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We report on the development of the Italian translation of the Schedule for Nonadaptive and Adaptive Personality-2 (SNAP-2). First, correspondence of the English and Italian versions was established through both the backtranslation method and administering both versions to a sample of 50 English-Italian bilingual participants. The translation's psychometric properties were evaluated in 837 Italian community-dwelling adults (Sample 1) and 429 Italian psychiatric adults (Sample 2). The Italian SNAP-2 trait scales had adequate internal-consistency reliability and 6-month temporal stability in a sub-group (n = 97) of Sample 1 participants. The three-component factor structure of the 15 SNAP-2 trait scales replicated in both samples (median comparability coefficient =.96). The SNAP-2 trait scales in their Italian translation showed adequate nomological network validity with respect to Five Factor Model trait measures, self-reports and interview ratings of DSM-IV Axis II/DSM-5 Section II personality disorders and DSM-5 Section III dysfunctional personality domains. [ABSTRACT FROM AUTHOR]

Personality disorders are a highly prevalent mental health condition. Historically, clinician attitudes have been negative, and only a small number have specialised training. This study evaluated clinician attitudes and confidence in working with people with personality disorder following the combination of training and implementation of a stepped care whole‐of‐service approach. A total of 102 multidisciplinary mental health clinicians were trained to implement the stepped care approach, and completed surveys prior to implementation and at 12 months follow up. Clinicians delivered manualised structured psychological therapy as part of the model. Measures assessed changes in attitudes and confidence, and impact of the service changes and therapy approach. Qualitative responses elucidated core themes. Evaluation at 12 months post training and service redesign showed improvements in clinician skills, confidence, theoretical knowledge and attitudes. Qualitative thematic analysis found core themes of improved understanding, clinical skills and improvements in the accessibility and timeliness of treatment. Implementing a whole‐of‐service model featuring stepped care therapies enhanced clinician attitudes, confidence, skills and knowledge in working with people with personality disorders. Clinicians identified that the whole‐of‐service model also improved accessibility to treatment, and quality of clinical care to the consumer and their carers. [ABSTRACT FROM AUTHOR]

Offenders with personality disorder cause disproportionate harm to society and pose significant challenges for those responsible for their care and rehabilitation. Personality disorders are heterogeneous in terms of symptoms, as well as their pathways to offending behaviour. Thus, there is limited evidence regarding effective interventions. One solution might be to focus on how interventions are delivered as well as what is delivered. Within the non‐offender personality disorder literature, the identification of potential mediators of change has enabled interventions to focus on 'how' they are delivered (e.g., therapeutic alliance) rather than the intervention itself. We explore the evidence and present a scoping review of the available literature on the mechanisms of change in psychological treatments for offenders with personality disorder. Only one study was found in the scoping review, highlighting a significant gap in the evidence base. We discuss the implications of this finding and potential future directions. [ABSTRACT FROM AUTHOR]

Background: Schema therapy is effective for most outpatients with personality disorders (PDs). However, a subgroup does not sufficiently benefit from outpatient programmes. Despite its common clinical use, a thorough evaluation of day treatment group schema therapy (GST) is lacking. Aims: This study aimed to investigate the effectiveness of day treatment GST for patients with PDs. Methods and Procedures: Negative core beliefs were the primary outcome in a multiple baseline single‐case design, measured weekly before and during 30 weeks of day treatment GST. Secondary outcomes included severity of primary PD, early maladaptive schemas (EMS), schema modes and general psychopathology measured before and after day treatment GST. Intervention effects were evaluated through visual inspection and randomization test analysis, with a reliable change index calculated for the secondary outcome measures. Outcomes and Results: A total of 79% of treatment completers showed a significant positive effect of day treatment GST with large effect sizes (Cohen's d: 0.96–10.04). Secondary outcomes supported these findings: 56% had a significant decrease in the severity of primary PD and 53% in general psychopathology. In addition, 63% of EMS and 72% of schema modes (87.5% for functional schema modes) showed significant positive reliable changes. Conclusions and Implications: This is the first empirical study that demonstrated the effectiveness of day treatment GST in patients with severe PDs. Day treatment GST can serve as a stepped care treatment option for nonresponsive patients in outpatient programmes. Further randomized controlled (cost‐)effectiveness research is necessary to substantiate these findings and investigate the specific patient populations for which day treatment is essential. [ABSTRACT FROM AUTHOR]

Enhancing personal recovery in persons with personality disorders is an important but understudied topic. Guided by the framework for developing and evaluating complex interventions of the U.K. Medical Research Council, this study follows a qualitative approach with the first aim of using the best scientific, professional, and client expertise to design a narrative intervention aiming for personal recovery in persons with personality disorders. The second aim was to assess the feasibility of the intervention in a practice setting before an effectiveness study can be conducted. The prototype included a 12-week intervention "An Empowering Story" consisting of weekly group sessions with homework and a life story book as final product. Both studies show that the overall aim and structure of the intervention are highly appreciated by professionals as well as clients. The preliminary findings pave the way to examine the effectiveness of "An Empowering Story" in a controlled study. Public Significance Statement: The present study suggests that a 12-week group narrative intervention may be helpful in enhancing personal recovery in individuals with personality disorders. Writing assignments support the exploration of new perspectives on their lives, which are shared within the group and documented in a digital application to print a unique life story book. Both patients and clinicians appreciate the intervention, which is especially appropriate during the last part of a psychotherapeutic treatment. [ABSTRACT FROM AUTHOR]

Accessible Summary: What the paper adds to existing knowledge?: Personality disorder is a serious mental health condition affecting up to 52% of psychiatric outpatients and 70% of inpatients and forensic patients. People with a diagnosis of personality disorder have higher morbidity and mortality than those without.Service users and carers reported a lack of training for staff in the management of individuals with a diagnosis of personality disorder, particularly with regard to self‐harm and suicidal behaviours.Staff burnout creates barriers to compassionate person‐centred care for individuals with a diagnosis of personality disorder as staff struggled to accommodate the nature of the presentation when under significant emotional, psychological and professional strain caused by understaffing and lack of support. What are the implications for practice?: This paper adds new knowledge by informing services of ways to improve care provision from the perspectives of both carers and service users.A more holistic and less medicalised approach to the treatment of problems associated with a diagnosis of a personality disorder should be adopted, and personality disorder training introduced for all healthcare practitioners, to improve patient outcomes. Introduction: There is limited understanding of the experience of people with complex mental health (CMH) needs, including those with a diagnosis of personality disorder (PD) and carers of those individuals. Little is known about carers of those in inpatient forensic settings, yet it has been identified that they may have additional needs when compared to general carers. Research highlights that community carer support services were perceived as inadequate and out‐of‐area placements were described as putting an added strain on ability to support loved ones. Understanding PD within a population of people with CMH needs and how a diagnosis described as PD impacts on care and treatment experience is vital to providing high‐quality care. Aim: To evaluate the care experience of service users and carers with lived experience of a diagnosis of PD and out‐of‐area placements. Method: Semi‐structured interviews were conducted with six service users and four carers to explore the experiences and perspectives of people with a diagnosis of PD. Interviews were audio recorded and thematically analysed. Results: Four interrelated themes were developed; Influence of a diagnosis of PD on Staff, Early and Appropriate Intervention, Recognition of the Individual and Training and Knowledge of people with a diagnosis of PD. Discussion: Anti‐stigma interventions for staff, research on care provision and structural changes to services including more evidence‐based therapy for individuals with a diagnosis of PD may help reduce disparate treatment and improve prognosis for recovery. Implications for Practice: This paper informs services of ways to improve care provision from the perspective of carers and service users. A more holistic and less medicalised approach to the treatment of problems associated with diagnoses of PD should be adopted, and PD training for all healthcare practitioners to improve patient outcomes. [ABSTRACT FROM AUTHOR]

There is a lack of studies that have prospectively examined adverse childhood experiences (ACEs) in association with a personality disorder (PD). Data from a sample of 8,199 adolescents first assessed for ACEs were linked with subsequent data from the Norwegian Patient Register in order to obtain diagnoses of a PD in adulthood (after a 14-year follow-up). We used logistic regression analysis. Any type of ACE gave a 3.8-fold higher risk of developing a PD. Abuse, more specifically emotional abuse, came out as one of the strongest predictors. Of the adolescents who developed a PD, approximately 90% had a history of ACE. The results of this study support the importance of assessing ACEs, such as abuse, neglect, and household dysfunction, in the diagnostic procedure and treatment for PD. [ABSTRACT FROM AUTHOR]

Poor quality sleep is common for people who have a diagnosis of personality disorder (PD). Core cognitive and behavioral features of PD may cause and perpetuate poor sleep, but to date, no review has collated the evidence on the efficacy of interventions to improve sleep quality for people with PD. Structured searches for interventional studies among adults with PD and reporting validated measures of sleep quality were conducted up to November 2022 in multiple databases. Single‐case reports were excluded. Study quality was assessed with standardized risk of bias tools. Unreported data was sought systematically from authors. This review was pre‐registered with an international prospective register of systematic reviews (PROSPERO) (CRD42021282105). Of the 3503 identified studies, nine met inclusion criteria, representing a range of psychological, pharmaceutical, and other interventions and outcome measures. Meta‐analytic methods were not feasible because of the serious risk of bias in all studies, and results were therefore synthesized narratively. There is limited and low‐quality evidence of the effects of a variety of interventions to improve the sleep quality of people living with PD. Further research might consider specifically including people diagnosed with PD in trials of sleep interventions and using sleep outcome measures in trials of established PD treatments. [ABSTRACT FROM AUTHOR]

This study investigated the effectiveness of brief individual experiential schema therapy (ST) in 12 adult outpatients with cluster C personality disorders (PD) using randomised multiple baseline design. Waitlist period was followed by five explorative sessions, 18 experiential ST sessions, two treatment follow‐up (FU) booster sessions and a 6‐month FU assessment. Overall well‐being (ORS), behavioural treatment goals and negative core beliefs were assessed 60–91 times, global symptomatic distress (BSI) six times. PD severity (SCID‐5‐PD) was pre‐post‐analysed. Randomisation and non‐parametric tests showed large significant effects (d = 1.08–2.38, r =.53–.66) on all outcomes at treatment‐FU and 6‐month FU assessment. This is the first study providing preliminary evidence of effectiveness of brief individual experiential ST for patients with cluster C PD, tentatively challenging the common tenet that long treatment duration is required. Due to limitations, replication is recommended. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to analyse personality disorders among patients in the early phase of psychotherapy as a source of variance in the quality of the emerging alliance. Methods: The sample consisted of 131 individual psychotherapy patients with borderline (BPD), narcissistic (NPD), dependent (DPD) and obsessive–compulsive (OCPD) personality disorders and 131 psychotherapists. Different sources of alliance estimation were included. Therapeutic alliance was operationalized on several dimensions. The hypothesis was tested using an independent samples one‐way analysis of variance. Results: The study revealed a significant effect of personality disorder type on early therapeutic alliance quality. BPD patients rated their early alliance the lowest compared to NPD, DPD and OCPD patients. This trend was dominant and replicated regardless of who rated the alliance and which dimension of alliance was estimated. Conclusions: NPD, DPD and OCPD patients have better initial therapeutic alliances than BPD patients, and their alliances do not differ significantly. BPD patients build weaker alliances, and what poses a challenge for them is not only developing a strong and close bond but also conceptualizing goals and reaching agreement on tasks. [ABSTRACT FROM AUTHOR]

Bibliotherapy is used as a low-cost, non-pharmacological intervention in the treatment of many mental disorders. This study aimed to investigate the effect of cognitive bibliotherapy on personality traits of psychopathic disorder in delinquent adolescents. This research was a quasi-experimental study with a pre-test and posttest design and experimental and control groups. The study's statistical population consisted of all 160 male adolescents at the Tehran Correctional Center, and the samples consisted of 30 persons with psychopathic personalities. They were selected by purposive sampling. After the bibliotherapy and poetry therapy intervention, there was a significant difference in the overall score of psychopathic traits between the experimental and control groups favoring the experimental group (P = 0.001). The findings showed that bibliotherapy and poetry therapy intervention reduced personality traits of psychopathy in delinquent adolescents, thus it can be concluded that bibliotherapy effectively reduces and improves the traits that constitute a psychopathic disorder. [ABSTRACT FROM AUTHOR]

Background: Group schema therapy (GST) is increasingly popular as a treatment for personality disorders (PDs), including Cluster‐C PDs. Individual ST has proven to be effective for Cluster‐C PD patients, while the evidence for GST is limited. This study aimed to investigate the effectiveness of GST for Cluster‐C PD. Moreover, differences between the specific Cluster‐C PDs (avoidant PD, dependent PD and obsessive‐compulsive PD) were explored. Methods: A multicentre open trial was conducted, including 137 patients with a Cluster‐C PD (avoidant PD: n = 107, dependent PD: n = 11 and obsessive‐compulsive PD: n = 19). Patients received 30 weekly GST sessions with a maximum of 180 min of individual ST and five optional monthly booster sessions. Outcome measures including Cluster‐C PD severity, general psychopathological symptoms, quality of life, functional impairment, happiness, PD‐related beliefs, self‐esteem, self‐ideal discrepancy, schemas and schema modes were assessed at baseline until 2‐year follow‐up with semi‐structured interviews and self‐report measures. Change over time and differences between the specific Cluster‐C PDs were analysed with mixed regression analyses. Results: The outcome measures showed significant improvements for all Cluster‐C PDs, with medium to large effect sizes after 2 years. A treatment dropout rate of 11.7% was found. There were some indications for differences between the Cluster‐C PDs in severity at baseline, change trajectories and effectiveness of GST. Conclusions: This study demonstrated that GST is a promising treatment for Cluster‐C PDs. The following step is a randomized controlled trial to further document the (cost‐)effectiveness of GST. [ABSTRACT FROM AUTHOR]

An editorial is presented expressing views on the challenges in evaluating the efficacy and effectiveness of treatments for personality disorders. Topics include the historical legacy of randomized controlled trials, specific problems in choosing control interventions for psychological treatments, the importance of testing precisely framed questions, challenges in establishing a standard set of patient-reported outcomes,and the difficulties in recruiting representative populations.

Background: Italy can be viewed as a laboratory to assess the quality of mental healthcare delivered in a community-oriented system, especially for severe mental disorders, such as personality disorders. Although initiatives based on clinical indicators for assessing the quality of mental healthcare have been developed by transnational-organisations, there is still no widespread practice of measuring the quality of care pathways delivered to patients with severe mental disorders in a community-oriented system, especially using administrative healthcare databases. The aim of the study is to evaluate the quality of care delivered to patients with personality disorders taken-in-care by mental health services of four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily). Methods: A set of thirty-three clinical indicators, concerning accessibility, appropriateness, continuity, and safety of care, was implemented using regional healthcare utilization databases, containing data on mental health treatments and diagnosis, hospital admissions, outpatient interventions and exams and drug prescriptions. RESULTS: 31,688 prevalent patients with personality disorders treated in 2015 were identified, of whom 2,331 newly taken-in-care. One-in-10 patients received a standardized assessment, the treatment discontinuity affected half of the cases. 12.7% of prevalent patients received at least one hospitalization, 10.6% in the newly taken-in-care cohort. 6-out-of-10 patients had contact with community-services within 14 days from hospital discharge. Access to psychotherapy and psychoeducational treatments was low and delivered with a low intensity. The median of psychosocial interventions per person-year was 19.1 and 9.4, respectively, in prevalent and newly taken-in-care cases. Nearly 50% of patients received pharmacological treatments. Conclusions: Healthcare utilization databases were used to systematically evaluate and assess service delivery across regional mental health systems; suggesting that in Italy the public mental health services provide to individuals with personality disorders suboptimal treatment paths. [ABSTRACT FROM AUTHOR]

Purpose: The UK Mental Health Act (MHA) Reform (2021) on race and ethnicity promotes new governmental strategies to tackle inequalities faced by ethnically racialised communities detained under the MHA. However, there is a scarcity in personality disorder and ethnicity research. This study aims to investigate what is available in the UK in relation to prevalence, aetiology and treatment provisions of personality disorder for ethnically diverse patients, and to understand their interconnectedness with mental health and criminal justice service provisions. Three key areas of investigations were reviewed, (1) UK prevalence of personality disorder amongst ethnically diverse individuals; (2) aetiology of personality disorder and ethnicity; (3) treatment provisions for ethnically diverse individuals diagnosed with personality disorder. Design/methodology/approach: A scoping study review involved a comprehensive scanning of literature published between 2003 and 2022. Screening and data extraction tools were co-produced by an ethnically diverse research team, including people with lived experience of mental health and occupational expertise. Collaborative work was complete throughout the review, ensuring the research remained valid and reliable. Findings: Ten papers were included. Results demonstrated an evident gap in the literature. Of these, nine papers discussed their prevalence, three papers informed on treatment provisions and only one made reference to aetiology. This review further supports the notion that personality disorder is under-represented within ethnic minority populations, particularly of African, Caribbean and British heritage, however, the reasons for this are multi-facetted and complex, hence, requiring further investigation. The evidence collected relating to treatment provisions of personality disorder was limited and of low quality to reach a clear conclusion on effective treatments for ethnically diverse patients. Originality/value: The shortage of findings on prevalence, aetiology and treatment provisions, emphasises the need to prioritise further research in this area. Results provide valuable insights into this limited body of knowledge from a UK perspective. [ABSTRACT FROM AUTHOR]

Trust is central to successful therapeutic work with adolescents, but establishing trust can be challenging, especially with adolescents with personality disorders. We present our understanding of trust in working with adolescents with and without personality disorders. We draw on complementary and overlapping perspectives, namely the attachment model, Kernberg's object relations model, and Fonagy's mentalization model. In Kernberg's object relations conceptualization, difficulties in trust experienced by patients with borderline personality disorders result from paranoia associated with splitting and identity diffusion. In Fonagy's mentalization model, epistemic trust is rooted in early experiences of being responded to and understood. We outline how techniques used in transference-focused psychotherapy for adolescents promote the development of the adolescent's capacity to trust by facilitating identity integration, thus reducing paranoia. Finally, we use two clinical case illustrations to demonstrate how trust unfolds in working with adolescents with and without personality disorders. [ABSTRACT FROM AUTHOR]

Purpose: Although schema therapy has been predominantly applied to treat personality disorders, interest into its application in other clinical disorders is growing. Central to schema therapy are Early Maladaptive Schemas (EMS) and Schema Modes. Since existing EMS and Schema Modes were primarily developed in the context of personality disorders, their relevance for clinical disorders is unclear. Methods: We conducted a systematic review of the presence of EMS and Schema Modes in clinical disorders according to DSM criteria. Per disorder, we evaluated which EMS and Schema Modes were more pronounced in comparison with clinical as well as non‐clinical control groups and which EMS and Schema Modes were most highly endorsed within the disorder. Results: Although evidence concerning EMS was scarce for several disorders, and only few studies on Schema Modes survived inclusion criteria, we identified meaningful relationships and patterns for EMS and Schema Modes in various clinical disorders. Conclusions: The present review highlights the relevance of EMS and Schema Modes for clinical disorders beyond personality disorders. Depending on the theme of the representation, EMS act as vulnerabilities both across diagnoses and for specific disorders. Thus, EMS and resulting Schema Modes are potential, valuable targets for the prevention and treatment of clinical disorders. [ABSTRACT FROM AUTHOR]

Different views exist regarding the nature of patients' dependency in psychotherapy (trait versus contextual dependency), and its impact on treatment outcome and duration. Therefore we examined whether patients' levels of care dependency changed over time during a 9-month treatment period, and whether care dependency was related to symptom reduction and patients' wish for treatment continuation at the end of the treatment. Participants in this longitudinal study were 113 patients (Mage = 33.6, 78% female) with personality disorders receiving inpatient or daycare group psychotherapy. Both increases and decreases on different aspects of care dependency were found over the course of treatment. Decreases in dependency were related to larger symptom reduction, and higher levels of care dependency, especially patients' lack of perceived alternative options for the current treatment, were related to patients' stronger wish to continue their treatment. Changes in care dependency during treatment mainly supports the contextual view on patients' care dependency, and decreasing levels of dependency may have beneficial treatment effects. However, dependency may also lead to prolonged treatment duration. Clinical implications for therapists are presented. [ABSTRACT FROM AUTHOR]

Background: One in five adults in the US experience mental illness and over half of these adults do not receive treatment. In addition to the access gap, few innovations have been reported for ensuring the right level of mental healthcare service is available at the right time for individual patients. Methods: Historical observational clinical data was leveraged from a virtual healthcare system. We conceptualize mental healthcare services themselves as therapeutic interventions and develop a prototype computational framework to estimate their potential longitudinal impacts on depressive symptom severity, which is then used to assess new treatment schedules and delivered to clinicians via a dashboard. We operationally define this process as "session dosing": 497 patients who started treatment with severe symptoms of depression between November 2020 and October 2021 were used for modeling. Subsequently, 22 mental health providers participated in a 5-week clinical quality improvement (QI) pilot, where they utilized the prototype dashboard in treatment planning with 126 patients. Results: The developed framework was able to resolve patient symptom fluctuations from their treatment schedules: 77% of the modeling dataset fit criteria for using the individual fits for subsequent clinical planning where five anecdotal profile types were identified that presented different clinical opportunities. Based on initial quality thresholds for model fits, 88% of those individuals were identified as adequate for session optimization planning using the developed dashboard, while 12% supported more thorough treatment planning (e.g. different treatment modalities). In the clinical pilot, 90% of clinicians reported using the dashboard a few times or more per member. Although most clinicians (67.5%) either rarely or never used the dashboard to change session types, numerous other discussions were enabled, and opportunities for automating session recommendations were identified. Conclusions: It is possible to model and identify the extent to which mental healthcare services can resolve depressive symptom severity fluctuations. Implementation of one such prototype framework in a real-world clinic represents an advancement in mental healthcare treatment planning; however, investigations to assess which clinical endpoints are impacted by this technology, and the best way to incorporate such frameworks into clinical workflows, are needed and are actively being pursued. [ABSTRACT FROM AUTHOR]

Objective: Heightened sensitivity toward social rejection has been implicated in eating disorders (ED) and personality disorder (PD). This study examined the effect of a cognitive bias modification training (CBM‐I) targeting the interpretation of ambiguous social situations in individuals with comorbid ED and PD. Method: A total of 128 participants [33 with ED and PD, 22 with ED‐only, 22 with PD‐only, and 51 healthy controls (HC)] were recruited from a hospital and university settings, and included in the final analyses. The participants were randomly assigned to a CBM‐I task with benign resolutions or a control task with neutral resolutions in a counterbalanced order in two sessions using a within‐subject design. Interpretation bias toward social stimuli was measured using the ambiguous sentence completion task before and after completing the assigned task. Results: The CBM‐I task increased benign and decreased negative interpretations with large effect sizes in the diagnostic groups, and with a moderate effect size in the HC group. Participants' anxiety levels were also reduced after the task. The size of the change in negative interpretation was positively associated with baseline negative affect, and negatively associated with baseline positive affect. Discussion: The results suggest that modifying interpretation bias has the potential as a transdiagnostic target of treatment for ED and PD, and a fully powered clinical trial with consecutive sessions would be warranted. Public Significance: Participants with eating disorders and/or personality disorder, and healthy controls completed a single session of a cognitive training intervention targeting rejection sensitivity. The training produced a large decrease in negative interpretation in the diagnostic groups, and a moderate effect in healthy controls. The findings indicate that training for positive processing of social information may be of value to augment treatment in conditions such as eating disorders and personality disorder, in which there are high levels of rejection sensitivity. [ABSTRACT FROM AUTHOR]

Objective: Personality disorders are serious psychiatric conditions, and some studies have examined neurofeedback training as a potential alternative treatment to improve cognitive and clinical symptoms in patients with such disorders. Here, we aimed to provide a first systematic review of such trials and present existing evidence regarding this treatment for individuals with personality disorders. Method: A systematic search of peer-reviewed English journal articles was conducted for this study to identify original studies on fMRI and EEG neurofeedback treatment protocols in patients with personality disorders up to January 2023. PubMed, Web of Science, ProQuest, Cochrane Library, and Google Scholar databases were queried through the keywords "neurofeedback," "biofeedback," and "personality disorder," as well as their related Mesh synonyms. Results: Totally, five studies were included in our systematic review. Two studies utilized EEG neurofeedback protocols, while three articles used real-time fMRI neurofeedback protocols. The types of studies were non-randomized, not-blinded case reports, case series, and single-arm trials with a high risk of bias. EEG neurofeedback protocols applied more training sessions and reported improvements in patients' neuropsychological and behavioral functions after treatment. Furthermore, fMRI-based neurofeedback studies reported neurophysiological changes, such as a shift in vmPFC-amygdala connectivity, towards healthy states following treatment. Moreover, behavioral symptoms of patients were reported to be improved after fMRI neurofeedback. Conclusion: Neurofeedback studies investigating this therapeutic technique for personality disorders are still very preliminary, and no strict conclusions can be drawn at this time. Therefore, further basic and clinical investigations are required to address several open methodological and technical questions and establish consensus and standardization, which will eventually lead to translational works. [ABSTRACT FROM AUTHOR]

The interpersonal personality theory and the schema therapy model proposed similar explanations for the development and maintenance of personality and interpersonal dysfunctions. They both emphasize that the fundamental needs of childhood are met within interpersonal relationships, and that unsatisfactory relational experiences in early years can lead to interpersonal problems in adulthood. The present study conducted a circumplex analysis of early maladaptive schemas to examine their locations on the interpersonal circumplex. A community sample of Turkey consisting of 1056 adults with an age range of 18 to 77 participated in the study. Results indicated that interpersonal problems were most strongly associated with the schemas in disconnection and the impaired autonomy domain that were located on the hostile-submission quadrant. The exaggerated standards schema domain was located on the friendly-dominance, the other-directedness domain was located on the friendly-submission quadrant, and the impaired limits/entitlement schema was located on the dominance vector of the interpersonal circumplex. All schemas and schema domains were represented on the interpersonal circumplex, consistent with the schema therapy model's conceptualizations of interpersonal relationship patterns. Circumplex locations of early maladaptive schemas revealed their structural map on the interpersonal circumplex. The present findings provide cross-cultural validation of the schema therapy model and empirical support for its integration with interpersonal theory of personality. [ABSTRACT FROM AUTHOR]

Previous evidence showed significant discrepancies in psychiatric services utilization between migrants and reference populations. Our study aims were to evaluate incidence and characteristics of psychiatric hospitalizations of migrant patients compared with reference populations and to assess how the COVID-19 pandemic affected admissions. All patients admitted to the psychiatric ward "SPDC-Malpighi" of the Bologna Mental Health Department from 01/01/2018 to 31/12/2020 were included. Differences in sociodemographic and clinical characteristics were tested by migrant status. Incidence rate ratios of hospital admissions by migrant status were estimated via Poisson regression considering population-at-risk, gender, and age-group. Migrants had higher hospitalization rates due to any psychiatric disorder (IRR = 1.16). The risk was especially pronounced among women (IRR = 1.25) and within the youngest age-group (IRR = 3.24). Young migrants had also a greater risk of compulsory admission (IRR = 3.77). Regarding admissions due to a specific diagnosis, we found relevant differences in hospitalization rates for psychosis, mood disorders, and personality disorders. Finally, migrants were more likely to be admitted via Emergency Department and less likely to be referred from a specialist. During the year of pandemic (2020) we observed an increase in the proportion of migrants admitted voluntarily or compulsorily. Migrants, especially those from the youngest age-group, had higher hospitalization rates for any disorder. Younger migrants were also at higher risk of compulsory treatment. The distribution of psychiatric admissions during the pandemic period seemed to have further increased discrepancies in mental healthcare needs and provision between migrants and the reference population. Tailored interventions and policies are urgently needed to address this issue. [ABSTRACT FROM AUTHOR]

Background: To our knowledge, treatment of personality disorder (PD) comorbidity in autistic adults is understudied and is still in its infancy. We investigated the effectiveness of schema therapy (ST) for autistic adults with PD. Method: A multiple case series design with 12 adults (aged 19–62 years) was used with baseline, exploration, ST (with cognitive behavioural and experiential techniques) and follow‐up conditions. Participants rated dysfunctional core beliefs (primary outcome) weekly during baseline and treatment and monthly during follow‐up. Schema modes, general mental health symptoms, social responsiveness, PD traits and common Axis‐I mental disorders were assessed. Results: Mixed model analyses indicated significant effects of ST with medium to large effect sizes for dysfunctional core beliefs, functional schema modes, PD traits, general mental health symptoms and social responsiveness. Results remained stable during follow‐up. Conclusion: The results of this study indicate that ST might be effective in decreasing dysfunctional core beliefs, PD traits and general mental health symptoms and in increasing functional schema modes and social responsiveness. Improvements persisted over time. ST seems effective in treating PD in autistic individuals. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 had an immediate impact on the way Improving Access to Psychological Therapy (IAPT) services in the United Kingdom were delivered, requiring services to move to remote therapy. While remote therapy has been shown to be effective, little is known about the effects associated with moving to remote therapy delivered during COVID‐19 within IAPT services. Objective: The objective of the study was to assess the characteristics of those undergoing remote therapy and test the effects associated with the effect of remote delivery on anxiety and depression symptoms compared with in‐person therapy before lockdown. Methods: We conducted a retrospective, cross‐sectional benchmark comparison of remote therapy across four IAPT services in Greater Manchester. Routinely collected measures of anxiety (GAD‐7) and depression (PHQ‐9) were used to compare effects across the two time periods. A mixed‐effects model was conducted to assess within and between group changes in anxiety and depression, while controlling for pre‐specified confounders. Findings: Remote therapy did not appear to impact on service provision, with the number of sessions offered and attended being similar to those prior to COVID‐19. Both face‐to‐face (pre‐COVID‐19) and remote therapy (during COVID‐19) were associated with variable improvements in anxiety and depression with no significant difference between them. However, remote therapy was associated with a more rapid decrease in symptoms in comparison with face‐to‐face treatment. Mean improvement in symptoms was small and increased as number of sessions/time increased and analysis of rates of improvement indicated that both face‐to‐face and remote therapy might need more time to reach target cut‐off points on measures. Conclusions: Both face‐to‐face and remote therapies delivered under IAPT were associated with improvements in symptoms with no apparent difference apart from the finding that remote therapy was associated with more rapid change. Clinical Implications: Remote therapy delivery in IAPT does not appear to confer a disadvantage over face‐to‐face contact, but at a group mean level the magnitude of improvement associated with both treatments was small. Remote therapy provision may widen patient access to and engagement with psychological services. [ABSTRACT FROM AUTHOR]

Background & Aims: Personality disorder is a type of mental disorder in which a rigid and unhealthy pattern of thought, performance, and behavior is observed in a person. A person with a personality disorder has difficulty in understanding and communicating with situations and people. This causes significant problems and limitations in relationships, social activities, and understanding of diseases. The presence of personality disorders in sick people leads to the development of the disease and increases the level of stress and depression in patients. Among the diseases observed in patients suffering from personality disorders such as dual personality, the presence of stress, depression, harming themselves, scratching the skin, and causing self-inflicted wounds are mentioned. Personality disorders usually start in adolescence or early adulthood. There are different types of personality disorders. Some types may become less apparent during middle age. Types of personality disorders are classified into three clusters based on similar characteristics and symptoms. Many people with one personality disorder also have signs and symptoms of at least one other personality disorder. To diagnose a disorder, showing all signs and symptoms is unnecessary. Cluster A personality disorders are characterized by abnormal and unusual thinking or behavior. They include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Cluster B personality disorders are characterized by dramatic, overly emotional, or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder, and obsessivecompulsive personality disorder. There is increasing evidence about the negative impact of personality disorders on various physical, mental, and emotional aspects of healthy and sick people. Psychotherapy can help a person understand the effects of their behavior on others, learn to manage or cope with symptoms and reduce behaviors that cause problems in functioning and relationships. The type of treatment depends on the specific personality disorder, its severity, and the individual's condition. If personality disorders are not treated in people, the level of many diseases such as depression, cardiovascular diseases, and skin diseases will increase. Skin diseases are conditions that affect the skin. These diseases may cause rashes, inflammation, itching, or other skin changes. Some skin diseases may be genetic, while lifestyle and psychological factors such as severe obsessions and personality disorders may cause others. Both the skin and the central nervous system are derived from the ectoderm during embryogenesis. Their anatomicalfunctional relationship has been known for a long time. However, many aspects of this relationship are not fully understood. There are several studies that confirm the link between Dermatosis and mental illness. The findings of studies conducted in the field of psychiatry show that infectious-parasitic Dermatoses are the most common skin diseases in more than 70% of patients with mental disorders. The general explanation for this complication is that the physical condition of many mental patients decreases, which is associated with a decrease in immune defense and, as a result, an increase in sensitivity to skin infections. Considering the importance of skin diseases and the effect of personality disorders on this type of disease and the explanations provided, the question raised here is the relationship between personality disorders and skin diseases in various studies in the field of psychiatry. What results have been obtained and what requirements have been recommended regarding the reduction of this disease through psychotherapy? Methods: The current study is a review study that includes papers published in domestic and foreign journals available in SID, PubMed, Google Scholar, Magiran, Springer, Wiley, Web of Science (ISI), Scopus, Science direct, and ProQuest databases. The range of years 2020 to 2022 was used. Papers were searched using the keywords "acute skin diseases, skin diseases, personality disorders, mental disorders" and their English equivalents. As a result of the initial search of papers, there were 156 articles, of which 74 apapers remained in the screening stage, and at the end, 12 papers were subjected to content analysis. Results: This review study showed that personality and mental disorders have an effect on the development of skin diseases and controlling these disorders is considered as a solution to reduce the complications of skin diseases. Conclusion: In general, it can be concluded that in order to reduce the complications of skin diseases, paying attention to the personality and mental disorders of people can increase the patient's understanding of the disease and reduce the level of complications of this disease. Psychotherapy of the last century uses biological, psychological, and social factors at different levels significantly in the pathogenesis of each disease, through complex interactions in the treatment of diseases. There are many ontogenetic, anatomical, and functional connections between the skin, the psyche, and the immune system. These connections are the reason that Neuro-immunological mechanisms are often involved in the pathogenesis of Dermatoses. This is why skin diseases are classified as "paradigm" psychosomatic diseases. The skin is the only organ that is completely visible, and therefore the patient can always observe it closely. Patients are free to act on their ideas about pathogenic mechanisms. This means that, as mentioned above, clinicians, especially in the field of dermatology, must examine (and respect) patient disease models. However, skin lesions are visible not only to the patients themselves but often to other people as well. For example, patients with Dermatosis are often exposed to stigma: skin diseases may cause hatred or fear of contagion. Therefore, feelings such as embarrassment about one's illness, or disgust expressed by other people, may affect the patient's outlook on life. Some patients actually anticipate and experience imaginary stigma even in the case of minimal skin lesions. The fact that skin is very visible has also contributed to psychoanalytic theories and interpretations of psychoanalysts interested in psychosomatic medicine for skin diseases. [ABSTRACT FROM AUTHOR]

Introduction: Transference (meant in this context, as the patient relational patterns expressed towards the clinician) and therapeutic alliance play a crucial role in the treatment of personality pathology. To date, no empirical study examined the association between these two dimensions of the clinical relationship and patients' personality maladaptive traits in psychotherapy. Methods: A national sample of therapists (N = 100) of different theoretical orientations assessed dysfunctional personality features of a patient in their care using a comprehensive and empirically grounded dimensional diagnostic approach from the Shedler–Westen Assessment Procedure‐200 (SWAP‐200). Moreover, they filled in the Psychotherapy Relationship Questionnaire (PRQ) to identify interpersonal patterns expressed early in treatment by the patients and the Working Alliance Inventory (WAI‐T) to evaluate quality of therapeutic alliance. Results: Overall, the most severe and maladaptive dimensions of patients' personality were associated with more negative clinician–patient dynamics and poorer levels of therapeutic alliance in statistically significant and clinically relevant ways. Notably, the hostile transference was predicted by both SWAP Hostility and Psychopathy, whereas the SWAP Narcissism was the strongest predictor of the special/entitled transference. The latter was also predicted by SWAP Emotional Dysregulation; conversely, the SWAP Dysphoria was the most robust predictor of anxious/preoccupied pattern. The SWAP Schizoid Orientation and Psychopathy predicted avoidant/dismissing attachment pattern; moreover, they were strongly and negatively related to the SWAP Psychological Health that was the best predictor of positive transference and alliance. Conclusions: Findings support that therapists' careful understanding of patients' interpersonal ways during early treatment stages may meaningfully inform diagnostic and therapeutic processes. [ABSTRACT FROM AUTHOR]

Background: Personality traits may confer vulnerability to psychopathology. However, few studies have examined the association between personality traits and obsessive-compulsive disorder (OCD) course. The present study investigates personality traits, OCD symptom severity, and illness duration as a predictor of OCD remission.Methods: 166 treatment-seeking adults with OCD, recruited as part of the Brown Longitudinal Obsessive-Compulsive Study, completed the NEO Five-Factor Inventory 3 (NEO-FFI) and were in episode for OCD at time of NEO-FFI completion. Participants were followed for up to 3 years.Results: Results suggest individuals with OCD had a 21 % likelihood of reaching remission over the course of 3 years. Greater OCD symptom severity and longer illness duration were associated with a decreased likelihood of remission. Among the five factors of personality, only low extraversion was associated with a decreased rate of remission. Neuroticism, openness, agreeableness, and conscientiousness were not associated with remission.Limitations: As this was an observational study, treatment was not controlled precluding examination of treatment on course. Further, data collected on age of onset and symptom severity during follow up were retrospective and therefore are also subject to recall bias.Conclusions: Our findings provide preliminary support that personality traits are potential factors impacting course and symptom presentation. Future research is necessary to determine the mechanisms in which personality traits may influence the presentation and course of OCD. [ABSTRACT FROM AUTHOR]

Following the introduction of the 11th revision of the International Classification of Diseases (ICD-11), adolescents can now be diagnosed with a personality disorder based on severity ranging from mild to moderate to severe. This dimensional model has potential implications for treatment, as it allows clinicians and researchers to search for effective treatments targeting adolescents at different severity levels rather than offering all patients the same treatment. In this conceptual paper, we propose that the short-term mentalization-based therapy (MBT) program, originally developed to treat adults with borderline personality disorder (BPD), has potential clinical advantages for adolescents with ICD-11 personality disorder at the mild to moderate severity level. The short-term MBT program is a 5-month structured treatment approach including individual therapy, combined psychotherapy with the individual therapist also being one of the group therapists, and closed-group therapy to enhance cohesion and a feeling of security. The purpose of this paper is to make a case for the use of this format, as opposed to the traditional long-term MBT format, for adolescents with BPD. Future research should include large-scale randomized clinical trials powered to assess patient-important outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to report the presence of categorical and dimensional personality disorders (PD) in adults with longstanding eating disorders (ED) over a period of 17 years and to investigate whether changes in PD predict changes in ED symptoms or vice versa. Methods: In total, 62 of the 80 living patients (78% response rate) with anorexia nervosa (n = 23), bulimia nervosa (n = 25), or other specified feeding or ED (n = 14) at baseline were evaluated during hospital treatment and at 1‐year, 2‐year, 5‐year, and 17‐year follow‐up. PD were assessed using the Structured Clinical Interview for DSM‐IV Axis II disorders, and the eating disorder examination (EDE) interview was used to assess ED. Data were analyzed using multilevel modeling. Results: From baseline to the 17‐year follow‐up, the number of patients with any PD decreased significantly from 74.2% to 24.2%, and the total number of PD diagnoses declined from 80 to 22. Mean EDE score was significantly reduced from 4.2 (SD: 1.1) to 2.0 (SD: 1.6). There was a positive association between ED and PD where the initial level of either disorder was followed by similar levels of the other disorder throughout the entire follow‐up period. High baseline levels of borderline PD predicted less decrease in ED symptoms. No significant within‐person effects were found. Conclusions: Both ED and PD significantly declined over time. As the severity of either disorder seems to be associated with the other, thorough assessment and treatment that incorporates both the ED psychopathology and the personality disturbances are advisable. Public Significance Statement: While personality disorders were highly prevalent in the sample of patients with longstanding eating disorders, both disorders were significantly reduced at the 17‐year follow‐up. The disorders are related in the sense that an initial high level of either disorder is associated with a high level of the other over time. A thorough assessment and attention to both illnesses are advisable in therapy. Clinical Trial Identifier: NCT03968705. [ABSTRACT FROM AUTHOR]

This study examined patients' personality traits as operationalized by the five-factor model in relation to early alliance and reduction of interpersonal distress through an intensive group treatment program for personality dysfunction. A sample of 79 consecutively admitted psychiatric outpatients with personality dysfunction who attended an 18-week intensive group treatment program completed the NEO Five-Factor Inventory at pretreatment, the Inventory of Interpersonal Problems at pre- and posttreatment, and the Edmonton Therapeutic Alliance Scale, a measure of the therapeutic alliance with the program therapist, at Session 5. Results indicated that patients who were relatively extraverted tended to rate the alliance with their program therapist higher and subsequently reported more improvement of interpersonal distress. The presence of a personality disorder did not moderate this mediation. Patients' extraversion likely promotes a bonding with the therapist and facilitates the interpersonal group work necessary for improvement. Assessing patients' level of extraversion before starting intensive group treatment might indicate which intervention strategies could be useful with that patient within the program frame. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disability often receive diagnoses which may complicate their clinical care. Among these, personality disorder diagnoses are still considered contentious. Little is also known on the perspectives of staff caring for people with intellectual disability who have received a personality disorder diagnosis. Methods: Three focus groups were carried out to explore 15 healthcare professionals' subjective experiences of working with people with intellectual disability who also have a recorded additional diagnosis of personality disorder. Data were analysed through thematic analysis. Findings: Four overarching themes were identified: (a) diagnostic issues and the need for person‐centred approaches; (b) challenges and adjustments to working with combined intellectual disability and PD diagnoses; (c) the importance of multidisciplinary team training, support, and cohesion; (d) provision issues and barriers to service access. Conclusions: The themes are outlined in depth and a number of implications for clinical management and service improvement are discussed. [ABSTRACT FROM AUTHOR]

Personality disorders (PDs) are relatively common, especially in clinical settings. A number of evidence-based treatments are now available, especially for borderline personality disorder (BPD). However, little is known about the relevant training available to doctoral students in clinical and counseling psychology. In the current study, data were extracted from 336 clinical and counseling PhD and PsyD programs from the Insider's Guide to Graduate Programs in Clinical and Counseling Psychology (Sayette & Norcross, 2020), including the number of programs with faculty with specific interests in personality disorders and the number of programs with clinical opportunities related to personality disorders. We found that formal training in personality disorders is not widely available to most trainees in American Psychological Association (APA)-accredited doctoral training programs. Only 16% of programs have faculty with interests in personality disorders, all of them clinical psychology programs. PhD programs were more likely to have PD-interested faculty than PsyD programs, and, within clinical PhD programs, Psychological Clinical Science Accreditation System (PCSAS)-accredited programs were more likely to have PD-interested faculty than programs without PCSAS accreditation. Similarly, only 15% of programs (all clinical psychology programs) offer practicum opportunities in psychotherapy for personality disorders. Our findings indicate that doctoral-level psychology programs are not sufficiently preparing their students with personality disorder training, which serves as a substantial disservice to both trainees and the public. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to qualitatively explore the views and opinions of service users accessing remote therapy through a community forensic personality disorder service during the COVID-19 pandemic. Design/methodology/approach: A qualitative exploratory approach was adopted. Nine community forensic service users accessing virtual/telephone therapy through a community forensic mental health service were interviewed using semi-structed interviews. Data was analysed using Braun and Clarke (2006) thematic analysis techniques. Findings: Analysis resulted in three overall themes: experience of communication in the therapeutic relationship; impacts of the change to remote working and making the best of what we have. A further seven subthemes were developed. A range of advantages and disadvantages to remote therapy were highlighted. Research limitations/implications: This study was based on a small sample of service users accessing one community forensic service in England, and therefore caution should be taken when generalising the findings. All interviews were conducted remotely and thus may have only supported those who are able to engage in this way. Practical implications: This paper has the potential to inform future remote therapy guidelines. Health services should consider keeping some elements of remote working and offering this as a choice to all service users. Originality/value: This study is, to the best of the authors' knowledge, the first study that attempts to explore the experiences of individuals accessing remote therapy within a forensic population who have personality disorders or traits. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the demographic and reconviction data of individuals who had engaged in an established Intensive Intervention and Risk Management Service, a community service within the offender personality disorder pathway (OPD). Design/methodology/approach: Demographic information and reconviction data from the Police National Computer was accessed for all participants (n = 69) released to the service over a 10-year period (2008– 2018), 45 of who met criteria to be included in the study. Their intervention period spans custody to community, with an expected period of 2 years engagement upon release. Findings: Participants in the service had experienced significant traumatic histories, with four or more adverse childhood experiences. Individuals had a mean of 17 convictions for violent and/or sexual offences and an average of 11 years in custody prior to release. The average length of intervention at Resettle in the community was almost 19 months, with an additional minimum of six months in-reach prior to release. A total of 60% of individuals were recalled back to custody at least once during their intervention, with this being more likely for those who had been convicted of a violent rather than sexual offence. Within the group who were reconvicted, the reconvictions were for less serious offences than the index offence, with only 16% being convicted of an indictable offence. Almost two-thirds (64.4%) did not receive a further conviction post-intervention in the follow-up period. Research limitations/implications: This follow-up study focused upon demographic and reconviction data from one established IIRMS. Although findings are not necessarily generalisable to other IIRMS and OPD pathway services, the demographic and reconviction data has important learning for how services may reflect upon engaging with individuals whose needs and risks had not previously been adequately met and managed upon release. This data are useful learning, for what may help individuals with complex needs upon release into the community after long sentences and how to best meet their needs. There are aspects of the Resettle IIRMS approach which could be applied to non-specialist services to encourage a holistic, compassionate and relational approach to reaching those with complex needs who pose significant risks to others. Practical implications: This follow-up study has provided access to participants' engagement with an established IIRMS. Although participants "opt in" to the service whilst in custody, engagement on release becomes a probation licence condition; a fixed boundary regarding attendance and engagement which, although enables robust risk management and reduces the likelihood of drop-out, also raises consideration about choice and control. The four day per week service provides an intensive intervention, for those with complex needs and limited prior experience of living safely (with minimal risk to self or others) in the community. Participants were previously offered little hope of release or effective support because of their risk, need, complexity and, in some cases, concern about whether their risk could be effectively managed. Although not a panacea for all, the results are suggestive of a service that is navigating the boundary between "care and control" to good effect for future resettlement and desistance. Originality/value: The findings are important for service providers, commissioners and the public purse. The results are useful for the national development of IIRMS. The findings are also important for prisoners and people on probation to inform their decision-making regarding intervention choices and hope for what may be achievable. [ABSTRACT FROM AUTHOR]

This study aims at evaluating the effectiveness of an intensive 1-month residential treatment course in an Italian psychiatric unit for patients meeting criteria for personality disorders (PD). This study involved 189 patients consecutively admitted to the unit and assessed at admission and discharge. The inpatient program was based on Dialectical Behavior Therapy (DBT) combined with Metacognitive interventions. Primary outcome was a reduction of general symptom severity (as measured by SCL-90-R). Secondary outcomes were reduction in depression (BDI), interpersonal problems (IIP-47). Other outcomes were impulsivity (BIS-11), aggressiveness (AQ), and dissociation (DES). We found a significant reduction in symptom severity, as well as in depression, interpersonal problems, dissociation, impulsivity and aggressiveness. The size of this benefit was predicted mostly by number of criteria met at SCID-II and intake scores mostly for impulsiveness and dissociation. In conclusion, intensive 1-month residential DBT combined with metacognitive interventions can be effective in treating patients with any PD presenting with severe global suffering, prominent self-harm and suicidal risk. [ABSTRACT FROM AUTHOR]

Mentalization-based treatment (MBT) has been developed to treat people with complex presentations who may have diagnoses of personality disorder. Whilst psychological formulation is deemed central to the approach, MBT has no standardised approach to formulation. This article therefore proposes a diagrammatic formulation (the "MBT passport"), the elements of which can also be used to construct a narrative MBT formulation. Two fictional case studies exemplify the approach. We consider factors around co-production of MBT formulations and the use of the MBT Passport to manage ruptures within therapy. Common challenges are a therapist/client reluctance to share in a group, that formulations are overly focused on the past to the exclusion of the present, and that formulations are delivered to (rather than 'owned by') the client. Processes to mitigate or remedy these situations are suggested. [ABSTRACT FROM AUTHOR]

A significant proportion of those with eating disorders (EDs) do not respond to first‐line treatments. This systematic review was conducted to identify whether personality disorders (PDs)/traits predict or moderate ED treatment outcomes and whether these outcomes were differentially influenced by ED or PD diagnostic subtypes, or treatment approach. A comprehensive systematic literature search was conducted using the PRISMA guidelines. A total of seven randomised controlled trials (RCTs) plus four follow‐up studies were reviewed investigating the impact of PD and PD traits on treatment outcomes for EDs. The majority indicated that PD had some impact on treatment outcomes. Outcome measures and time‐point measurements varied across studies. Included studies suggested that bulimia nervosa treatment outcomes were not hindered by co‐morbidity of borderline PD; however, psychiatric impairment remained high at post‐treatment and follow‐up. Cluster C PDs were found to negatively impact treatment outcomes for binge ED and attrition rates for anorexia nervosa. Included studies suggested that interventions that addressed aspects of personality pathology showed greater main effects for ED treatment outcomes. There is an urgent need for future RCTs on ED treatments to include routine measures of core personality features to allow their impacts to be more thoroughly examined and for psychotherapies to be tailored accordingly. [ABSTRACT FROM AUTHOR]

Our aim was to evaluate longitudinal data for adolescents who were treated with Dialectical Behavior therapy (DBT) skills groups having been previously diagnosed with depressive disorder. Intervention with an observational cross-sectional design was implemented to evaluate the treatment outcome of a 10-week DBT skills groups with female adolescents with depression. After the patients were identified for enrollment, parents and adolescents were evaluated with psychometric measurements pre-, post-intervention, and at one-year follow-up. Repeated measures analysis was undertaken with the Child Depression Inventory (CDI), Pediatric Quality of Life Inventory (PedsQL) and Strengths and Difficulties Questionnaire (SDQ) for participants. Statistical significance was detected for self-report CDI scores and both self-report and parent SDQ and PedsQL scores. This study is the first DBT intervention in Turkish children, shows that a group DBT skills groups training can be adapted and put into practice successfully with depressed Turkish adolescents. [ABSTRACT FROM AUTHOR]

Both individuals with intellectual disability (ID) and individuals with personality disorders represent populations that require unique interactions with healthcare providers and consist of high utilizers of the healthcare system. The intersectionality of these diagnoses poses further considerations in diagnosis and management. This article describes two fictional case studies intended to illustrate, examine, and identify symptomology of individuals with these comorbid diagnoses and establish recommendations for evidence-based management of these individuals. While personality disorders should not be diagnosed in individuals with severe and profound ID, they can and should be diagnosed in patients with mild or moderate ID who have characteristic symptoms and meet diagnostic criteria. Management for these diagnoses focuses on themes of consistency, safety, staff education, and goal-based behavioral objectives. Care must be taken in ruling out confounding factors and overlapping symptomology, but appropriate comorbid diagnoses can aid in apposite treatment, reduce stigma, and improve quality of life. [ABSTRACT FROM AUTHOR]

The article reports that During the 1990s, publications on personality disorders in the elderly began to appear. In 2006, the handbook ‘Personality disorders and older adults: diagnosis, assessment and treatment' was published. Despite these contributions to the literature, the concept of late personality disorders is still unclear, which can impact on the management of patients with this diagnosis.

Research has demonstrated that maladaptive relational functioning of patients suffering from personality disorders is associated with more negative God representations. This study demonstrated with a single group design among a group of 37 Christian patients with personality disorders, that changes in implicit God representations during psychotherapy, as assessed with the recently developed implicit Apperception Test God Representations (ATGR), were associated with changes in explicit God representations and object-relational functioning, but not in distress. Changes in explicit distress were associated with changes in explicit God representations. Results of cross-lagged analyses suggested that object-relational functioning affected God representations more than vice versa. [ABSTRACT FROM AUTHOR]

Purpose: People with personality disorders often present with interpersonal difficulties which affect their relationship with significant others but also with staff involved in their care. Administrators work in "frontline positions" where they are required to face challenging situations yet their role has not been studied. This study aims to describe the role and contribution of an administrator in a personality disorder service. Design/methodology/approach: A mixed-methods design was used. All incoming calls to a specialist personality disorder service over three months were documented. A semi-structured focus group (n = 7) with clinicians working in the service was conducted. The data was analysed using thematic analysis. Clinical vignettes are presented to highlight typical interactions. Findings: The qualitative results highlighted that the administrator is key in psychological preparations, managing pressure and maintaining clinical boundaries. Traits identified as useful in an administrator working in a personality disorder service are flexibility, consistency and assertiveness. Tensions between administrators and clinicians were related to the role definition of the administrator, boundaries, countertransference and process interaction. The majority of incoming calls were from patients scheduling and cancelling appointments. Only 3% of calls evoked negative feelings in the administrator such as feeling "annoyed" or "drained". Practical implications: Results highlight a need for careful selection, training and supervision of staff. A key recommendation is the need for integration and close coordination of the administrator within the clinical team. Originality/value: This study represents one of the first efforts to explore the contribution of administrators within personality disorder services. It explores the impact of the administrator on the team. [ABSTRACT FROM AUTHOR]

Individuals with psychopathic traits detained in forensic settings are considered a difficult-to-treat population, but empirical support for this claim has not been systematically evaluated. This systematic review aimed to answer two research questions for both youth and adults detained in forensic settings: Are specialized (psycho)therapeutic interventions more effective than Treatment As Usual in (1) reducing psychopathic traits; and (2) reducing criminal recidivism in individuals with high psychopathic traits? Literature searches yielded five studies, involving 653 youth (four studies: two assessing the changeability of psychopathic traits; two assessing criminal recidivism) and 64 adults detained in forensic settings (one study assessing criminal recidivism). Regarding the changeability of psychopathic traits, one study showed a reduction of psychopathic traits for treatment participants in comparison with controls, while the other did not find differences between groups. Regarding criminal recidivism, studies with youth showed that criminal recidivism could be reduced after the delivery of psychotherapeutic interventions, while the study with adults found that treatment could reduce the severity of subsequent offenses, but not recidivism per se. Although scarce and limited, these findings presented promising treatment outcomes, especially in youth, stressing the need to develop evidence-based interventions to this high-risk population. (PROSPERO-CRD42021240218). • People with psychopathy detained in forensic settings are considered difficult to treat. • This is the first systematic review analyzing controlled trials in this population. • Five studies were identified: four in youth and one in adults. • Findings showed mixed results on the treatment of youth/adults. • Findings stress the need to develop evidence-based interventions to this population. [ABSTRACT FROM AUTHOR]

Background: Existing recommended treatment options for personality disorders (PDs) are extensive and costly. There is emerging evidence indicating that trauma-focused treatment using eye movement desensitization and reprocessing (EMDR) therapy aimed at resolving memories of individuals' adverse events can be beneficial for this target group within a relatively short time frame. The primary purpose of the present study is to determine the effectiveness of EMDR therapy versus waiting list in reducing PD symptom severity. Furthermore, the effects of EMDR therapy on trauma symptom severity, loss of diagnosis, personal functioning, quality of life, and mental health outcomes will be determined. In addition, the cost-effectiveness of EMDR therapy in the treatment of PDs is investigated. Moreover, predictors of treatment success, symptom deterioration and treatment discontinuation will be assessed. Lastly, experiences with EMDR therapy will be explored.Method: In total, 159 patients with a PD will be included in a large multicentre single-blind randomized controlled trial. The Structured Clinical Interview for DSM-5 Personality Disorders will be used to determine the presence of a PD. Participants will be allocated to either a treatment condition with EMDR therapy (ten biweekly 90-min sessions) or a waiting list. Three months after potential treatment with EMDR therapy, patients can receive treatment as usual for their PD. All participants are subject to single-blinded baseline, post-intervention and 3-, 6- and 12-month follow-up assessments. The primary outcome measures are the Assessment of DSM-IV Personality Disorders and the Clinician-Administered PTSD Scale for DSM-5. For cost-effectiveness, the Treatment Inventory of Costs in Patients with psychiatric disorders, EuroQol-5D-3L, and the Mental Health Quality of Life Questionnaire will be administered. The PTSD Checklist for DSM-5, Brief State Paranoia Checklist and Difficulties in Emotion Regulation Scale will be used to further index trauma symptom severity. Type of trauma is identified at baseline with the Childhood Trauma Questionnaire-SF and Life Events Checklist for the DSM-5. Personal functioning and health outcome are assessed with the Level of Personality Functioning Scale-BF 2.0, Outcome Questionnaire-45 and Mental Health Quality of Life Questionnaire. Experiences with EMDR therapy of patients in the EMDR therapy condition are explored with a semi-structured interview at post-intervention.Discussion: It is expected that the results of this study will contribute to knowledge about the effectiveness, and cost-effectiveness of trauma-focused treatment using EMDR therapy in individuals diagnosed with a PD. Follow-up data provide documentation of long-term effects of EMDR therapy on various outcome variables, most importantly the reduction of PD symptom severity and loss of diagnoses.Trial Registration: Netherlands Trial Register NL9078 . Registered on 31 November 2020. [ABSTRACT FROM AUTHOR]

Background: Patients with difficult personalities or personality disorders are a special challenge for primary care physicians. Their style of interpersonal interaction is often difficult. As the ICD-11 classification comes into use, a new systematic approach to diagnosis is being introduced that focuses on the patient's functional impairments in everyday life. We describe the implications for the diagnosis and treatment of patients of this type. Methods: This review is based on pertinent publications retrieved by a selective search, with particular attention to primary care and to somatic morbidity and mortality. Results: 10-12% of the population suffers from personality disorders. A high degree of psychiatric comorbidity is typical; somatic diseases are also more than twice as common as in the general population. In emergency medicine, persons with personality disorders are more likely than others to present with a suicide attempt. Their lifetime risk of suicide is between 1.4% and 4.5% (the latter for persons with borderline personality disorder). Conclusion: Primary care physicians have an important role in the initial diagnosis of patients with personality disorders and in the planning of their treatment. Such patients require special care and attention from their physicians in view of their elevated somatic morbidity and mortality. In everyday clinical practice, physicians who encounter patients with complex and persistent mental problems, or just with a difficult style of interpersonal interaction, should consider the possibility of a personality disorder and motivate such patients to undergo psychotherapy, if indicated. [ABSTRACT FROM AUTHOR]