Anxiety and depressive symptoms in first-time parents: A dyadic longitudinal study based on attachment theory

BACKGROUND

The aim of this study was to examine the temporal and dyadic associations between anxiety and depressive symptoms during the transition to parenthood (TTP), while exploring the antecedence of attachment insecurities in these associations.

METHOD

Couples of first-time parents (N = 211) completed the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, the Experiences in Close Relationships scale, and a sociodemographic questionnaire during the second trimester of pregnancy and at four and twelve months postpartum.

RESULTS

Both prenatal anxiety and depressive symptoms predicted postnatal depressive and anxiety symptoms. Prenatal attachment-related anxiety predicted higher postnatal anxiety and depressive symptoms whereas prenatal attachment-related avoidance predicted higher postnatal depressive symptoms only. Parents whose partners had a higher level of prenatal attachment-related anxiety experienced higher postnatal anxious and depressive symptoms via their own's prenatal depressive symptoms. Parents whose partners had a higher level of prenatal attachment-related avoidance experienced higher postnatal depressive symptoms via their own's prenatal anxious symptoms. No gender differences were found for these associations.

LIMITATIONS

The sample was predominantly composed of educated heterosexual French-Canadian Caucasian couples and all measures were self-reported.

CONCLUSIONS

Our original findings suggest that professionals should routinely screen for anxiety and depressive symptoms in both partners from pregnancy up to one year postpartum. Also, our findings suggest addressing attachment insecurities with both partners to prevent the development of future symptoms during pregnancy or after childbirth. Finally, our study supports the relevance of considering these symptoms at subclinical levels during the TTP.

Romantic Attachment and Intimate Partner Violence Perpetrated by Men: The Role of Affect Dysregulation and Gender Hostility

Intimate partner violence (IPV) is a major public health problem, associated with considerable consequences for the victims. Among the risk factors associated with the perpetration of male IPV, attachment insecurities (avoidance, anxiety) and affect dysregulation (AD) have received strong empirical support. A few studies showed that hostility toward women (HTW) is a correlate of IPV perpetration, but none have explored hostility toward men (HTM). This study's aim was to test direct and indirect associations between romantic attachment insecurities and IPV perpetration (psychological, physical, and sexual coercion) through AD in men seeking help, and to examine the moderator role of HTW and HTM in theses links. A sample of 1,845 men aged between 18 and 88 years and from a diverse population (e.g., cultural background, education, and sexual orientation) were recruited through 18 community organizations providing IPV services in a Canadian province. As part of the systematic assessment protocol of each organization, participants answered a series of online questionnaires. Results from a path analysis model showed indirect associations between attachment insecurities (avoidance and anxiety) and IPV perpetration (psychological, physical, and sexual coercion) through AD. Beyond these links, attachment avoidance was also directly associated with psychological violence, attachment anxiety with sexual coercion, and HTM with sexual coercion. The results revealed two moderation effects: higher HTW amplified the link between AD and physical IPV, whereas higher HTM amplified the link between AD and sexual coercion. Results highlight the relevance of assessing attachment, AD, and gender hostility in IPV programs. They also highlight the relevance of targeting HTM as a risk marker for IPV perpetration in men.

Attachment as an intermediary variable between childhood maltreatment and perceived partner responsiveness in adolescents and young adults

Cumulative childhood maltreatment (CCM) is associated with relationship difficulties including lower perceived partner responsiveness (PPR)-the degree of feeling cared for, understood, and validated by a person's partner. Attachment theory is understood via its representations of self and others and could offer a better understanding of how CCM effects continue into adulthood and affect PPR. We examined whether CCM is related to PPR via attachment in French-speaking adolescents and young adults. A sample of 427 individuals in a romantic relationship and another sample of 159 couples completed self-report measures. In both samples, a person's CCM was associated with their own lower PPR via their higher attachment anxiety and avoidance. In the dyadic sample, a person's CCM was associated with their partner's lower PPR via their own higher attachment anxiety. Attachment insecurities help understand the associations between CCM and PPR and may represent an important intervention target.

Do perfectionism, body image concerns, and intimacy predict genitopelvic pain in the postpartum? A prospective study of new mothers

BACKGROUND

Genitopelvic pain following childbirth is common and likely to challenge the psychological, relational, and sexual well-being of new mothers. While genitopelvic pain generally decreases during the postpartum period, personal and interpersonal characteristics may explain why genitopelvic pain persists beyond the period of physical recovery in some mothers. Body image concerns, increased stress, and relationship challenges would be particularly salient during pregnancy and the postpartum period, which could put new mothers at greater risk of sexual difficulties. Also, mothers may display a negative appraisal regarding genitopelvic pain and doubt their ability to cope with it, which may contribute to the pain.

AIM

The current study aimed to examine the role of perfectionism, body image concerns, and perceived intimacy in the occurrence and change in genitopelvic pain in new mothers in postpartum.

METHODS

A total of 211 new mothers and their partners were recruited for a larger prospective dyadic study on the transition to parenthood.

OUTCOMES

Mothers completed a single item assessing genitopelvic pain, in addition to brief validated questionnaires measuring perfectionism, body image concerns, and perceived couple intimacy during pregnancy and at 4, 8, and 12 months postpartum.

RESULTS

Five multilevel modeling analyses revealed that adaptive perfectionism, maladaptive perfectionism, and body image concerns were associated with a higher occurrence of genitopelvic pain from 4 to 12 months postpartum. Mothers' and partners' perceived intimacy was not significantly related to new mothers' genitopelvic pain. None of the predictors modified the trajectory of genitopelvic pain over time.

CLINICAL IMPLICATIONS

Raising awareness among health care professionals regarding the role of perfectionism and body image concerns in genitopelvic pain may help them identify new mothers at risk of chronic genitopelvic pain, while offering a new avenue of intervention.

STRENGTHS AND LIMITATIONS

There has been little research examining the role of perfectionism, body image concerns, and intimacy in postpartum genitopelvic pain. Based on a longitudinal prospective approach, this study identified perfectionism and body image concerns as significant predictors of postpartum genitopelvic pain. However, prepregnancy genitopelvic pain, genitopelvic pain intensity, and sexual distress were not measured.

CONCLUSION

Adaptive and maladaptive perfectionism and body image concerns are associated with new mothers' genitopelvic pain up to 12 months postpartum.

Associations Between Pornography Use Frequency and Intimate Partner Violence Perpetration Among Young Adult Couples: A 2-Year Longitudinal Study

Pornography use is a common sexual activity for many individuals including those in a romantic relationship. Some studies have shown that violent content depicted in pornography is a risk factor for perpetration of violence in real life. Even if most of these studies examined perpetration of violent behaviors in general, not specifically toward the intimate partner, some studies have shown that pornography use frequency is related to a greater perpetration of intimate partner violence (IPV), while other studies have found that it is not significantly related. However, most previous studies were cross-sectional, sampled individuals rather than couples, and did not include separately forms of IPV (e.g., physical, psychological, and sexual). The present study examined the associations between pornography use frequency and the perpetration of physical and psychological IPV, and sexual coercion among young adult couples. A convenience sample of 113 couples aged between 16 and 29 years old completed self-reported online questionnaires two times over a 2-year period. The results of autoregressive cross-lagged models showed that a person's pornography use frequency at Time 1 was related to their own higher sexual coercion perpetration 2 years later and that a person's sexual coercion perpetration was related to their partner's lower pornography use frequency 2 years later. However, no significant association between pornography use frequency and physical and psychological IPV emerged. In line with previous studies, our results suggest that pornography use represents an important risk factor for the perpetration of sexual coercion. Findings support the need to include education around pornography use in sexual violence prevention programs to avoid that young adults reproduce pornographic scripts in their sexuality.

Romantic Attachment, Sex Motives and Sexual Difficulties in Emerging Adults: The Role of Childhood Interpersonal Victimization

A growing body of research has revealed that many emerging adults (i.e., aged 18 to 25) experience sexual difficulties. Past studies have emphasized the need to examine sexual difficulties by accounting for sex motives (i.e., reasons for engaging in sex) and by using a trauma-focused or attachment-based framework. This study examined the role of sex motives in the associations among attachment insecurities (anxiety, avoidance) and sexual difficulties in emerging adults, and assessed whether these links varied on the basis of low or high exposure to childhood interpersonal victimization (CIV) (i.e., 0-3 different types of CIV or 4 or more types of CIV). A sample of 437 French-Canadian emerging adults completed validated questionnaires online. Path analyses revealed that participants with higher attachment anxiety were more likely to endorse the partner approval sex motive, which was related to more sexual difficulties. Participants with higher attachment avoidance were less likely to endorse the pleasure sex motive, which was associated with more sexual difficulties. Results indicated a significant effect of CIV showing that some indirect effects were significant only in participants who reported high CIV exposure. Results suggest that addressing sex motives using an attachment- and trauma-focused framework might help understand, prevent and treat sexual difficulties among emerging adults.

Associations Between Contents of Pornography and Sexual Satisfaction and Function Among Young Adults

Pornography offers a wide variety of sexual contents and has documented potential positive (e.g., higher sexual satisfaction) and negative associations (e.g., lower sexual function) with sexuality. The aims of this study were to describe the proportion of use of five different contents of pornography (i.e. group sex, passion and romance, gender-bending, taboo transgression and forbidden sex, power, control, and rough sex pornography), to examine gender-based differences in the frequency of use of these contents, and to examine the associations between the frequency of use of these contents and sexual satisfaction and function, considering potential differences among genders and individuals with and without a romantic or sexual partner, and controlling for frequency of masturbation. A sample of 827 young adults (503 women; Mage = 23.44) completed online self-report questionnaires. Results of path analysis indicated that, controlling for frequency of masturbation, the use of passion and romance pornography was associated with higher sexual satisfaction, whereas the use of power, control, and rough sex pornography was associated with lower sexual satisfaction. Cisgender men's use of power, control, and rough sex pornography was also associated with lower sexual function. These findings suggest different associations between pornography use and sexual satisfaction and function depending on the pornographic contents used.

Attachment and Breakup Distress: The Mediating Role of Coping Strategies

Breakups are common among emerging adults and are associated with elevated depressive and anxiety symptoms, especially in the presence of attachment insecurities. Previous authors have suggested that inadequate coping strategies might explain this association, yet this has not been examined longitudinally. This study examined the mediating role of five coping strategies (self-help, approach, accommodation, avoidance, self-punishment) in the longitudinal associations between attachment insecurities (anxiety, avoidance) and depressive and anxious symptoms in 196 emerging adults experiencing a romantic breakup. Measures of pre-breakup attachment, post-breakup coping strategies (one-month post-breakup), and depressive and anxiety symptoms (one- and three-month post-breakup) were administered. Results from a longitudinal autoregressive cross-lagged model showed that pre-breakup attachment insecurities were related to higher depressive and anxiety post-breakup symptoms through higher use of self-punishment and lower use of accommodation coping strategies. Findings highlight coping strategies as potential intervention targets to promote the recovery of emerging adults experiencing breakup distress.

Attachment and Sexual Functioning in Couples Seeking Fertility Treatment: The Role of Infertility-Specific Coping Strategies

Couples facing infertility often experience sexual difficulties. Yet, little is known about the factors associated with these difficulties. We examined whether infertility-related coping strategies explain the associations between attachment insecurities (anxiety, avoidance) and sexual function and satisfaction in 97 couples seeking fertility treatment. Anxiety was associated with one's lower sexual satisfaction and function via self-neglect coping strategies. Anxiety was also associated with the partner's lower sexual satisfaction via self-blame coping. Avoidance was associated with lower partner support-seeking and sexual satisfaction. These findings support the roles of attachment and coping in the experience of sexual difficulties among couples seeking fertility treatment.

Correction to: Explaining the Association Between Childhood Maltreatment and Psychological Adjustment in Youth in a Romantic Relationship

[This corrects the article DOI: 10.1007/s40653-023-00562-w.].

Correction to: Explaining the Association Between Childhood Maltreatment and Psychological Adjustment in Youth in a Romantic Relationship

[This corrects the article DOI: 10.1007/s40653-023-00562-w.].

"I Was Trying to Be the Mother to Her That I Didn't Have": Mothers' Experiences of Child Sexual Abuse and Intergenerational Maltreatment

Child sexual abuse (CSA) can have lasting negative impacts on one's sense of safety and trust, ultimately affecting the quality of relationships, and increasing the likelihood of future victimization experiences. The present study provides a qualitative description of the themes that were generated through interviews conducted with 23 mothers who experienced CSA (dis)continuity (12 continuity, 11 discontinuity). The mothers described a variety of experiences related to parent-child and romantic relationships and parenting behaviors, which could be further researched and targeted by interventions to reduce the risk of intergenerational cycles of maltreatment.

Romantic Attachment and Sexual Satisfaction Trajectories Among Couples Transitioning to Parenthood

The transition to parenthood (TTP) is an exciting yet destabilizing time for couples. First-time parents may experience changes in their sexual satisfaction during the TTP, but little is known about the factors associated with these changes. Romantic attachment might help understand why some new parents experience a decrease in sexual satisfaction while others do not. This prospective and dyadic study aimed to examine new parents' sexual satisfaction trajectories through the moderator role of prenatal attachment anxiety and avoidance in these trajectories. A total of 221 primiparous Canadian couples completed four online questionnaires from the second trimester of pregnancy to 12 months postpartum. Dyadic latent growth curve analyses revealed that although pregnant people present lower prenatal sexual satisfaction than their partners, both parents show an increase in their sexual satisfaction from pregnancy to 12 months postpartum. For both parents, partners' attachment anxiety was related to one's own steeper increase in sexual satisfaction from pregnancy to 12 months postpartum. Finally, both parents' attachment avoidance was related to their own lower sexual satisfaction during pregnancy. These findings will help educate and support expectant parents about anticipated fluctuations in sexual satisfaction.

Sexual growth and destiny beliefs: Longitudinal associations with dyadic coping among couples seeking medically assisted reproduction

BACKGROUND

Medically assisted reproduction is a vulnerable time for couples' sexual health. Believing that sexual challenges can be worked through (i.e., sexual growth beliefs) or that these challenges indicate incompatibility (i.e., sexual destiny beliefs) may be related to dyadic coping-the strategies couples use to cope-with the physical and psychological stressors of medically assisted reproduction.

AIM

In the current study we aimed to examine the longitudinal associations between typical (i.e., average) levels of sexual growth and destiny beliefs and positive and negative facets of dyadic coping and how greater than typical levels of these constructs predicted each other across time.

METHODS

Couples (n = 219) seeking medically assisted reproduction were recruited for an online longitudinal, dyadic study.

OUTCOMES

Couples completed online measures of sexual growth and destiny beliefs and positive and negative dyadic coping at baseline, 6-and 12-months.

RESULTS

Random intercept cross-lagged panel models demonstrated that at the within-person level, reporting higher sexual growth beliefs at baseline, relative to their average across time points, was associated with lower negative dyadic coping at 6 months. Higher negative dyadic coping at 6 months, relative to their average, was linked to lower sexual growth beliefs at 12-months. When individuals reported higher sexual destiny beliefs at 6-months, relative to their average, they and their partners reported higher negative dyadic coping at 12 -months. At the between-person level, higher overall levels of sexual destiny beliefs were related to higher overall levels of negative dyadic coping. No associations with positive dyadic coping were identified.

CLINICAL IMPLICATIONS

Couples may benefit from identifying and reducing unhelpful beliefs about sex and negative dyadic coping.

STRENGTHS AND LIMITATIONS

Strengths of this study include our large, inclusive sample, engagement of community partners, and novel analytical approach to assess change over time. However, following couples in 6-month increments and not using questionnaires specific to medically assisted reproduction may have limited our ability to detect nuanced changes that couples experience during this time.

CONCLUSION

Lower sexual growth and higher sexual destiny beliefs may promote couples' engagement in less adaptive coping behaviors as they seek medically assisted reproduction.

A Latent Profile Analysis of Intimate Partner Violence Perpetrated by Men Seeking Help

Past research has emphasized the need to identify profiles of men who perpetrate intimate partner violence (IPV) as a way to better understand this heterogeneous population and guide the development of tailored services. However, empirical validation for such profiles remains limited, since it still focuses on specific populations or fails to consider IPV as reported by men seeking treatment for IPV. We know little about the profiles of men who seek services for their use of IPV (with or without a justice referral). This study sought to identify profiles of men seeking treatment for IPV, based on their self-reported use of the various forms and severity of IPV perpetrated, and to compare the identified groups on key psychosocial risk markers of IPV. A total of 980 Canadian men entering treatment in community organizations specialized in IPV answered a series of questionnaires. A latent profile analysis identified four profiles: (a) "no/minor IPV" (n = 194), (b) "severe IPV with sexual coercion" (n = 122), (c) "minor IPV and control" (n = 471), and (d) "severe IPV without sexual coercion" (n = 193). Results revealed differences in psychosocial risk markers, including attachment insecurities, childhood interpersonal trauma, undesirable personality traits, affect dysregulation, and psychological distress, mostly between the "severe IPV without sexual coercion" profile and the "no/minor IPV" and "minor IPV and control" profiles. Very few differences were found, however, between the "severe IPV with sexual coercion" and "severe IPV without sexual coercion" profiles. Implications for awareness, prevention, and treatment efforts for each profile are discussed.

Attachment Injury Severity, Injury-related Stress, Forgiveness, and Sexual Satisfaction in Injured Adult Partners

An attachment injury can occur when one partner violates the assumption that they will provide comfort and caring during a moment of increased need. For injured partners, unresolved attachment injuries can underlie an enduring stress reaction and lower relationship satisfaction. However, no research has examined the associations between the perceived severity of the injury and sexual satisfaction, a central component of relationship well-being. In this cross-sectional study, we examined the direct and indirect associations between the perceived severity of the attachment injury and sexual satisfaction via injury-related stress symptoms and levels of forgiveness, in injured partners. A total of 145 adults who reported having experienced an attachment injury in their current relationship completed self-report questionnaires measuring injury severity, event-related stress, forgiveness, and sexual satisfaction. An indirect association between the perceived severity of the attachment injury and sexual satisfaction through higher injury-related stress and lower forgiveness was found via a path analysis. Results suggest that fostering forgiveness and attending to injury-related stress may be key toward sexual satisfaction in couples where a partner reports an attachment injury. Clinical implications of these results are discussed in light of theory and potential treatment strategies for addressing an attachment injury in couple's therapy.

Toward an Integrative Model of Intimacy, Sexual Satisfaction, and Relationship Satisfaction: A Prospective Study in Long-Term Couples

Sexual and relationship well-being are strongly intertwined in couple relationships. However, relationship quality is generally examined through relationship satisfaction only, neglecting the importance of sexual satisfaction as an aspect of relationship quality for many couples. Moreover, considering the role of interpersonal processes, such as intimacy, in relationship quality seems essential to better understand couples' optimal functioning. Although the Vulnerability-Stress-Adaptation Model posits bidirectional associations between interpersonal processes and relationship quality, few studies have tested such models. This dyadic study examined the longitudinal associations between the process of intimacy and sexual and relationship satisfaction in 145 long-term mixed-gender/sex couples. Participants completed online questionnaires three times over 13 months. A cross-lagged panel model revealed bidirectional associations between intimacy behaviors and both sexual and relationship satisfaction. Findings suggest that intimacy behaviors could foster both sexual and relationship satisfaction in couples, and that higher sexual and relationship satisfaction could also promote intimacy behaviors over time. These results highlight that satisfaction may not only be an outcome of positive interpersonal processes, but also a facilitator of these interpersonal processes over time. This study underscores the need to consider the complex interplay of interpersonal processes and satisfaction to foster relationship quality in long-term couples over time.

Cumulative childhood trauma, sex motives and sexual satisfaction among emerging adults

BACKGROUND

To better understand sexual satisfaction in emerging adults, previous research has emphasized the importance of considering the role of developmental experiences, such as cumulative childhood trauma (CCT; the number of different forms of abuse and neglect sustained during childhood). However, the mechanisms by which CCT and sexual satisfaction are related remain unknown. Sex motives are suggested as an explanatory mechanism given the previously found associations between sex motives and both sexual satisfaction and CCT.

OBJECTIVE

This study examined the direct associations between CCT and sexual satisfaction, as well as indirect associations through sex motives, in emerging adults.

PARTICIPANTS AND SETTING

A sample of 437 French Canadian emerging adults (76 % women, mean age of 2.3) were recruited.

METHODS

Participants completed online self-reported validated questionnaires assessing CCT, sex motives and sexual satisfaction.

RESULTS

Results from a path analysis revealed that CCT was associated with a higher endorsement of the self-affirmation sex motive (β = 0.25, p < .001) which was linked to lower sexual satisfaction (β = -0.13, p < .001). CCT was also associated with a higher endorsement of the coping (β = 0.25, p < .001) and partner approval (β = 0.09, p < .05) sex motives. A higher endorsement of the intimacy (β = 0.28, p < .001) and pleasure (β = 0.24, p < .001) sex motives, and a lower endorsement of the partner approval sex motive (β =  -0.13, p < .001) were linked to greater sexual satisfaction.

CONCLUSIONS

Results suggest education and intervention targets to improve emerging adults' sexuality.

Cumulative Childhood Trauma, Communication Patterns, and Intimate Partner Violence Perpetrated by Men Seeking Help

Intimate partner violence (IPV) is a complex and multifactorial public health problem associated with important physical and psychological repercussions. Recent studies suggest that cumulative childhood trauma (CCT) may be related to higher IPV perpetration through dysfunctional communication patterns, but to our knowledge, no study has tested this proposition in a clinical population. This study aimed to explore the direct and indirect links between CCT and perpetrated IPV through dysfunctional communication patterns among 577 men seeking help from community centers specializing in IPV. Prior to receiving services, participants completed a battery of questionnaires including validated brief measures of CCT (sexual, physical, and psychological abuse; physical and psychological neglect; witnessing of physical and psychological parental violence; bullying), communication patterns (demand/demand, partner demands/man withdraws, man demands/partner withdraws), and IPV (psychological, physical, coercive control). Results from a path analysis reveal that having sustained a higher number of different forms of childhood trauma is directly related to men's higher risk of perpetrating psychological IPV. CCT is also indirectly related to higher perpetrated psychological and physical IPV and coercive control through a higher report of the demand/demand communication pattern and a higher report of the man demands/partner withdraws communication pattern. The tested model explains 23% of the variance in psychological IPV, 6% of the variance in physical IPV, and 12% of the variance in coercive control. Results highlight the importance of assessing, in therapy, both distal and proximal variables associated with IPV, including the accumulation of many forms of childhood interpersonal trauma, and to tailor trauma-informed interventions that promote constructive communication strategies.

Emerging Adults' Adverse Life Events and Psychological Functioning: A Comparison Based on Intergenerational Trajectories of Child Maltreatment

Intergenerational continuity of child maltreatment (CM) is a well-documented phenomenon of concern; however, its effects on the child's level of exposure to CM, as well as subsequent trauma exposure and adult functioning remain undocumented. The present study aimed to further explore the intergenerational effects of CM by comparing emerging adults (EA; ages 18-25) on their exposure to CM, adult victimization, and psychological functioning according to their mother's CM histories. One hundred and eighty-five mothers and their EA completed independently an online survey measuring sociodemographics, material deprivation, CM, adult victimization, and psychological functioning. The participating dyads (primarily White and female-identifying) were recruited online through social media, universities, and advertisements in non-profit organizations throughout Canada. Findings revealed that maternal histories of CM were associated with increased neglectful and physically abusive acts endured in childhood for maltreated EA. Maternal histories of CM, regardless of the EA' victimization status, were associated with a higher EA' number of adulthood interpersonal-but not non-interpersonal-traumas experienced. While a maternal history of CM was a risk factor for intimate partner violence (IPV) in maltreated EA, it was protective for non-maltreated EA. Maltreated EA with maltreated versus non-maltreated mothers presented more psychological difficulties, but only if they also reported material deprivation. Practitioners working with children at-risk or exposed to CM should document parents' histories of CM and take that into account in their assessments and intervention practices. This study also provides further evidence to support social policies targeting the family system as a whole.

How Relationship Satisfaction and Negative Communication Trajectories Change in Emerging Adults' Dating Relationships: A Group-Based Dual Trajectory Analysis

Early romantic relationships are salient to the development of healthy future relationships. Yet, little is known about the evolution of romantic relationships of emerging adults since most of the research has been conducted on married or well-established couples. The current study aims to examine how relationship satisfaction and negative communication evolve and are interrelated during emerging adulthood. Using age as a time metric, we conducted group-based dual trajectory modeling analyses on 1566 unmarried Canadian individuals (from 17 to 24 years old) in a relationship, who could either stay with the same partner or change partner over time. A four-group model for relationship satisfaction and a four-group model for negative communication were found. Dual analyses highlighted the high concordance between specific trajectories of both constructs. These findings demonstrate that relationship satisfaction and negative communication do not evolve in the same ways for everyone and provide useful insights to existing clinical interventions.

Attachment, Sexual Motives, and Sexual Satisfaction among Couples Expecting their First Child

This study examined direct and indirect links among attachment insecurities (anxiety, avoidance) and sexual satisfaction through sexual motives in couples expecting their first child. A sample of 204 first-time pregnant couples completed online questionnaires. Dyadic path analyses revealed that attachment and sexual satisfaction were not directly associated, but rather indirectly associated through three sexual motives: partner approval, self-affirmation, and intimacy. For non-pregnant partners, attachment anxiety was related to higher sexual satisfaction through higher intimacy, whereas attachment avoidance was related to lower sexual satisfaction through lower intimacy. Results are discussed in light of clinical implications for expecting couples.

Post-acute phase and sequelae management of epidermal necrolysis: an international, multidisciplinary DELPHI-based consensus

BACKGROUND

Long-term sequelae are frequent and often disabling after epidermal necrolysis (Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)). However, consensus on the modalities of management of these sequelae is lacking.

OBJECTIVES

We conducted an international multicentric DELPHI exercise to establish a multidisciplinary expert consensus to standardize recommendations regarding management of SJS/TEN sequelae.

METHODS

Participants were sent a survey via the online tool "Survey Monkey" consisting of 54 statements organized into 8 topics: general recommendations, professionals involved, skin, oral mucosa and teeth, eyes, genital area, mental health, and allergy workup. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). Results were analyzed according to the RAND/UCLA Appropriateness Method.

RESULTS

Fifty-two healthcare professionals participated. After the first round, a consensus was obtained for 100% of 54 initially proposed statements (disagreement index < 1). Among them, 50 statements were agreed upon as 'appropriate'; four statements were considered 'uncertain', and ultimately finally discarded.

CONCLUSIONS

Our DELPHI-based expert consensus should help guide physicians in conducting a prolonged multidisciplinary follow-up of sequelae in SJS-TEN.

Attachment insecurities and under-commitment in distressed couples: The role of positive and negative partner behaviors

Research has rarely considered intermediate variables in the association between attachment insecurities and relationship commitment. Based on attachment theory and Rusbult's Investment Model, we tested whether positive and negative partner behaviors explain this association in 91 distressed couples undergoing therapy. Path analyses based on the Actor-Partner Interdependence Model revealed that individuals with attachment avoidance reported perceiving fewer positive behaviors from their partner, which was associated with their own higher under-commitment. Partners of individuals with avoidance also reported perceiving fewer positive partner behaviors, which was in turn associated with their own higher under-commitment. Partners of individuals with attachment anxiety perceived more positive behaviors from their partner, which was associated to their own lower under-commitment. Perceived negative partner behaviors were only directly associated with higher under-commitment. These findings imply that perceived positive partner behaviors may be a key aspect to target in relationship therapy in couples who present with high attachment insecurities.

"We're in this together": Attachment insecurities, dyadic coping strategies, and relationship satisfaction in couples involved in medically assisted reproduction

Attachment is an important predictor of relationship satisfaction and attachment insecurities are a risk factor for couples under stress. Drawing from the Vulnerability-Stress-Adaptation model, we investigated whether dyadic coping strategies (DCS) would explain the links between attachment insecurities and relationship satisfaction in 97 couples involved in medically assisted reproduction (MAR). Path analyses revealed that for women and men, attachment insecurities (anxiety, avoidance) were associated with their own lower relationship satisfaction through their lower use of positive DCS. Attachment avoidance was also associated with participants' own lower relationship satisfaction through their own lower use of negative DCS. Men's attachment avoidance was also related to their partner's lower relationship satisfaction via their own and their partner's lower use of positive DCS. The findings suggest that promoting the use of positive DCS may be important to preserve relationship satisfaction in couples involved in MAR.

Is it really that important to you? How the topics of conflict and emotional reactions to conflicts explain the associations between attachment insecurities and relationship satisfaction

This study sought to examine the intermediary roles of different topics of conflict and negative emotions following conflicts in the associations between attachment insecurities and relationship satisfaction in a sample of 253 mixed-gender couples from the community. Results from path analyses based on the Actor-Partner Interdependence Model showed that attachment anxiety and attachment avoidance were associated with the perception, in both partners, of experiencing more conflicts in the relationship. In turn, the more participants perceived conflicts related to major issues and daily annoyances, the more they reported negative emotions following conflicts and lower relationship satisfaction. Participants' report of conflicts related to major issues was also related to their partner's lower relationship satisfaction. Findings highlight the significance of accounting for the topics on which couples argue and of using an attachment-based framework to help couples deal with the negative emotions that they experience following conflicts.

Childhood Sexual Abuse, Dyadic Empathy, and Intimate Partner Violence Among Men Seeking Psychological Help

Childhood sexual abuse (CSA) and intimate partner violence (IPV) have both been associated with numerous negative repercussions. The first aim of this study is to understand IPV perpetrated by men within a clinical population, by examining the effects of two potential predictors: CSA and dyadic empathy (cognitive and emotional). The second aim of this study is to explore whether dyadic empathy is an intermediary variable of the association between CSA and IPV. A sample of 198 men (aged 18-69 years old) who were seeking help for relationship problems, completed a set of self-administered questionnaires. While controlling for social desirability and family violence history, our findings outlined the mediating and moderating role of dyadic empathy in the link between CSA and perpetrated psychological, but not physical, IPV. Emotional empathy mediated and moderated the link between CSA and psychological IPV, whereas cognitive empathy only moderated this link. The examination of the direct links between the variables also revealed that CSA was related to lower emotional empathy and higher rates of both types of IPV. In addition, cognitive empathy was negatively associated with physical and psychological IPV, whereas emotional empathy was positively associated with psychological IPV. This study contributes to the literature by documenting some of the mechanisms that could explain the perpetration of IPV and highlights the importance of investigating CSA and empathy in men who are seeking help.

Intimate Partner Violence Perpetrated by Men Seeking Help: The Explanatory Roles of Psychological Distress and Affect Dysregulation

Despite an increase in research initiatives and prevention campaigns, intimate partner violence (IPV) remains a public health problem that affects many victims worldwide. The current study aims to examine whether psychological distress symptoms (anger, depression, and anxiety) are indirectly related to the perpetration of IPV (physical assault, psychological abuse, and coercive control) through affect dysregulation (AD) in men seeking help. Online questionnaires assessing psychological distress symptoms, AD, and violent behaviors were completed by 335 adult men entering treatment for IPV. A path analysis model revealed the indirect associations between psychological distress symptoms and higher IPV perpetration through higher AD. Symptoms of anger were indirectly related to the three forms of perpetrated IPV through higher AD. Symptoms of depression were, directly and indirectly, related to the three forms of perpetrated IPV through higher AD. Finally, symptoms of anxiety were directly related to lower physical assault perpetration, and indirectly related to higher physical assault and coercive control perpetration through higher AD. The final model explained 10% of the variance in perpetrated physical assault, 23% of the variance in perpetrated psychological abuse, and 13% of the variance in perpetrated coercive control. These results underline the necessity of assessing and addressing symptoms of psychological distress and AD among men perpetrators in the treatment of IPV.

Why do you have sex and does it make you feel better? Integrating attachment theory, sexual motives, and sexual well-being in long-term couples

Attachment theory postulates that three behavioral systems are central to optimal couple functioning: attachment, caregiving, and sex. However, few studies have examined the concurrent contribution of these systems to understand sexual well-being. This daily diary study examined the intermediary role of attachment- and caregiving-related sexual motives in the associations linking attachment insecurities and positive and negative emotions during sexual activity in 149 long-term mixed-gender/sex couples. Multilevel analyses revealed that individuals higher in attachment avoidance endorsed less caregiving sexual motives, which was associated with their own more negative emotional experience during sexual activity. Individuals higher in attachment anxiety endorsed more attachment sexual motives, which was associated with their own and their partner's more negative emotional experience during sex. However, individuals higher in attachment anxiety also concurrently endorsed more caregiving sexual motives, which predicted their own and their partner's more positive emotional experience during sex. Overall, the findings support the associations between the attachment, caregiving, and sexual behavioral systems and suggest that engaging in sex as a way to care for one's partner might foster sexual well-being in long-term couples.

Exploring Insecure Romantic Attachment and Justifications for the Use of Intimate Partner Psychological Aggression in Couples

The attachment theory has commonly been used to examine intimate partner psychological aggression (IPPA), but few studies have examined its association with self-reported justifications for one's own use of IPPA. Behaviors, including the use of IPPA, are influenced, maintained, and function within the context of their justifications, highlighting the importance of investigating these justifications to obtain a clearer picture of IPPA. This study examined whether insecure romantic attachment (i.e., attachment anxiety and attachment avoidance) in both partners of a couple was associated with their justifications for their own use of IPPA. A community sample of 81 mixed-sex couples who reported using IPPA in the last year completed self-reported questionnaires on adult romantic attachment and their justifications for their use of IPPA. Results of a path analysis based on the actor-partner interdependence model revealed moderate positive associations between attachment anxiety and one's use of internal and external justifications for their IPPA perpetration in men and women. An unexpected dyadic positive association is discussed. These results suggest that the use of justifications for one's use of IPPA may reflect a strategy of hyperactivation that could contribute to the cycle of psychological aggression. Uncovering the function of these justifications could provide important therapeutic benefits, which are discussed in the study's implications.

Changes in Attachment and Commitment in Couples Transitioning to Parenthood

This study examined whether attachment predicts changes in commitment and whether commitment predicts changes in attachment in both partners during the transition to parenthood. Both partners of 93 couples completed online questionnaires individually at the second trimester of pregnancy and at 4 months postpartum. Autoregressive cross-lagged path analyses based on the Actor-Partner Interdependence Model tested the bidirectional associations between attachment dimensions (anxiety and avoidance) and three modes of commitment (optimal, over-commitment, and under-commitment). Results revealed that for both partners, prenatal attachment avoidance was associated with a decrease in optimal commitment and an increase in under-commitment from pre- to postpartum. Fathers' attachment anxiety was associated with a decrease in mothers' under-commitment. Furthermore, prenatal optimal commitment was associated with a decrease in attachment avoidance, whereas under-commitment was associated with an increase in attachment avoidance. Fathers' prenatal over-commitment was associated with an increase in their own attachment anxiety and avoidance. These results highlight how attachment insecurities and relationship commitment interrelate during this major transition.

Sexual activity based fears during pregnancy, sexual function and dyadic adjustment in couples who are expecting their first child

Purpose: Sexual activity based fears during pregnancy are common, but very few studies have examined their association with relationship variables. Secondary analysis of associations between these fears during pregnancy and both partners' sexual function and dyadic adjustment were conducted.Materials and Methods: A sample of 67 French-Canadian first-time parenting couples living in Ontario completed online questionnaires on sexual activity based fears, sexual function, and dyadic adjustment as experienced during pregnancy.Results: While one-third of participants reported no fears, other couples experienced one to six fears, the two most common fears among partners being inducing labor and causing a miscarriage. Dyadic path analyses supported indirect associations between sexual activity based fears and lower dyadic adjustment via poorer sexual function. During pregnancy, these fears in women and men are associated with poorer dyadic adjustment in both partners through the women's poorer sexual function.Conclusion: These findings suggest including prenatal sexual activity based fears in perinatal sexuality counseling, education, and interventions.

Relational Instability in Couples Seeking Therapy: The Contribution of Attachment, Caregiving and Sex

Attachment theory postulates that three behavioral systems-attachment, caregiving, and sex-are essential for optimal relationship functioning in couples. We examined the contribution of attachment insecurities, perceived partner support, and sexual satisfaction to relational instability in 274 couples seeking relationship therapy. The results underscore the importance of all three systems for relationship stability, showing that for both men and women, avoidance of intimacy, low perceived partner support, and low sexual satisfaction were significant and concurrent predictors of relational instability. As such, intervening on factors associated with all three behavioral systems might help reduce relationship instability in couples experiencing relationship distress.

How to Deal With Sexual Changes During and After Pregnancy: Results of a Brief Psycho-Educational Workshop With Future and New Parenting Couples

After documenting parenting couples' needs regarding perinatal sexuality, this study developed and evaluated a brief psycho-educational workshop on perinatal sexuality. Participants (16 future and 17 new parents) completed five steps: (1) online questionnaire (T1) assessing needs toward the workshop and sexoperinatal knowledge, attitudes, and perceptions; (2) 2-hour online workshop on perinatal sexuality; (3) post-workshop satisfaction questionnaire; (4) 1-month (T2) and (5) 2-month (T3) post-workshop questionnaires with the same measures as in T1. One month after the workshop, knowledge, attitudes, and perceptions toward perinatal sexuality increased significantly. Sexoperinatal interventions from health-care workers are still uncommon, although there is a need for information and support. This brief online workshop is promising for better education and empowerment of parenting couples regarding perinatal sexuality.

Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics

BACKGROUND

Research to date suggests that couples undergoing assisted reproductive technology (ART) are at a high risk of experiencing sexual difficulties.

AIM

This dyadic cross-sectional study aimed to provide a better understanding of the infertility-specific personal (ie, emotional, mind-body) and relational stressors associated with the sexual desire, orgasm, arousal, and sexual satisfaction of infertile couples seeking ART.

METHODS

The sample included 185 mixed-sex infertile couples seeking ART. Participants completed online the Fertility Quality of Life tool and either the Female Sexual Function Index or the International Index of Erectile Function. Data were analyzed using path analyses based on the Actor-Partner Interdependence Model.

OUTCOMES

Individuals' own and their partners' sexual function (desire, orgasm, arousal domains) and sexual satisfaction.

RESULTS

For men and women, infertility-related emotional stressors were associated with their own and their partner's lower sexual desire. For women, experiencing greater infertility-related emotional stressors was also associated with their partner's lower sexual satisfaction. While experiencing greater infertility-related mind-body stressors was not associated with men and women's own sexual desire, arousal, orgasm, and satisfaction, for women, it was associated with their partner's lower sexual arousal. Lastly, for men and women, infertility-related relational stressors were associated with their own lower sexual arousal, as well as with their own and their partner's lower sexual satisfaction. For women, experiencing greater relational stressors was also associated with their own lower sexual desire and orgasm.

CLINICAL IMPLICATIONS

Interventions addressing the emotional, mind-body, and relational spheres of infertile couples seeking ART may help facilitate improvements in sexual function and satisfaction and better serve their needs.

STRENGTHS & LIMITATIONS

This study included a large sample of couples. Our sample was heterogeneous with regards to couples' cause of infertility and treatment stage. The use of an infertility-related measure allowed us to better capture personal and relational stressors specific to couples seeking ART. Given the cross-sectional design of our study, causality between infertility-related stressors and sexual function and satisfaction cannot be inferred. Our sample included predominantly White, mixed-sex individuals with a high level of education, which may reduce the generalizability of our findings.

CONCLUSION

Couples' subjective experience of infertility and treatment (personal and relational stressors) seems to be strongly associated with their sexual health, allowing us to identify potential targets of intervention with couples seeking ART. S.E. Amiri, A Brassard, N.O. Rosen, et al. Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics. J Sex Med 2021;18:1984-1997.

Transcranial direct current stimulation for provoked vestibulodynia: What roles do psychosexual factors play in treatment response?

There is growing evidence that provoked vestibulodynia (PVD), a frequent and debilitating condition, is characterized by central sensitization. This study aimed to examine predictive factors of transcranial direct current stimulation (tDCS) efficacy in this chronic pain population. Exploratory analysis derived from a randomized controlled trial was performed to assess predictors of pain reduction among 39 women with PVD who received 10 daily sessions of either active or sham tDCS. Clinical characteristics (e.g. pain intensity, duration and pain sensitivity) and psychosexual factors (e.g. pain catastrophizing, pain-related fear, anxiety, depressive symptoms and vaginal penetration cognitions) were assessed at baseline and used to predict tDCS response at 3-month follow-up. Analysis revealed that higher depressive symptoms and lower negative self-image cognitions were significant predictors of pain reduction at follow-up and accounted for 62.3% of the variance in the active tDCS group. Higher genital incompatibility cognitions were related to poorer response, regardless of treatment group. These findings suggest that women with PVD presenting higher depressive symptoms and lower levels of negative self-image cognitions could derive greater benefits from tDCS. These results suggest that tDCS could be effective in a subgroup of women with PVD - a possibility worth exploring with future prospective larger studies.

The role of relationship dissatisfaction in the dyadic associations between attachment insecurity and intimate partner violence among couples seeking therapy

For several decades, attempts have been made to understand the risk markers of intimate partner violence (IPV) to prevent its occurrence, but few studies have emphasized both partners' perspective in examining these markers. This study explored the associations between attachment insecurity (anxiety and avoidance) and the perpetration of psychological and physical IPV through relationship dissatisfaction in a sample of 88 couples seeking therapy for relationship difficulties. Results from path analyses based on the Actor-Partner Interdependence Model showed that participants' attachment avoidance was indirectly related to their own and their partner's higher perpetration of psychological IPV through higher relationship dissatisfaction. Participants' attachment avoidance was also associated with their own higher perpetration of physical IPV through their higher relationship dissatisfaction. The findings highlight that attachment insecurities and relationship dissatisfaction can both contribute to establishing dysfunctional and violent interaction patterns in couples.

How Do Partner Support, Psychological Aggression, and Attachment Anxiety Contribute to Distressed Couples' Relationship Outcomes?

Few studies have simultaneously looked at the relative contribution of positive and negative behaviors to understand relationship outcomes. This study examined the relative roles of perceived partner support and psychological aggression in two relationship outcomes-relationship satisfaction and the willingness to invest in the relationship-as well as the contribution of attachment anxiety as a moderator in 307 couples seeking relationship therapy. Path analyses revealed that perceived partner support was associated with individuals' own higher relationship satisfaction and willingness to invest in the relationship. Attachment anxiety moderated these associations. Perceived partner psychological aggression was not associated with relationship outcomes.

Attachment Insecurities and Sexual Coercion in Same- and Cross-Gender Couples: The Mediational Role of Couple Communication Patterns

The use of subtle strategies to have sex with an unwilling partner is harmful to a couple's sexual well-being but these strategies remain understudied. This research examined the mediating role of communication patterns in the associations between attachment insecurities and sustained sexual coercion in 145 same- and cross-gender couples, and the moderating role of partners' gender. In addition to actor and partner effects, results revealed significant indirect effects from attachment insecurities to sexual coercion via communication patterns, with moderating effects of gender. Results may help practitioners and researchers understand the ways attachment insecurities and dysfunctional communication patterns can manifest in the experience of subtle forms of sexual coercion within couples.

Couple Adaptation to the Birth of a Child: The Roles of Attachment and Perfectionism

This study aims to examine two explanatory factors of relationship satisfaction and parental alliance among both parents of a new child, namely romantic attachment and perfectionism. A sample of 80 couples completed individual online questionnaires. Path analyses based on the Actor-Partner Interdependence Model were carried out to explore the actor and partner effects of each explanatory variable (attachment, perfectionism) on both partners' postnatal relationship satisfaction and parental alliance. Results revealed that attachment avoidance is negatively related to each partner's own relationship satisfaction and parental alliance, whereas attachment anxiety is related to their own lower parental alliance. Maladaptive perfectionism is negatively related to each partner's own relationship satisfaction, whereas adaptive perfectionism is positively related to each partner's own relationship satisfaction. These results extend the understanding of the factors contributing to parental and couple adaptation in the postnatal period. They highlight the role of attachment and perfectionism for improving postnatal professionals' interventions.

Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: an international, multidisciplinary Delphi-based consensus

BACKGROUND

Supportive care is the cornerstone of management of adult and paediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking.

OBJECTIVES

Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN.

METHODS

Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method.

RESULTS

Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements.

CONCLUSIONS

We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.

Testing an Online Training Session on Couples' Perinatal Sexual Changes Among Health Care Professionals and Paraprofessionals

INTRODUCTION

During and after pregnancy, couples have to adapt to sexual changes. Although many couples have questions and preoccupations regarding those changes, they are rarely addressed by professionals and paraprofessionals in perinatal health care, mainly because of lack of knowledge and training. An online training session that addressed couples' perinatal sexual changes tailored for health care perinatal professionals (nurses and midwives) and paraprofessionals (doulas) was developed, implemented, and evaluated.

METHODS

Participants completed 4 steps: (1) a baseline online questionnaire assessing training needs and measures on knowledge, attitudes, and perceived counseling skills regarding couples' perinatal sexual changes; (2) a 2-hour online training session on the topic with theoretical and practical content; (3) an online post-training satisfaction questionnaire; and (4) a one-month follow-up assessment using the same measures as at baseline.

RESULTS

Of the 74 participants (20 nurses, 20 midwives, 34 doulas) who completed the study, 37.8% had previous training in sexuality and 18.9% in perinatal sexuality. Results showed pre- to post-training significant increases in knowledge and attitudes toward couples' perinatal sexual changes, characterized by more positivity, flexibility, openness, and sense of competence regarding the topic. There were also significant pre- to post-training increases in perceived utility, comfort, intention, and sense of self-efficacy related to counseling skills regarding couples' perinatal sexual changes. After training, more participants discussed couples' sexual changes with couples during and after pregnancy. After training, significantly fewer participants reported lack of knowledge, lack of training, and lack of discomfort as barriers to discussions on couples' perinatal sexual changes, whereas more reported lack of time as a barrier. Global satisfaction with the training was high.

DISCUSSION

This training can help foster more discussions on the topic from perinatal professionals and paraprofessionals to better meet couples' needs for information and support.

Measuring adult romantic attachment: psychometric properties of the brief Spanish version of the experiences in close relationships

The Experiences in Close Relationships (Brennan et al, Attachment theory and close relationships, 1998) questionnaire is one of the most widely used measures of adult romantic attachment. Despite the advantages of the ECR, the length of this measure may discourage its use in clinical and research contexts. Consequently, the goal of this study was to develop a brief Spanish version of the ECR questionnaire and to examine its psychometric properties when administered to six different Spanish-speaking samples from Chile. Confirmatory factor analyses replicated the two-dimensional structure of the ECR and its invariance across gender. Results also supported the reliability and concurrent validity of our brief Spanish version of the ECR (i.e., Spanish ECR-12), by its association with measures of emotion regulation, dyadic empathy, psychological distress and well-being, and relationship satisfaction. The Spanish ECR-12 can be used by researchers and clinical professionals as an abridged measure of adult attachment.