Fiorenzo Ranieri

The authors hypothesize that the child’s psychic withdrawal
is a potential precursor to the social withdrawal called
‘hikikomori’, a phenomenon frequently observed among
adolescents and young adults. They also hypothesize a
continuum between psychic withdrawal, social withdrawal
and the ‘psychic retreats’ by John Steiner. The authors
investigate very early psychic withdrawal and its potential
link to the development of social withdrawal. Two
observations collected using the Infant Observation and
Young Child Observation method provided essential
support. Children with premonitory signs of psychic
withdrawal observed when they were very young were
contacted years later for new observations. The aim was to
test the hypothesis that the mental and social functioning
mechanisms observed were maintained over time,
hindering the children’s lines of development. In both
cases, it is shown that over the years, precursor signs of
mental withdrawal can be traced in the non-spontaneous
modes of interaction with peers, with an adaptation to the
environment that, especially in a child, seems to rely on the
family context and home to avoid contact with others. The
article provides clues as to how psychic withdrawal fuels
social withdrawal and can contribute to the construction of
internal personality organizations that lead to self-reclusion
called hikikomori.

Gli autori ipotizzano che il ritiro psichico del bambino sia un potenziale precursore del ritiro sociale chiamato "hikikomori", un fenomeno frequentemente osservato tra gli adolescenti e i giovani adulti. Essi ipotizzano inoltre un continuum tra il ritiro psichico, il ritiro sociale e i "rifugi della mente” di John Steiner. Gli autori hanno indagato il ritiro psichico molto precoce e il suo potenziale legame con lo sviluppo del ritiro sociale. Due osservazioni raccolte con il metodo dell'Infant Observation e della Young Child Observation hanno fornito un supporto essenziale all'indagine. I bambini con segni premonitori di ritiro psichico osservati quando erano molto piccoli sono stati contattati anni dopo per nuove osservazioni. L'obiettivo era verificare l'ipotesi che i meccanismi di funzionamento mentale e sociale osservati si fossero mantenuti nel tempo, ostacolando le linee di sviluppo dei bambini. In entrambi i casi viene mostrato come negli anni i segnali precursori di ritiro psichico possano essere rintracciabili nelle modalità di interazione non spontanee con i coetanei, con un adattamento all’ambiente che soprattutto in un bambino sembra affidarsi al contesto familiare e alla casa per evitare il contatto con gli altri. L'articolo fornisce indizi su come il ritiro psichico alimenti il ritiro sociale, e può contribuire alla costruzione di organizzazioni interne di personalità che portano all’autoreclusione chiamata hikikomori.

Introduction: The Internet provides adolescents the chance to experience autonomy through the collection of information and contact with peers with whom to share experiences, emotions and thoughts. A misuse of the Internet can occur if a teenager avoids real relationships and surfing the web turns into a psychological defense, in contrast with a healthy mental development. Objectives: and Aims The research investigates forms and motivations of misuse of the internet among a group of Italian teenagers. Objective of the work is the hypothesis of a correlation between massive use of internet and behaviours of social retreat. Methods: The research used a questionnaire. The areas of investigation were: school performance, hours of internet surfing, activity on the Internet (social networks, games, information research, gambling online), psychological reasons of the Internet use, behaviours of social retreat. 583 adolescents (45% males and 54% females, mean age 17 years) responded to the questionnaire. Results: The 6% of adolescents sample responded to always think the Internet even when not on the computer or gets irritated and reacts impulsively if someone bothers him while it is connected. The 5% prefer surfing rather then going out with friends. Hours of internet sulfing and responses of social retreat were correlated. Conclusions: The social retreat can be one of consequences of the Internet misuse, with difficulties in socializing and use of the Internet as a psychological defense.

In this work, we suggest that children’s social withdrawal might be a precursor of Hikikomori, a phenomenon observed among adolescents and young adults. Hence, psychotherapy interventions with preschool children showing signs of social withdrawal might play a critical role in Hikikomori prevention. This paper presents the case of a five-year-old child treated with intensive psychoanalytic psychotherapy who began therapy due to his refusing to go to school and exhibiting isolating behavior from other children. Among other symptoms were regression, emotional tension, nightmares, and nocturnal and diurnal enuresis. Moreover, the relationship in the family was difficult, both between the parents and between the parent and the child. The intensive psychoanalytic treatment involved three weekly sessions for about a year, followed by six months with one weekly session. Besides illustrating the therapeutic process through clinical vignettes taken from the sessions, this paper also provides ...

In this work, we suggest that children’s social withdrawal might be a precursor of Hikikomori, a phenomenon observed among adolescents and young adults. Hence, psychotherapy interventions with preschool children showing signs of social withdrawal might play a critical role in Hikikomori prevention. This paper presents the case of a five-year-old child treated with intensive psychoanalytic psychotherapy who began therapy due to his refusing to go to school and exhibiting isolating behavior from other children. Among other symptoms were regression, emotional tension,
nightmares, and nocturnal and diurnal enuresis. Moreover, the relationship in the family was difficult, both between the parents and between the parent and the child. The intensive psychoanalytic treatment involved three weekly sessions for about a year, followed by six months with one weekly session. Besides illustrating the therapeutic process through clinical vignettes taken from the sessions, this paper also provides clues on how early social withdrawal can contribute to the construction of
internal personality organizations that lead to social withdrawal up to self-reclusion (or Hikikomori).

Summary Objectives: This paper presents a research conducted in Ser.T. of Arezzo with a sample of 359 users arrived to the Service with a clinical request. In order to investigate the existence of a specific addictive profile, it were studied the anamnesis of the subjects, their habits of consumption and their average profiles of personality obtained by the analysis of MMPI-2. Methods: The analyses concern the entire sample and distinct subgroups in relation to the type of substance used or behavioral addiction that led the persons to require a clinical help. The psychologists of Ser.T. assessed the patients with the MMPI-2 during the last 14 years to detect psychopathological behaviors with clinical and statistical criteria. The questionnaires were divided in two groups (males and females) and for each subject were derived T points of the Fundamental and Content Scale. Then for each scale was calculated the average value. The tests were processed using the “Panda” software. The ave...

This paper illustrates features of psychoanalytic psychotherapy with a young adolescent who had experienced adverse childhood events, culminating in cumulative trauma. This led to the atrophying of her ‘sense of place’ and ‘place identity’, both integral to the development of a sense of self. The patient’s memory of places seemed to have been pulverised and required the contact and containment of the adult mind of the therapist to find recomposition. A therapeutic relationship developed, thanks to the sharing of objects and places which had become fragmented in the patient’s mind. There was a need for locations, paths, places, indeed entire nations needed to be emotionally recomposed in the transference, to assume rudimentary but thinkable forms. The psychotherapy made it possible to find part of my young patient’s memory through play, and the value of intensive but short-term work became evident. Psychotherapy allowed partial repair of the capacity for place attachment, which facilitated the exploration of the external world, the possibility of attachment to new places, and the construction of new place identities, alongside her developing sense of herself.

L’Unità Funzionale Salute Mentale Infanzia e Adolescenza della Az. USL 8 Arezzo (UFSMIA) ha ricevuto negli ultimi anni diverse richieste di presa in carico di adolescenti che presentavano forti analogie con i casi descritti in letteratura come “hikikomori” o “ragazzi ritirati” (Teo, 2010). Le richieste presentate dai genitori spesso si sono associate con le segnalazioni del Servizio Sociale per evasione dell’obbligo scolastico. L’articolo presenta dati clinici ed epidemiologici raccolti in corso d’opera su questo fenomeno.

Extreme risk-seeking behaviours are commonly observed in children. By using observational and clinical material, the precocity of these behaviours is investigated. The author supports the model of an existing connection between the modalities involved in the formation of anticipatory representations and risk-seeking behaviours. The idea that the necessary mental mechanism for anticipating events and predicting risks are formed as early as in the first year of life is also supported. The risk-taker child uses extreme risk seeking as a defensive tool to keep painful emotions out of the way. Every risky action is an attempt to repair those malfunctioning mental mechanisms necessary for the anticipatory process. The development of the capacity for mentalisation during childhood and adolescence enables one to structure more evolved anticipatory mechanisms, progressively less based on action and increasingly more on reflective thought. Children who dare too much or too often are driven by rudimentary or damaged anticipatory mechanisms. The importance of the model for the child psychotherapist working with daredevil children is underlined. Special emphasis is given to dissociation, enactment in the therapeutic relationship and the complex relationship between the psychotherapist and the parents of these risk-seeking young patients.

This paper illustrates features of psychoanalytic psychotherapy with a young adolescent who had experienced adverse childhood events, culminating in cumulative trauma. This led to the atrophying of her ‘sense of place’ and ‘place identity’, both integral to the development of a sense of self. The patient’s memory of places seemed to have been pulverised and required the contact and containment of the adult mind of the therapist to find recomposition. A therapeutic relationship developed, thanks to the sharing of objects and places which had become fragmented in the patient’s mind. There was a need for locations, paths, places, indeed entire nations needed to be emotionally recomposed in the transference, to assume rudimentary but thinkable forms. The psychotherapy made it possible to find part of my young patient’s memory through play, and the value of intensive but short-term work became evident. Psychotherapy allowed partial repair of the capacity for place attachment, which facilitated the exploration of the external world, the possibility of attachment to new places, and the construction of new place identities, alongside her developing sense of herself.

Dans cet article, l’auteur fait l’hypothese que la quete de risques extremes – soit la recherche deliberee et continuelle d’evenements dangereux procurant des emotions fortes – peut devenir une addiction comportementale pathologique. L’article suggere un modele d’interpretation de la prise de risques extremes et le compare avec celui du Syndrome de stress post-traumatique (Sspt). A l’inverse des sujets qui experimentent une situation reellement traumatique, ceux qui prennent des risques deliberement y trouvent du plaisir, de l’excitation et une satisfaction en l’absence de trauma a la suite d’une action accomplie sans dommages, ni consequences. Ces experiences renforcent le sentiment d’un Moi puissant et invulnerable et produisent des emotions si fortes qu’elles conduisent le sujet a renouveler de tels comportements. Dans ce cas, cela devient une addiction.

“Hikikomori syndrome,” or extreme social withdrawal, determines a refusal to go to school or work where one’s life style is centred around the home. In Japan hikikomoris, also called “family hermits” or “bedroom hermits,” were first identified in the late seventies. In the West (USA, France, UK, Spain, Italy) clinical psychologists are treating an increasing number of adolescents and young hikikomoris. Over the last few years, the Unità Funzionale Salute Mentale Infanzia Adolescenza (UFSMIA) in Arezzo has received a number of requests for treating young people who present strong similarities with hikikomoris as well as teenagers in early adolescence “on their way to social withdrawal.” The signs of the syndrome are largely similar to the Japanese description, with some differences linked to the Italian cultural context. As to treatment, a single clinical approach (e.g. individual or family psychotherapy) has not given the expected results. By combining different approaches it may be possible to create a network able to stimulate the subject’s resources and those of his or her family. Findings reveal the need to develop more in depth clinical knowledge on this social withdrawal syndrome and create new protocols which will be useful for future psychological and psychotherapeutic programmes. Zespół hikikomori, czyli zespół skrajnego wycofania społecznego, polega na rezygnacji z udziału w życiu społecznym łącznie z odmową uczęszczania do szkoły lub pracy, a życie osoby nim dotkniętej ogranicza się do przebywania we własnym domu. W Japonii przypadki „hikikomori”, nazywanych również „domowymi pustelnikami” (chory przebywa jedynie we własnym domu lub nawet tylko we własnym pokoju), po raz pierwszy zidentyfikowano i opisano w późnych latach 70. XX wieku. Obecnie w krajach zachodnich, takich jak USA, Francja, Wielka Brytania, Hiszpania i Włochy, obserwuje się rosnącą liczbę pacjentów „hikikomori” w okresie dojrzewania oraz młodych dorosłych trafiających do psychologów klinicznych. W minionych kilku latach do naszej Poradni Zdrowia Psychicznego Wieku Dziecięcego i Wieku Dojrzewania w Arezzo (Unità Funzionale Salute Mentale Infanzia Adolescenza, UFSMIA) skierowano pewną liczbę młodych pacjentów wykazujących znaczące podobieństwo do japońskich „hikikomori”, jak również nastoletnich pacjentów we wczesnej fazie wieku dojrzewania „zmierzających w kierunku wycofania społecznego”. Objawy zespołu, z którym mamy do czynienia, w dużej mierze pokrywają się z opisem japońskim, z uwzględnieniem pewnych różnic uwarunkowanych włoskim kontekstem kulturowym. W leczeniu wspomnianych przypadków zastosowanie jednego konkretnego podejścia klinicznego, takiego jak np. psychoterapia indywidualna lub psychoterapia rodzinna, nie przyniosło oczekiwanych efektów. Poprzez połączenie różnych sposobów postępowania w przypadku poszczególnych pacjentów możliwe wydaje się stworzenie sieci pomocy stymulującej zasoby własne pacjenta oraz jego rodziny. Wyniki badań wskazują na potrzebę poszerzenia wiedzy klinicznej dotyczącej tego zespołu wycofania społecznego, jak również stworzenia nowych.

The term hikikomori describes a specific form of social withdrawal that can be observed in children, adolescents, and young adults. Epidemiological research studies have shown that this condition is comorbid with a psychopathological disorder only in 50% of all cases. Many young people in a state of withdrawal do not show symptoms ascribable to already known diagnostic parameters. The authors, psychologist, and psychiatrist at the UFSMIA (Functional Mental Health Unit for Children and Adolescents) in Arezzo, illustrate the current debate on the hikikomori phenomenon from a number of viewpoints: psychiatric, sociological, anthropological, and psychological. On the basis of a clinical case discussed at length in this paper, the authors define their viewpoints and the strategies initiated at the Mental Health Unit in the presence of a patient displaying a state of acute social withdrawal. The multiple actions taken by the UFSMIA are combined according to the concept of modularity. Clin...

Extreme risk-seeking behaviours are commonly observed in children. By using observational and clinical material, the precocity of these behaviours is investigated. The author supports the model of an existing connection between the modalities involved in the formation of anticipatory representations and risk-seeking behaviours. The idea that the necessary mental mechanism for anticipating events and predicting risks are formed as early as in the first year of life is also supported. The risk-taker child uses extreme risk seeking as a defensive tool to keep painful emotions out of the way. Every risky action is an attempt to repair those malfunctioning mental mechanisms necessary for the anticipatory process. The development of the capacity for mentalisation during childhood and adolescence enables one to structure more evolved anticipatory mechanisms, progressively less based on action and increasingly more on reflective thought. Children who dare too much or too often are driven by...

L’articolo nasce da una indagine retrospettiva sugli adolescenti che si sono rivolti al Servizio di Salute Mentale aretino. Sono stati analizzati i percorsi clinici di 60 ragazzi e ragazze tra i 14 e i 18 anni che hanno completato la valutazione psicodiagnostica e sono stati avviati ad un programma terapeutico – riabilitativo. Viene descritta la distribuzione per diagnosi dei soggetti. L’articolo riporta poi per ogni sottogruppo diagnostico il profilo medio al test di personalità MMPI A con relativo Codice di Butcher e Williams, l’incidenza di Disturbi Specifici dell’Apprendimento nel campione, il tipo di trattamento avviato e la ripartizione dei casi di Drop Out. Lo studio offre informazioni utili per orientare le equipe curanti nelle scelte dei programmi terapeutico - riabilitativi.
Parole chiave: adolescenza, salute mentale, UFSMIA, MMPI A, trattamento psicologico

A hikikomori is a child, an adolescent or a young adult who voluntarily
retreats into his own home for long periods, not showing evident signs
of psychological distress or overt mental disorder. This phenomenon
was first described in Japan, but several research studies show that it is
spreading in many countries around the world. The author hypothesizes
that the decision to become a hikikomori is made by the person in an
attempt to find a solution to difficulties in relationships with himself and
with others. The choice of reclusion rapidly becomes a trap: in this condition
the individual is imprisoned in complex functions of the mind
which curb and restrict independence and personal autonomy. This is
owing to the fact that, with the withdrawal, a pathological personality
organization, formed during the years of early infancy, gradually takes
control of the internal world, pushing towards anti-developmental mental
states and behaviours. The paper continues with some reflections on
individual treatment with psychoanalytic psychotherapy of adolescents
and young adults in a state of acute social withdrawal. The reference
model used is John Steiner’s notion of ‘psychic retreat’. A description
of a four-year treatment completes the paper, allowing for further clinical
reflections.

The term hikikomori describes a specific form of social withdrawal that can be observed in children, adolescents, and young adults. Epidemiological research studies have shown that this condition is comorbid with a psychopathological disorder only in 50% of all cases. Many young people in a state of withdrawal do not show symptoms ascribable to already known diagnostic parameters. The authors, psychologist, and psychiatrist at the UFSMIA (Functional Mental Health Unit for Children and Adolescents) in Arezzo, illustrate the current debate on the hikikomori phenomenon from a number of viewpoints: psychiatric, sociological, anthropological, and psychological. On the basis of a clinical case discussed at length in this paper, the authors define their viewpoints and the strategies initiated at the Mental Health Unit in the presence of a patient displaying a state of acute social withdrawal. The multiple actions taken by the UFSMIA are combined according to the concept of modularity. Clinical experiences collected allow the definition of therapeutic protocols useful for the treatment of hikikomori adolescents. The overall objective is to promote the autonomy of the adolescent, as well as the reinforcement of his/her identity and personal resources, as well as the non-traumatic re-entry into the social context.

Recent studies show that approximately 3.2% of Italian children have dyslexia. The present study aims to explore the epidemiological features found in patients of the CAMHS (Child and Adolescent Mental Health Services) of Arezzo (Italy) presenting with Specific Learning Disorders (SLD).

La ricerca qui presentata si inserisce in un programma di prevenzione del tabagismo rivolto a studenti delle scuole superiori. I ragazzi che hanno partecipato all’intervento sono in totale 567 (337 maschi, 59%; e 220 femmine, 39%) con un’età compresa tra i 14 ed i 21 anni (età media=17 anni). In un incontro è stata proposta loro la compilazione di un questionario appositamente costruito per raccogliere le loro opinioni,
conoscenze e le loro abitudini relativamente al consumo di tabacco e alcol.

L'indagine è stata condotta allo scopo di convalidare l'ipotesi di correlazione tra funzioni psichiche e stato di tossicodipendenza, indagata all'interno di una popolazione campionaria di soggetti in trattamento. Utilizzando il reattivo psicologico Myers - Briggs, di derivazione junghiana, si è compiuta una indagine nel campo della struttura della personalità, osservando un campione arbitrario di tossicodipendenti e verificando tratti e caratteristiche peculiari.

L’Unità Funzionale Salute Mentale Infanzia e Adolescenza della Az. USL 8 Arezzo (UFSMIA) ha ricevuto negli ultimi anni diverse richieste di presa in carico di adolescenti che presentavano forti analogie con i casi descritti in letteratura come “hikikomori” o “ragazzi ritirati” (Teo, 2010). Le richieste presentate dai genitori spesso si sono associate con le segnalazioni del Servizio Sociale per evasione dell’obbligo scolastico. L’articolo presenta dati clinici ed epidemiologici raccolti in corso d’opera su questo fenomeno.

“Hikikomori syndrome,” or extreme social withdrawal, determines a refusal to go to school or work where one’s life style is centred around the home. In Japan hikikomoris, also called “family hermits” or “bedroom hermits,” were first identified in the late seventies. In the West (USA, France, UK, Spain, Italy) clinical psychologists are treating an increasing number of adolescents and young hikikomoris. Over the last few years, the Unità Funzionale Salute Mentale Infanzia Adolescenza (UFSMIA) in Arezzo has received a number of requests for treating young people who present strong similarities with hikikomoris as well as teenagers in early adolescence “on their way to social withdrawal.” The signs of the syndrome are largely similar to the Japanese description, with some differences linked to the Italian cultural context. As to treatment, a single clinical approach (e.g. individual or family psychotherapy) has not given the expected results. By combining different approaches it may be possible to create a network able to stimulate the subject’s resources and those of his or her family. Findings reveal the need to develop more in depth clinical knowledge on this social withdrawal syndrome and create new protocols which will be useful for future psychological and psychotherapeutic programmes.

Zespół hikikomori, czyli zespół skrajnego wycofania społecznego, polega na rezygnacji z udziału w życiu społecznym łącznie
z odmową uczęszczania do szkoły lub pracy, a życie osoby nim dotkniętej ogranicza się do przebywania we własnym domu.
W Japonii przypadki „hikikomori”, nazywanych również „domowymi pustelnikami” (chory przebywa jedynie we własnym
domu lub nawet tylko we własnym pokoju), po raz pierwszy zidentyfikowano i opisano w późnych latach 70. XX wieku.
Obecnie w krajach zachodnich, takich jak USA, Francja, Wielka Brytania, Hiszpania i Włochy, obserwuje się rosnącą liczbę
pacjentów „hikikomori” w okresie dojrzewania oraz młodych dorosłych trafiających do psychologów klinicznych.
W minionych kilku latach do naszej Poradni Zdrowia Psychicznego Wieku Dziecięcego i Wieku Dojrzewania w Arezzo
(Unità Funzionale Salute Mentale Infanzia Adolescenza, UFSMIA) skierowano pewną liczbę młodych pacjentów wykazujących
znaczące podobieństwo do japońskich „hikikomori”, jak również nastoletnich pacjentów we wczesnej fazie wieku dojrzewania
„zmierzających w kierunku wycofania społecznego”. Objawy zespołu, z którym mamy do czynienia, w dużej mierze
pokrywają się z opisem japońskim, z uwzględnieniem pewnych różnic uwarunkowanych włoskim kontekstem kulturowym.
W leczeniu wspomnianych przypadków zastosowanie jednego konkretnego podejścia klinicznego, takiego jak
np. psychoterapia indywidualna lub psychoterapia rodzinna, nie przyniosło oczekiwanych efektów. Poprzez połączenie
różnych sposobów postępowania w przypadku poszczególnych pacjentów możliwe wydaje się stworzenie sieci pomocy
stymulującej zasoby własne pacjenta oraz jego rodziny. Wyniki badań wskazują na potrzebę poszerzenia wiedzy klinicznej
dotyczącej tego zespołu wycofania społecznego, jak również stworzenia nowych.

Abstract
The "hikikomori syndrome" causes an social extreme withdrawal with a refusal of school or work; the style life is centered on the own home. In Japan the hikikomori persons, also called "family hermits" or "bedroom hermits", are known since the seventies. In the West (USA, France, UK, Spain, Italy) clinical psychologists are meeting with an increasing number of adolescents and young people hikikomori. The Unità Funzionale Salute Mentale Infanzia Adolescenza of Arezzo (Ufsmia) has received during last years a number of requests to take care of teenegers in early adolescence "on the way of a social withdrawal" showing strong similarities with Japanese hikikomori. The signs of disease are in large part similar to the Japanese descriptions, with some differences linked to the Italian cultural context. About the treatment, a single clinical approach (e.g. individual or family psychotherapy) results not sufficient. Combining different approaches it is possible to create a network able to promote the resources of the subject and of his/her family. Results underline the necessity of increasing the clinical knowledge on the social withdrawal syndrome and creating new protocols useful for psychological and psychoterapic programs.

The main subject of this paper is extreme risk seeking, seen as a pathological addiction. There are endless ways of seeking extreme risks. You can drive riskily or practise extreme sports that push the individual to the limit of his/her possibilities, you can make hasty and risky investments on the Stock Exchange, you can gamble, steal or damage other people’s property, you can take notoriously dangerous substances, behave frivolously with the aim of endangering oneself.  This type of behaviour has become more especially among adolescents, though noticeable in other age groups too.  It not always easy to distinguish between risk seeking seen as experience seeking and the mere repetition of more or less similar behaviours which have the only purpose of reaching high states of excitement and pleasure. Risks become extreme when they are continuous, and when they characterize and individual’s life style, jeopardising possessions, safety and the person’s own life, but especially when the fun and enjoyable experience of risk turns in a way that absorbs the person, allowing him to move away from the everyday realities and not tolerable feelings . The risk behavior becomes so a kind of internal object. It seems benevolent and protective, but in fact is tyrannical and able to dominate the psychic life.  In these cases it is possible that real addiction has developed.  One might calls such addiction Extreme Risk Seeking (ERS). This paper focuses on how risk seeking can become a pathological addiction. 
The article begins with a brief description of those addictions that originate from behaviours and not from the use of drugs. These are pathological conditions such as gambling, Internet addiction and compulsive shopping which have recently aroused widespread interest, even though they were described in literature as far back as the first half of the past century.  It shall then address the issue of risk using different types of approaches ranging from historical to anthropological and from sociological to psychological approaches, focussing on works by authors who have dealt with decision-making psychology, analysing certain viewpoints of how emotions influence decision-making in a risk situation.. Thus, the real issue of the article shall be discussed: deliberate risk seeking or risk-taking. It is important to distinguish between behaviour risk and risk taking. Behaviour risks are not necessarily related to awareness or to active seeking whereas risk taking implies seeking out excessively risky situations. This fascinating search may become inevitable and turn into a behavioural addiction. It is not clear why this happens. The various models suggested in the literature shed light on many aspects of risk seeking, but nevertheless they do not seem to have completely clarified the mental process through which the link between behaviour and person is created. The article will attempt to define the relationship between present experiences, feelings, extreme risk addiction and consequences deriving from traumatic events. In particular, the characteristics of Post-traumatic Stress Disorder (PTSD) shall be confronted with those of Extreme Risk Seeking (ERS).  As a result of this, the author shall suggest a model which will define risk seeking as a consequence of a specific mental process, i.e. risk seeking without trauma.

In questo lavoro ipotizzo che la passione per il rischio, la ricerca deliberata di eventi pericolosi capaci di provocare eccitazione e forte emozioni, possa trasformarsi in una dipendenza patologica. Il rischio diventa estremo quando si corrono pericoli che minacciano averi, incolumità, vita della persona. Si ha un rischio estremo anche quando la ricerca di rischio, diventata continua, finisce per caratterizzare lo stile di vita. Nell’articolo ho dedicato una certa attenzione alle teorie di Zuckerman che ha proposto come causa della ricerca di rischio un tratto di personalità, Il Sensation Seeking Trait. Al di là delle critiche al modello di Zuckerman, l’ipotesi Sensation Seeking Trait non permette di comprendere perché la ricerca di rischio diventi per alcune persone, da un certo punto in poi, inevitabile alla stregua di una dipendenza. La mia idea è che le emozioni giochino un ruolo di primo piano nella nascita di questa dipendenza patologica e che la dipendenza sia dovuta a uno schema di comportamento basato su emozioni che governano la capacità di decidere.

L’Unità Funzionale Salute Mentale Infanzia e Adolescenza della Az. USL 8 Arezzo (UFSMIA) ha ricevuto negli ultimi anni alcune richieste di presa in carico di adolescenti che presentavano forti analogie con i casi descritti in letteratura come “hikikomori”. Queste ammissioni hanno portato a uno studio epidemiologico per quantificare il comportamento di ritiro sociale tra gli adolescenti a Arezzo. Dallo studio emerge che circa l’1% degli iscritti alle scuole medie non frequenta le lezioni e che una parte di questi non va a scuola perché rimane autorecluso nella propria casa.

I comportamenti di ricerca del rischio estremo sono diffusi tra i bambini. Questo articolo indaga queste condotte utilizzando materiale proveniente dalla osservazione di bambini molto piccoli e dalla clinica. L’autore sostiene che esiste una relazione tra le modalità con cui si costituiscono le rappresentazioni anticipatorie e i comportamenti di ricerca del rischio. Egli sostiene inoltre l’idea che i meccanismi mentali necessari per anticipare gli eventi e predire i rischi si formano molto precocemente a partire dal primo anno di vita. Il motivo per cui i bambini rischiano è duplice: da un lato il rischio estremo è usato come una difesa per allontanare le emozioni dolorose; dall’altro lato ogni azione rischiosa è un tentativo di riparare i meccanismi mentali mal funzionanti necessari al processo di anticipazione. Lo sviluppo della capacità di mentalizzare durante l’infanzia e l’adolescenza consente di strutturare meccanismi anticipatori più evoluti, basati sempre meno sulla azione e sempre più sul pensiero riflessivo. I bambini che rischiano troppo o troppo spesso sono guidati da meccanismi anticipatori rudimentali o danneggiati. L’articolo sottolinea l’importanza del modello proposto per il lavoro degli psicoterapeuti infantili che lavorano con bambini risk seeker. Una particolare enfasi è data alla dissociazione, alla relazione terapeutica e alla complessa relazione tra psicoterapeuta e genitori dei giovani pazienti cercano il rischio.

Objectives: This paper presents a research conducted in Ser.T. of Arezzo with a sample of 359 users arrived to the Service with a clinical request. In order to investigate the existence of a specific addictive profile, it were studied the anamnesis of the subjects, their habits of consumption and their average profiles of personality obtained by the analysis of MMPI-2.
Methods: The analyses concern the entire sample and distinct subgroups in relation to the type of substance used or behavioral addiction that led the persons to require a clinical help. The psychologists of Ser.T. assessed the patients with the MMPI-2 during the last 14 years to detect psychopathological behaviors with clinical and statistical criteria. The questionnaires were divided in two groups (males and females) and for each subject were derived T points of the Fundamental and Content Scale. Then for each scale was calculated the average value. The tests were processed using the “Panda” software. The average of the scores of each subgroup produced
the total profile. Results: The results show that it is not possible to identify a typical profile of the addict personality. Subjects
show multiple profiles and about one-third of the sample doesn’t show psychopathological features detectable with the test.
Conclusions: The difficulty to define a typical psychodiagnostic profile of addicted confirms the opportunity of accurate clinical assessment for an effective clinical treatment. The MMPI-2 profiles included in the sample show the psychological state in which are the addicted when they ask for clinical support. In this sense, the profiles represent a kind of cut-off, an image of the psychopathological state in which is located an individual who is not able to manage his or her dependence. 
Keywords: MMPI-2, addiction, personality, assessment.
Fin dal 1998 il test Minnesota Multiphasic Personality Inventory
2 (MMPI-2) è stato utilizzato presso il Ser.T. dell’Azienda USL8
di Arezzo per l’assessment psicopatologico degli utenti in ingresso.
A partire dal 2004 il Ser.T. ha stabilito un protocollo psicodiagnostico
che prevede la somministrazione dei test MMPI e Addiction Severity Index (ASI) oltre che lo svolgimento di colloqui clinici finalizzati a raccogliere l’anamnesi dell’utente e l’eventuale disponibilità ad intraprendere un percorso terapeutico riabilitativo. Lo studio qui presentato si propone di individuare le caratteristiche socio-anamnestiche di un campione di utenti, le loro abitudini di consumo e i profili medi di personalità ottenuti grazie all’analisi del test MMPI, distinguendo il campione in sottogruppi relativamente alla tipologia di sostanza assunta o la dipendenza comportamentale che ha spinto il soggetto a recarsi al Ser.T. Abbiamo dunque indagato se il campione generale e, in seguito, i singoli sottogruppi, presentano caratteristici profili di personalità secondo i risultati ottenuti al test MMPI.
Parole chiave: MMPI-2, dipendenza patologica, personalità, valutazione diagnostica.

Extreme risk-seeking behaviours are commonly observed in children. By using observational and clinical material, the precocity of these behaviours is investigated. The author supports the model of an existing connection between the modalities involved in the formation of anticipatory representations and risk-seeking behaviours. The idea that the necessary mental mechanism for anticipating events and predicting risks are formed as early as in the first year of life is also supported. The risk-taker child uses extreme risk seeking as a defensive tool to keep painful emotions out of the way. Every risky action is an attempt to repair those malfunctioning mental mechanisms necessary for the anticipatory process. The development of the capacity for mentalisation during childhood and adolescence enables one to structure more evolved anticipatory mechanisms, progressively less based on action and increasingly more on reflective thought. Children who dare too much or too often are driven by rudimentary or damaged anticipatory mechanisms. The importance of the model for the child psychotherapist working with daredevil children is underlined. Special emphasis is given to dissociation, enactment in the therapeutic relationship and the complex relationship between the psychotherapist and the parents of these risk-seeking young patients.
Keywords: daredevil children; risk taking; psychic retreats; dissociation; enactment

Extreme Risk Seeking Addiction (ERSA) is a behavioural addiction manifested as a repeated voluntary search for risk. This article introduces some theoretical reference points to discuss a clinical case study, a once-weekly psychotherapy which extended over more than ten years. The model followed assumes that ERSA is due to the feelings of excitement and ‘narrow escape’ which, if reiterated, bring about the construction of a pathological organization, a psychic retreat in Steiner's terms. This organization is a part of the self which is tyrannical and falsely protective, and is able to create illusory feelings of invulnerability and all-powerfulness. Psychotherapy can offer a benevolent interaction which is sufficiently in tune with the ERSA-affected person to be able to favour self-reflective experiences promoting the mentalization of affect and, more generally, the skills which make it possible to recognize emotions in the self and in others, and to manage emotional states within relationships effectively and competently.

Abstract: In this paper, the author is hypothesising that Extreme Risk Seeking (ERS) – i.e. deliberately and continually seeking Dangerous events able to arouse strong emotions – can become a pathological behavioural addiction. The article suggests an interpretative model of ERS and confronts it with Post-traumatic Stress Disorder (PTSD). Unlike those who experience a real trauma, people who deliberately seek risks take pleasure from the excitement and satisfaction that derives from the non-trauma, from the experience of an accomplished action without damages or consequences. These experiences strengthen the sense of omnipotent and invulnerable Self and cause such strong emotions to drive these people to repeating such behaviour. When this happens we are faced with an addiction.

Résumé : Dans cet article, l’auteur fait l’hypothèse que la quête de
risques extrêmes – soit la recherche délibérée et continuelle d’événements dangereux procurant des émotions fortes – peut devenir une addiction comportementale pathologique. L’article suggère un modèle d’interprétation de la prise de risques extrêmes et le compare avec celui du Syndrome de stress post-traumatique (SSPT). À l’inverse des sujets qui expérimentent une situation réellement traumatique, ceux qui prennent des risques délibérément y trouvent du plaisir, de l’excitation et une satisfaction en l’absence de trauma à la suite d’une action accomplie sans dommages, ni conséquences. Ces expériences renforcent le sentiment d’un Moi puissant et invulnérable
et produisent des émotions si fortes qu’elles conduisent le
sujet à renouveler de tels comportements. Dans ce cas, cela devient une addiction.

Le slide di tre incontri tenuti sul tema "Dipendenze patologiche e nuove tendenze della psicanalisi" diretto agli operatori dei Ser.T. della Provincia di Arezzo. Vengono toccati numerosi temi tra cui lo sviluppo delle organizzazioni patologiche di personalità, la dissociazione, le modifiche alla tecnica della psicoterapia. In conclusione viene presentato come esempio una seduta con una paziente in trattamento tossicodipendente.