Search Results (388)

Introduction: The recognition of Complex Post-Traumatic Stress Disorder (CPTSD) as a distinct diagnosis in ICD-11 has intensified the need to clarify its boundaries with Borderline Personality Disorder (BPD), given their symptom overlap and shared traumatic origins. Therefore, this systematic review aimed to examine whether CPTSD is distinct from BPD, assess their comorbidity and symptom overlap, identify key criteria for differential diagnosis, and explore therapeutic implications. Method: A systematic search was conducted in PubMed, Scopus, and Web of Science following PRISMA 2020 guidelines. Seven empirical studies (2015–2025) were included, comprising 2574 adults (mean age 40.4 years; 73.3% women). Methods included latent class analysis, structural equation modeling, and network analysis. The methodological quality of the included studies was evaluated independently by two reviewers using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Results: Findings consistently supported that CPTSD and BPD are empirically distinguishable, though substantially correlated, particularly within the ICD-11 framework. High symptom co-occurrence was observed, with affective dysregulation identified as the symptom most centrally connecting the two symptom networks. Self-concept emerged as the most robust differentiator: stable and persistently negative in CPTSD versus unstable and fragmented in BPD. Shame was a key affective marker of more severe presentations, and trauma severity, rather than diagnostic category, was associated with symptom variation across studies. Conclusions: CPTSD and BPD are distinct yet frequently co-occurring conditions. Differential diagnosis should focus on self-concept stability, patterns of behavioral dysregulation, and shame. Treatment requires individualized, trauma-informed, and shame-sensitive approaches, with transdiagnostic emotion regulation strategies across presentations. These conclusions should be interpreted with caution, given the predominantly cross-sectional design and methodological heterogeneity of the available evidence. Full article

Drawing on attribution theories, this study presents an integrated moderated serial mediation model to explain when and why customer mistreatment is associated with victimized employees’ contrasting “flight” and “fight” responses. Specifically, we propose that observed customer mistreatment serves as an individually perceived social cue that shapes how employees interpret and respond to their own mistreatment experiences. When similar mistreatment is rarely observed among colleagues, employees are more likely to see themselves as singled out, a perception accompanied by greater self-blame and, in turn, shame and psychological withdrawal. When such mistreatment is commonly observed, employees may instead hold customers responsible, which is linked to greater hostility and, in turn, retaliatory service sabotage. Using three-wave time-lagged data from 282 customer-service employees across various industries, we found support for the hypothesized moderating effects of observed customer mistreatment. The conditional serial indirect effect on psychological withdrawal through self-blame and shame was significant, whereas for service sabotage, the separate indirect effects through customer-directed blame and hostility were significant, but their serial indirect effect was not. These findings advance understanding of the boundary conditions and cognitive–affective processes that may underlie employees’ flight-or-fight reactions to customer mistreatment and offer implications for both theory and practice. Full article

Stigma-related beliefs toward mental illness may change during psychiatric clinical exposure, but individual differences in this process remain insufficiently understood. This single-center observational pre–post study examined observed changes in mental illness-related beliefs among 185 medical interns who completed an approximately 30-day psychiatry clerkship between May 2025 and May 2026, with perceived dangerousness defined as the primary outcome. Beliefs were assessed before and after the exposure period using the Beliefs Toward Mental Illness Scale. Associations between baseline cognitive–metacognitive characteristics and observed change were evaluated using paired comparisons, linear mixed-effects models, and sensitivity analyses. Dangerousness scores decreased by the end of the exposure period, mean change = −2.66, 95% CI [−3.48, −1.81], q < 0.001, d_z = −0.47. Smaller decreases were observed in Helplessness and Deterioration in Interpersonal Relationships, whereas no significant change was found in the two-item Shame subscale. Higher baseline ruminative thought style was associated with a more limited decrease in dangerousness scores; B = 1.70, SE = 0.55, 95% CI [0.62, 2.77], q = 0.023. Although this association was consistent across sensitivity analyses, its incremental contribution was small (ΔR²_marginal = 0.017; f² = 0.018 in the focused model). The finding should therefore be interpreted as a quantitatively modest association with observed belief change, not as a clinically meaningful predictor. Because the study included no concurrent control group or experimental manipulation and was conducted at one center, it does not establish a causal clerkship effect or support educational screening based on ruminative thought style. Full article

Over the last few years, TikTok has become one of the most notable social networking apps, allowing users to upload videos with the possibility of gaining popularity. This has given rise to the emergence of influencers native to the platform. While Global North–focused TikTok studies have empirically examined the media economics of this platform in various capacities, emerging markets have experienced a research dearth in this regard. To understand the strategies they employ to monetize, as well as the challenges they face in generating revenue, this study interviewed 23 Nigerian TikTok influencers between the ages of 19 and 26. We find that Nigerian TikTok influencers rely on a mixture of brand partnerships, sponsored promotions, referral systems, cross-platform visibility, collaborative growth strategies, and account-region bypass to generate income within a platform environment that offers limited direct monetization opportunities to creators. The findings further show that influencer labour in the Nigerian context is shaped by unstable payment systems, algorithmic dependence, brand distrust, and the constant pressure to remain visible and relevant. Beyond economic concerns, the study reveals that creators experience emotional strain arising from online harassment, body shaming, and the psychological demands of continuous self-presentation. Full article

Objective: Women in recovery from opioid use disorder (OUD) experience sexual and reproductive health disparities which worsen health outcomes and may negatively impact recovery. While in recovery programs, women engage with different healthcare professionals, but how these professionals provide sexual and reproductive healthcare (SRH) is not well known. The purpose of this study is to identify perceived barriers and strategies to overcome barriers to providing SRH to women in recovery from OUD from the perspective of OUD recovery healthcare professionals. Methods: Guided by the social ecological framework, we used a qualitative descriptive study design to conduct individual semi-structured interviews with healthcare professionals (nurses, doctors, leaders/managers, peer support specialists, therapists, and case managers). Data was analyzed using thematic analysis. Results: Among individual interviews with N = 34 healthcare professionals, we identified two overarching themes: Barriers and Facilitators. Barriers included unmet provider training needs, navigating patient stigma and shame surrounding SRH, and fragmented healthcare systems. Facilitators included leveraging communities of shared experiences and developing ideal models of SRH programming. This included co-location of SRH and recovery spaces and the importance of peer support specialists in women’s recovery journeys. Conclusions: Multi-level challenges to address SRH in recovery require discipline specific training of healthcare professionals, empowering peer professionals, and policy and advocacy to address systemic issues. Full article

Background: Hospitalization and incarceration are distinct institutional experiences, but both may involve reduced autonomy, externally regulated routines, uncertainty, restricted privacy, and disruption of meaningful social relationships. This systematic review examined shared and setting-specific psychological outcomes and associated factors across the two environments. Methods: PubMed, Scopus, Web of Science and the Cochrane Library were searched from database inception to 30 January 2026. Of 1149 identified records, 22 studies met the eligibility criteria. Methodological quality was assessed using the Mixed Methods Appraisal Tool 2018, and findings were synthesized narratively because substantial clinical and methodological heterogeneity precluded meta-analysis. Results: Ten studies examined incarcerated populations and twelve examined hospitalized populations. Across incarceration studies, reported estimates ranged from 14.9% to 72.6% for depressive symptoms or mood disorders and from 23.3% to 77.8% for anxiety symptoms or disorders. Across hospitalization studies, corresponding estimates ranged from 5.1% to 41.0% and from 5.8% to 60.0%, respectively. These ranges reflect heterogeneous screening instruments, diagnostic procedures, populations, and outcome definitions and were not statistically pooled. In both settings, poorer psychological outcomes were associated with reduced perceived control, disrupted routines, uncertainty, limited social support, and individual vulnerability. Setting-specific factors included prison climate, coping style, shame, and sentence-related circumstances in incarceration, and illness severity, functional impairment, prognostic uncertainty, isolation precautions, and prolonged or repeated admission in hospitalization. Findings concerning exposure duration were inconsistent in both settings. Conclusions: Hospitalization and incarceration should not be regarded as psychologically equivalent. Nevertheless, they may share experiential conditions associated with distress, particularly when autonomy, privacy, predictability, and social connectedness are reduced. Because the evidence was heterogeneous and predominantly observational, causal conclusions and direct quantitative comparisons cannot be made. Full article

Primary CLIL teacher wellbeing remains underexplored in France and Spain. This exploratory, context-specific qualitative study examined the factors that ten primary teachers, five in France (Montpellier and Lille) and five in Andalusia, associated with their wellbeing. Bronfenbrenner’s ecological framework, enriched with the ontosystem and the flourishing/floundering distinction, was used as an interpretive device. The interviews were analysed through reflexive thematic analysis. Participants’ accounts converged around perceived gaps in CLIL-specific training, time, coordination, and human and material resources, while differing in how they interpreted programme stability and recent policy change. The analysis tentatively developed a compensatory pedagogy of affection and a broader pattern of professional delegitimation and identity-related loss. Explicit bilingual professional shame appeared in one account. It also identified native-speaker-oriented linguistic self-demand and an emerging pattern of AI-assisted material adaptation across six accounts. We offer a provisional, context-specific tensional ecological framework to organise the relationships participants described between conditions perceived as structural pressures and personal, relational, formative, and material resources. The framework is intended as a heuristic and hypothesis-generating contribution rather than a validated causal or longitudinal model. The findings identify areas for institutional review and further research. Full article

There remains a widespread lack of knowledge regarding hidradenitis suppurativa (HS) among physicians in the United States, impeding timely diagnosis and implementation of comprehensive treatment interventions. Despite the presence of supporting communities for affected adolescents and their caretakers, the overall awareness of HS remains low, and a greater consensus on the treatment of HS is needed. Current research highlights the lack of standardized pediatric guidelines for treatment of HS largely due to the varied nature of the disease and limited efficacy of current therapies. Our study aims to explore the relationship between the chronic skin condition HS and social–emotional concerns, mental health, and physical health issues in US children and adolescents. Using the Arksey and O’Malley framework and PRISMA-ScR reporting, we searched PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase for U.S. studies (2015–2025) on pediatric HS (<18 years) and social–emotional, mental health, or quality-of-life outcomes. Recommendations were synthesized, and study quality was appraised with CASP checklist methods and rigor. Ten studies (2020–2025) met inclusion criteria. Pediatric HS was associated with depression, anxiety, social withdrawal, shame, low self-esteem, and reduced quality of life. Physical comorbidities increased psychosocial burden. Socioeconomic and racial disparities worsened outcomes and access to care. Studies emphasized early diagnosis, routine screening, multidisciplinary management, and disparity-focused interventions. Findings may inform clinical practice and guide research initiatives aimed at improving outcomes for children and adolescents with HS. Full article

Background: Although cervical cancer is preventable, Latinas are twice as likely to receive a late diagnosis compared with non-Hispanic Whites (NHW). We currently know very little about the experiences of cervical cancer among middle- to older-age Latinas in the U.S. This study aimed to document Latina cervical cancer survivors’ journeys with an emphasis on improving the cervical cancer system of care to address inequities among a rapidly aging Latina population. Methods: We interviewed participants aged ≥ 40 years with a diagnosis of cervical cancer of three months or greater who identify as Latina. Recruitment was multi-pronged, including electronic healthcare records search, community tabling events, and snowball sampling. We conducted a qualitative study using the Database of Individual Patient Experiences (DIPEx) methodology and identified themes using grounded theory constructivist analysis. Results: A total of 20 Latinas (43 to 85 years old) participated, including 16 Spanish-language interviews. We identified three themes: formative experiences driving screening and prevention behaviors, provider communication that was suboptimal throughout the cancer continuum, and survivorship impacts including isolation and stigma with implications for the next generation. Conclusions: A central takeaway was the pervasiveness of Latinas’ feelings of shame, lack of communication, and isolation. Healthcare systems must improve culturally responsive communication, survivorship support, and screening equity for aging Latina populations. Abuelas, tias, and/or primas (grandmothers, aunts, and cousins) could play a critical role in raising awareness and increasing timely and early screening among the wider Latina population. Full article

Poverty stigma scapegoats people with direct experience of poverty, blaming and shaming them for being poor. The depiction of poverty as individual moral failure has enabled political leaders to sidestep its systemic causes. In breadline Britain the blaming and shaming of people in poverty as ‘undeserving’ ‘skivers’ has resembled a debilitating form of epistemic violence. Drawing on case studies and interview data from our Life on the Breadline project, this paper breaks new ground by fashioning an austerity-age theology of liberation that provides researchers with the tools to subvert the demeaning damage wrought by poverty stigma. The paper demonstrates the ways in which the power of language enabled policymakers to fashion a powerful political myth that has scapegoated and diminished the agency and the dignity of people in poverty. The use of primary research and the transformative potential of dub hermeneutics enable the paper to demonstrate how a holistic emancipatory engagement with the Biblical concept of shalom and the development of a politics of empathy and spirituality of solidarity can resource a new theology of liberative reversals that subverts poverty stigma. Full article

Many university students have a history of exposure to adverse and potentially traumatic life events and may therefore experience Moral Injury (MI). University students exposed to trauma, and especially relational trauma, should be less impacted if they feel and know with certainty that they are valued and matter to other people. The current study uniquely examined MI distress and its correlates in 382 university students who reported the experience of at least one potentially traumatic event. Additionally, we examined the traumatic experiences faced by a subgroup of 2SLGBTQIA+ students and their associated reactions. Various self-report measures were administered including MI emotions, mattering, anti-mattering, and adverse childhood experiences (ACEs). Our analyses confirmed that MI distress was evident and was linked with ACEs and higher levels of anti-mattering. Main findings accord with the notion that traumatic interpersonal events are not only distressing but are connected with feeling unimportant and insignificant to others. In addition, comparisons with the sexual and gender non-minority subgroups established that 2SLGBTQIA+ students were exposed to higher rates of major life stressors and they had comparatively elevated feelings of not mattering to others and MI-related emotional distress. Collectively, the results underscore the heterogeneity that exists among students and that feelings of mattering versus feelings of not mattering can be a source of strength or vulnerability. Clinical and public health implications are discussed as relevant to addressing feelings of personal insignificance and moral-injury related shame and mistrust. Full article

Background: Self-objectification has been consistently associated with adolescent depressive symptoms; however, the psychological processes linking appearance-based self-evaluation with broader self-directed negativity remain unclear. Objective: This three-wave study examined whether body shame and self-disgust were involved in the longitudinal association between self-objectification and depressive symptoms. It also tested perceived peer connectedness, indexed by reverse-coded loneliness, as a contextual moderator and used network analysis to explore item-level associations between body shame and self-disgust. Methods: A total of 1181 Chinese adolescents completed measures of self-objectification and perceived peer connectedness at Time 1, body shame and self-disgust at Time 2, and depressive symptoms at Time 3. Path analysis within a structural equation modeling framework tested a moderated indirect-effects model controlling for gender and grade. Results: Self-objectification was longitudinally associated with depressive symptoms both directly and indirectly through body shame and self-disgust. Perceived peer connectedness modestly attenuated the association between self-objectification and body shame. Network analysis identified item-level bridge associations between body shame and self-disgust. Conclusions: The findings suggest that self-objectification may be linked to later depressive symptoms through appearance-specific shame and broader self-directed negativity. Perceived peer connectedness showed a modest buffering pattern, and the network results highlighted item-level links between body shame and self-disgust that may inform future research on adolescent body-related self-evaluation. Full article

Background: Lung cancer carries a high psychosocial burden. Tobacco use, the stigma attached to the disease, and coping strategies are thought to interact and shape psychological outcomes, yet they have rarely been examined together. This review aimed to synthesise the evidence on the relationship between tobacco use, lung cancer stigma, and coping, and how these factors interact and influence patients’ psychological outcomes. Methods: Following the PRISMA 2020 guideline, PubMed/MEDLINE and Dialnet were searched (window 2014–April 2026) for empirical studies conducted in adults with lung cancer that addressed stigma, coping, or relevant psychological outcomes (e.g., anxiety, depression, distress, or quality of life). Study selection and data extraction were performed independently by two reviewers, with discrepancies resolved by consensus and, where needed, by a third reviewer. Methodological quality was appraised with design-specific tools (JBI for cross-sectional and cohort studies, CASP for qualitative studies, and COSMIN-oriented criteria for the psychometric study). Given the clinical and methodological heterogeneity, a structured narrative synthesis was conducted following the SWiM guideline. The protocol was registered in the Open Science Framework. Results: Twenty-four studies were included. Stigma was prevalent and consistently associated with depression, anxiety, distress, and poorer quality of life, with longitudinal evidence indicating that stigma precedes and predicts distress. Internalised stigma (guilt, shame, self-blame) was the facet most strongly linked to depression and anxiety. Smoking history graded stigma intensity (current > former > never smokers) but did not determine it, since clinically significant stigma also affected never-smokers. Adaptive coping (e.g., fighting spirit, positive reappraisal) and social support were consistently associated with better psychological adjustment and quality of life, while maladaptive coping (e.g., helplessness, avoidance, anxious preoccupation) was associated with worse outcomes; cross-sectional evidence further indicated that coping modes mediated the relationship between stigma and quality of life and that social support and self-compassion attenuated the impact of stigma on distress. Conclusions: Internalised stigma is a central, modifiable psychosocial stressor in lung cancer that affects smokers and never-smokers alike. Systematic screening for stigma, coping, and social support, together with non-stigmatising care, is warranted. Full article

Moral injury has been gaining increasing prominence as a means of understanding psychological suffering in response to moral transgressions. Despite repeated evidence of exposure to moral transgressions among those detained in forensic services, moral injury as a construct within this population has not been widely explored. This research aimed to explore the lived experience of moral injury in service users detained in a forensic healthcare setting. Interviews with six service users and eight practitioners were conducted. Three themes were identified using multi-perspective interpretive phenomenological analysis: the mutuality of moral injury, pathways to harm, and a road to healing. Findings identified a complex trajectory towards moral injury, which significantly affected service users’ cognitive and emotional processes. Results also highlighted the impact of moral injury on risk to self and others. Implications for practice and policy are considered. These include: the need for wider recognition of moral injury and its effects within formulations and assessments, collective responsibility to reduce feelings of shame, and greater opportunities to seek forgiveness and generate a sense of purpose. Full article

Neither women’s studies nor lesbian and gay studies offers an adequate theoretical or political base for disruptive scholarship. Reading and interpreting Southern African writers, especially Sindiwe Magona and Ngugi wa Thiong’o, promotes women’s studies as an academic and political approach to both gender and the erotic. Drawing on genealogies of rupture and intergenerational studies, we argue that the feminist is a positionality that must be widely available to challenge heterosexual perspectives and become a catalyst for audiences to engage in nuanced analyses of discourses on places and genres—narrative in particular—where memories are rearticulated and elaborated. This article explores how the narratives of Magona, Ngugi, and Soyinka inform and complicate the erasure, erosion, and amnesia that accompany contemporary imaginaries of what is re/membered. We challenge the tendency to evaluate African feminisms as only either oppressive or empowering and read the selected texts and their prototypical characters as dynamic embodiments that inform gendered spaces across both the attachments that people hold to particular gender identities and styles and recognising the punitive realities of dominant gender expectations. The article takes a positionality on the often troubled relationship between feminism and femininity, a critical but generous reading that highlights the potential for an affirmative orientation towards identity politics. This study utilises the theoretical lenses of border thinking and decolonial and African feminisms to interrogate matrifocal borderlands and the sociohistorical and cultural dis/continuities of being and becoming. We explore notions of the entanglement of motherhood, daughterhood, wifehood, and sisterhood as morphing identities. These are identities at the margins of political, sociocultural, and gender normativities in African literature. Magona’s “threshold people”, like Ngugi’s perfect nine, destabilise, disrupt, and refuse to be subordinated as they codify living differently in the in-between worlds. Magona, for instance, laminates the challenging discourse of contestation to map difficult, dangerous, and marginal spaces where women live at the borders of sociocultural, religious, ethnic, and gendered norms. These are spaces suffused with affective possibilities—defensiveness, shame, anxiety, anger, curiosity—and the women have to develop relational solidarities in negotiating hyper-visibilities or (in)visibilities within the 21st-century global south. Full article