Giovanni Stanghellini - Academia.edu (original) (raw)

Papers by Giovanni Stanghellini

British Journal of Psychiatry, Oct 19, 2018

The Abnormal Bodily Phenomena questionnaire (ABPq) is a semi-structured interview that originates... more The Abnormal Bodily Phenomena questionnaire (ABPq) is a semi-structured interview that originates from analyses of the clinical files of over 350 patients with schizophrenia. The result provide a rich and detailed collection of patients' self-descriptions related to subjective, experiential anomalies about feelings, sensations, perceptions and cognitions arising in the domain of the lived body. ABPq comprises nine distinctive items, grouped in five categories: demarcation, vitality, coherence, identity and activity. For each item and category, an accurate description and a list of examples are provided. Different intensities of phenomena are assessed through a Likert Scale by rating each item according to its quantitative features (frequency, intensity, impairment and coping). ABPq may help to discriminate schizophrenia from other psychoses and cluster A personality disorders from other personality disorders. This scale may also contribute in assessing features of clinical high risk or ultra high risk syndromes.

Official Journal of the Italian Society of Psychopathology, Jul 6, 2014

The concept of Typus Melancholicus (TM) was shaped by Tellenbach to describe the premorbid and in... more The concept of Typus Melancholicus (TM) was shaped by Tellenbach to describe the premorbid and intermorbid personality vulnerable to endogenous depression. The first part of this paper aims the description of the premorbid features of TM personality-orderliness, conscientiousness, hyper/hetereonomia and intolerance of ambiguity. After, we present the life world of the TM, i.e. a qualitative descriptions of the lived experiences about the body, self, time, space, and others. Also, we describe the basic principles of Tellenbach's theory-the method, the concept of endon, rhythmic and situation sensu Tellenbach as a special way of the person of living the relationship with the world per se in an endless reciprocal exchange. Starting from a clinical case, we show the theoretical evolutions of TM concept and underline the typical way which links the premorbid condition to melancholia. Finally, we ask if the TM concept can be still considered a valid construct in today's society, helpful in understanding and explaining identity crisis leading to depressive decompositions.

Brain Sciences

This paper, aligned with contemporary thinking in terms of patient-centered care and co-creation ... more This paper, aligned with contemporary thinking in terms of patient-centered care and co-creation of patient care, highlights the limitations of the reductionist approaches to psychiatry, offering an alternative, “emergent” perspective and approach. Assuming that psychopathological phenomena are essentially relational, what kind of epistemological framework and ‘logic of discovery’ should be adopted? I review two standard methods I call ‘ticking boxes’ and ‘drafting arrows’. Within the ticking boxes framework, the clinician’s main goal is to discover whether a patient showing psychopathological phenomena meets pre-given diagnostic criteria. The process of discovery can be compared to two people assembling a puzzle where the patient has the pieces and the interviewer has the image of the completed design. Drafting arrows consists in constructing pathogenetic diagrams that display linear causative relationships between variables connected by an arrow to other nodes. These explanatory n...

BJPsych Bulletin

Summary There is increasing recognition of the importance of the humanities and arts in medical a... more Summary There is increasing recognition of the importance of the humanities and arts in medical and psychiatric training. We explore the poetry of Charles Baudelaire (1821–1867) and its evocations of depression through themes of mood, time and self-consciousness and discuss their relation to images of ‘spleen’, the ‘snuffling clock’ and the ‘sinister mirror’. Following the literary critical commentaries of Walter Benjamin (1892–1940) and Jean Starobinski (1920–2019) we identify some of their roots in the poet's experience of the rapid and alienating urbanisation of 19th-century Paris. Appreciation of the rich vocabulary of poetry and the images it generates adds depth to clinical practice by painting vivid pictures of subjective experience, including subjective experience of the ‘social’ as part of the biopsychosocial constellation.

Frontiers in Psychology

The psychopathological analysis of hysteria is a victim of narrow conceptualizations. Among these... more The psychopathological analysis of hysteria is a victim of narrow conceptualizations. Among these is the inscription of hysteria in the feminine sphere, about body and sexuality, which incentivized conceptual reductionism. Hysteria has been mainly considered a gendered pathology, almost exclusively female, and it has been associated with cultural and/or religious features over time rather than treated as a psychopathological world. Further, hysteria has been dominated by conceptual inaccuracies and indecision, not only in terms of clinical features but also in terms of its definition. For this reason, it seems necessary to “undress” hysteria from this feminization, sexualization, and corporealization with which it has been abundantly clothed over the years. “Undressing” hysteria will make possible a reconfiguring and deconstructing of the explanatory-causal model of Charcot and Freud. However, if we take out this cultural heritage, the stigma accompanying this diagnosis, and the wei...

International Perspectives in Values-Based Mental Health Practice, 2020

Building on a view of Feeding and Eating Disorders (FEDs) as passions, this chapter illustrates t... more Building on a view of Feeding and Eating Disorders (FEDs) as passions, this chapter illustrates through personal testimony and materials from publicly accessible (Pro-Ana) websites the nature of anorexia as a kind of religion. The explicit values of this ‘religion’ are shown to have their origins in a cultural value we call ‘ocularcentrism’. Some of the limitations and further developments of this model are indicated. The model though we conclude may be helpful in developing more effective approaches to therapy.

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2021

Purpose Recent studies demonstrated that the embodiment disorder represents a core feature of eat... more Purpose Recent studies demonstrated that the embodiment disorder represents a core feature of eating disorders (EDs). The aim of this study was to evaluate the role of its variation as a possible mediator of the efficacy of enhanced cognitive behavioural therapy (CBT-E) on classic ED symptomatology, including body uneasiness. Methods 73 patients with anorexia nervosa and 68 with bulimia nervosa were treated with a multidisciplinary approach including CBT-E. Psychometric questionnaires were administered at baseline (T0) and after one (T1) and 2 years (T2) to evaluate general and ED-specific psychopathology, body uneasiness and the embodiment disorder. Data regarding diagnostic crossover and remission were also collected. Results Longitudinal analysis showed an improvement of all psychopathological dimensions at T1, which remained stable at T2 (p < 0.05). Remission rate at T2 was 44.7%, and diagnostic crossover occurred in 17.0% of patients. Higher levels of embodiment disorder pre...

European Psychiatry, 2020

Background: Patients with schizophrenia display experiential anomalies in their feelings and cogn... more Background: Patients with schizophrenia display experiential anomalies in their feelings and cognitions arising in the domain of their lived body. These abnormal bodily phenomena (ABP) are not part of diagnostic criteria for schizophrenia. One of the reasons is the difficulty to assess specific ABP for schizophrenia spectrum disorders. The present study aimed to explore the presence in patients with schizophrenia of specific ABP. Methods: We used a semistructured interview—the Abnormal Bodily Phenomena questionnaire (ABPq), an instrument devised to detect and measure ABP specific to patients with schizophrenia. Fifty-one outpatients affected by schizophrenia and 28 euthymic outpatients affected by bipolar disorder type I with psychotic features (BD-pf-e) were recruited. Before assessing the specificity for schizophrenia of the observed ABP, we tested the internal consistency and the convergent validity of the ABPq in patients with schizophrenia. Specificity was assessed by examining...

Research in Psychotherapy: Psychopathology, Process and Outcome, 2020

This is an explorative study on values of 25 patients affected by borderline personality disorder... more This is an explorative study on values of 25 patients affected by borderline personality disorder interviewed in a clinical setting (phenomenological-dynamic psychotherapy) and re-classified following Consensual Qualitative Research. We identified three main categories of values: recognition (the importance for attention, acknowledgment, commendation and acceptance by the other), authenticity (the importance of absolute emotional fusion with the other), and immediacy (the importance of instantaneous, hic et nunc satisfaction of one’s needs/desires). Each of these values expresses a kind of ‘logic’, namely the logic of intimacy (the other’s closeness as indispensable for defining oneself and establish/reinforce one’s selfhood and identity), spontaneity (over-reliance on feelings unrestricted by social norms undermining their intensity), and instantaneity (glorification of ‘now-moments’/execration of procrastination draining the vitality of feelings). The borderline person lives an em...

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2020

The available treatments of Eating Disorders (EDs) mirror an excessive focus on symptoms to be el... more The available treatments of Eating Disorders (EDs) mirror an excessive focus on symptoms to be eliminated rather than on the acknowledgment of what is relevant from the patient's perspective. This Editorial offers a critical review of the limitations of the DSM-5-oriented approaches, as well as of their extreme consequences, namely ocularcentrism, nosographism, and paternalistic moralism. To overcome these limitations, it is suggested to get back to Psychopathology as the basic science of psychiatric practice whose aim is to grasp the distinctly personal dimension of the patient's experience and to connect understanding with care. With the help of Psychopathology, clinicians engaged in the treatment of ED patients will better make sense of what it is like to suffer from these disorders and be encouraged to suspend their judgment and take patient's perspective in the light of their troubled existence which is rich in meanings and not merely in abnormal beliefs and trivial anomalous behavior. According to these principles, treatment is a journey shared with the patient, which allows her/him to feel recognized and accepted in terms of her/his individuality.

Frontiers in Psychiatry, 2019

This article builds on and extends the 'optical-coenaesthetic disproportion' (OCDisp) hypothesis ... more This article builds on and extends the 'optical-coenaesthetic disproportion' (OCDisp) hypothesis of feeding and eating disorders (FEDs) matching data obtained through clinical research with laboratory evidence from neuroscience and neuropsychological studies. The OCDisp hypothesis, developed through the assessment in clinical setting of bodily experience using the IDentity and EAting (IDEA) disorder questionnaire, argues that in persons with FED the internal perception of one's embodied self (i.e., coenaesthesia) is deeply affected (their possibility to feel themselves is weakened or threatened by coenaesthopathic and emotional paroxysms; their bodily feelings are discontinuous over time), and as a compensation to it, these persons experience their own body as an object that is looked at by others. To FED persons, their body is principally given to them as an object 'to be seen.' The other's look serves as an optical prosthesis to cope with hypo-and dis-coenaesthesia and as a device through which persons with FED can define themselves and attenuate the anxiety produced by the conflicts between being-oneself and being-for-others. After describing the OCDisp hypothesis, we will gather evidence supporting it with neuroscience studies on FED. Our focus will be on data pointing to dampened multisensory integration of interoceptive and esteroceptive signals, demonstrating a predominance of the visual afferents toward signals arising within the body. In the final part of the article, we will show consistencies but also draw distinctions between our clinical hypothesis and neuroscience-based data and hypotheses and draft a potential agenda for translational research inspired by these.

L'Évolution Psychiatrique, 2019

Objectif : cet article présente la version francophone du questionnaire d'inspiration phénoménolo... more Objectif : cet article présente la version francophone du questionnaire d'inspiration phénoménologique Identity and Eating Disorders (IDEA) (Stanghellini et al., 2012). La littérature d'inspiration phénoménologique met en évidence que les personnes souffrant d'anorexie mentale présentent des perturbations au niveau de l'incarnation et de l'intersubjectivité. Cette recherche évalue les expériences corporelles subjectives de participantes anorexiques grâce au concept du corps-pour-autrui proposé par J.-P. Sartre (1943). Hypothèse : les patientes anorexiques se définissent davantage à travers le regard des autres et tendent à moins ressentir leur corps de manière sensorielle. Méthode : 67 patientes anorexiques et 246 participantes contrôles ont répondu à la version francophone, traduite par nos soins, du questionnaire IDentity and EAting disorders. Des tests non paramétriques de Mann-Whitney pour échantillons indépendants ont été effectués. Conclusion : les résultats statistiques confirment l'hypothèse de recherche : les patientes anorexiques obtiennent des scores au questionnaire significativement supérieurs à ceux des participantes contrôles. Ces résultats confirment des difficultés au niveau de l'incarnation et de l'intersubjectivité chez les sujets anorexiques et annoncent des perspectives de recherche importantes.

Frontiers in psychiatry, 2018

Phenomenological psychopathology is a body of scientific knowledge on which the clinical practice... more Phenomenological psychopathology is a body of scientific knowledge on which the clinical practice of psychiatry is based since the first decades of the twentieth century, a method to assess the patient's abnormal experiences from their own perspective, and more importantly, a science responsible for delimiting the object of psychiatry. Recently, the frontiers of phenomenological psychopathology have expanded to the productive development of therapeutic strategies that target the whole of existence in their actions. In this article, we present an overview of the current state of this discipline, summing up some of its key concepts, and highlighting its importance to clinical psychiatry today. Phenomenological psychopathology understands mental disorders as modifications of the main dimensions of the life-world: lived time, lived space, lived body, intersubjectivity, and selfhood. Psychopathological symptoms are the expression of a dialectical modification of the proportions of ce...

Trends in psychiatry and psychotherapy

L'Évolution Psychiatrique, 2017

Hyper-réflexivité et perspective en première personne : un apport décisif de la psychopathologie ... more Hyper-réflexivité et perspective en première personne : un apport décisif de la psychopathologie phénoménologique contemporaine à la compréhension de la schizophrénie Hyperreflexivity and first-person perspective: a decisive contribution of contemporary phenomenological psychopathology to the understanding of schizophrenia Article Type: Article original

PloS one, 2017

Eating Disorders (EDs) show a multifactorial etiopathogenesis including environmental, psychologi... more Eating Disorders (EDs) show a multifactorial etiopathogenesis including environmental, psychological and biological factors. In the present study, we propose a model of interactions between genetic vulnerability-represented by Fat Mass and Obesity-Associated (FTO) gene-and stable psychopathological traits, such as bodily disorders and emotion dysregulation for EDs patients. The distribution of a polymorphism of the FTO (rs9939609 T>A) was evaluated in a series of 250 EDs patients and in a group of 119 healthy control subjects. Clinical data were collected through a face-to-face interview and several self-reported questionnaires were applied, including the Emotional Eating Scale and the IDentity and EAting disorders (IDEA) questionnaire for bodily disorders and self-identity. The A-allele was associated with an increased vulnerability to EDs (AA+AT genotypes frequency 72.8% in EDs vs. 52.9% in controls). The presence of the A-allele was associated with binge eating behavior, highe...

The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

Journal of Psychopathology, Dec 1, 2014

This article argues for the importance of investigating emotions in psychiatry. In a time dominat... more This article argues for the importance of investigating emotions in psychiatry. In a time dominated by striding naturalistic explanations of mental illness, phenomenological psychopathology provides a crucial investigation into the subjective aspect of the disordered mind. Emotional phenomena are Janus-faced in the sense that they bring out the complex interplay of impersonal, biological and personal features of mental illness. We propose a framework for understanding emotional experience that is grounded in four key points: a general concept of "affectivity", the definition of "emotion" as felt motivation to move, the distinction between "affect" and "mood" according to their intentional structure and the dialectics between affects and moods. The reason why emotions matter in psychiatry is that mental suffering brings out an emotional fragility that we argue is constitutive of personal identity. Emotional experience reveals an intimate alienation at the heart of our mental life. What we feel is our own experience, but in this experience we may feel that we are not ourselves. To be a person is to live with this affective experience of selfhood and otherness. Emotions disclose an inescapable fragility at the heart of our identity that plays a significant role in our vulnerability to mental illness. We propose a model constructed upon the theoretical assumption that the fragility characterising human personhood stems from the dialectics of selfhood and otherness at the core of being a person. These dialectics become particularly evident in the way our moods challenge our sense of personal identity by complicating our relation to norms and values. In fact, we argue that moods are the most conspicuous epiphany of otherness in human life, in that they, more than other experiences, complicate our sense of being who we are. By way of conclusion, we illustrate our model with a phenomenological and hermeneutical analysis of the experience and meaning of shame.