Emotional regulation appears to be a key factor in self-injury. But body image also may play an important role in self-harming.

Analysis of the relationship between non-suicidal self-injurious behavior and various aspects of body representation and body perception in adolescents and young women suffering from depression.

The study involved 85 women with endogenous depression. The answer to the question “Sometimes I purposely injure myself” was used as an indicator of self-harm. The methods include: SCL-90-R, Body Investment Scale (BIS), Physical Appearance Comparison Scale-Revised (PACS-R), Body Satisfaction Scale (BSS), Cambridge Depersonalization Scale (CDS).

The relationship between self-injurious behavior and emotional, cognitive and behavioral characteristics of the self-body perception was revealed: more negative body image - dissatisfaction with its parts and the whole body (correlation with BSS_head ,238*, BSS_body ,472**, BSS_total_score ,453**), which is accompanied by behavioral manifestations - reduced “Protection” (correlation with BIS -,281**), higher rates of self-surveillance and comparisons of the self-body with others (PACS-R ,323**), depersonalization (CDS ,301**), body dissociation (CDS ABE ,346**), somatization (SCL-90-R ,226*).

For young women with depression, it has been shown that when self-harming, the self-body is “devalued”, perceived as “bad,” and the need to protect it is ignored. The severity of self-harm directly correlates with the phenomena of somatopsychic depersonalization. The results obtained may indicate that rejection of the self-body, “alienated” attitude and deprivation of the body of “subjectivity” can contribute to its use as a tool for solving psychological problems, which is a risk factor for the development, consolidation and aggravation of self-injurious behavior.

No significant relationships.

Depersonalization during panic attacks may be a feature of a subgroup of Panic disorder. Several studies suggest that such subgroup corresponds to a more clinically severe form of Panic Disorder, with earlier onset and a higher rate of comorbidity with other psychiatric disorders, such as obsessive-compulsive disorder and generalized anxiety disorder. It is also hypothesized that depersonalization during panic attacks may lead Panic disorder to evolve into Agoraphobia.

To present the case report of a patient with severe Agoraphobia, whose only symptom of Panic disorder was depersonalization.

Description of a case report.

We describe the case of a 20-year-old woman who developed Agoraphobia after a single panic attack, during a physical education class, at the age of 13, with depersonalization symptoms only. After the attack, the patient stopped playing sports and engaging in any kind of activity in the absence of a trusted person. At the age of 20, the patient will only travel alone in the immediacies of her home, sometimes missing classes, because she cannot get a ride from trusted acquaintances. She justifies such avoidances with her fear of feeling depersonalized again. Over the course of her illness, she denied having experienced any other symptoms of a panic attack. She was treated with Paroxetine 40mg daily and cognitive behavioral therapy, having improved.

We believe this case provides good insight into depersonalization in panic attacks, supporting the view that Panic disorder with depersonalization may be a distinct and more severe subgroup of Panic Disorder.

Burnout is present at a high rate in emergency medicine. The ambulance driver-rescuers, who furnish first aid to the victims, are the non-medical part of the Italian 118-service staff. There is a lack of research on burnout risk in Italian Emergency Medical Services and, particularly, for this category of workers. The two Italian studies, including a little group of ambulance driver-rescuers, reported inconsistent findings.

This survey investigated for the first time the prevalence and exact profile of burnout in a large sample of Italian driver-rescuers. As a secondary aim, the study described how the items of the Italian version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) cluster in components in this sample.

This cross-sectional census survey was conducted from June 2015 through May 2016 and involved all the driver-rescuers operating in Sicily, the biggest and most southern region of Italy. The subjects received a classification according to different profiles of burnout by using the Italian version of the MBI-HSS (burnout, engagement, disengagement, over-extension, and work-inefficacy). In order to explore the existence of independent factors, a Principal Component Analysis (PCA) was conducted on the survey to obtain eigenvalues >one for each component in the data.

The final sample comprised 2,361 responders (96.6% of the initial sample). Of them, 29.8% were in burnout (95% confidence interval [CI], 27.8% to 31.8%) and 1.7% presented a severe form (95% CI, 1.1% to 2.3%); 30.0% were engaged in their work (95% CI, 21.0% to 34.8%), 24.7% of responders were disengaged (95% CI, 22.9% to 26.5%), 1.2% presented an over-extension profile (95% CI, 0.8% to 1.7%), and 12.6% felt work-inefficacy (95% CI, 11.3% to 14.1%). The factors loaded into a five-factor solution at PCA, explaining 48.1% of the variance and partially replicating the three-factor structure. The Emotional Exhaustion (EE) component was confirmed. New dimensions from Personal Accomplishment (PA) and Depersonalization (DP) sub-scales described empathy and disengagement with patients, respectively, and were responsible for the increased risk of burnout.

These results endorse the importance of screening and psychological interventions for this population of emergency workers, where burnout could manifest itself more insidiously. It is also possible to speculate that sub-optimal empathy skills could be related to the disengagement and work-inefficacy feelings registered.