Psychoanalytic literature on extreme traumatization usually distinguishes between natural catastrophes and man-made catastrophes. While the first ones are usually sensed as nature’s ferocity, fate, or God’s will, the second ones are experienced as a volountary and violent attack aimed at disrupting other human beings. In this paper we focus on man-made disasters caused by a profit-driven logic. When traumatization is due to irresponsible actions perpetrated by the owners of the major economic resource of a community, it deeply affects the identity of the group, entailing the loss of basic trust and lively parts of the Self. In such a situation, where the whole community is severely traumatized, psychoanalytic group therapy seems to be the most suitable setting: it allows to place the historization of the event and the creation of multiple narratives of somato-psychic suffering. Trust and faith are two crucial factors in the encounter with patients lacking a sense of vitality. The working through of each one through the group field is an essential forerunner to the construction of a recovered sense of faith and reliability that precedes the onset of a true new-beginning.

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Si richiede di derogare a quanto previsto dall'art. 4.1.b del Regolamento di Ateneo sull'accesso aperto per il prodotto a causa di:

Mental representations of attachment and emotion regulation influence individual patterns of stress response and vulnerability to illness. The present study investigates the adult attachment states of mind of 40 women with systemic lupus erythematosus (SLE) using the Adult Attachment Interview. We also assessed alexithymia using the Toronto Alexithymia Scale and dissociation using the Dissociative Experiences Scale. The results showed a high prevalence of the unresolved state of mind (13 patients, 32.5%) and the entangled state of mind (10 patients, 25%). The alexithymia score also varied significantly as a function of the mental representation of attachment and was modulated by amnestic dissociation. These findings suggest that adult attachment in patients with SLE influences the presence of alexithymic features. Moreover, these also indicate that dissociative states mediate the perception of painful memories and feelings, thus contributing to the partial avoidance of emotions and the failure to fully experience and recognize them. The clinical implications of these findings are also discussed.

Background The assessment of quality of Life (QoL) in chronic rheumatic diseases such as systemic lupus erythematosus (SLE) is very important as it does not necessarily correlates with activity and damage. Recently it has been highlighted that QoL represents an important outcome to be considered in clinical trials. Coping represents the type of strategy adopted by a person to face a stressor event such as a disease. Three types of coping trategies have been described: avoidance- oriented, emotion oriented and task-oriented. Objectives In the present study QoL and coping in a cohort of SLE patients were evaluated and their correlation with disease activity, disease duration and damage was also assessed. Methods Consecutive in and out SLE patients followed at our clinic were asked to participate to the study. At enrollment disease activity and damage were evaluated with the ECLAM index and the SLICC/DI ACR respectively. Disease was defined as active if ECLAM >2. Damage was considered as present or absent (SLICC ≥1). The SF-36 and the CISS were administered to the patients to evaluate quality of life and coping strategies respectively. Results Seventy-seven consecutive SLE patients (F 69, M 8), with a mean age of 41 years and a mean disease duration of 14 years, were enrolled; 76% had joint involvement, 56% had kidney involvement and 19% neuropsychiatric manifestations. Disease was active in 27% patients and 37% of patients had damage. Although all SF36 scales were reduced in SLE patients, limitation in physical activities because of health problems and general health were the subscales mostly affected; a correlation between damage and the SF-36 scale of physical function was observed (p<0.001). Fifty- four percent of patients presented an avoidance- oriented coping, 32% an emotion- oriented coping, while a task oriented coping was observed in 47% of patients. A positive correlation was observed between task- oriented coping and mental health (r=0.493 p<0.001); a negative association was observed between emotion-oriented coping and physical function (r= -0.321 p<0.01), limitations in usual role activities because of emotional problems (r= -0,429 p<0.001) emotional vitality (r= -0.358 p<0.01), mental health (r= -0.554 p<0.001).Finally a correlation was also noted between avoidance-oriented coping and mental health (r=0.250 p<0.01). Conclusions A correlation was observed between emotion-oriented coping and avoidance-oriented coping and a number of scales of the SF36, suggesting that a lower QoL is associated with the tendency to adopt strategies that may determine a underestimation of disease, its severity and maybe a lower adherence to treatment and follow up. Interventions to modify QoL and coping strategies appear important to optimize the care offered to SLE patients. Additional studies aimed at evaluating also the role of disease perception, mood status, adherence to treatment are underway. Disclosure of Interest None Declared