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Given this context, the present study explores the role of some protective and risk factors for problematic gambling in online gamblers by focusing on the interaction between alexithymia, dissociation, and family functioning. A sample of 193 online gamblers (Mage = 28.8 years, SD = 10.59; 17% females, 83% males) completed the South Oaks Gambling Screen, Twenty-Items Toronto Alexithymia Scale, Dissociative Experience Scale-II, and Family Adaptability and Cohesion Evaluation Scales-IV through an online survey. MANOVA, ANOVA and moderated mediation analyses were carried out to analyse the data. Significant differences in cohesive family functioning, alexithymia and dissociation have been found between online gamblers with problematic, at-risk or absent levels of gambling disease. Furthermore, the results showed a significant and positive association between alexithymia and problematic online gambling, partially mediated by dissociation, with the moderation of cohesive family functioning. Such data may have relevant clinical implications, highlighting the interaction of some core personal and environmental variables that may be involved in the etiology of online pathological gambling and could be kept in mind to tailor preventive interventions.<\/jats:p>","DOI":"10.3390\/ijerph182413291","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T11:27:36Z","timestamp":1639654056000},"page":"13291","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Alexithymia, Dissociation, and Family Functioning in a Sample of Online Gamblers: A Moderated Mediation Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0849-1249","authenticated-orcid":false,"given":"Eleonora","family":"Topino","sequence":"first","affiliation":[{"name":"Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6867-2319","authenticated-orcid":false,"given":"Alessio","family":"Gori","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Cacioppo","sequence":"additional","affiliation":[{"name":"Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s40429-015-0057-8","article-title":"Online gambling addiction: The relationship between internet gambling and disordered gambling","volume":"2","author":"Gainsbury","year":"2015","journal-title":"Curr. Addict. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Publishing. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1007\/s10899-013-9370-0","article-title":"An overview of and rationale for changes proposed for pathological gambling in DSM-5","volume":"30","author":"Petry","year":"2014","journal-title":"J. Gambl. Stud."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s11469-010-9300-7","article-title":"Motivating and inhibiting factors in online gambling behaviour: A grounded theory study","volume":"10","author":"McCormack","year":"2012","journal-title":"Int. J. Ment. Health Addict."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1111\/j.1360-0443.2012.03669.x","article-title":"Beyond addiction or compulsion: The continuing role of environment in the case of pathological gambling","volume":"107","author":"Reith","year":"2012","journal-title":"Addiction"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Yan, Z. (2012). Internet gambling behavior. Encyclopedia of Cyber Behavior, IGI Global.","DOI":"10.4018\/978-1-46660-315-8"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.chb.2015.12.020","article-title":"Impact of Internet gambling on problem gambling among adolescents in Italy: Findings from a large-scale nationally representative survey","volume":"57","author":"Canale","year":"2016","journal-title":"Comput. Hum. Behav."},{"key":"ref_8","first-page":"92","article-title":"Meta-analysis of individual and environmental factors that influence people\u2019s addiction tendencies","volume":"1","author":"Aghaii","year":"2012","journal-title":"Int. J. High Risk. Behav. Addict."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Caretti, V., Gori, A., Craparo, G., Giannini, M., Iraci-Sareri, G., and Schimmenti, A. (2018). A new measure for assessing substance-related and addictive disorders: The addictive behavior questionnaire (ABQ). J. Clin. Med., 7.","DOI":"10.3390\/jcm7080194"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s40429-019-00282-y","article-title":"Identifying early risk factors for addiction later in life: A review of prospective longitudinal studies","volume":"7","author":"Morales","year":"2020","journal-title":"Curr. Addict. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1037\/a0034259","article-title":"Risk, compensatory, protective, and vulnerability factors related to youth gambling problems","volume":"28","author":"Lussier","year":"2014","journal-title":"Psychol. Addict. Behav."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1177\/070674370004500203","article-title":"Recent developments in alexithymia theory and research","volume":"45","author":"Taylor","year":"2000","journal-title":"Can. J. Psychiat."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s40429-016-0097-8","article-title":"Alexithymia and addiction: A review and preliminary data suggesting neurobiological links to reward\/loss processing","volume":"3","author":"Morie","year":"2016","journal-title":"Curr. Addict. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1016\/j.psychres.2016.10.046","article-title":"Impulsivity, alexithymia and dissociation among pathological gamblers in different therapeutic settings: A multisample comparison study","volume":"246","author":"Gori","year":"2016","journal-title":"Psychiatry Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Gori, A., Topino, E., Craparo, G., Bagnoli, I., Caretti, V., and Schimmenti, A. (2021). A Comprehensive Model for Gambling Behaviors: Assessment of the Factors that can Contribute to the Vulnerability and Maintenance of Gambling Disorder. J. Gambl. Stud., Online first.","DOI":"10.1007\/s10899-021-10024-3"},{"key":"ref_16","first-page":"187","article-title":"The somatic marker theory in the context of addiction: Contributions to understanding development and maintenance","volume":"8","author":"Olsen","year":"2015","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Allen, D.F. (1987). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. The Cocaine Crisis, Springer.","DOI":"10.1007\/978-1-4613-1837-8"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1007\/s10899-016-9637-3","article-title":"Gambling disorder and affect regulation: The role of alexithymia and attachment style","volume":"33","author":"Renzi","year":"2017","journal-title":"J. Gambl. Stud."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1556\/2006.7.2018.52","article-title":"Conceptualizing gambling disorder with the process model of emotion regulation","volume":"7","author":"Rogier","year":"2018","journal-title":"J. Behav. Addict."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Marchetti, D., Verrocchio, M.C., and Porcelli, P. (2019). Gambling problems and alexithymia: A systematic review. Brain Sci., 9.","DOI":"10.3390\/brainsci9080191"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Rogier, G., Capone, A., and Velotti, P. (2021). Emotion regulation strategies and dissociation in Gambling Disorder. Int. Gambl. Stud., Online first.","DOI":"10.1080\/14459795.2021.1949622"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1037\/adb0000693","article-title":"Gambling disorder and dissociative features: A systematic review and meta-analysis","volume":"35","author":"Rogier","year":"2021","journal-title":"Psychol. Addict. Behav."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1002\/cpp.1997","article-title":"The association among childhood trauma, pathological dissociation and gambling severity in casino gamblers","volume":"24","author":"Imperatori","year":"2017","journal-title":"Clin. Psychol. Psychother."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.psc.2005.10.004","article-title":"Normative dissociation","volume":"29","author":"Butler","year":"2006","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"229","DOI":"10.31887\/DCNS.2018.20.3\/rloewenstein","article-title":"Dissociation debates: Everything you know is wrong","volume":"20","author":"Loewenstein","year":"2018","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1007\/s10899-014-9510-1","article-title":"The role of anxiety and dissociation in young Australian gamblers","volume":"31","author":"Cartmill","year":"2015","journal-title":"J. Gambl. Stud."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1111\/add.12675","article-title":"The allure of multi-line games in modern slot machines","volume":"109","author":"Dixon","year":"2014","journal-title":"Addiction"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s10899-011-9281-x","article-title":"Psychological vulnerability and problem gambling: An application of Durand Jacobs\u2019 general theory of addictions to electronic gaming machine playing in Australia","volume":"28","author":"McCormick","year":"2012","journal-title":"J. Gambl. Stud."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Olson, D., Russell, C.S., and Sprenkle, D.H. (2014). Circumplex Model: Systemic Assessment and Treatment of Families, Routledge.","DOI":"10.4324\/9781315804132"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1080\/01926180902754745","article-title":"Addictive behavior and family functioning during adolescence","volume":"37","author":"Baiocco","year":"2009","journal-title":"Am. J. Fam. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/s10826-016-0531-5","article-title":"Female adolescents with eating disorders, parental psychopathological risk and family functioning","volume":"26","author":"Cimino","year":"2017","journal-title":"J. Child Fam. Stud."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1007\/s12187-013-9188-4","article-title":"The role of individual and relational characteristics on alcohol consumption among Italian adolescents: A discriminant function analysis","volume":"6","author":"Guzzo","year":"2013","journal-title":"Child Indic. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1556\/2006.6.2017.082","article-title":"Gambling and family: A two-way relationship","volume":"6","author":"Subramaniam","year":"2017","journal-title":"J. Behav. Addict."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1080\/16066359.2017.1393531","article-title":"Family functioning and gambling problems in young adulthood: The role of the concordance of values","volume":"26","author":"Sleczka","year":"2018","journal-title":"Addict. Res. Theory"},{"key":"ref_35","first-page":"1066","article-title":"The gambling disorder: Family styles and cognitive dimensions","volume":"22","author":"Paolini","year":"2018","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1080\/1533256X.2013.838130","article-title":"Problem gambling and families: A systematic review","volume":"13","author":"Kourgiantakis","year":"2013","journal-title":"J. Soc. Work Pract. Addict."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1176\/ajp.144.9.1184","article-title":"The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers","volume":"144","author":"Lesieur","year":"1987","journal-title":"Am. J. Psychiatry"},{"key":"ref_38","unstructured":"Guerreschi, C. (2002). Versione Italiana del South Oaks Gambling Screen (SOGS) di H.R. Giocati Dal Gioco. Quando il Divertimento Diventa una Malattia: Il Gioco D\u2019azzardo Patologico, San Paolo Edizioni."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/0022-3999(94)90005-1","article-title":"The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure","volume":"38","author":"Bagby","year":"1994","journal-title":"J. Psychosom. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/0022-3999(94)90006-X","article-title":"The twenty-item Toronto Alexithymia Scale-II. Convergent, discriminant, and concurrent validity","volume":"38","author":"Bagby","year":"1994","journal-title":"J. Psychosom. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/S0022-3999(96)00228-0","article-title":"Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: An Italian multicenter study","volume":"41","author":"Bressi","year":"1996","journal-title":"J. Psychosom. Res."},{"key":"ref_42","first-page":"16","article-title":"An update on the Dissociative Experiences Scale","volume":"6","author":"Carlson","year":"1994","journal-title":"Dissociation Prog. Dissociative Disord."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1080\/15299732.2015.1108948","article-title":"Dissociative experiences and dissociative minds: Exploring a nomological network of dissociative functioning","volume":"17","author":"Schimmenti","year":"2016","journal-title":"J. Trauma Dissociation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/j.1752-0606.2009.00175.x","article-title":"FACES IV and the circumplex model: Validation study","volume":"37","author":"Olson","year":"2011","journal-title":"J. Marital Fam. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1007\/s10826-012-9658-1","article-title":"Factorial and construct validity of FACES IV among Italian adolescents","volume":"22","author":"Baiocco","year":"2013","journal-title":"J. Child Fam. Stud."},{"key":"ref_46","unstructured":"Hayes, A.F. (2018). Introduction to Mediation, Moderation, and Conditional Process Analysis Second Edition: A Regression-Based Approach, Guilford Press."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1002\/job.2174","article-title":"The ripple effect: A spillover model of the detrimental impact of work\u2013family conflict on job success","volume":"38","author":"Wayne","year":"2017","journal-title":"J. Organ. Behav."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1089\/cyber.2012.0232","article-title":"Relationships between online gambling, mental health, and substance use: A review","volume":"15","author":"Hemphill","year":"2012","journal-title":"Cyberpsychol. Behav. Soc. Netw."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.cpr.2016.10.008","article-title":"Early risk and protective factors for problem gambling: A systematic review and meta-analysis of longitudinal studies","volume":"51","author":"Dowling","year":"2017","journal-title":"Clin. Psychol. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1007\/s10899-018-9760-4","article-title":"Co-development of problem gambling and depression symptoms in emerging adults: A parallel-process latent class growth model","volume":"34","author":"Edgerton","year":"2018","journal-title":"J. Gambl. Stud."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"305","DOI":"10.2147\/PRBM.S145463","article-title":"Family profiles in eating disorders: Family functioning and psychopathology","volume":"10","author":"Cerniglia","year":"2017","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1007\/s11136-019-02197-7","article-title":"The role of family functioning and self-esteem in the quality of life of adolescents referred for psychiatric services: A 3-year follow-up","volume":"28","author":"Jozefiak","year":"2019","journal-title":"Qual. Life Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1007\/s10826-019-01357-0","article-title":"Do attachment styles and family functioning predict adolescents\u2019 problematic internet use? A relative weight analysis","volume":"28","author":"Cacioppo","year":"2019","journal-title":"J. Child Fam. Stud."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Jimeno, M.V., Ricarte, J.J., Toledano, A., Mangialavori, S., Cacioppo, M., and Ros, L. (2021). Role of Attachment and Family Functioning in Problematic Smartphone Use in Young Adults. J. Fam. Issues, Online first.","DOI":"10.1177\/0192513X21993881"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.psychres.2017.05.030","article-title":"Relationships between parental attitudes, family functioning and Internet gaming disorder in adolescents attending school","volume":"255","author":"Bonnaire","year":"2017","journal-title":"Psychiatry Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1007\/s10899-016-9636-4","article-title":"Alterations in the emotional regulation process in gambling addiction: The role of anger and alexithymia","volume":"33","author":"Maniaci","year":"2017","journal-title":"J. Gambl. Stud."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1111\/ajad.12506","article-title":"Relationship between pathological gambling, alexithymia, and gambling type","volume":"26","author":"Bonnaire","year":"2017","journal-title":"Am. J. Addict."},{"key":"ref_58","first-page":"1","article-title":"Coping, attachment style and resilience: The mediating role of alexithymia","volume":"6","author":"Craparo","year":"2018","journal-title":"Mediterr. J. Clin. Psychol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1080\/17542863.2017.1307434","article-title":"Alexithymia and psychological symptomatology: Research conducted on a non-clinical group of Italian adolescents","volume":"10","author":"Pellerone","year":"2017","journal-title":"Int. J. Cult. Ment. Health"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e1864","DOI":"10.7717\/peerj.1864","article-title":"Impaired emotion recognition is linked to alexithymia in heroin addicts","volume":"4","author":"Craparo","year":"2016","journal-title":"PeerJ"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"330","DOI":"10.4306\/pi.2014.11.3.330","article-title":"The relationships between early trauma, dissociation, and alexithymia in alcohol addiction","volume":"11","author":"Craparo","year":"2014","journal-title":"Psychiatry Investig."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.addbeh.2018.02.004","article-title":"Association of Internet addiction and alexithymia-A scoping review","volume":"81","author":"Mahapatra","year":"2018","journal-title":"Addict. Behav."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1007\/s11469-012-9389-y","article-title":"Difficulty identifying feelings, distress tolerance and compulsive buying: Analyzing the associations to inform therapeutic strategies","volume":"10","author":"Rose","year":"2012","journal-title":"Int. J. Ment. Health Addict."},{"key":"ref_64","first-page":"61","article-title":"Exercise addiction and alexithymia","volume":"3","author":"Manfredi","year":"2015","journal-title":"J. Psychol. Behav. Sci."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1176\/appi.ajp.2017.17010025","article-title":"Dissociation in psychiatric disorders: A meta-analysis of studies using the dissociative experiences scale","volume":"175","author":"Lyssenko","year":"2018","journal-title":"Am. J. Psychiatry"},{"key":"ref_66","first-page":"330","article-title":"The role of dissociation, affect dysregulation, and developmental trauma in sexual addiction","volume":"11","author":"Craparo","year":"2014","journal-title":"Clin. Neuropsychiatry"},{"key":"ref_67","first-page":"35","article-title":"An exploratory study on problematic Internet use predictors: Which role for attachment and dissociation","volume":"15","author":"Musetti","year":"2018","journal-title":"Clin. Neuropsychiatry"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/s40429-019-0238-y","article-title":"Dissociative experiences in gambling disorder","volume":"6","author":"Schluter","year":"2019","journal-title":"Curr. Addict. Rep."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Est\u00e9vez, A., Jauregui, P., Mac\u00eda, L., and Mart\u00edn-P\u00e9rez, C. (2021). Alexithymia and Emotion Regulation Strategies in Adolescent Gamblers with and Without At-Risk Profiles. J. Gambl. Stud., Online first.","DOI":"10.1007\/s10899-021-10057-8"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1080\/14459790701870118","article-title":"Youth gambling problems: Examining risk and protective factors","volume":"8","author":"Dickson","year":"2008","journal-title":"Int. Gambl. Stud."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1353\/csd.2012.0005","article-title":"Characteristics of Internet gamblers among a sample of students at a large, public university in Southwestern United States","volume":"53","author":"Shead","year":"2012","journal-title":"J. Coll. Stud. Dev."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1046\/j.1360-0443.2002.00015.x","article-title":"A pathways model of problem and pathological gambling","volume":"97","author":"Blaszczynski","year":"2002","journal-title":"Addiction"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"401","DOI":"10.3390\/pediatric13030047","article-title":"The Playing Brain. The Impact of Video Games on Cognition and Behavior in Pediatric Age at the Time of Lockdown: A Systematic Review","volume":"13","author":"Smirni","year":"2021","journal-title":"Pediatr. Rep."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Gori, A., Topino, E., Pucci, C., and Griffiths, M.D. (2021). The Relationship between Alexithymia, Dysmorphic Concern, and Exercise Addiction: The Moderating Effect of Self-Esteem. J. Pers. Med., 11.","DOI":"10.3390\/jpm11111111"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Gori, A., Arcioni, A., Topino, E., Craparo, G., and Lauro Grotto, R. (2021). Development of a New Measure for Assessing Mentalizing: The Multidimensional Mentalizing Questionnaire (MMQ). J. Pers. Med., 11.","DOI":"10.3390\/jpm11040305"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1080\/00223891.2019.1594240","article-title":"Reliability, validity, and factor structure of the maladaptive daydreaming scale (MDS\u201316) in an Italian sample","volume":"102","author":"Schimmenti","year":"2020","journal-title":"J. Pers. Assess."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.jpsychires.2020.08.023","article-title":"Dissociation in relation to other mental health conditions: An exploration using network analysis","volume":"136","author":"Evans","year":"2021","journal-title":"J. Psychiatr. Res."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1097\/NMD.0000000000000853","article-title":"An initial study of alexithymia and its relationship with cognitive abilities among mild cognitive impairment, mild Alzheimer\u2019s disease, and healthy volunteers","volume":"206","author":"Smirni","year":"2018","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Luminet, O., Bagby, R.M., and Taylor, G.J. (2018). Therapeutic Issues. Alexithymia: Advances in Research, Theory, and Clinical Practice, Cambridge University Press.","DOI":"10.1017\/9781108241595"},{"key":"ref_80","unstructured":"Courtois, C.A., and Ford, J.D. (2009). Treating dissociation. Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide, Guilford Press."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1007\/s11469-019-00143-9","article-title":"Treatment for family members of people experiencing gambling problems: Family members want both gambler-focused and family-focused options","volume":"18","author":"Rodda","year":"2020","journal-title":"Int. J. Ment. Health Addict."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/24\/13291\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:50:07Z","timestamp":1760169007000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/24\/13291"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,16]]},"references-count":81,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["ijerph182413291"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182413291","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,16]]}}}