spirituality, the physically isolated nature of staying in the room because of the need to avoid social interaction, and the impact of past sexual abuse as an underlying factor of psychological trauma. The themes indicate that student depression is not just a medical problem but they are very much influenced by intrapersonal, social, cultural, and spiritual demands. It is thus recommendable to provide necessary support that will alleviate the deep-seated experience of depression, especially in the university.
Mental health services are constantly evolving with the gradual introduction of functionalized care, which means medical intervention has become more focused on a particular clinical area or stage of the illness. This has progressed to having designated teams for inpatient psychiatry. Usually, psychiatrists manage their patients both in outpatient and inpatient settings while working in a particular geographical area or sector. Moving away from this model to a functionalized inpatient setting, where other psychiatrists take care of their patients, is seen as a breach in continuity of care. In this context, it was intended to review the current literature for the experience of clinicians and patients in these sectorized (medical continuity) or functionalized models of psychiatric inpatient care. A narrative review of the current literature from multiple databases was conducted. The results suggested that there are positive and negative observations in both models. It appeared that neither met the expectations of patients nor clinicians. Patients preferred to be seen by the same consultant in community and inpatient settings, but clinical outcomes were not significantly different in the two models. The functionalized care was mostly medical continuity rather than multidisciplinary. Any changes in the care models may be driven by local facilities and issues. There is a need to improve the quality of care through existing models before any changes. More studies are needed to improve the evidence on the effectiveness of these service models.
This study examined the influence of attachment style on fear of intimacy among emerging adults aged 18–25 years. A quantitative approach involved 152 participants who were currently or had previously been in romantic relationships, recruited through convenience sampling. Data were collected using the Experiences in Close Relationships–Revised (ECR-R) and Fear of Intimacy Scale (FIS). Linear regression analysis showed that insecure attachment significantly predicted fear of intimacy (β = 0.570, p < .001). Both attachment avoidance (β = 0.432, p < .001) and attachment anxiety (β = 0.368, p < .001) were significant predictors, with avoidance showing a stronger association. These findings suggest that discomfort with emotional closeness and anxiety in romantic relationships are associated with greater fear of intimacy. The results highlight the potential value of psychological interventions that support emerging adults in developing safer and healthier romantic relationships.
Abstract Background Borderline personality disorder (BPD) is a severe mental illness associated with emotional and functional impairment, elevated suicide risk, and high individual and societal costs. BPD is under-researched in the general population, especially among males, and from a developmental perspective. We examined the prevalence and development of BPD symptoms in young men and explored the longitudinal associations with risk-taking behaviors. Methods Data came from the prospective-longitudinal Cohort Study on Substance Use Risk Factors (C-SURF), a population sample of young men. Participants were screened for BPD risk using the McLean Screening Instrument (MSI-BPD) at mean age 25 (2016–2018; n = 5,516) and again at mean age 28 (2019–2020; n = 5,367). Risk-taking behaviors (e.g., interpersonal violence, gambling, substance use) were self-reported at both time points. Multilevel regression models examined within-person changes in BPD symptoms, including self-harm, and risk-taking behaviors over time. Results 7.4% of participants had a high risk of BPD, defined by endorsing 7 + MSI-BPD items at least once. Among those with 7 + items endorsed at the first assessment, 29.5% still endorsed 7 + items three years later. Despite a general within-person decline in BPD symptoms with age, participants at initially high risk for BPD continued to exhibit elevated levels of risk-taking behaviors after three years. Conclusion BPD symptomatology affects a substantial proportion of young men. Despite its modest stability over time, it is associated with persistent engagement in various risk-taking behaviors. Interventions targeting BPD symptoms in male populations may offer a promising avenue towards mitigating substantial psychosocial burden associated with these behaviors.
Mothers handle everyday discipline while also carrying the strain and worry of the parenting role, yet these experiences are often studied separately. This study examined the relationships between parenting attitude, parental stress, and anxiety among mothers. A quantitative, cross-sectional correlational design was used with a convenience sample of 59 mothers, who completed a 30-item questionnaire rated on a five-point Likert scale. Parenting attitude was assessed through three discipline dimensions based on the Parenting Scale (laxness, over-reactivity, and verbosity), and parental stress and anxiety were each assessed with ten statements developed for the study. Data were analysed using descriptive statistics, Cronbach's alpha, and Pearson and Spearman correlations. Mean scores were 3.30 (SD = 0.54) for parenting attitude, 3.06 (SD = 0.89) for parental stress, and 3.16 (SD = 0.72) for anxiety. Parenting attitude correlated positively with parental stress (r = .52, p < .001) and anxiety (r = .44, p < .001), and parental stress correlated with anxiety (r = .51, p < .001). Over-reactivity and verbosity were more closely related to stress than laxness was. Internal consistency was high for the stress (α = .91) and anxiety (α = .88) scales. The findings suggest that discipline difficulties, stress, and worry tend to occur together in mothers, although the design does not permit causal conclusions. Support programmes for mothers may benefit from addressing stress and worry alongside parenting skills.
Caregivers of children with neurodevelopmental disorders experience significant multifaceted burdens. However, little qualitative research has been done to explore caregivers’ lived experiences in relation to the effect of burden and coping strategies in the study area. The study sought to investigate caregivers’ awareness problems, coping mechanisms, and support systems in caring for children with neurodevelopmental disorders in Addis Ababa, Ethiopia. The study was conducted in three public, non-teaching hospitals in Addis Ababa, Ethiopia. Using a descriptive phenomenological technique. In-depth interviews were conducted with 15 purposively selected caregivers. The data was analyzed using Braun and Clarke’s six-phase framework technique. The analysis found six interrelated themes: Awareness and Perception of Neurodevelopmental Disorders (NDDs), Emotional Responses to Diagnosis and Adaptation, Caregiving Roles and Responsibilities, Multidimensional Burden and Challenges, Coping Strategies and Adaptation Mechanisms, and Support Systems and Structural Barriers. Bronfenbrenner’s ecological systems theory was used to explain how personal, institutional, and systemic factors explain participants’ experiences and interpret caregiving realities. These findings underscore the call for integrated and collaborative efforts to address individual and system-level challenges among caregivers. Enhancing support systems, mitigating stigma, and correcting systemic inadequacies can improve caregiver well-being and optimize care for children with NDDs.
Introduction In Japan, noriuchi refers to a collaborative gambling practice in which multiple players pool money used for betting and later split the final net profit or loss. This cross-sectional online study aimed (a) to estimate the prevalence of noriuchi among adult Japanese gamblers and (b) to examine how the frequency of noriuchi participation relates to gambling involvement and problem gambling severity. Methods In February 2022, an online survey was administered via Rakuten Insight, Inc. to adults aged 20 years or older. Participants were eligible if they reported gambling at least monthly in at least one of nine gambling activities during the past 12 months ( N = 2,000). Noriuchi participation frequency was assessed on a four-point scale (never, less than monthly, monthly or more, weekly or more). Outcomes included monthly gambling days, monthly gambling expenditure, and problem gambling severity measured with the Japanese version of the Problem Gambling Severity Index (PGSI). Results Overall, 498 participants (24.9%) reported noriuchi experience in the past 12 months; among them, 198 (39.76%) met the PGSI criterion for problem gambling. After adjustment for demographic covariates, noriuchi participation was associated with greater problem gambling severity across several gambling activities. Associations with monthly gambling days and expenditure were more limited and varied across gambling activities, with significant increases primarily observed among those engaging in noriuchi weekly for certain gambling activities. Discussion These findings suggest that noriuchi is associated with problem gambling severity, whereas its associations with gambling frequency and individual gambling expenditure are less consistent.
The dance piece “Luka Pulih” (Healing Wounds) is a contemporary dance work that explores the emotional experiences of individuals who have been bullied and subjected to social pressure from their surroundings. This work was created as an effort to visualize the psychological process of a person when facing adversity until they are able to rise again through inner strength. The purpose of this work is to convey the message about the impact of bullying on mental health and to describe the healing process as a form of courage and determination in living life. The creative method in this work includes the stages of idea gathering, movement exploration, concept formation, composition, and evaluation. The movements were developed from observations of human body expressions under emotional pressure, which were then processed into contemporary movements with varying dynamics. The accompanying music, makeup, and costumes were designed to reinforce the emotional character in each part of the work. The results of the creation show that the processing of movement, tempo dynamics, and changes in spatial composition are able to present a representation of the character's emotional transition from a phase of despair and indecision to a phase of awakening. Through the work “Luka Pulih”, the choreographer hopes that the audience can understand that the healing process from the experience of bullying requires time, acceptance, and determination. Keywords: Wound Healing, Bullying, Empirical Experience, Langon Method
Orthorexia Nervosa (ON) is widely regarded as an emerging eating disorder although it is not currently recognised as a formal diagnosis. It is characterised by a strict adherence to “pure” eating which becomes excessive and can lead to nutritional deficiencies, psychological distress, and impaired daily functioning. Restrictive eating behaviour in ON shows overlap with Restricted Repetitive Behaviours (RRBs) observed in autism. However, the conceptual relationship between ON and autism remains underexplored. This perspective article synthesises existing literature to explore potential overlapping and diverging mechanisms of RRBs across ON and autism. Intolerance for Uncertainty is highlighted as a possible shared mechanism that may contribute to RRBs observed in both ON and autism, whereas Cognitive Inflexibility and Perfectionism may mechanistically differentiate the conditions. We consider that autistic RRBs reflect neurodevelopmental divergence, whereas orthorexic RRBs may be influenced by evaluative belief-centred cognitions. We propose a conceptual model outlining how cognitive, affective and functional factors may interact to produce and maintain RRBs. Clarifying these distinctions is important in supporting clinicians to appropriately consider the drivers and mechanisms underlying RRBs across ON and autism, therefore supporting accurate diagnosis, formulation and treatment.
Background Cumulative exposure to adverse childhood experiences (ACEs) is associated with an increased risk of substance use, overdose, and suicide. Rural children are more likely to experience most ACEs. There is limited literature contextualizing rural individuals’ experiences with ACEs. Public Health 3.0 calls for multisector partner engagement to generate collective impact. The purpose of this study was to evaluate rural providers’ perspectives on challenges and recommendations for ACEs mitigation in their community from a cross-sector context. Participants and setting Participants were 74 providers enrolled in an online ACEs training. Participants lived and/or worked in five rural Missouri counties with high drug overdose death rates. Methods This was a conventional content analysis of written responses to structured discussion prompts from three training modules. Analysis included familiarization, inductive identification of major codes, and refinement of codes, followed by independent coding by two authors until consensus, and reporting major patterns. Artificial intelligence supported preliminary code development. An adapted Sequential Intercept Model (SIM) framework organized challenges and recommendations by setting. Results Results included personal stories about how ACEs impacted their communities through overdose, suicide, homelessness, unemployment, and adverse health effects. Settings included schools, government, healthcare, daycares, criminal justice, Extension, fire departments, libraries, and nonprofits. Participants recommended expanding the ACEs definition to include satanic abuse, bullying, incest, war, genocide, military family stressors, and death of a loved one. Intervention recommendations included whole-family interventions, community-wide training, trauma-informed training, expanded access to treatment, classes in prison/jails, and fostering positive childhood experiences. Conclusion Community voice is necessary to contextualize setting-specific insights that inform development of upstream interventions appropriate for and tailored to the community. Participants identified both strategies that could be incorporated into everyday practice—including empathy, listening, providing judgment-free and safe spaces, providing food for children experiencing hunger, encouraging positive childhood experiences, mentoring, and connecting individuals with resources for food, shelter, clothing, and mental health—and broader structural changes that may require policy-level action. The adapted SIM organizes these concepts.
Self-harm represents a serious mental health concern in which emotional experiences play a significant role in both its onset and maintenance. This exploratory study examined which emotions were most frequently reported before and after self-harm, how selected emotions changed following self-harm, and how emotional experiences were associated with specific forms of self-harm and demographic factors (gender, religious identification). The sample comprised of 158 university students, of whom 130 reported a history of self-harming behavior and were included in analyses of emotional experiences. Data were collected using a modified Self-Harm Inventory questionnaire and measures assessing the occurrence of emotions before and after self-harm. Anger, feelings of failure, and sadness were the most frequently reported emotions preceding self-harm, whereas sadness, relief, disappointment, guilt, and shame were the most frequently reported emotions following self-harm. The reported frequency of anger, guilt, and sadness decreased following self-harm, whereas negative emotions remained prominent after the behavior. After Benjamini–Hochberg correction for multiple comparisons, religious identification remained negatively associated with self-harm frequency and with the reported frequency of several emotions. Gender was not significantly associated with the examined variables, although this finding should be interpreted cautiously given the gender imbalance and limited sample size. After correction, selected associations between emotions and specific forms of self-harm remained significant, including associations of anger with hitting oneself, disgust with starving oneself, hatred with self-defeating thoughts, guilt following laxative misuse, and changes in anger with hitting oneself and intentionally worsening medical situations. Overall, the findings indicate selective associations between emotional experiences and self-harming behavior while underscoring the need for longitudinal and event-level research to clarify their temporal and causal dynamics.
This article aims to establish the possibility of a phenomenological-hermeneutic psychopathology of anorexia nervosa based on Martin Heidegger's thought. To this end, it uses a narrative review methodology to articulate an understanding of the Phenomenological Psychopathology of this pathology, the problem of corporeality in Phenomenology and the Heideggerian perspective on corporeality, and the interrelationships between the technology age, anorexia nervosa and the body lived in the first person. It should be emphasized that the current model of descriptive psychopathology of signs and symptoms, as well as the cognitivist views that explain anorexia as an alteration of beliefs and body image, are insufficient to highlight the profound transformations that occur in the lived body (Leib) of the anorexic experience. This corporeality is experienced as a source of concern, constant measurement, the search to acquire a new identity, closure to otherness and alienation. A panorama of possible articulations of the temporality, spatiality and corporeality of such suffering is then established. In addition, based on the Heideggerian approach, which emphasizes the mundanity of the experience of the body, it is possible to establish a link between corporeality as an intermediary phenomenon and the world of technology, which emphasizes modes of relationship focused on control, manipulation, representation and objectification.
Family members who provide daily care for people with chronic mental illness often carry substantial emotional, social and financial strain. This study examined caregiver burden, anxiety and depression among primary caregivers of patients with chronic mental illness, and tested whether burden was related to anxiety and depression and whether these outcomes differed by age, gender and relationship to the patient. A cross-sectional correlational design was used with a purposive sample of primary caregivers recruited through psychiatric outpatient and community rehabilitation settings in Bengaluru (planned n = 100; 105 complete records analysed). Burden was assessed with the 22-item Zarit Burden Interview (ZBI), and anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). Because scores departed from normality, Spearman correlations, permutation-based Mann-Whitney and Kruskal-Wallis tests and Holm-adjusted Dunn comparisons were used. The mean ZBI score was 32.37 (SD = 15.96); 77.1% of caregivers scored in at least the mild-to-moderate burden band, 59.0% had HADS anxiety scores of 8 or higher and 60.0% had HADS depression scores of 8 or higher. Burden correlated strongly with anxiety (rs = .810) and depression (rs = .816), Holm-adjusted ps < .001. Relationship to the patient was significantly associated with burden, anxiety and depression (adjusted ps < .001), with parent caregivers scoring highest, whereas age and gender differences did not survive correction for multiple testing. Findings are provisional because of an unresolved sample-size discrepancy and the cross-sectional, self-report, non-probability design. The results support routine screening of caregivers? psychological health, with particular attention to parent caregivers, alongside caregiver-focused psychoeducation and counselling.
Traditional diagnostic systems, such as the DSM-5 and ICD-11, suffer from well-documented limitations, including high comorbidity rates, arbitrary diagnostic thresholds, and within-disorder heterogeneity. Consequently, the field is evolving towards hierarchical, transdiagnostic, dimensional models of psychopathology. This study reports on the development and initial validation of the Multidimensional Transdiagnostic Inventory of Psychopathology (MTIP). This new broadband inventory aligns traditional DSM disorders with contemporary dimensional models of psychopathology. We conducted initial development and basic psychometric analyses in a mixed sample of 301 adults. We then validated the MTIP in a second independent sample (N = 826), of which 640 who self-reported no history of past mental health treatment were used as our normative/reference sample. The final MTIP contained 13 clinical scales and seven supplemental scales. All the MTIP scales met core psychometric assumptions at the item, scale, and transdiagnostic levels. A series of exploratory and second-order factor analyses supported the MTIP hierarchical dimensional structure. Concurrent validity correlations with the DSM-5 level 1 cross-cutting symptom measure were strong, ranging from 0.89 (depression) to 0.51 (drug misuse). Regression analyses supported the construct validity of the higher-order transdiagnostic scales. Twelve of the 13 clinical scales differentiated individuals with a history of mental health care from those without past care, with effect sizes ranging from 0.20 (Alcohol Misuse) to 1.06 (Anxiety). Effect sizes for the transdiagnostic scales ranged from 0.33 (Thought Dysregulation) to 1.07 (Emotion Dysregulation). The clinical implications and potential applications of the MTIP are discussed.
This study addresses the process of symbolic grief experienced by mothers of children with Autism Spectrum Disorder (ASD), considering psychological vulnerability and resilience in the face of the deconstruction of the image of the idealized child. It is based on the understanding that an ASD diagnosis may disrupt expectations developed throughout pregnancy regarding the child’s development and future, thereby affecting the maternal experience. The general objective is to analyze the process of symbolic grief experienced by mothers of children with ASD, integrating psychological vulnerability, resilience, and support networks. Specifically, the study seeks to identify factors of psychological vulnerability resulting from maternal overload; discuss the impact of symbolic grief on atypical motherhood; and evaluate the role of support networks and public policies in promoting these women’s mental health. This is a narrative literature review of a qualitative, descriptive, and exploratory nature, conducted using the BVS-Psi and SciELO databases. The results indicate that a diagnosis may trigger psychological distress, frustration, guilt, fear, and emotional overload, contributing to social isolation and mental health problems. However, psychological support, family and community assistance as part of a support network, and effective public policies contribute to strengthening resilience and reframing the experience of atypical motherhood. It is concluded that understanding the impact of symbolic grief on these mothers is essential to broadening the perspective of psychology and public policies regarding their socio-emotional needs, promoting comprehensive care and strengthening mental health.
