جستجوی پیشرفته

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.

Introduction Research on associations between pornography viewing and sexual violence has been limited by the absence of validated instruments that differentiate exposure along a violence continuum within pornographic practices, with existing measures focused on consumption frequency or problematic patterns rather than on the specific content consumed. The Pornography Violence Exposure Scale (PVES) was developed to assess exposure to pornographic content graded across three violence levels: non-violent material and domination-without-pain (Level 1), coercive content (Level 2), and explicit physical aggression (Level 3). Methods A cross-sectional study with 2,181 Spanish young adults aged 18–35 years who reported viewing pornography examined factor structure, measurement invariance across sex and age, convergent, nomological, and incremental validity, and discriminative capacity for sexual violence outcomes via Receiver Operating Characteristic (ROC) analysis. Results A bifactor model demonstrated good fit (CFI = 0.978, TLI = 0.957, RMSEA = 0.076), with a dominant general factor (ωH = 0.84, ECV = 0.81) capturing graded exposure to violent content. Strict measurement invariance was supported across sex and age groups. Convergent correlations with sexual violence outcomes (mean | r | = 0.24) substantially exceeded near-zero nomological associations with sexual function and partner-evaluation indicators (mean |r| = 0.03), and the general factor produced significant incremental validity for both victimization (Δ R 2 = 0.088) and perpetration (Δ R 2 = 0.200), with acceptable discrimination for perpetration (AUC = 0.753). Discussion The PVES is the first psychometrically validated instrument for measuring differentiated exposure to violent pornographic content, enabling more precise investigation of content-specific associations with sexual violence outcomes.

Background Non-suicidal self-injury (NSSI) is common among adolescents and often remains concealed because of shame and stigma. Voluntary disclosure can provide access to support, but emotional and interpersonal concerns shape the decision to disclose. This review will synthesize disclosure experiences, barriers, and facilitators reported by adolescents who have voluntarily disclosed NSSI at least once. Methods Primary qualitative studies and separately extractable qualitative components of mixed-methods studies involving adolescents aged 10–19 years will be eligible. Searches will cover PubMed, Embase, APA PsycINFO, CINAHL, Scopus, and Web of Science Core Collection. China National Knowledge Infrastructure, Wanfang Data, and the Chinese Biomedical Literature Database will also be searched. Coverage will extend from inception through 31 March 2026, inclusive, without language restrictions; formal searches have not yet been executed. Gray literature, reference lists, and forward citations will also be searched. Two human reviewers will independently select studies, appraise them using the Joanna Briggs Institute (JBI) qualitative checklist, and extract findings. Findings will be synthesized using JBI meta-aggregation, with confidence assessed using ConQual. Discussion The synthesis will examine disclosure decisions, recipients' responses, and subsequent experiences from adolescents' perspectives. Findings may inform clinical, school, and family support for voluntary NSSI disclosure. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261355173 , identifier: CRD420261355173.

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.

Applied behavior analysis (ABA) has developed an effective technology of reinforcement delivery, including Discrete Trial Training, Natural Environment Teaching, and token economies, largely on functional-behavioral grounds. Computational neuroscience has independently produced formal accounts of reinforcement learning centered on prediction errors and credit assignment. I propose a testable hypothesis connecting the two: the effectiveness of a reinforcement procedure depends on the quality of the learning signal that its delivery produces on each occasion, a property I term Reward Prediction-Error Fidelity (RPE Fidelity). The property is decomposed into four dimensions, temporal credit, contingency, prediction, and outcome value, each corresponding to a construct long studied in behavior analysis. Formalized within an actor-critic model with eligibility traces, the four dimensions enter the learning update multiplicatively, which implies that they cannot compensate for one another and that the effect of each depends on the others and on the learner’s history. The combination rule distinguishes the hypothesis from the separate behavioral constructs it draws on, and its dependence on learning history distinguishes it from steady-state quantitative models of reinforcement. I situate the hypothesis within an integrative framework, discuss its application to autistic learners, including differences in reward processing and volatility estimation and the role of learner assent, and compare it with procedural fidelity, quantitative behavioral theory, and alternative learning models, including attentional, timescale-invariant, successor-representation, and Bayesian accounts. I derive nine predictions, specifying for each the result that would favor the hypothesis and the result that would favor its strongest competitor, and outline a staged research programme compatible with single-case experimental designs.

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.

Background Functional tic-like behaviors (FTLBs) have emerged as a prominent clinical presentation within the context of the COVID-19 pandemic. Although FTLBs share phenomenological overlap with Tourette Syndrome and other tic disorders (collectively Tourette Syndrome, TS), evidence suggests that differences exist in demographics, phenomenology, clinical course, psychiatric comorbidity, and response to intervention. Given the rapid rise in the incidence of FTLBs—along with their complex clinical presentation—we provide a systematic review and integrated synthesis of the extant literature. Methods We conducted a systematic review following PRISMA guidelines. PubMed and PsycINFO databases searches were completed in June 2026, using terms related to functional tics and TS. Inclusion criteria were English-language studies reporting clinical data on FTLB with sample sizes of 8 or greater. Case reports, non-human studies, and commentaries were excluded. Thirty-nine studies were included. Data were extracted on demographics, phenomenology, clinical course, psychiatric comorbidity, and treatment responsiveness. Since multiple reports originated from the same data repositories, information was synthesized qualitatively by study sample and conceptual domain. Results The results of our review suggest that FTLBs predominantly affect adolescents and young adults and exhibit a strong female predominance—with higher than anticipated representation of gender-diverse individuals. Compared with TS, the onset of FTLB symptoms was abrupt and characterized by complex motor movements and vocalizations that cause functional impairment. While there is a considerable overlap between FTLBs and TS, there were distinctions in patterns of psychiatric comorbidities. Pharmacological and cognitive behavioral therapy (CBT) provided some benefit for individuals with FTLBs, but the therapeutic target of these interventions was not specified. Conclusions While sharing some similarities, FTLBs have a distinct clinical presentation from TS. There is some evidence to inform treatment approaches, but findings are complicated by the retrospective nature of most extant reports. Future research is essential to characterize longitudinal trajectories, underlying mechanisms, and evaluation of targeted interventions in randomized clinical trials.

زمینه: رفتارهای تیک‌مانند عملکردی (FTLBs) به عنوان یک تظاهر بالینی برجسته در زمینه همه‌گیری COVID-19 ظاهر شده‌اند. اگرچه FTLBs از نظر پدیدارشناسی با سندرم تورت و سایر اختلالات تیک (که به طور جمعی سندرم تورت، TS نامیده می‌شوند) همپوشانی دارند، شواهد نشان می‌دهد که تفاوت‌هایی در جمعیت‌شناسی، پدیدارشناسی، سیر بالینی، همبودی روان‌پزشکی و پاسخ به مداخله وجود دارد. با توجه به افزایش سریع بروز FTLBs و همچنین تظاهر بالینی پیچیده آن‌ها، ما یک مرور نظام‌مند و سنتز یکپارچه از ادبیات موجود ارائه می‌دهیم. روش‌ها: ما یک مرور نظام‌مند مطابق با دستورالعمل‌های PRISMA انجام دادیم. جستجو در پایگاه‌های PubMed و PsycINFO در ژوئن ۲۰۲۶ با استفاده از اصطلاحات مرتبط با تیک عملکردی و TS انجام شد. معیارهای ورود شامل مطالعات انگلیسی‌زبان گزارش‌دهنده داده‌های بالینی درباره FTLB با حجم نمونه ۸ نفر یا بیشتر بود. گزارش‌های موردی، مطالعات غیرانسانی و تفسیرها حذف شدند. سی و نه مطالعه وارد شدند. داده‌ها در زمینه جمعیت‌شناسی، پدیدارشناسی، سیر بالینی، همبودی روان‌پزشکی و پاسخ به درمان استخراج شد. از آنجا که چندین گزارش از منابع داده‌ای مشترک منشأ گرفته بودند، اطلاعات به صورت کیفی بر اساس نمونه مطالعه و حوزه مفهومی سنتز شد. یافته‌ها: نتایج مرور ما نشان می‌دهد که FTLBs عمدتاً نوجوانان و بزرگسالان جوان را تحت تأثیر قرار می‌دهد و غالباً در زنان شایع‌تر است، با نمایندگی بالاتر از حد انتظار افراد دارای تنوع جنسیتی. در مقایسه با TS، شروع علائم FTLB ناگهانی بوده و با حرکات پیچیده حرکتی و آواگری‌هایی که منجر به اختلال عملکردی می‌شود، مشخص می‌گردد. اگرچه همپوشانی قابل توجهی بین FTLBs و TS وجود دارد، اما تفاوت‌هایی در الگوهای همبودی روان‌پزشکی مشاهده شد. درمان دارویی و درمان شناختی-رفتاری (CBT) برای افراد مبتلا به FTLBs تا حدی سودمند بود، اما هدف درمانی این مداخلات مشخص نشده بود. نتیجه‌گیری: اگرچه برخی شباهت‌ها وجود دارد، FTLBs تظاهر بالینی متمایزی از TS دارند. شواهدی برای اطلاع‌رسانی رویکردهای درمانی وجود دارد، اما یافته‌ها به دلیل ماهیت گذشته‌نگر اکثر گزارش‌های موجود پیچیده شده‌اند. پژوهش‌های آینده برای توصیف مسیرهای طولی، سازوکارهای زمینه‌ای و ارزیابی مداخلات هدفمند در کارآزمایی‌های بالینی تصادفی ضروری است.

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.

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.

In modern scholarly perspectives on grieving, being saddened has been associated with bodily experience. Numbness, shaking, a heavy heart, and other physical symptoms are caused by the intense pain of loss. Most Western philosophies have increasingly focused on psychological models based on the idea of how the self adjusts to the devastating experience of losing a loved one, and this has received a lot of attention. To connect death, embodiment, self-identification, and psychological well-being, this conceptual article develops a mourning process from an Indigenous psychological perspective. This article proposes a psychological paradigm grounded in Indigenous contemplative knowledge through an interpretive analysis of the teachings of the Ashtavakra Gita. Rather than treating the Ashtavakra Gita solely as a philosophical or spiritual text, this article interprets it as an Indigenous psychological knowledge system offering culturally grounded insights into selfhood, attachment, suffering, and psychological well-being. The proposed Ashtavakra Witnessing Consciousness Model conceptualises grief as a five-stage, non-linear process involving embodied grief, existential crisis, meaning reframing, mortality acceptance, and witnessing consciousness, culminating in psychological well-being. This model shows how a traumatic incident can be transformed into a meaningful experience and a path to psychological well-being. Advaita Vedanta’s foundational text, the Ashtavakra Gita, presents a nondual viewpoint in which suffering arises from attachment to the body, ego, and interpersonal attachments. It distinguishes between witnessing consciousness and the short-lived embodied self. This psychological Model of Witnessing Consciousness offers an alternative understanding of control, attachment, suffering, and embodied grief, grounded in the Ashtavakra Gita. It highlights the psychological implications of developing the art of witnessing consciousness. This indigenous model of traditional knowledge has implications for existential, contemplative, and meaning-centred mourning therapies and adds a cross-cultural, psychological and philosophically informed perspective to bereavement research. The article explains how the five stages were derived from the text, illustrates the model with a composite case vignette, outlines clinical cautions against encouraging detachment prematurely, and sets out the model’s limitations and directions for empirical validation.

Defense mechanisms, one of the core constructs of psychodynamically oriented psychotherapy and a concept with broader relevance across psychiatric practice, remain difficult to grasp for many trainees. Given their clinical utility, this article aims to provide postgraduate psychiatry residents with an overview and foundational understanding of the concept, including its historical origins, established classifications, relationship to personality organization and psychopathology, and emerging neurobiological perspectives. A detailed discussion of individual defense and their technical use in psychotherapy is beyond the scope of this manuscript. A suggested reading list is provided for further understanding. Rather than serving as a treatment guide or manual, this article is intended as a sensitizer — an orientation toward understanding how the mind protects itself against conflicts, and why that understanding matters clinically.

مکانیزم‌های دفاعی، که یکی از مفاهیم بنیادی در روان‌درمانی با رویکرد روان‌پویشی و مفهومی با اهمیت گسترده‌تر در سراسر عمل روان‌پزشکی هستند، همچنان برای بسیاری از فراگیران دشوار درک می‌شوند. با توجه به کاربرد بالینی آن‌ها، این مقاله با هدف ارائه مروری کلی و درک پایه‌ای از این مفهوم برای دستیاران تخصصی روان‌پزشکی نگاشته شده است؛ از جمله ریشه‌های تاریخی، طبقه‌بندی‌های تثبیت‌شده، ارتباط با سازمان شخصیت و آسیب‌شناسی روانی، و دیدگاه‌های عصب‌زیستی نوظهور. بحث تفصیلی درباره مکانیزم‌های دفاعی فردی و کاربرد فنی آن‌ها در روان‌درمانی خارج از حیطه این مقاله است. برای درک بیشتر، فهرستی از منابع پیشنهادی ارائه شده است. این مقاله به جای آنکه به عنوان راهنمای درمان یا دستورالعمل عمل کند، به عنوان یک آگاهی‌بخش و جهت‌دهنده برای فهم چگونگی محافظت ذهن از خود در برابر تعارضات و اهمیت بالینی این درک نگاشته شده است.

Background Digital mental health platforms routinely deliver self-administered symptom scales on the assumption that users with more severe symptoms are more likely to enter professional care. That assumption is rarely tested with linked participant-level data, and almost never in the Arabic-speaking Gulf. Objective To examine whether symptom severity at a user’s first self-assessment predicts booking a professional session within 90 days, across four symptom domains, on a Saudi commercial digital mental health platform. Methods Retrospective cohort analysis of 10,100 first assessments — depression, generalized anxiety, panic, and obsessive-compulsive scales — contributed by 5,524 unique users of the Talbinah platform and linked to demographic and session-booking records through a pseudonymous (SHA-256 hashed) user identifier. The primary outcome was any session booked within 90 days after the assessment. Severity was banded by the established cut-offs for the PHQ-9 and GAD-7, and by percentage of scale maximum for the panic and obsessive-compulsive measures, for which no severity thresholds are established. Per-scale multivariable logistic regression estimated adjusted odds ratios (aOR) for severity band (reference None/Minimal), adjusting for age, sex, and device type. Pre-specified sensitivity analyses used 30- and 180-day windows, an attended-session outcome, percentage-of-maximum banding applied to all four scales, and a subset with no prior booking (incident help-seeking). Reporting followed STROBE. Results Users were young (mean age 26.7 years, SD 8.1) and predominantly female (78.1%); 16.6% of first assessments were followed by a booking within 90 days. No severity band on any of the four scales was associated with higher odds of booking (severe vs None/Minimal: depression aOR 0.71, 95% CI 0.51–1.01; generalized anxiety 0.76, 0.49–1.16; panic 0.83, 0.52–1.31; obsessive-compulsive 1.01, 0.59–1.74). One severity contrast was statistically significant, in the opposite direction: moderate depression was associated with lower odds of booking (0.66, 95% CI 0.45–0.97). Older age (aOR ~1.2 per decade) and iOS device use (1.4–2.0) were associated with booking across scales. This absence of a positive severity–booking association was consistent across 30-, 90-, and 180-day windows, the attended-session outcome, and percentage-of-maximum banding; a nominal association for moderate anxiety seen under percentage banding did not persist with validated GAD-7 cut-offs. Estimates for the panic and obsessive-compulsive scales, which lack established severity thresholds, are exploratory. Conclusions On a Saudi digital mental health platform, greater self-reported symptom severity at first assessment was not followed by higher subsequent booking of professional care, consistently across specifications, and for moderate depression was associated with lower odds of booking; demographic and access-related attributes showed stronger associations with booking than symptom load did. Self-screening on its own appears insufficient as a pathway into care.

CDigital therapeutics (DTx) are software-based medical devices that deliver evidence-based therapeutic interventions directly to patients. While the clinical use of DTx is expanding rapidly, regulatory fragmentation and the absence of harmonized legal definitions hinder their assessment and reimbursement policies, as well as their integration into healthcare systems. There is currently a lack of comprehensive overviews of DTx clinical development, which are essential for informing policy, research and regulatory priorities. This paper provides an updated overview of randomised clinical trials involving DTx. 254 eligible trials on DTx, (defined according to ISO/TR 11147:2023) registered through January 2025 were identified through a search on C linicalTrials.gov . Mobile applications represent the most prevalent technology (65%), followed by web-based tools and virtual reality (20%). Psychiatric disorders are the primary therapeutic target (52% of the studies) with insomnia, depression, and anxiety being the most addressed conditions. Trials were primarily conducted in North America (41%) and Europe (32%), where Germany, Spain, and Italy represent the most active countries. The analysis of clinical trials registrations on ClinicalTrials.gov reveals a heterogenous geographical distribution of DTx development but also a clear direction in the type of conditions for which they are mostly indicated, namely psychiatric and nervous system disorders. The fragmented policies on DTx reimbursement, even among EU countries, and the different capacity of governments to fund DTx research and development emerge as key factors, along with cultural and ethical issues, in determining the willingness of the industry to invest in these devices.

درمان‌های دیجیتال (DTx) ابزارهای پزشکی مبتنی بر نرم‌افزار هستند که مداخلات درمانی مبتنی بر شواهد را مستقیماً به بیماران ارائه می‌دهند. اگرچه استفاده بالینی از DTx به سرعت در حال گسترش است، اما پراکندگی مقررات و فقدان تعاریف قانونی هماهنگ، ارزیابی و سیاست‌های بازپرداخت آن‌ها و همچنین ادغام آن‌ها در نظام‌های سلامت را با مشکل مواجه کرده است. در حال حاضر، مرورهای جامعی از توسعه بالینی DTx وجود ندارد که برای اطلاع‌رسانی به سیاست‌گذاری، پژوهش و اولویت‌های مقرراتی ضروری است. این مقاله مروری به‌روز از کارآزمایی‌های بالینی تصادفی‌سازی‌شده مرتبط با DTx ارائه می‌دهد. تعداد ۲۵۴ کارآزمایی واجد شرایط در زمینه DTx (مطابق تعریف ISO/TR 11147:2023) که تا ژانویه ۲۰۲۵ در ClinicalTrials.gov ثبت شده‌اند، شناسایی شدند. برنامه‌های تلفن همراه رایج‌ترین فناوری را تشکیل می‌دهند (۶۵٪)، و پس از آن ابزارهای مبتنی بر وب و واقعیت مجازی (۲۰٪) قرار دارند. اختلالات روان‌پزشکی هدف اصلی درمانی هستند (۵۲٪ مطالعات) و بی‌خوابی، افسردگی و اضطراب بیشترین شرایط مورد بررسی را تشکیل می‌دهند. کارآزمایی‌ها عمدتاً در آمریکای شمالی (۴۱٪) و اروپا (۳۲٪) انجام شده‌اند که در میان کشورهای اروپایی، آلمان، اسپانیا و ایتالیا فعال‌ترین کشورها هستند. تحلیل ثبت کارآزمایی‌های بالینی در ClinicalTrials.gov توزیع جغرافیایی ناهمگونی از توسعه DTx را نشان می‌دهد، اما همچنین جهت‌گیری روشنی در نوع شرایطی که عمدتاً برای آن‌ها تجویز می‌شوند، یعنی اختلالات روان‌پزشکی و سیستم عصبی، مشاهده می‌شود. سیاست‌های پراکنده در زمینه بازپرداخت DTx، حتی در میان کشورهای اتحادیه اروپا، و ظرفیت متفاوت دولت‌ها برای تأمین مالی پژوهش و توسعه DTx، همراه با مسائل فرهنگی و اخلاقی، به عنوان عوامل کلیدی در تعیین تمایل صنعت برای سرمایه‌گذاری در این ابزارها مطرح می‌شوند.

Abstract The increasing use of visual social media has intensified societal pressure to achieve flawless skin and may contribute to excessive preoccupation with appearance and skincare. The emerging terms dermorexia and cosmeticorexia have been used to describe potentially compulsive skincare behaviors extending beyond conventional self-care. This narrative review examines the proposed concept of dermorexia, its conceptual overlap with recognized psychiatric conditions, potential risk factors and clinical manifestations, dermatological and psychological consequences, and implications for aesthetic practice. The available literature was conducted, focusing on compulsive skincare behaviors, social media–related body image concerns, body dysmorphic disorder (BDD), and obsessive-compulsive spectrum conditions. Relevant evidence was critically synthesized to assess the current conceptual and clinical basis of dermorexia. Dermorexia has conceptual similarities to orthorexia nervosa and may overlap with obsessive-compulsive and body dysmorphic psychopathology. Adolescents and young adults may represent a particularly vulnerable population. Proposed manifestations include excessive and prolonged skincare routines, compulsive product use, repetitive mirror checking, skin picking, and recurrent pursuit of cosmetic procedures. Potential dermatological consequences include epidermal barrier disruption, irritant or allergic contact dermatitis, and excoriation-related scarring. Psychological consequences may include anxiety, depressive symptoms, appearance-related distress, and functional impairment. However, empirical validation, standardized diagnostic criteria, and prevalence estimates are currently lacking Dermorexia/cosmeticorexia remains an unvalidated clinical construct rather than a formally recognized psychiatric diagnosis. Nevertheless, increasing awareness may help aesthetic clinicians identify maladaptive skincare and appearance-related behaviors and facilitate appropriate psychological referral. Further research is required to establish its epidemiology, diagnostic boundaries, and clinical significance.

چکیده: افزایش استفاده از شبکه‌های اجتماعی تصویری، فشار اجتماعی برای دستیابی به پوستی بی‌عیب و نقص را تشدید کرده و ممکن است به اشتغال ذهنی بیش از حد با ظاهر و مراقبت از پوست منجر شود. اصطلاحات نوظهور درمورکسیا و کازمتیکورکسیا برای توصیف رفتارهای بالقوه وسواسی مراقبت از پوست که فراتر از خودمراقبتی متعارف هستند، به کار رفته‌اند. این مرور روایتی به بررسی مفهوم پیشنهادی درمورکسیا، همپوشانی مفهومی آن با اختلالات روان‌پزشکی شناخته‌شده، عوامل خطر بالقوه و تظاهرات بالینی، پیامدهای پوست‌شناختی و روان‌شناختی، و پیامدهای آن برای طب زیبایی می‌پردازد. ادبیات موجود با تمرکز بر رفتارهای وسواسی مراقبت از پوست، نگرانی‌های مرتبط با تصویر بدنی ناشی از شبکه‌های اجتماعی، اختلال بدشکلی بدن (BDD) و اختلالات طیف وسواس-اجبار مورد بررسی قرار گرفت. شواهد مرتبط به طور انتقادی تلفیق شد تا مبنای مفهومی و بالینی فعلی درمورکسیا ارزیابی شود. درمورکسیا از نظر مفهومی با اورتورکسیا نروزا شباهت دارد و ممکن است با آسیب‌شناسی وسواسی-اجباری و بدشکلی بدن همپوشانی داشته باشد. نوجوانان و بزرگسالان جوان ممکن است جمعیت آسیب‌پذیرتری باشند. تظاهرات پیشنهادی شامل روتین‌های بیش از حد و طولانی مراقبت از پوست، استفاده وسواسی از محصولات، چک کردن مکرر آینه، کندن پوست و پیگیری مکرر اقدامات زیبایی است. پیامدهای پوست‌شناختی بالقوه شامل اختلال سد اپیدرمال، درماتیت تماسی تحریکی یا آلرژیک و اسکار ناشی از خراشیدن است. پیامدهای روان‌شناختی ممکن است شامل اضطراب، علائم افسردگی، پریشانی مرتبط با ظاهر و اختلال عملکرد باشد. با این حال، اعتبارسنجی تجربی، معیارهای تشخیصی استاندارد و برآوردهای شیوع در حال حاضر وجود ندارد. درمورکسیا/کازمتیکورکسیا همچنان یک ساختار بالینی تأییدنشده است و به عنوان یک تشخیص روان‌پزشکی رسمی شناخته نمی‌شود. با این وجود، افزایش آگاهی ممکن است به متخصصان زیبایی در شناسایی رفتارهای ناسازگارانه مراقبت از پوست و ظاهر و تسهیل ارجاع روان‌شناختی مناسب کمک کند. تحقیقات بیشتری برای تعیین همه‌گیرشناسی، مرزهای تشخیصی و اهمیت بالینی آن مورد نیاز است.

Purpose: Transgender and gender non-conforming (TGNC) individuals are under-represented in inflammatory bowel disease (IBD) research, and little is known about their diagnostic experiences, disease burden, mental health comorbidity, or quality of life (QoL). We therefore aimed to characterise clinical features, diagnostic timelines, comorbidity, and QoL among TGNC people with IBD and to contextualise key outcomes using a matched cisgender cohort. Patients and Methods: We conducted a nationwide cohort study within the IBD BioResource population. Using questionnaires and linked BioResource data, we collected information on demographics, clinical history, gender-affirming care, comorbidity, and QoL. TGNC participants were matched to cisgender controls by sex and age category for a contextual and exploratory comparison. Analyses were performed using regression models. Results: Thirty-nine TGNC participants responded (46.2% Crohn’s disease, 43.6% ulcerative colitis, 10.3% IBD-unclassified). Median time from symptom onset to diagnosis was 10.5 months (interquartile range 6.0– 18.0), 62.3% reported prior hospitalisation and 28.2% prior IBD surgery. Psychiatric comorbidity was frequent (79%). Gender-affirming hormone therapy was reported in 30.7% and prior gender-affirming surgery in 17.9%. Matched analyses demonstrated a trend towards longer diagnostic delays and higher rates of hospitalisation and IBD-related surgery in TGNC participants. Psychiatric comorbidity was significantly higher (79.5% vs 56.8%, p =0.033). QoL impairment was substantial and broadly comparable between groups. Conclusion: TGNC individuals with IBD demonstrated a high burden of psychiatric comorbidity and signals of longer diagnostic timelines and poorer disease control compared with cisgender peers. These findings highlight potential disparities across IBD care pathways and underscore the need for larger, dedicated studies. Keywords: ulcerative colitis, Crohn’s disease, inflammatory bowel disease, transgender persons, quality of life

هدف: افراد ترنس‌جندر و غیرهم‌سو با جنسیت (TGNC) در پژوهش‌های بیماری التهابی روده (IBD) کمتر نمایان هستند و اطلاعات اندکی درباره تجربیات تشخیصی، بار بیماری، همبودی سلامت روان یا کیفیت زندگی (QoL) آن‌ها وجود دارد. بنابراین هدف ما توصیف ویژگی‌های بالینی، زمان‌بندی تشخیص، همبودی و کیفیت زندگی در افراد TGNC مبتلا به IBD و زمینه‌یابی نتایج کلیدی با استفاده از یک کوهورت همتای سیس‌جندر بود. بیماران و روش‌ها: ما یک مطالعه کوهورت سراسری در جمعیت IBD BioResource انجام دادیم. با استفاده از پرسشنامه‌ها و داده‌های پیوندی BioResource، اطلاعاتی درباره جمعیت‌شناسی، سابقه بالینی، مراقبت تأییدکننده جنسیت، همبودی و کیفیت زندگی جمع‌آوری کردیم. شرکت‌کنندگان TGNC بر اساس جنس و گروه سنی با گروه کنترل سیس‌جندر همتا شدند تا مقایسه‌ای زمینه‌ای و اکتشافی صورت گیرد. تحلیل‌ها با استفاده از مدل‌های رگرسیون انجام شد. نتایج: سی‌ونه شرکت‌کننده TGNC پاسخ دادند (۴۶٫۲٪ بیماری کرون، ۴۳٫۶٪ کولیت اولسراتیو، ۱۰٫۳٪ IBD طبقه‌بندی‌نشده). میانه زمان از شروع علائم تا تشخیص ۱۰٫۵ ماه (دامنه بین‌چهاری ۶٫۰ تا ۱۸٫۰) بود، ۶۲٫۳٪ سابقه بستری قبلی و ۲۸٫۲٪ سابقه جراحی IBD قبلی را گزارش کردند. همبودی روان‌پزشکی شایع بود (۷۹٪). ۳۰٫۷٪ درمان هورمونی تأییدکننده جنسیت و ۱۷٫۹٪ جراحی تأییدکننده جنسیت قبلی را گزارش کردند. تحلیل‌های همتا شده روندی به سوی تأخیر بیشتر در تشخیص و نرخ بالاتر بستری و جراحی مرتبط با IBD در شرکت‌کنندگان TGNC نشان داد. همبودی روان‌پزشکی به طور معناداری بالاتر بود (۷۹٫۵٪ در مقابل ۵۶٫۸٪، p = ۰٫۰۳۳). اختلال کیفیت زندگی قابل توجه و به طور کلی بین گروه‌ها قابل مقایسه بود. نتیجه‌گیری: افراد TGNC مبتلا به IBD بار بالای همبودی روان‌پزشکی و نشانه‌هایی از زمان‌بندی طولانی‌تر تشخیص و کنترل ضعیف‌تر بیماری نسبت به همتایان سیس‌جندر نشان دادند. این یافته‌ها به تفاوت‌های بالقوه در مسیرهای مراقبت IBD اشاره دارد و بر نیاز به مطالعات بزرگ‌تر و اختصاصی تأکید می‌کند.

The 11th edition of the International Classification of Diseases introduced a dimensional model of personality disorder diagnosis supplemented by an optional borderline pattern qualifier.The Borderline Pattern Scale (BPS; Oltmanns & Widiger, 2019) is a self-report instrument assessing this qualifier via four symptom clusters: affective instability, maladaptive self-functioning, maladaptive interpersonal functioning, and maladaptive self-regulation strategies.This study translated, adapted, and validated the BPS for German-speaking clinical populations (N = 405) using a back-translation procedure.Psychometric evaluation included internal consistency, test-retest reliability, and factor structure analyses (parallel analysis, exploratory graph analysis) confirmatory factor analysis, as well as construct validity via correlations with the Borderline Symptom List-23 and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Screening Personality Questionnaire.Receiver operating characteristic analyses assessed classification accuracy for clinician-assigned borderline personality disorder diagnoses.Results demonstrated excellent internal consistency (α = .89)and test-retest reliability (r = .87).Exploratory graph analysis indicated a robust unidimensional structure, while confirmatory factor analysis supported a hierarchical four-factor model with incremental validity over a unidimensional solution.BPS total scores showed strong convergent validity with the Borderline Symptom List-23 and discriminant validity against nonborderline personality disorder scales.Receiver operating characteristic analyses revealed good classification accuracy (area under the curve = .82),with optimal cutoffs balancing sensitivity and specificity.German BPS scores demonstrate reliability and support multiple sources of validity evidence for their intended interpretation as measures of the 11th edition of the International Classification of Diseases borderline pattern severity.The low internal consistency of the Maladaptive Interpersonal Functioning subscale (ᾰ = .41)warrants caution; the BPS total score is psychometrically preferable for most purposes. Public Significance StatementThis study introduces the first validated German questionnaire assessing borderline personality patterns according to the 11th edition of the International Classification of Diseases.Scores derived from the German Borderline Pattern Scale demonstrated strong reliability and supported multiple sources of validity evidence for their intended interpretation in a psychiatric sample, allowing clinicians and researchers to better identify and understand borderline psychopathology.This facilitates accurate diagnosis, individual case formulation, treatment planning, and international consistency in the 11th edition of the International Classification of Diseases assessment.

ویرایش یازدهم طبقه‌بندی بین‌المللی بیماری‌ها مدل ابعادی تشخیص اختلال شخصیت را معرفی کرده است که با یک شاخص اختیاری الگوی مرزی تکمیل می‌شود. مقیاس الگوی مرزی (BPS؛ Oltmanns & Widiger، 2019) یک ابزار خودگزارشی است که این شاخص را از طریق چهار خوشه نشانه‌ای ارزیابی می‌کند: ناپایداری عاطفی، عملکرد ناسازگارانه خود، عملکرد ناسازگارانه بین‌فردی و راهبردهای ناسازگارانه تنظیم خود. این مطالعه BPS را برای جمعیت‌های بالینی آلمانی‌زبان (N = 405) با استفاده از روش ترجمه معکوس ترجمه، تطبیق و اعتبارسنجی کرد. ارزیابی روان‌سنجی شامل بررسی انسجام درونی، پایایی بازآزمایی و تحلیل ساختار عاملی (تحلیل موازی، تحلیل گراف اکتشافی)، تحلیل عاملی تأییدی و همچنین روایی سازه از طریق همبستگی با فهرست نشانه‌های مرزی-۲۳ و پرسشنامه غربالگری مصاحبه بالینی ساختاریافته برای راهنمای تشخیصی و آماری اختلالات روانی، ویرایش پنجم بود. تحلیل‌های منحنی مشخصه عملکرد گیرنده دقت طبقه‌بندی برای تشخیص‌های اختلال شخصیت مرزی تعیین‌شده توسط بالینگر را ارزیابی کرد. نتایج نشان‌دهنده انسجام درونی عالی (α = .89) و پایایی بازآزمایی (r = .87) بودند. تحلیل گراف اکتشافی ساختار یک‌بعدی قوی را نشان داد، در حالی که تحلیل عاملی تأییدی از مدل سلسله‌مراتبی چهارعاملی با روایی افزایشی نسبت به راه‌حل یک‌بعدی حمایت کرد. نمرات کل BPS روایی همگرا قوی با فهرست نشانه‌های مرزی-۲۳ و روایی افتراقی در برابر مقیاس‌های اختلال شخصیت غیرمرزی را نشان دادند. تحلیل‌های منحنی مشخصه عملکرد گیرنده دقت طبقه‌بندی خوبی را نشان دادند (مساحت زیر منحنی = .82)، با نقاط برش بهینه که تعادل حساسیت و ویژگی را برقرار می‌کردند. نمرات آلمانی BPS پایایی و شواهد متعددی از روایی را برای تفسیر مورد نظر به عنوان سنجه شدت الگوی مرزی در ویرایش یازدهم طبقه‌بندی بین‌المللی بیماری‌ها نشان می‌دهند. انسجام درونی پایین زیرمقیاس عملکرد ناسازگارانه بین‌فردی (ᾰ = .41) نیازمند احتیاط است؛ نمره کل BPS از نظر روان‌سنجی برای اغلب اهداف ترجیح داده می‌شود. بیانیه اهمیت عمومی: این مطالعه نخستین پرسشنامه آلمانی اعتبارسنجی‌شده برای ارزیابی الگوهای شخصیت مرزی بر اساس ویرایش یازدهم طبقه‌بندی بین‌المللی بیماری‌ها را معرفی می‌کند. نمرات به‌دست‌آمده از مقیاس الگوی مرزی آلمانی پایایی قوی و شواهد متعددی از روایی را برای تفسیر مورد نظر در نمونه روان‌پزشکی نشان دادند و به بالینگران و پژوهشگران امکان شناسایی و درک بهتر آسیب‌شناسی مرزی را می‌دهند. این امر تشخیص دقیق، تدوین مورد فردی، برنامه‌ریزی درمان و انسجام بین‌المللی در ارزیابی ویرایش یازدهم طبقه‌بندی بین‌المللی بیماری‌ها را تسهیل می‌کند.

This study evaluated changes in attachment behaviors among Spanish-speaking couples participating in emotionally focused couple therapy (EFCT), using data from a randomized clinical trial of EFCT in this population. The study examined perceived secure attachment behaviors -accessibility, responsiveness, and engagement- measured by the Brief Accessibility, Responsiveness, and Engagement (BARE) scale, and their association with dyadic adjustment measured by the Dyadic Adjustment Scale (DAS). Seventy couples were randomly assigned to EFCT or a waiting list; two withdrew before beginning the intervention, resulting in a final analyzed sample of 68 couples. Results showed some changes in attachment behaviors, with significant effects observed only in women's perceptions of their partners. Increases in both self- and partner-perceived secure attachment behaviors significantly predicted improvements in dyadic adjustment. These findings highlight the clinical relevance of targeting secure attachment behaviors as mechanisms of therapeutic change related to relationship satisfaction.

این پژوهش تغییرات رفتارهای دلبستگی را در میان زوج‌های اسپانیایی‌زبان شرکت‌کننده در زوج‌درمانی هیجانی متمرکز (EFCT) با استفاده از داده‌های یک کارآزمایی بالینی تصادفی‌شده‌ی EFCT در این جمعیت ارزیابی کرد. در این مطالعه، رفتارهای دلبستگی ایمن ادراک‌شده -دسترس‌پذیری، پاسخ‌دهی و درگیری- که با مقیاس مختصر دسترس‌پذیری، پاسخ‌دهی و درگیری (BARE) سنجیده شد و ارتباط آن‌ها با سازگاری دوتایی که با مقیاس سازگاری دوتایی (DAS) اندازه‌گیری شد، مورد بررسی قرار گرفت. هفتاد زوج به طور تصادفی به گروه EFCT یا فهرست انتظار تخصیص یافتند؛ دو زوج پیش از آغاز مداخله انصراف دادند و در نتیجه نمونه نهایی مورد تحلیل شامل ۶۸ زوج بود. نتایج نشان داد برخی تغییرات در رفتارهای دلبستگی رخ داده است، اما اثرات معنادار تنها در ادراک زنان از شریک خود مشاهده شد. افزایش رفتارهای دلبستگی ایمن ادراک‌شده توسط خود و شریک به طور معناداری بهبود در سازگاری دوتایی را پیش‌بینی کرد. این یافته‌ها اهمیت بالینی هدف‌گیری رفتارهای دلبستگی ایمن به عنوان سازوکارهای تغییر درمانی مرتبط با رضایت از رابطه را برجسته می‌کند.