Evaluación de las experiencias vitales tempranas: la escala ELES y su uso clínico

anales de psicología / annals o psychology 2019, ol. 35, nº 2 (may), 195-203 h p://dx.doi.o g/10.6018/analesps.35.2.304501 © Copy igh 2019: Edi um. Se icio de Publicaciones de la Uni e sidad de Mu cia. Mu cia (Spain) ISSN p in edi ion: 0212-9728. ISSN on line edi ion (h p:// e is as.um.es/analesps): 1695-2294. On line edi ion License C ea i e Commons 4.0: BY-NC-ND - 195 - E alua ion o ea ly li e expe iences: The ELES scale and i s clinical use Ma ía de G acia León-Palacios1, Miguel Ga ido-Fe nández1, C is ina Senín-Calde ón2, Sal ado Pe ona-Ga celán1, Paul Gilbe 3, and Juan F ancisco Rod íguez-Tes al1,* 1 Pe sonali y, E alua ion and Psychological T ea men Depa men , Uni e si y o Se ille (Spain) 2 Depa men o Psychology, Uni e si y o Cadiz (Spain) 3 Men al Heal h Resea ch Uni , Kingsway House, Kingsway Hospi al, De by (UK) Tí ulo: E aluación de las expe iencias i ales emp anas: la escala ELES y su uso clínico. Resumen: An eceden es: la escala de Expe iencias Vi ales Temp anas (ELES) e alúa el ecue do de la amenaza y subo dinación pe cibidas du an e la in- ancia en las elaciones amilia es pa iendo de la eo ía del ango social. Se p opone adap a al español dicha escala y comp oba su es uc u a ac o ial median e una alidación c uzada y explo a sus p opiedades psicomé icas. Mé odo: pa icipa on 960 suje os (863 de población gene al y 97 pacien es). Resul ados: los da os con i man la es uc u a ac o ial de la e sión inicial de Gilbe , Cheung, G and ield, Campey, y I ons (2003), ob eniendo es ac- o es: sumisión, amenaza, y des alo ización, explicando un 66.31% de la a ianza. La e sión española de la escala ELES esul ó es a compues a po el mismo núme o de í ems que la o iginal y mos ó índices adecuados de alidez, consis encia in e na, iabilidad e es , iabilidad compues a e in- a ianza po géne o. Conclusiones: la escala de Expe iencias Vi ales Temp anas (ELES) puede se de u ilidad pa a e alua las expe iencias i ales emp a- nas, es udia la elación en e dichas expe iencias en di e en es mani es a- ciones psicopa ológicas y es ablece posibles modelos explica i os. Palab as cla e: expe iencias i ales; sumisión; amenaza; des alo ización; escala ELES; alidación c uzada. Abs ac : Backg ound: The Ea ly Li e Expe iences Scale (ELES) e alua es he memo y o h ea and subo dina ion pe cei ed in childhood amily ela- ionships based on social ank heo y. This scale was adap ed o Spanish, i s ac o s uc u e was es ed by c oss- alida ion, and i s psychome ic p ope ies we e explo ed. Me hod: 960 subjec s pa icipa ed (863 subjec s om he gene al popula ion and 97 pa ien s). Resul s: Da a con i m he ac o s uc u e o he o iginal e sion by Gilbe , Cheung, G and ield, Campey, and I ons (2003), ob aining a simila model wi h h ee ac o s: submission, h ea , and de alua ion, which explained 66.31% o he a i- ance. The Spanish e sion o he ELES was comp ised o he same num- be o i ems as in he o iginal s udy and showed adequa e indices o alidi- y, in e nal consis ency, e es and combined eliabili y, and in a iance by gende . Conclusions: The Ea ly Li e Expe iences Scale (ELES) can be a use ul measu e o e alua ing ea ly li e expe iences. I s applica ion may be e y ele an in s udying he ela ionship be ween hese expe iences and psy- chopa hological mani es a ions in cons uc ing explana o y models. Keywo ds: li e expe iences; submission; h ea ; de alua ion; ELES scale; c oss alida ion. In oduc ion Ea ly ela ionships wi h pa en s and hei in luence on he de elopmen o psychopa hology has been a subjec o in e - es om di e en heo e ical app oaches. T adi ionally, he ocus has been on analysis o a achmen ela ionships, based on he heo y p oposed by John Bowlby. In his heo y, he c ea ion o emo ional ies unc ions as he basis o e olu- iona y de elopmen and se es as he model o social be- ha io which is main ained h oughou li e, as e lec ed in biological, cogni i e and socio-emo ional de elopmen o he human being (Bowlby, 1980). In ecen yea s, he e has been g owing in e es in s udying his a achmen and he de el- opmen o psychopa hology in you h and adul s (Pae zold, Rholes, & Kohn, 2015), and o example, whe he he s yle o a achmen p io o ea men is associa ed wi h clinical and unc ional changes in pe sons wi h men al s a es a high isk o psychosis (Quijada, Kwapil, Tizón, Sheinbaum, & Ba an es-Vidal, 2015). Among he men al diso de s ela ed o impai men o a achmen a e pe sonali y, anxie y, dep es- si e and pos auma ic s ess diso de s, psycho ic, and ea ing beha io diso de s (Gumley, Taylo , Schwannaue , & MacBe h, 2014; Wickham, Si ko, & Ben all, 2015). * Co espondence add ess [Di ección pa a co espondencia]: Juan F. Rod íguez-Tes al. Pe sonali y, E alua ion and Psychological T ea - men Depa men , Uni e si y o Se ille. S . Camilo José Cela s/n, 41018 Se ille (Spain). E-mail: [email p o ec ed] (A icle ecei ed: 17-09-2017; e ised: 18-03-2018; accep ed: 09-04-2018) S e ens and P ice (2000) belie e his esponds o he basic need o a achmen . Howe e , he e is ano he basic need which has o do wi h s a us ( espec o alida ion) in in- e pe sonal ela ionships es ablished wi h ca egi e s. Some au ho s base his on he Social Rank Theo y (Gilbe , 2001a; Gilbe , Allan, B ough, Melley, & Miles, 2002). This heo y sugges s ha ela ions be ween ca egi e s and hei child en a e based on powe ela ionships (dominance e sus submis- sion), in which a pe son’s e alua ions o own ank o s a us (incompe ence e sus compe ence) in e ene. The e o e, ano he way o s udying ea ly expe iences is based no so much on he a achmen sys em molded by ex- pe iences and beha io o ca egi e s as by he memo y o eelings and beha io s o he pe son unde s udy ela ed o he beha io o hei ca egi e s. While he a achmen heo y ends o concen a e on he need o closeness and secu i y om he igu es o a achmen in di icul si ua ions, he so- cial ank heo y concen a es mo e on es ablishing ela ion- ships o con ol and domina ion by he ca egi e s (Gilbe e al., 2001) and aluing compe ence o capabili y o he one e alua ed, causing eelings o h ea (loss o ank) and sub- mission in he child en. Thus child en who a e a aid o hei pa en s and ha e he eeling o being subo dina e may lead o de ensi e beha io , o example, submissi e, he eby achie ing con ol o pa en al hos ili y o con ol (Lopes & Pin o-Gou eia, 2013). Submissi e beha io based on ea is associa ed wi h inhibi ion o asse i e beha io (Gilbe e al., 2002). Fu he mo e, child en who end o pay oo much a - 196 Ma ía de G acia León-Palacios e al. anales de psicología / annals o psychology, 2019, ol. 35, nº 2 (may) en ion o h ea s (ins ead o us ing hei pa en s as a secu e basis o emo ional egula ion) may be mo e ulne able o dep ession (Gilbe e al., 2002). The e o e, ea ly nega i e expe iences could cul i a e insecu e a achmen s yles and di icul ies in us ing in o he s (C uddas, Gilbe , & McEwan, 2012), bu wha causes sensi i i y o a ious diso - de s is he s ess o ejec ion and/o hos ili y by ca egi e s. This means he pe son akes on a de ensi e esponse o s ess (by being o ced in o an undesi ed subo dina e posi- ion), he physiological p ocess in ol ed and sus ained o e ime, and sel -o he schema (e.g., seeing onesel as in e io ) (Gilbe , Cheung, G and ield, Campey, & I ons, 2003). In b ie , child en may g ow up in en i onmen s whe e hey eel a aid and unde go s ess esponses, anxie y and dep essi e s a es, and de elop a en ional biases owa d h ea ening s imuli causing ch onic e ec s due o main e- nance o physiological esponses o al e ed mood (Gilbe , 2001b; 2001c). This in u n may in luence de elopmen o schemas abou hemsel es which a e ac i a ed in in e pe - sonal ela ionships (e.g., eeling in e io o o he s may lead o gene alized beha io based on submission). This s yle based on submission and subo dina ion has been ela ed o he de- elopmen o dep ession, social anxie y, shame, cogni i e umina ion (Cheung, Gilbe , & I ons, 2004; Gilbe , 2000), pa anoia (Lopes & Pin o-Gou eia, 2013; Pin o-Gou eia, Ma os, Cas ilho, & Xa ie , 2014), hallucina ions (Bi chwood, Meaden, T owe , Gilbe , & Plais ow, 2000), o ea ing diso - de s (Ca di, Di Ma eo, Gilbe , & T easu e, 2014; Dua e e al., 2017). Mo e speci ically, pa anoid idea ion is ela ed di ec ly o ex e nal shame and indi ec ly o in e nal shame o submis- sion based on ea ly nega i e expe iences. In dep ession, in- e naliza ion o expe iences o shame, h ea and submission in he belie ha one is una ac i e and wo hless in he eyes o o he s, is wha makes one ulne able o he diso de (Pin- o-Gou eia e al., 2014). In unipola dep ession, in addi ion o submission and shame (Cheung e al., 2004), inhibi ed and in apuni i e ange has been cha ac e ized, as in bipola de- p ession, bu in unipola dep ession i is speci ically ex a- puni i e ange (Allan & Gilbe , 2002). In bipola diso de , a ia ions in social ank ha e been obse ed o be ela ed o changes in humo (Gilbe , McEwan, Hay, I ons, & Cheung, 2007). In s udies o hallucina ions, subo dina ion o oices becomes ele an o hei onse and o igin (Paulik, 2012). In b ie , in schizoph enia wi h oices and in dep ession, subo - dina ion akes place as a de ense agains one’s own hough s o sel -con emp (Gilbe e al., 2001). The ole o h ea and submission has been emphasized. Howe e , no all pe cep ion o subo dina ion and submissi e beha io implies a diso de in i sel . I has been sugges ed ha social de ea and he impossibili y o unning away o escaping (en apmen ) a e condi ions clea ly ela ed o he anhedonia which cha ac e izes dep ession (Gilbe e al., 2002; Gilbe & Allan, 1998), schizoph enia (Gilbe , 2000), and pe sons a isk o psychosis (Valmaggia e al., 2015). Reliable, alida ed scales ha e been cons uc ed o sci- en i ic s udies dealing wi h e alua ion o memo ies o eel- ings abou pa en al ela ionships. Gilbe de eloped he Ea ly Li e Expe iences Scale (ELES) (Gilbe e al., 2003), which e alua es he memo y o pe cei ed h ea and subo dina ion in childhood amily ela ionships. This e alua ion ool may be e y use ul o he s udy o psychopa hological mani es a- ions enabling explana o y models o be cons uc ed o he s udy o he ela ionship o hese ea ly expe iences wi h o - ma ion o he a achmen sys em and exp essed emo ion, as well as ela ed emo ional s a es. I has ecen ly been adap ed o Po uguese and alida ed o use wi h an adolescen popu- la ion (Pin o-Gou eia, Xa ie , & Cunha, 2016), alida ed wi h uni e si y s uden s in he Tu kish e sion (Akin, Uysal, & Çi emel, 2013), and some s udies ha e a emp ed o ana- lyze he ela ionship be ween ea ly li e expe iences and sel - compassion (Sa ici, Uysal, & Akin, 2015). The goals o his s udy we e o adap he Ea ly Li e Expe- iences Scale (ELES) o Spanish, es he scale’s s uc u e using c oss- alida ion and explo e i s psychome ic p ope ies in an ins umen ela ed o social ank heo y and memo ies o h ea and subo dina ion pe cei ed du ing childhood. The impo ance o s udying h ea and submission is ha hey a e ele an condi ions o ulne abili y o de eloping and main- aining psychopa hological al e a ions, as well as essen ial o ollow du ing in e en ion ela ed o a pe son’s ea ly expe i- ences and how hey ank hemsel es and de end hemsel es om hem (Gilbe e al., 2002). We expec ed o ind adequa e alidi y o he cons uc based on he o iginal model wi h a ac o s uc u e simila o he o iginal e sion (Gilbe e al., 2003) comp ised o he h ee ac o s: submission, h ea , and de alua ion. We also expec ed hese ac o s o be signi ican ly associa ed wi h in- s umen s measu ing he anxie y, dep ession and soma ic p eoccupa ion componen s ound, and he e o e, signi ican con e gen and disc iminan alidi y, inding eliabili y indi- ca o s, as well as he adequa e sensi i i y and speci ici y o his ea ly li e expe iences scale. Me hod Pa icipan s The sample in his s udy was made up o a o al o 960 pa icipan s (863 om he gene al popula ion –PG- and 97 pa ien s). The pa ien s we e om public and p i a e men al heal h cen e s ec ui ed du ing one na u al yea . 62.9% we e women. Thei ages a ied om 19 o 65 yea s (M = 34.84; SD = 11.86). The a e age Social Class Index (SCI) (Hollingshead, 1975) was 37.9 (mean social class) ( anges: 11 – 17, e y high SCI; 18 – 27, high SCI; 28 – 43, middle SCI; 44 – 60, low SCI; 61 – 77, e y low SCI). Pa ien diagnoses we e made in clinical in e iew o ma by specialized p o es- sionals wi h o e 20 yea s o clinical expe ience ollowing DSM-IV-TR (Ame ican Psychia ic Associa ion, 2000) c i e- ia, and classi ied as: Dep essi e diso de s (n = 14), adjus - men diso de as (n = 6), dissocia i e diso de s (n = 1), anxie- E alua ion o ea ly li e expe iences: The ELES scale and i s clinical use 197 anales de psicología / annals o psychology, 2019, ol. 35, nº 2 (may) y diso de s (n = 25), schizoph enia and o he psycho ic dis- o de s (n = 19), ea ing diso de s (n = 3), bipola diso de s (n = 10), soma o o m diso de s (n = 11) and o he Axis I ca e- go ies o diso de s (n = 8). The PG g oup was made up o uni e si y s uden s e- c ui ed by accessibili y and non-uni e si y s uden s we e e- c ui ed by snowball sampling. 79.1% we e women aged 18 o 59 yea s (M = 23.03; SD = 6.55). Thei a e age SCI was 54.42 (low social class). All subjec s who exp essly s a ed ha hey had some psychopa hology a he ime o e alua ion o we e aking medica ion we e elimina ed om he sample. The o e all sample was di ided in o wo hal es a andom (SPSS e . 22) (hal 1 = 435 pa icipan s in PG and 45 pa- ien s; hal 2 = 428 PG subjec s and 52 pa ien s) o c oss alida ion. Bo h g oups we e equi alen in gende (χ2(960) = 0.597, p = .440), ma i al s a us (χ2(960) = 1.98, p = .576), age ( (960) = 0.531, p = .093) and SCI ( (228) = .773, p = .416) (see Table 1). Table 1. Sociodemog aphic cha ac e is ics o pa icipan s. To al sample N: 960 EFA sample N: 480 CFA sample N: 480 n % M SD n % M SD n % M SD Gende Male Female 216 744 22.5 77.5 113 367 23.5 76.5 103 377 21.5 78.5 Age 24.22 8.08 24.08 7.83 24.36 8.33 Ma i al s a us single ma ied/pa ne widowed sepa a ed/di o ced 844 101 3 12 87.9 10.5 0.3 1.3 427 45 1 7 89.0 9.4 0.2 1.5 417 56 2 5 86.9 11.7 0.4 1.0 Social Class Index 48.19 22.91 46.98 23.29 49.33 22.60 G oup Pa ien s Con ols 97 863 10.1 89.9 45 435 9.4 90.6 52 428 10.8 89.2 Ins umen s Ea ly Li e Expe iences Scale, (ELES) (Gilbe e al., 2003): Tes e alua ing he memo y o h ea and subo dina ion pe - cei ed in childhood amily ela ionships. The scale consis s o 15 i ems and con ains h ee main ac o s: h ea (e.g.: “The a mosphe e a home could suddenly become h ea en- ing o no ob ious eason”), submission (e.g.: “I el on edge because I was unsu e i my pa en s migh ge ang y wi h me”), and de alua ion (e.g.: “I el able o asse mysel in my amily”). The i ems a e sco ed on a Like - ype scale o 1 (comple ely alse) o 5 (comple ely ue). The scale has adequa e in- e nal consis ency o i s h ee ac o s in he o iginal s udy: h ea (α = .89), submission (α = .85) and de alua ion (α = .71). Fi s sel - epo ed e alua ion ( ool de eloped by au ho s). Iden i- ies he social class index (SCI) (Hollingshead, 1975), cu en illnesses, psychopa hological backg ound, his o y and du a- ion o symp oms, psychopha macological ea men s and use o d ugs. Gene al Heal h Ques ionnai e, GHQ-28, (Goldbe g, 1996). This is a b ie o m o he o iginal 93-i em Goldbe g scale o Spanish alida ion. I is a sc eening es which e alua es gene al heal h and social dys unc ion. I consis s o 28 i ems g ouped in ou subscales on soma ic symp oms, anxie y and insomnia, social dys unc ion and se e e dep ession. I has adequa e eliabili y p ope ies ( es - e es , .90) and alidi y (sensi i i y om 44% o 100% and speci ici y om 74% o 93%). Fo his s udy, h ee symp om subscales we e used wi h he o e all sample: soma ic (α = .78), anxie y (α = .82) and dep essi e (α = .77) symp oms. Hospi al Anxie y and Dep ession Scale, (HADS) (Zigmond & Snai h, 1983). This 14-i em ques ionnai e e alua es anxie y (odd i ems) and dep essi e (e en i ems) symp oma ology, se en i ems in each pa , on a Like - ype scale o 0-3 poin s acco ding o he symp oms du ing he pas week. The Span- ish e sion by Teje o, Guime a, Fa é, and Pe i (1986) had a o al in e nal consis ency o α = .86, α = .83 o anxie y, and α = .87 o dep ession. In his s udy o e all in e nal con- sis ency was α = .84, α = .78 o anxie y, and α = .71 o de- p ession, conside ing he whole sample. P ocedu e Fi s , pe mission o ansla ion and adap a ion o his scale was eques ed o he au ho , Paul Gilbe . Adap a ion and ansla ion o Spanish o he ELES was done by bilin- gual expe s ollowing he me hod o e e se ansla ion and conside ing he guidelines o he In e na ional Tes Commis- sion (Muñiz, Elosua, & Hamble on, 2013). The pa icipan s we e in o med o he pu poses o he s udy and be o e ap- plying he es s, hey we e asked o hei w i en in o med consen , a e which hei clinical and demog aphic in o - ma ion was acqui ed, and hen he measu emen ins umen s we e adminis e ed. The s udy was au ho ized by he E hics Commi ee and he e hical p inciples o medical esea ch in ol ing human subjec s p oposed by he Wo ld Medical 198 Ma ía de G acia León-Palacios e al. anales de psicología / annals o psychology, 2019, ol. 35, nº 2 (may) Associa ion in he Helsinki Decla a ion (Wo ld Medical As- socia ion, 2013) we e gua an eed. Da a we e analyzed using he SPSS 22 and LISREL 8.7 p og ams. Desc ip i e analyses o he sociodemog aphic a - iables and compa isons o means o pa icipan s in he wo andom g oups o med we e pe o med o ELES c oss- alida ion. F equency, skewness and ku osis analyses we e done o each i em esponse. In e nal consis ency o he comple e ELES and o he h ee ac o s p oposed by Gilbe e al. (2003) was es ed o e alua e he sui abili y o he o igi- nal s uc u e. As he main analysis o es ablishing he alidi- y o he cons uc , i s an Explo a o y Fac o Analysis (EFA) was done using he Robus Maximun Likelihood (RML) ex ac ion me hod and a Di ec Oblimin o a ion on he i s hal o he sample. The mul i a ia e no mali y was es ed using he Ma dia es . Then a Con i ma o y Fac o Analysis (CFA) using he RML p ocedu e and he asymp o ic co a iance ma ix was done o es he hypo hesized model wi h he second hal o he sample. The Chi-squa ed, Non- No med Fi Index (NNFI), Goodness o Fi Index (GFI), and Compa a i e Fi Index (CFI) which mus be > .90 (Baumga ne & Hombu g, 1996) we e used o es he o e - all i o models. In addi ion o hese indices, he Roo Mean Squa e E o o App oxima ion (RMSEA) and i s con idence in e al a 90%, which mus be < .06 o a good i , as well as he S anda dized Roo Mean Squa e Residual (SRMR), which has o be < .08 (Hu & Ben le , 1999), we e also calcu- la ed. Mul i-g oup CFA we e pe o med o es he meas- u emen in a iance o he ELES scale ac oss gende wi h AMOS 22 so wa e. Model i was e alua ed conside ing he ΔCFI and ΔRMSEA. In a iance exis s i he Δ in he CFI and RMSEA is low (usually accep ed Δ <.01, Cheung & Rens old, 2002). The Pea son’s co ela ion coe icien o ELES sco es, GHQ-28 ac o s, and HADS ac o s was used o s udy con- e gen alidi y. Fo disc iminan alidi y, he con idence in- e al o he co ela ions be ween he ELES ac o s was cal- cula ed based on hei co a iance and e o (Ande son & Ge bing, 1988). Wi h he inal s uc u e o he ELES es ab- lished, in e nal consis ency was es ed using he o dinal alpha gi en he cha ac e is ics o he esponse sys em (Elosua & Zumbo, 2008), and o es - e es eliabili y, he Pea son co - ela ion coe icien ( ) was used. The indica o s o Combined Reliabili y (CR), A e age Va iance Ex ac ed and Maximum Sha ed Squa ed Va iance (MSV) a e p o ided. Finally, he Recei e Ope a ing Cha ac e is ic Cu e (ROC) was ana- lyzed conside ing he signi icance o he a ea unde he cu e, he con idence in e al and es ablishing he sensi i i y and speci ici y o he o e all ELES sco e and pa- ien /con ol c i e ion. Resul s Desc ip i e Analysis o ELES i ems Skewness and ku osis a ied om 0.23 o 2.20 and om -0.29 o 4.08, espec i ely, ollowing he ac o s in he Eng- lish e sion o he scale. I em 13 o he h ea ac o had he mos skewness and ku osis. These esul s show ha i o he sco es on hese ac o s is adequa e in absolu e alues since hey a e below 2 o skewness and 7 o ku osis (Cu - an, Wes , & Finch, 1996). Cons uc alidi y Explo a o y Fac o Analysis o he ELES An EFA was done wi h he i s hal o he simple. The Ma dia es esul was 46.70 (p < .001). Pa allel analysis and eigen alue ecommended a h ee- ac o solu ion. The esul showed adequa e alues o he Kaise -Meye -Olkin es (KMO = .93) and Ba le 's s a is ic = 3472.1 (d = 105; p < .001). This solu ion explains 63.57% o he a iance. The ac- o s a e simila o hose ound by Gilbe e al. (2003), so hey ha e he same names as in he o iginal e sion o he scale. Table 2 shows he ac o solu ion ound. The i s ac o explained he highes pe cen age o a iance (46.3%), and co esponds in la ge pa o he o iginal “submission” ac o , excep o I em 4, which in Gilbe ’s o iginal sa u a es on he h ea ac o . The second ac o g oups all o he i ems in he o iginal “de alua ion” ac o . The hi d ac o g oups he same i ems in he “ h ea ” ac o . The co ela ions be ween ac o s a y om .541 o .607. The goodness o i indica o s we e adequa e CFI = .983, NNFI = .97, GFI = .99, RMSEA = .072 (95% CI = .068-.080), RMSR = .027 (95% CI = .026- .026). Table 2. S uc u e ma ix om Explo a o y Fac o Analysis. I ems Fac o I Fac o II Fac o III 1. I o en had o gi e in o o he s a home. .797 5. I I didn’ do wha o he s wan ed I el I would be ejec ed. .635 2. I el on edge because I was unsu e i my pa en s migh ge ang y wi h me. .593 12. I o en had o go along wi h o he s e en when I did no wan o. .581 4. The e was li le I could do o con ol my pa en s’ ange once hey became ang y. .519 3. I a ely el my opinions ma e ed much. .501 10. I o en el subo dina e in my amily. .375 7. I el e y com o able and elaxed a ound my pa en s. .748 9. I el an equal membe o my amily. .678 6. I el able o asse mysel in my amily. .624 13. In o de o a oid ge ing hu I used o y o a oid my pa en s. .798 8. My pa en s could hu me i I did no be- ha e in he way hey wan ed. .787 E alua ion o ea ly li e expe iences: The ELES scale and i s clinical use 199 anales de psicología / annals o psychology, 2019, ol. 35, nº 2 (may) I ems Fac o I Fac o II Fac o III 14. The a mosphe e a home could suddenly become h ea ening o no ob ious ea- son. . .604 15. I expe ienced my pa en s as powe ul and o e whelming. .594 11. My pa en s exe ed con ol by h ea s and punishmen s. .573 FI - F II .541 F III .607 .566 No e: The bo om pa o he able co esponds o he co ela ions be ween he ac o s (FI: submission; FII: de alua ion; FIII: h ea ). Con i ma o y Fac o Analysis o he ELES To es he sui abili y o he EFA s uc u e, a CFA was done wi h he second g oup o pa icipan s. The 15 i ems on he ELES i o he h ee- ac o model wi h he ollowing goodness o i indica o s: Sa o a Ben le Scaled χ2(87) = 183.44, p < .001; NNFI = .99, GFI = .88, CFI = .99, RMSEA = .048 (95% CI = .038-.058), SRMR = .047. The inal model con aining he same numbe o i ems as he one by Gilbe e al. (2003) consis ed o se en i ems o he “submission” dimension (4, 12, 1, 5, 3, 2, 10), i e i ems o he “ h ea ” dimension (13, 14, 15, 11 y 8) and h ee o “de- alua ion” (6, 7, 9). I em 4 on Gilbe ’s o iginal scale e- mained in he submission ac o as no change was sugges ed by he modi ica ion indices. Figu e 1 shows he CFA wi h s anda dized ac o weigh s. A ac o ial in a iance es was ca ied ou ac oss gende . The gende in a iance es showed ha he con igu al in a i- ance model ac oss gende demons a ed accep able model i . The esul s o me ic in a iance analyses sugges ha he i em sco es can be meaning ully compa ed ac oss gende . The scala in a iance e ealed ha when cons aining i em weigh s and in e cep s, he e is in a iance ac oss men and women. The indings o his es showed ha he model i s he da a well (Table 3). Figu e 1. Model esul ing om Con i ma o y Fac o Analysis (FI: submission; F2: h ea ; F3: de alua ion). Table 3. Goodness o i s a is ics o es s o measu emen in a iance o he ELES scale ac oss gende Gende χ2 d CFI RMSEA (90 % CI) ΔCFI ΔRMSEA Con igu al in a iance1 621.22 176 .934 .051 [.047, .056] N/A N/A Me ic in a iance2 628.79 186 .935 .050 [.046, .054] .001 .001 Scala in a iance3 644.44 201 .935 .048 [.044, .052] .000 .002 No e. 1 Uncons ained model; 2 Equali y o ac o loading; 3 Equali y o ac o loading, ac o a iances/co- a iances. Con e gen alidi y o he ELES To examine con e gen alidi y, Pea son’s co ela ion coe icien s we e calcula ed wi h o he ins umen s (see Ta- ble 4). The h ee ELES ac o s co ela ed posi i ely and s a- is ically signi ican ly wi h he GHQ-28 subscales and wi h he sco es on he HARS and HRSD scales. The highes co - ela ions we e be ween ELES submission and GHQ-28 se- e e dep ession ( = .390), and de alua ion and se e e de- p ession ( = .371), while he lowes co ela ions we e h ea and anxie y ( = .185) and GHQ-28 insomnia and h ea and social dys unc ion ( = .140) on he GHQ-28. Disc iminan alidi y o he ELES As he ELES scale ac o s we e signi ican ly co ela ed wi h each o he (p < .01): submission- h ea , .718; submis- sion-de alua ion, .608; h ea -de alua ion, .592, he h ee ac- o s ep esen ing di e en ia ed cons uc s we e e i ied, since he con idence in e als did no con ain 1: submission- h ea , .820-.940; submission-de alua ion, .710-.830; h ea - de alua ion, .704-.876. 200 Ma ía de G acia León-Palacios e al. anales de psicología / annals o psychology, 2019, ol. 35, nº 2 (may) Table 4. Co ela ions o ELES, GHQ-28 and HADS subscales. SOM AN DS DEP HA HD SUM .316** .306** .255** .390** .352** .344** AME .234** .185** .140* .268** .300** .326** DES .257** .252** .257** .371** .329** .357** SUM: submission; AME: h ea ; DES: de alua ion; SOM: soma ic symp oms; AN: anxie y and insomnia; DS: social dys unc ion; DEP: se e e dep ession; HA: HADS anxie y; HD: HADS dep ession. ** p < .01 ( wo- ailed) * p < .05 ( wo- ailed) Reliabili y o he ELES In e nal consis ency o he ELES was analyzed wi h he o dinal alpha, which esul ed in α = .86 o submission, α = .81 o de alua ion and α = .90 o he h ea ac o . Fo empo al s abili y, es - e es co ela ion coe icien s ound we e .90 o e a pe iod o one mon h o a sample o 292 pa icipan s (78.8% women), M = 21.68 yea s (SD = 4.68), ange 18 o 56 yea s o age. As a inal summa y, Table 5 shows he indices o he e- liabili y and con e gen alidi y s udy o he ins umen o he h ee- ac o model. We ound ha he Combined Relia- bili y (CR) alues o submission, h ea and de alua ion we e o e .7, and he e o e, he h ee ac o s ha e adequa e in e nal consis ency. Fu he mo e, he A e age Va iance Ex- ac ed (AVE) was o e .5 o he h ea and de alua ion ac- o s, while submission was sligh ly lowe . Con e gen alidi y ound o h ea and de alua ion was he e o e adequa e wi h CR>AVE, AVE> .05 (Fo nell & La cke , 1981). Table 5. Validi y and eliabili y coe icien s o he h ee- ac o ELES model. CR AVE MSV Reliabili y CR> .7 Con e gen Reliabili y CR>AVE, AVE> .5 SUBMISSION .846 .440 .693 ✓ X THREAT .873 .580 .692 ✓ ✓ DEVALUATION .808 .587 .554 ✓ ✓ Calcula ion o he ROC cu e The Recei e Ope a ing Cha ac e is ic cu e (ROC) was ca ied ou o he whole sample and o he o e all ELES sco e, aking he pa ien /con ol condi ion as he c i e ion. The esul s show ha he a ea unde he cu e was .756 (p < .0001), o a con idence in e al (CI) o .705-.808, wi h a sensi i i y o 70% and speci ici y o 71% o a cu o poin o 32.5. Discussion The main pu pose o his s udy was o adap he Ea ly Li e Expe iences Scale (ELES) o Spanish. I s ac o s uc u e was analyzed by c oss- alida ion, con e gen and disc iminan alidi y indica o s and by inding indica o s o he ins u- men ’s eliabili y. In he i s place, ou da a con i m he ac o s uc u e o he o iginal e sion by Gilbe e al. (2003) inding a simila model wi h he h ee ac o s, submission, h ea and de alua- ion. This solu ion explained 66.31% o he a iance. The e- sul s o he inal model was comp ised o he same numbe o i ems as in he o iginal s udy. The inal model consis ed o se en i ems o he “submission” dimension, i e i ems o he “ h ea ” dimension and h ee o “de alua ion”. The e- o e, as p edic ed, his eplica ion o he ac o s uc u e shows ELES cons uc alidi y o hese h ee ac o s. The analysis o measu emen in a iance showed ha he ac o ial s uc u e, he ela ionship be ween he i ems and hei co e- sponding ac o a e in a ian ac oss gende , which shows ha he ELES scale is a concep ually app op ia e measu e ha does no gene a e skewed in e p e a ion be ween men and women. In he second place, esul s o con e gen alidi y show ela ionships be ween he measu es o dep ession and anxie- y, especially o he submission and de alua ion ac o s. The ela ionship be ween submission and p esence o soma ic symp oms and de alua ion wi h social dys unc ion a e also s ong, and all o hem a e heo e ically cohe en . Fu he - mo e, he ac o s on he ELES scale we e co ela ed wi h each o he al hough disc iminan alidi y was ound. The Spanish e sion o he ELES shows in e nal con- sis ency, e es eliabili y and combined eliabili y indices ad- equa e o use wi h gua an ees simila o he o iginal e sion. Finally, his ins umen showed adequa e sensi i i y and speci ici y, conside ing he gene al pa ien condi ion, wi hou di e en ia ing diagnosis ype. This ins umen may be e y ele an in he s udy o ea - ly expe iences and hei ole in psychopa hological mani es- a ions. Fo example, he h ea ac o has been ela ed o dysmo phic body diso de (Veale & Gilbe , 2014) and he p esence o psychosis (B aehle , Ha pe , & Gilbe , 2012). I has been epo ed ha pe cei ed loss o social posi ion, shame, nega i e social iden i y and ea o s igma p o ide a pa hway o social anxie y o appea in i s psycho ic epi- sodes (Bi chwood e al., 2007). The submission ac o has been associa ed wi h he p esence o psychosis and dep es- sion (Gilbe e al., 2001; 2002). The ela ionship be ween eelings o shame, pe cei ed social Rank and umina ion in dep ession was explo ed (Cheung e al., 2004), inding ha E alua ion o ea ly li e expe iences: The ELES scale and i s clinical use 201 anales de psicología / annals o psychology, 2019, ol. 35, nº 2 (may) social Rank and shame we e highly ela ed, ha bo h co e- la ed wi h umina ion and ha his pa ially media ed be- ween shame and dep ession. The submission and h ea ac o ha e also been associ- a ed wi h pa anoia (Pin o-Gou eia e al., 2014), inding ha pa anoid hinking is closely ela ed o social anxie y, in he con ex o in e p e a ions o male olence and when a ilia- i e emo ions a e cons ained (Gilbe , Boxall, Cheung, & I ons, 2005; Mills, Gilbe , Bellew, McEwan, & Gale, 2007). Di e ences in gende ha e been ound, whe e women ha e highe sco es in social anxie y, submissi e beha io and low social powe (Gilbe e al., 2005). An associa ion be ween submissi e beha io and ea ing diso de s has been ound (Ca di e al., 2014), and i has been demons a ed ha indi iduals wi h ano exia and bulimia ne - osa seem o ha e highe le els o o e all in e nal shame han pa ien s wi h anxie y o dep ession (G abho n, S enne , Kau bold, O e beck, & S angie , 2005). Finally, he de alua ion ac o could ha e a ele an ole in ea ing diso de s. I has been epo ed ha a i udes owa d ea ing and anxie y abou appea ance a e associa ed wi h al- ua ions o in e io i y, eelings o insecu i y and ea o loss in in e pe sonal ela ions (Bellew, Gilbe , Mills, McEwan, & Gale, 2006). I is also possible ha his ac o spans a mo e a ilia i e o emo ional secu i y dimension (in he sense o loss) and he e o e mo e ela ed o wa m h (Gilbe e al., 2003). Summa izing, he s udy o ea ly in e pe sonal ela ion- ships wi h pa en s may equi e wo app oaches: on one hand, a achmen may ha e o do wi h a ilia i e suppo in which pe sons a e less ulne able o eco e mo e easily om p oblems i he bond is secu e (Gilbe e al., 2007). This ap- p oach may ha e o do wi h he s udy o he need o p o- ec ion, secu i y o calmness (and he e o e wi h pa icipa- ion o he opioid sys em and oxy ocin). Bu his pe spec i e is incomple e wi hou s udying he sea ch o s a us, espec and esou ces (social anking), whe e mo i a ion o success and ac i a ion (and he e o e ela ed o monoamines such as dopamine), bu which cause condi ions o ulne abili y when s a us is h ea ened o de ensi e esponses such as submis- si e beha io a e equi ed (Ca alho e al., 2013). These condi ions may appea wi h pa en s o in o he si ua ions (e.g., bullying, abuse, e c.) (Ca di e al., 2014). We conclude by a i ming ha he Spanish e sion o he ELES is a eliable, alid ins umen o e alua ing he memo y o h ea and subo dina ion pe cei ed du ing child- hood in amily ela ions and can be use ul in cons uc ing explana o y models in he s udy o a ious psychopa hologi- cal mani es a ions. On he o he hand, he analysis ac oss gende in a iance showed ha he ELES scale can be used wi h men and women indis inc ly. This ou pu may allow o analyze ca e ully a iables ha can be ele an o he gende in e ms o he ela ionships wi h he p ogeni o s, o exam- ple, in condi ions o abuse wi hou he gende skew in he measu ing ool i sel . In he u u e i would be o in e es o widen he s udies on ea ly expe iences and he a ious emo- ional s a es in an a emp o es ablish p edic i e and media- ion models, as well as pa o e alua ion p io o applica ion o Compassion Focused The apy (Gilbe , 2014), used in a ious psychological al e a ions. This s udy had some limi a ions which should be kep in mind. Fi s , i is a c oss-sec ional s udy, and he e o e, wi h no ollow-up o pa icipan s. The sel - epo measu es used in ol e sou ces o e o such as esponse endencies, social desi abili y o memo y dis o ion, as he a he back in ime he in o ma ion eques ed o he subjec is, he g ea e he likelihood o o ge ing. Ce ain emo ional al e a ions, such as dep essi e o dissocia i e s a es, could also lead o memo y al e a ions and biases. The e o e, as he ELES is a es which e alua es amily ela ionships, including he pe - cep ion o wha hey we e like in he pas , i would be ec- ommendable o include con ols o he a iables ha could al e memo y. Finally, i is o in e es o be able o s udy he psychome ic p ope ies o he ELES wi h la ge speci ic samples o he clinical popula ion, which enable a ac o analysis o ind ou whe he he unde lying h ee- ac o s uc u e emains in di - e en subg oups o clinical subjec s. Re e ences Akin, A., Uysal, R., & Çi emel, N. (2013). Çocukluk Deneyimle i Ölçeğinin Tü kçeye uya lanması. 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