Suicide is the second-leading cause of death during adolescence.^1,2 The most recognized risk factors for suicide and attempted suicide are previous attempts, psychiatric illness, bullying, and childhood abuse and trauma.^3-6 Among these risk factors, sexuality and related issues have been investigated, particularly in connection with abuse and gender identity.^7-9 Gender identity is part of the self-identity that contributes to the full development of an adult human. Even if its roots are in childhood, gender orientation fully expresses itself during adolescence, especially because of the onset of sexual drive. Homosexual, bisexual, and transgender people are generally at higher risk of isolation, exposure to violence, and stigmatization, both self-inflicted and from peers or family members.^10-13 The calculation of the real extent of suicide and attempted suicide during adolescence often stems from research led by lesbian, gay, bisexual, and transgender (LGBT) communities or focused on bullying within the school context.^14-17 Neither of these situations is appropriate for the precise quantification of suicide among sexual minority youths. Studies within LGBT communities may have incorrect estimations because they are composed of people with higher self-consciousness about their sexual orientation and represent a place of aggregation and support. On the other hand, focusing on bullying may increase quantification because of a biased selection for the implication of an explicit risk factor.

Background and aims: The concept of "Food Addiction" has been based on criteria of Substance Use Disorder. Several studies suggested a relationship between food addiction and eating disorders, but little is known about its extent or role. We aim at exploring if food addiction is coincident with a specific eating disorder (binge eating disorder appears the closest) or it is a separate diagnostic entity that afflicts in comorbidity with eating disorders or other conditions like obesity or even in the general population. Methods: This systematic review and meta-analysis analyzed observational studies with a comparative estimation on rates of subjects affected by binge eating disorder and food addiction. Results: Binge eating disorder shows higher comorbidity with food addiction compared to other eating disorders (OR = 1.33, 95% CI, 0.64–2.76; c² = 4.42; p = 0.44;I² = 0%), or each eating disorder [anorexia nervosa purging type (OR = 1.93, 95% CI, 0.20–18.92; p = 0.57) and restrictive type (OR = 8.75, 95% CI, 1.08–70.70; p = 0.04)], obese patients (OR = 5.72, 95% CI, 3.25–10.09; p = < 0.0001) and individuals from the general population (OR = 55.41, 95% CI, 8.16–376.10; c² = 18.50; p < 0.0001; I² = 0%)but has decreased prevalence when compared to bulimia nervosa (OR = 0.85, 95% CI, 0.33–2.22; c² = 0.35; p = 0.74; I² = 0%). Discussion and conclusions: Our data show that the prevalence of food addiction in binge eating disorder is higher than in other eating disorders except in bulimia nervosa. Moreover, it is a separate diagnostic reality and can be detected in people without mental illness and in the general population. Food addiction might have a prognostic value, since in comorbidity, and should be addressed to boost treatment efficacy and patient’s recovery. Level of evidence: I: Evidence obtained systematic reviews and meta-analyses.

Narcissistic personality disorder is characterized by self-absorption, grandiosity, exploitation of others and lack of empathy. People with that disorder may switch from an overt form, mainly with grandiosity, to a covert presentation, with fears, hypersensitivity and dependence from others. Empathy represents a key point in detecting people affected by narcissistic personality disorder because, even if it is described as reduced, it plays a fundamental role in exploitation and manipulation. A systematic search of Literature without any language or time restriction, was performed combining thesaurus and free-search indexing terms related to Narcissistic personality disorder and empathy and produced 531 results. Fifty-two papers that analyzed possible issues in the empathic attitude of people with narcissistic personality disorder were included in this narrative review. Empathy is the capability of understating and feeling others emotions. It is not a unitary construct and can be distinguished in cognitive and affective. It might be channeled into prosocial and antisocial behaviors. A crucial trait identified in narcissistic empathy is affective dissonance that is closely related to rivalry as part of the dark tetrad (narcissism, machiavellianism, psychopathy, and sadism). Subjects affected by narcissistic personality disorder show greater impairment in affective aspects while their cognitive part of empathy appears preserved. Saving at least the cognitive aspects of empathy may contribute to therapeutic improvement of affective aspects.

Therapeutic termination of pregnancy and women’s mental health: Determinants and consequences

Background: Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice. Methods: Narrative review of the literature combined with the authors’ collective experience and knowledge of personality disorders. Results: In six of the eight countries where EAS is currently legal, mental disorders are accepted as disorders for which EAS may be granted. In four of these countries, EAS in minors with mental disorders is also accepted. Our literature search resulted in 9 papers on the subject of EAS in people with personality disorders. These studies suggest that most clinicians who grant EAS have indeed perceived their patients’ suffering as chronic, unbearable and untreatable without prospect of improvement. The majority of patients with personality disorders had tried some form of psychotherapy, but very few had received any of the relevant evidence-based treatments. The decision to grant EAS based on a perception of the patient’s illness as being untreatable with no prospect of improvement, could, thus, in many cases fail to meet the due care criteria listed in EAS laws. People with personality disorders more often wish for death for extended periods of time than people without these disorders. However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time. Conclusions: In light of our findings, we believe that the current legislation and practice of EAS for people with personality disorders is based on an inadequate understanding of underlying psychopathology and a lack of awareness about the contemporary treatment literature. Moreover, we assert that this practice neglects the individual’s potential for having a life worth living.