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BACKGROUND: Resurgent psychedelic research has largely supported the safety and efficacy of psychedelic therapy for the treatment of various psychiatric disorders. As psychedelic use and therapy increase in prevalence, so does the importance of understanding associated risks. Cases of prolonged negative psychological responses to psychedelic therapy seem to be rare; however, studies are limited by biases and small sample sizes. The current analytical approach was motivated by the question of whether rare but significant adverse effects have been under-sampled in psychedelic research studies. METHODS: A bottom margin analysis approach was taken to focus on negative responders to psychedelic use in a pool of naturalistic, observational prospective studies (N = 807). We define negative response by a clinically meaningful decline in a generic index of mental health, that is, one standard error from the mean decrease in psychological well-being 4 weeks post-psychedelic use (vs pre-use baseline). We then assessed whether a history of diagnosed mental illness can predict negative responses. RESULTS: We find that 16% of the cohort falls into the negative responder subset. Parsing the sample by self-reported history of psychiatric diagnoses, results revealed a disproportionate prevalence of negative responses among those reporting a prior personality disorder diagnosis (31%). One multivariate regression model indicated a greater than four-fold elevated risk of adverse psychological responses to psychedelics in the personality disorder subsample (b = 1.425, p

Accessible Summary: What is known on the subject?: The term 'complex emotional needs' (CEN) is used here to describe people with difficulties and needs that are often associated with the diagnostic label of 'personality disorder'.People with CEN might use out of hours services such as emergency departments and Crisis Resolution/Home Treatment (CRHT) teams more often when experiencing a mental health crisis.Very little is understood about the experiences of both those receiving, and those delivering care, for people with CEN within CRHT settings. What this paper adds to existing knowledge?: There are differences between priorities for those delivering and those receiving care within CRHT settings. CRHT staff members are likely to focus more upon those aspects of their role relating to risk issues. managing resources, anxieties and the expectations of others. Service users, meanwhile, focus upon the caring relationship, wanting staff to listen to them, and to feel supported and reassured.In the papers reviewed, service users experiencing CEN did not always feel 'listened to' or 'taken seriously' especially in relation to risk issues and decision‐making. What are the implications for practice?: Relating the findings to mental health nursing and CEN within the context of CRHT, to better understand the person experiencing a mental health crisis, mental health nurses need to focus more upon the person and when making decisions around their care and must be aware of the potential for power imbalances.Collaborative 'sense‐making' in relation to a person's risk behaviours may help. Background: A growing body of qualitative evidence focusing upon the experiences of care within Crisis Resolution/Home Treatment (CRHT) is emerging; however, a firm evidence base regarding both the giving and receiving of care for those with complex emotional needs (CEN) in this context is yet to be established. Objective: A qualitative evidence synthesis was used to develop a comprehensive understanding of how crisis care for people with CEN is experienced by both those giving and receiving care, within the context of CRHT. Method: Findings from 19 research papers considering both clinician and service users' experiential accounts of CRHT were synthesised using meta‐ethnography. Findings: Both the giving and receiving of care within a CRHT context was experienced across four related meta‐themes: 'contextual', 'functional', 'relational' and 'decisional'. Discussion: Service user accounts focused upon relational aspects, highlighting a significance to their experience of care. Meanwhile, clinicians focused more upon contextual issues linked to the management of organisational anxieties and resources. For those with CEN, a clinician's focus upon risk alone highlighted power differentials in the caring relationship. Conclusions: There is a need for nurses to connect with the experience of the person in crisis, ensuring a better balance between contextual issues and relational working. [ABSTRACT FROM AUTHOR]

Introduction: There is little evidence for what influences occupational participation for justice-involved people 'with a personality disorder' living in community contexts, and no validated occupational participation assessments specific to this group. We assessed a sample of justice-involved people 'with a personality disorder' to ascertain what influences occupational participation using commonly applied assessments and evaluated their construct validity. Method: As part of a mixed-methods study, a purposive sample of 18 justice-involved people 'with a personality disorder' were scored on the Model of Human Occupational Screening Tool and Occupational Performance History Interview–Version Two scales. Mean scores were calculated per Model of Human Occupational Screening Tool (MOHOST) item and Occupational Performance History Interview–Version Two (OPHI-II) items and scales and compared to published data. Mann–Whitney U Tests were used to identify within-sample differences based on demographic characteristics. Results: Participants had low scores on MOHOST items and OPHI-II items and scales. Differences were identified compared to published data. Within-sample differences were most apparent in comparisons by employment status and ethnicity. The OPHI-II scales did not operate as intended with this population and recommended adjustments impacted its construct validity. Conclusion: Replication is required with a larger random sample. Integrating these data with qualitative exploration would further elucidate factors influencing occupational participation in this population. [ABSTRACT FROM AUTHOR]

ABSTRACT Crisis Resolution Home Treatment (CRHT) teams have become a widespread alternative to psychiatric hospitalisation. Despite their popularisation, Malta has only recently introduced a CRHT team. The aims of the current study were to investigate (i) patient characteristics, (ii) factors influencing patients' length of follow‐up (LoFU) and (iii) predictors of clinical outcomes. Descriptive and quantitative non‐identifiable data were collected and analysed for patients utilising the CRHT service within its first 2 years of operation (n = 643). One‐way ANOVA tests investigated influencing factors for LoFU, whereas binary logistic regressions deduced predictive factors for clinical outcomes. Patients without acute psychiatric disorders had the shortest LoFU, indicating that the team received inappropriate referrals. Patients were most likely to have extended LoFU if they were diagnosed with OCD & related disorders and were most likely to be diagnosed with an underlying personality disorder if they were diagnosed with anxiety & phobic disorders. Continuity of care facilitates discharge planning. Patients receiving the CRHT service in Malta are most comparable with health systems that prefer to hospitalise patients with a higher risk profile. The high occurrence of personality disorders necessitates staff to have interdisciplinary knowledge and an appropriate skill mix. [ABSTRACT FROM AUTHOR]

Mentalization‐based treatment (MBT) is a spectrum of interventions that share a central focus on improving the capacity for mentalizing. Although MBT was originally developed as a treatment for individuals with borderline personality disorder, its scope and focus have been broadened to become a socioecological approach that stresses the role of broader sociocultural factors in determining the closely related capacities for mentalizing and epistemic trust. This special issue brings together some of the newest developments in MBT that illustrate this shift. These contributions also highlight several current limitations in mentalization‐based approaches, providing important pointers for further research. In this editorial, we first outline the broadening scope of the mentalizing approach, and then provide a discussion of each of the contributions to this special issue in the context of the need for further research concerning some of the key assumptions of mentalization‐based approaches and their implementation in clinical practice. We close this editorial with considerations concerning future research. [ABSTRACT FROM AUTHOR]

Although hallucinations are a feature of psychosis, they can present in non-psychotic disorders and may occur in non-pathological states. Jung argues that unconscious complexes underpin hallucinations and further observes that some of the symptoms of 'hysteric' patients – including hallucinations – were also common amongst patients with schizophrenia. However, the outward presentation of symptoms was markedly different for each patient group. Jung mobilises his complex theory to explain this difference. We argue that Jung's understanding of hallucinations applies to contemporary healthcare; it frames how hallucinations may manifest in multiple conditions, not just psychosis. This brief report discusses Jung's theories and their continued veracity in contemporary contexts. [ABSTRACT FROM AUTHOR]

A significant proportion of patients with a personality disorder do not benefit from treatment. Monitoring treatment progress can help adjust ineffective treatments. This study examined whether early changes in symptoms and personality dysfunction during the first phase of therapy could predict treatment outcomes. Data from 841 patients who received specialized treatment for personality disorders were analyzed. The study focused on whether changes in the Outcome Questionnaire-45.2 (OQ-45.2) symptom distress scale (SD), the General Assessment of Personality Disorder (GAPD), and Severity Indices of Personality Problems (SIPP) in the early phase of therapy predicted post-treatment personality dysfunction, as measured by the SIPP and GAPD. Early changes within a specific SIPP domain were the strongest predictors of post-treatment outcomes in that same domain. Early changes in symptoms significantly predicted outcomes in Self-Control, Relational Functioning, and Identity Integration, while the GAPD predicted outcomes in Self-Control and Social Attunement on the SIPP. For the GAPD, early changes on the GAPD itself, followed by early changes on the OQ-45 SD and the SIPP domain Social Attunement, were significant predictors. Thus, when it comes to personality dysfunction, early changes in a specific domain or measure are the best predictors of outcomes in that same domain. While the OQ-45 predicted some aspects of personality dysfunction, it should not replace disorder-specific measures. Additionally, the SIPP domains and the GAPD should not be used interchangeably to predict each other. In sum, considering these factors, monitoring early change can be useful in assessing progress in the treatment of patients with personality disorders. [ABSTRACT FROM AUTHOR]

Purpose: A pervasive and deeply entrenched stigma of personality disorders exists. For other mental disorders, a large body of research suggests that continuum beliefs (i.e., the endorsement of continuum perspectives on mental health and psychopathology) stimulate more favorable attitudes toward affected persons. Additionally, mental disorder classification systems increasingly incorporate continuous personality disorder models. Yet, it is unclear how continuum beliefs are related to personality disorder stigma. This study evaluated the link of continuum beliefs with personality disorder stigma based on correlational and experimental data. Methods: A large general population sample (N = 848) completed self-report measures of continuum beliefs regarding personality disorders, desired social distance, and prejudice toward persons with personality disorders. Additionally, participants were randomly presented with information supporting a continuous or a dichotomous view of personality disorders. Results: Continuum beliefs were associated with lower desired social distance (r = − 0.19) and prejudice (r = − 0.22). Additionally, the brief continuum intervention was associated with increased continuum beliefs (d = 0.99) and decreased desired social distance (d = − 0.14) and prejudice (d = − 0.17). Finally, the intervention effects on desired social distance and prejudice were mediated by continuum beliefs. Conclusion: This study suggests that highlighting continuum views on personality disorders in public communication and interventions might reduce personality disorder stigma. [ABSTRACT FROM AUTHOR]

Purpose: To examine the nature of positive and negative environmental change on clinical outcome in 210 patients presenting with anxiety and depression and followed up over 30 years. Methods: In addition to clinical assessments, major environmental changes, particularly after 12 and 30 years, were recorded in all patients by a combination of self-report and taped interviews. Environmental changes were separated into two major groups, positive or negative, determined by patient opinion. Results: In all analyses positive changes were found to be associated with better outcome at 12 years with respect to accommodation (P = 0.009), relationships (P = 007), and substance misuse (P = 0.003), with fewer psychiatric admissions (P = 0.011) and fewer social work contacts at 30 years (P = 0.043). Using a consolidated outcome measure positive changes were more likely than negative ones to be associated with a good outcome at 12 and 30 years (39% v 3.6% and 30.2% v 9.1%, respectively). Those with personality disorder at baseline had fewer positive changes (P = 0.018) than others at 12 years and fewer positive occupational changes at 30 years (P = 0.041). Service use was greatly reduced in those with positive events with 50–80% more time free of all psychotropic drug treatment (P < 0.001). Instrumental positive change had greater effects than imposed changes. Conclusions: Positive environmental change has a favourable impact on clinical outcome in common mental disorders. Although studied naturalistically in this study the findings suggest that if harnessed as a therapeutic intervention, as in nidotherapy and social prescribing, it would yield therapeutic dividends. [ABSTRACT FROM AUTHOR]

Introduction: Migraine is one of the most prevalent types of headache and is a subject of many clinical trials. There are various risk factors associated with migraine occurrence, from hormonal and genetic to environmental. It is observed that some migraineurs have specific psychological features- sometimes called as migraine personality. This encouraged researchers to evaluate migraine patients in terms of psychiatric co-existing conditions. Aim of study: The main aim of the study was to examine the relationship between migraine and psychiatric comorbidities, primarily personality disorders. Materials and methods: This article is based on the literature found in PubMed and Google Scholar Database with the use of keywords such as ”migraine”, “headache factors”, “personality disorder”, “migraine personality”, “migraine education”, “borderline personality disorder”, “anxious personality disorder”, “migraine health”, “depression and migraine”, “medication over-use in migraine”, “migraine comorbidities”, “depression”, “anxiety”. Results: Investigation of available literature revealed the connection between migraine and personality disorders. Psychiatric comorbidities worsen the treatment prognosis, are a risk factor of medication overuse and chronic headaches. Conclusion: Psychiatric comorbidities are frequent among migraineurs. Clinical evaluation of these patients should be complex and contain psychological and psychiatric analysis, especially in patients resistant to standard treatment. [ABSTRACT FROM AUTHOR]

This was a mixed methods cross-sectional study evaluating OPD EERSS services in London. This included whether engagement with EERSS improved service participants' well-being and relationships with others, and reduced risk. Participants completed self-reported measures on working alliance, psychological distress, and well-being; and at different time points of service participation, were compared on outcomes including risk and attendance at statutory appointments. EERSS were compared to two control groups; the Intensive Intervention Risk Management Service (IIRMS) group, and a 'no-intervention' OPD screened-in group. A subsample of EERSS participants took part in qualitative interviews. Findings highlighted the positive impact of EERSS and IIRMS; in particular, that participants in those services improved their attendance at statutory probation appointments, compared to controls. There was a positive indication of improvement in well-being and risk. Qualitative findings identified aspects of the therapeutic alliance which improved well-being and engagement with probation. In conclusion, EERSS added value to the OPD pathway and may be deserving of wider rollout. [ABSTRACT FROM AUTHOR]

Understanding and processing life experiences are essential in the treatment of personality disorders to promote personal recovery and psychological wellbeing. In this qualitative case report, drafted in co‐creation between the client, clinical psychologist, and art therapist, individual treatment consisted of two psychotherapeutic interventions, "An Empowering Story" and life‐story‐focused art therapy, in 12 parallel sessions for 24 weeks. Hilda, 68 years of age, had been diagnosed with an unspecified personality disorder and various traits of borderline personality disorder. She experienced emotional exhaustion following long‐term mental health problems rooted in a traumatic early childhood. This affected her ability to manage her emotions and social relations, resulting in the sense that her life had no meaning. Hilda was invited to reconstruct her life experiences, divided into the past, turning point, and present/future, in a written and a painted life story. This allowed for the integration of traumatic as well as positive memories, enhanced self‐compassion, and meaning making. She developed self‐reflection and integration of internal conflicts leading to a better emotional balance and self‐understanding. Art therapy emphasizes bottom‐up regulatory processes, while narrative psychology supports top‐down regulatory processes. The combined approach effectively integrated bottom‐up, experiential, sensory experiences with top‐down, cognitive emotion‐regulation processes. The results suggest that psychotherapeutic interventions involving a multi‐pronged, complementary, and thus more holistic approach can support personal recovery in personality disorders. [ABSTRACT FROM AUTHOR]

The escalating global concerns surrounding radicalization and violent extremism necessitate a comprehensive understanding and explanation. Identifying the risk factors associated with radicalism and violent extremism is critical to the development of risk assessment, prevention, and intervention strategies. It is imperative to distinguish these risks from civic responsibilities (i.e., activism) to safeguard individual rights. This study aims to examine the association between well-established risk factors for violence—personality disorder symptoms—and violent extremist attitudes, radicalism, and activism. Findings indicate that antisocial personality disorder symptoms were linked to violent extremist attitudes and radicalism, whereas obsessive-compulsive disorder symptoms were related to activism. This suggests that obsessive-compulsive personality disorder may signify a readiness for legal and nonviolent political action; in contrast, antisocial personality disorder symptoms signify a readiness for extremist violence and illegal political action. [ABSTRACT FROM AUTHOR]

Personality disorder (PD) is particularly common in adolescents, which underscores the significance of early screening, diagnosis, and intervention. To date, the definition of PD in the new ICD-11 has not yet been investigated in adolescents. This study therefore aimed to investigate the unidimensionality and criterion validity of self-reported ICD-11 PD features in Peruvian adolescents using the Personality Disorder Severity ICD-11 (PDS-ICD-11) scale. A total of 1,073 students (63% female; age range 12-16 years) were administered the PDS-ICD-11 scale along with criterion measures of personality pathology and symptom distress. The PDS-ICD-11 score showed adequate unidimensionality and conceptually meaningful associations with external criterion variables. The findings indicate that ICD-11 PD features, as measured with the PDS-ICD-11 scale, are structurally and conceptually sound when employed with adolescents. Norm-based cutoffs derived from the present study may be used for clinical interpretation. The PDS-ICD-11 may be employed as an efficient screening tool for personality dysfunction in adolescents. [ABSTRACT FROM AUTHOR]

Abstract Background Traumatic childhood experiences are a major risk factor for developing mental disorders later in life. Over the past decade, researchers have begun to investigate the role of early trauma in impairments in personality functioning following the introduction of the Alternative Model of Personality Disorders in Section III of the Diagnostic and Statistical Manual for Mental Disorders 5. Although first studies were able to empirically demonstrate a significant link between early trauma and impairments in personality functioning, only little is known about the underlying mechanisms. One possible mechanism is body connection due to its involvement in self-regulatory processes and its link to both early trauma and personality (dys)functioning. Objective In the current study, we investigated whether body connection, which encompasses the awareness, integration, and utilization of one’s own bodily signals, mediates the relationship between childhood trauma and personality functioning. Participants and setting A total of 1,313 adult participants recruited in Germany and Chile anonymously provided self-report data in an online survey. Methods Self-report data included the short form of the Childhood Trauma Questionnaire (CTQ-SF), the Scale of Body Connection (SBC), and the brief form of the Levels of Personality Functioning Scale (LPFS-BF 2.0) as well as demographic data (age, sex, education, clinical diagnoses). Results Traumatic childhood experiences explained 27.2% of the variance in impairments in personality functioning. Interestingly, 60.5% of this effect was explained by body connection, particularly body dissociation. Additional exploratory analyses revealed that body dissociation and, to a much lesser extent, body awareness, accounted for 64.41% of the variance in self functioning and 55.75% of the variance in interpersonal functioning explained by childhood trauma. Conclusion Body connection appears to be an important mediator in the association between early trauma and impaired personality functioning, underscoring the need for interventions specifically targeting the avoidance and ignorance of signals from one’s own body in individuals with traumatic childhood trauma.

Abstract Background We describe a collection of themes for a research agenda for personality disorders that was originally formulated for the ESSPD Borderline Congress in 2022. Methods Experts with lived and living experience (EE), researchers and clinicians met virtually, exchanged ideas and discussed research topics for the field of personality disorders. The experts - patients, relatives, significant others - named the topics they thought most relevant for further research in the field. These topics were presented at the ESPPD conference in October 2022. Results The five top themes were: 1. Prevention, early detection and intervention, 2. Recovery beyond symptom improvement, 3. Involvement of relatives in treatment, 4. Gender dysphoria, and 5. Stigma. Conclusions In general, the topics reflect current issues and changes in societal values. Overarching aims of research on these topics are the improvement of social participation and integration in society, better dissemination of research, and better information of the general public and political stakeholders.

Objectives: The high prevalence of borderline personality disorder, along with comorbid psychiatric disorders and impulsive reactions (suicide attempts, self-mutilation, substance use, and impulsive behaviors) increase the need for effective psychological interventions. In this study, the effectiveness of dialectical behavior skills training based on the Soler method and family education with individual therapies are compared in this group of patients. Methods: In this single-blind case study, eight cases were selected through a targeted sampling method based on the inclusion and exclusion criteria. The participants were divided into two groups: Intervention individually and individual intervention with family education. Both group members and the family members of the second group received dialectical behavior skills training based on the Soler model. The participants completed the borderline personality inventory, self-harm inventory, and Barratt impulsivity scale in four stages: At the beginning of the sessions, in the middle of the treatment, at the end of the treatment, and three months after treatment. Results: The data were analyzed using the Wilcoxon test, Friedman test, and Mann-Whitney U test. The results indicate the effectiveness of the dialectical behavior skills training method based on the Soler model in reducing symptoms of borderline personality disorder and self-mutilation, as well as emotion regulation improvement at the significant level of P=0.05. Discussion: This treatment is recommended as an effective and short-term method for controlling symptoms of borderline personality disorder. Family education, in addition to dialectical behavior therapy, has been shown to have a positive effect on reducing symptoms in patients.

Background Several studies have observed that mentalization-based treatment (MBT) is an effective treatment for borderline personality disorder (BPD), but its effectiveness for other personality disorders (PDs) has hardly been examined. Additionally, the evidence supporting the claim that MBT improves mentalizing capacity is scarce. The present study examined whether (i) patients with a broad range of PDs enrolled in an MBT program would improve on several outcome measures (ii) mentalizing capacity would improve over time; (iii) patients with BPD would improve more than those with non-borderline PDs. Method Personality disorders, psychiatric symptoms, social functioning, maladaptive personality functioning and mentalizing capacity were measured in a group of individuals with various PDs (n = 46) that received MBT. Assessments were made at baseline and after 6, 12, and 18 months of treatment. The severity of psychiatric symptoms, measured using the Outcome Questionnaire 45, was the primary outcome variable. Results Overall, enrollment in the MBT program was associated with a decrease in psychiatric symptoms and an improvement of personality functioning, social functioning for a mixed group of PDs (all p’s $$\le$$ ≤ .01). Bigger effect sizes were observed for BPD patients (n = 25) than for patients with non-BPD (n = 21), but the difference failed to reach statistical significance (p = 0.06). A primary analysis showed that the decrease in psychiatric symptoms was significant in BPD patients (p = 0.01), not in non-BPD (p = 0.19) patients. However, a sufficiently powered secondary analysis with imputed data showed that non-BPD patients reported a significant decrease in psychiatric symptoms too (p = 0.01). Mentalizing capacity of the whole group improved over time (d = .68 on the Toronto Alexithymia Scale and 1.46 on the Social Cognition and Object Relations System). Discussion These results suggest that MBT coincides with symptomatic and functional improvement across a broad range of PDs and shows that MBT is associated with improvements in mentalizing capacity. As the study is not experimental in design, we cannot make causal claims. Conclusion Mentalization-based treatment may be an effective treatment for patients with a broad range of PDs. Trial registration The study design was approved by the Leiden University Ethical Committee.

This article delves into the psychological literature concerning divorce and its impact on the personality development of preadolescents aged 9-12. Researchers in this field emphasize the significant role of family and socio-cultural environments in shaping a child’s personality, considering personality as a system embedded within a matrix of socio-cultural systems. The Millon Pre-Adolescent Clinical Inventory (MPACI) test was employed to identify personality disorders among preadolescents affected by parental separation. The underlying hypothesis posits that preadolescents with divorced parents would exhibit personality disorders, and significant differences would emerge in the personality patterns between preadolescents from divorced families and those from intact families. Statistical analysis of the results corroborated this hypothesis, shedding light on the nuanced effects of divorce on preadolescent personality development.

XiaoLiang Wang,1,&ast; XiaoDong Ni,1,&ast; YanYan Wei,1 LiHua Xu,1 XiaoChen Tang,1 HaiChun Liu,2 ZiXuan Wang,3 Tao Chen,4,5 JiJun Wang,1 Qing Zhang,1 TianHong Zhang1 1Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China; 2Department of Automation, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 3Department of Psychology, Shanghai Xinlianxin Psychological Counseling Center, Shanghai, People’s Republic of China; 4Big Data Research Lab, University of Waterloo, Waterloo, Ontario, Canada; 5Labor and Worklife Program, Harvard University, Cambridge, MA, USA&ast;These authors contributed equally to this workCorrespondence: TianHong Zhang; Qing Zhang, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai, 200030, People’s Republic of China, Tel +86-21-34773065, Fax +86-21-64387986, Email zhang_tianhong@126.com; qing.zhang@smhc.org.cnIntroduction: Despite numerous studies investigating personality disorder (PD) and childhood maltreatment (CM) characteristics in individuals with schizophrenia (SZ), there remains a scarcity of research focusing on sex differences in PD and CM within large samples of SZ patients.Methods: A total of 592 participants (257 males, 335 females) were consecutively sampled from patients diagnosed with SZ at the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. PDs were assessed using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were evaluated using the Chinese version of the Child Trauma Questionnaire Short Form.Results: Male patients exhibited a prominent self-reported trait of antisocial PD (t=1.972, p=0.049), while female patients demonstrated a notable emphasis on histrionic PD traits (t=− 2.057, p=0.040). Structured interviews for PD diagnoses further indicated a higher comorbidity of schizotypal (χ2=4.805, p=0.028) and schizoid (χ2=6.957, p=0.008) PDs among male patients compared to female patients. Additionally, male patients reported a higher degree (t=2.957, p=0.003) and proportion (χ2=5.277, p=0.022) of experiences of physical abuse in their self-reported CM. Logistic regression analyses highlight distinct factors: higher antisocial PD traits and physical abuse are associated with male patients, while histrionic PD traits and emotional abuse are associated with female patients.Discussion: These findings underscore the importance of recognizing and addressing sex-specific manifestations of personality pathology and the nuanced impact of CM in the clinical management of individuals with SZ. The study advocates for tailored interventions that consider the distinct needs associated with sex differences in both personality traits and CM experiences among SZ patients.Keywords: personality disorder, psychosis, abuse, neglect, schizophrenia

Background: Psychopathology research mainly focused on the cross-sectional and longitudinal associations between personality and psychiatric disorders without considering the moment-to-moment dynamics of personality in response to environmental situations. The present study aimed to both cluster a young sample according to three mixed clinical conditions (poor sleep quality, depression, and somatization) and to predict the derived clusters by maladaptive personality traits and sex differences using a deep machine learning approach. Methods: A sample of 839 adults aged 18-40 years (64% female) from the west of Iran were clustered according to the mixed clinical conditions using the cluster analysis techniques. An Artificial Neural Network (ANN) modeling is used to predict the derived clusters by maladaptive personality traits and biological gender. A receiver operating characteristic (ROC) curve was used to identify independent variables with high sensitivity specific to the derived clusters. Results: The cluster analysis techniques suggested a fully stable and acceptable four-cluster solution for Depressed Poor Sleepers, Nonclinical Good Sleepers, Subclinical Poor Sleepers, and Clinical Poor Sleepers. The ANN model led to the identification of one hidden layer with two hidden units. The results of Area under the ROC Curve were relatively to completely acceptable, ranging from.726 to.855. Anhedonia, perceptual dysregulation, depressivity, anxiousness, and unusual beliefs are the most valuable traits with importance higher than 70%. Conclusion: The machine learning approach can be well used to predict mixed clinical conditions by maladaptive personality traits. Future research can test the complexity of normal personality traits connected to mixed clinical conditions. [ABSTRACT FROM AUTHOR]

Introduction: Borderline Personality Disorder (BPD) traits play a crucial role in the prognosis of psychiatric disorders, as well as in assessing risks associated with negativity and impulsivity. However, there is a lack of data regarding the distribution characteristics of BPD traits and symptoms within clinical populations. Methods: A total of 3015 participants (1321 males, 1694 females) were consecutively sampled from outpatients at the psychiatric and psychocounseling clinics at the Shanghai Mental Health Center. BPD symptoms were assessed using a self-reported personality diagnostic questionnaire. Having BPD traits is defined as having five or more positive items in self-reported BPD characteristics. Participants were stratified into male and female groups, age groups, and diagnostic groups (schizophrenia, mood disorders, anxiety disorders). Exploratory factor analysis using principal components analysis was conducted. Three factors were identified: "F1: Affective Instability and Impulsivity", "F2: Interpersonal Unstable and Extreme Reactions", and "F3: Identity Disturbance". Results: Among 3015 participants, 45.9% of the patients self-reported BPD traits. Comparing of male and female patients, there was no statistically significant difference in the occurrence rate of BPD traits (χ² = 1.835, p=0.176). However, in terms of symptoms, female patients reported more symptoms than male patients. Female patients also exhibited more pronounced features on F2 compared to male patients (t =-1.972, p=0.049). There is a general decrease in BPD traits, symptoms, and factors with increasing age. Specifically, the proportion of positive BPD traits is approximately halved before the age of 30 and decreases to around one-third after the age of 30. BPD traits were most common in the Mood Disorders group at 55.7%, followed by the Anxiety Disorders group at 44.4%, and Schizophrenia group at 41.5% (χ² = 38.084, p<0.001). Discussion: Our study revealed the pervasive presence of BPD traits and symptoms among psychiatric outpatients, exhibiting distinctive distributions across gender, age, and diagnostic categories. These findings emphasize the significance of identifying and addressing BPD pathology in the clinical care of psychiatric outpatients. [ABSTRACT FROM AUTHOR]

Purpose: This discursive paper considers the use of restrictive practices in mental health inpatient settings and how these are often prioritised over relational approaches, especially where the diagnostic label of personality disorder intersects with risk. Design/methodology/approach: Key concepts from Orwell's 1984 are studied for their pertinence to mental health inpatient settings, supporting our argument that restrictive practices arise from dichotomous thinking and externalised fears. Findings: Drawing upon Orwellian themes of power, social control and digital surveillance from 1984, the authors highlight the role of fear in perpetuating restrictive practices under a guise of benevolent care in mental health inpatient settings, especially for those who are diagnosed with a personality disorder. A lack of preparedness to work with complexity in such environments, coupled with a deficit in self-reflexivity and critical thinking, can exacerbate challenges. Research limitations/implications: To transcend damaging dichotomies and reduce restrictive practices in inpatient settings, the authors make the argument for the adequate preparation and education of the mental health nurse and authentic, collaborative, user-involved care. Originality/value: The authors use Orwell's novel to support a critical discourse around those damaging dichotomies and inherent contradictions that contribute to restrictive practice in contemporary mental health settings and to question whose interests' these restrictive practices serve. [ABSTRACT FROM AUTHOR]

Current research on personality disorders strives to identify key behavioural and cognitive facets of patient functioning, to unravel the underlying root causes and maintenance mechanisms. This process often involves the application of social paradigms — however, these often only include momentary affective depictions rather than unfolding interactions. This constitutes a limitation in our capacity to probe core symptoms, and leaves potential findings uncovered which could help those who are in close relationships with affected individuals. Here, we deployed a novel task in which subjects interact with four unknown virtual partners in a turn-taking paradigm akin to a dance, and report on their experience with each. The virtual partners embody four combinations of low/high expressivity of positive/negative mood. Higher scores on our symptomatic measures of attachment anxiety, avoidance, and borderline personality disorder (BPD) were all linked to a general negative appraisal of all the interpersonal experiences. Moreover, the negative appraisal of the partner who displayed a high negative/low positive mood was tied with attachment anxiety and BPD symptoms. The extent to which subjects felt responsible for causing partners' distress was most strongly linked to attachment anxiety. Finally, we provide a fully-fledged exploration of move-by-move action latencies and click distances from partners. This analysis underscored slower movement initiation from anxiously attached individuals throughout all virtual interactions. In summary, we describe a novel paradigm for second-person neuroscience, which allowed both the replication of established results and the capture of new behavioural signatures associated with attachment anxiety, and discuss its limitations. [ABSTRACT FROM AUTHOR]

Background: Misophonia is a chronic condition in which the exposure to specific sounds increases the arousal and recurrence of specific intense negative emotions. We hypothesized that misophonia may be strongly related to maladaptive interpersonal schemas that create difficulties in interpersonal relationships. Subjects with maladaptive interpersonal schemas think that other people try to subjugate, criticize, dominate, exploit, deceive, disregard, and humiliate them. Furthermore, these patients typically endorse a representation of self as mistreated, constricted, harmed, damaged, humiliated, impotent, inadequate, or fragile. Methods: We describe the course of a treatment of Metacognitive Interpersonal Therapy (MIT) in a young man presenting misophonia and co-occurrent obsessive–compulsive personality disorder (OCPD) and avoidant personality disorder (AvPD), with narcissistic traits and normal hearing. We collected qualitative and quantitative data at the beginning of the intervention and at 2 years follow-up. Results: The therapy aimed at increasing awareness of maladaptive interpersonal schemas and promoting a healthy self. The results reported a significant decrease in misophonia; behavioural experiments were used to increase the quality of social relationships and tolerance to the trigger sounds. Conclusions: MIT can be an effective therapy for the treatment of misophonia. [ABSTRACT FROM AUTHOR]

Schizoid personality pathology is among the most debilitating and enigmatic forms of personality pathology. Some have suggested that a potential etiological influence on schizoid pathology is trauma. Thus far, research on the association between trauma and schizoid pathology has focused primarily on type of trauma (e.g., abuse vs. neglect during childhood) rather than who perpetrated the trauma. This contrasts with recent research on trauma perpetrated by someone upon whom the survivor relies and/or trusts (i.e. betrayal trauma), which many studies show has a uniquely pernicious association with several forms of personality pathology. However, this has not yet been examined with respect to schizoid pathology specifically. In this study, we examined the relative associations between trauma varying degrees of betrayal and schizoid personality pathology in a sample recruited from Amazon's Mechanical Turk (N = 300) using a Bayesian approach to structural equation modeling. Results suggest that interpersonal trauma in general was associated with higher levels of schizoid pathology. Findings further indicate that for men but not women, trauma with a high degree of betrayal was uniquely associated with schizoid pathology. These findings contribute to the growing body of research suggesting the influence of interpersonal trauma in general and betrayal trauma in particular on personality pathology and have implications for future research on and intervention with people with high levels of schizoid pathology. [ABSTRACT FROM AUTHOR]

Meaning-in-Life might be associated with self-direction for patients with personality disorder (PD) but also with depressive symptoms or existential factors such as self-transcendence and spiritual/religious worldviews. PD patients (n = 125) and a control group (n = 69) completed the following: Meaning-in-Life Questionnaire (MLQ-Presence and MLQ-Search), General-Assessment-of-personality-disorder subscale Lack-of-Meaning-Purpose-Direction (GAPD-LMPD), Symptom-Checklist-Depression (SCL-90-Depression), Temperament-and-Character-Inventory scale Self-Transcendence (TCI-ST) and a worldview-questionnaire. PD patients showed less meaning in life, but religious and spiritual/non-religious worldviews mattered. Results emphasize that PD, beyond depressive symptoms, possesses a unique association with meaning-in-life and suggest exploring spiritual/religious worldviews as possible sources for meaning-in-life. MLQ-Presence and GAPD-LMPD seem to assess no identical constructs. [ABSTRACT FROM AUTHOR]

People with personality disorders (PDs) are often difficult to reach emotionally in therapy. As music therapy (MT) provides an entry point to emotions and facilitates contact and communication, it is regularly used with this target group. This study presents a case study of a 40‐year‐old woman diagnosed with a PD not otherwise defined. "Nina" experienced depressive and physical symptoms, including severe anxiety. Previous treatments had failed. In MT, she experienced a sense of safety. Over the course of the treatment, she experimented with making herself heard, learned to listen to herself and recognize her own physical signals, permitted closeness and cooperation, and began setting boundaries and taking initiative. She got in touch with and learned to regulate emotions such as sadness and fear. Self‐criticism gave way to a more compassionate self. Nina began to experience positive feelings and showed progress in her work and social interactions. The findings suggest that MT can directly connect to clients' emotions, behaviors, and thoughts in a way they perceive as safe. This is of the utmost importance for clients who are hard to reach. The use of MT can potentially prevent dropout and further entrapment in personality problems. [ABSTRACT FROM AUTHOR]

Aims and Design: This study reports a qualitative phenomenological investigation of resilience in nursing staff working in a high‐secure personality disorder service. Method: Interviews were carried out with six nursing staff, and these captured the richness and complexity of the lived experience of nursing staff. Results: Four superordinate themes emerged from the analysis: Management of emotions: participants showed an awareness that their job is about giving care to patients who may present with very challenging behaviours. The care that they offered was conceptualized as something that needed to be provided in a measured way, with boundaries. A clear distinction was drawn between 'caring personally' for patients, and 'providing care'. Teamwork: teamwork was cited as a major influencing factor by all participants. This was seen as directly impacting the smooth running of the ward, and therefore on the well‐being of nursing staff, but also of patients. Understanding: nursing staff were acutely aware that they were working in an environment where everyday interactions would be open to intense scrutiny and possible misinterpretation by patients. Work–life balance: All the participants spoke of making a conscious effort to have a separate work and home life, which was influenced by a number of factors. Conclusion: The article has discussed the themes of managing emotion, team understanding and work–life balance, illustrating how each contributes to the resilience of nursing staff in this challenging environment. New insights – applicable in both national and international contexts – have been produced. Impact: In secure environments, mental health nursing staff need organizational support and assistance to develop ways of managing difficult experiences with patients, systems that promote recovery, and educational and supervisory support to help understand and process the effects on them. This article provides evidence to support the work of managers and clinicians in these environments. No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Purpose: A key aspect of psychologically informed planned environments (PIPEs), are the attachment theory-informed relationships between residents and staff (Bainbridge, 2017). The key-work provision of one-to-one support from officers to residents is one of the main ways through which relationships are formed. The purpose of this paper is to explore prison officers' experiences of the key-work role within a PIPE in a women's Prison in England. Design/methodology/approach: Semi-structured interviews explored ten prison officers' experiences. Interviews were analysed using thematic analysis. Findings: Five main themes were identified; "Professional support", "Negotiating Professional Boundaries", "A Successful Relationship", "Rupture and Repair" and "Growth for Everyone". These themes reflected the framework around keywork; what support officers need to cope with the emotional demands of the role, and how to manage challenging situations and build meaningful key-work relationships. Research limitations/implications: Limitations include the lack of focus on diversity, the impact of the COVID-19 pandemic on officer experience and applicability to other PIPE services. Future research could address some of these limitations. Practical implications: Practical implications highlight the need for consistent supervision, greater consideration of officers' transition to the role and trauma-informed training. Originality/value: The research provides an unprecedented account of prison officers' experiences of the key-work role, adding to the limited literature within PIPEs in the women's estate. The supportive nature of the key-work relationship was perceived by officers to contribute towards people's sentence progression and officers' personal and professional development. [ABSTRACT FROM AUTHOR]

The study examines the complex assessment of criminal culpability in individuals with ASPD, specifically regarding their ineligibility for conscription due to challenges obeying military regulations and endangering fellow soldiers. The research centers on 135 cases diagnosed with ASPD who sought exemption from conscription in Türkiye between 2018 and 2022, comparing their socio-demographic, clinical, and criminal characteristics. Significantly, individuals with severe ASPD demonstrate a correlation with increased rates of employment (p = .006), a greater frequency of planned offenses (p = .033), and a heightened frequency of criminal records (p < .001). Both groups with ASPD display self-harming tendencies, yet sASPD cases are more often subjected to exemption decisions prior to conscription (84.1%), in contrast to ASPD cases where disqualification arises primarily during conscription (59.1%) (p < .001). The rate of disqualification from conscription is greater among individuals with ASPD during service, particularly for severe cases earlier on. In both groups, younger individuals who live with their parents (p = .046) seek addiction treatment more frequently. sASPD individuals tend to have more criminal records, and exemption decisions often precede conscription. The study highlights differences between ASPD and sASPD, planned offenses, impulsivity, addiction treatment-seeking behavior, and frequency of criminal records as critical elements to consider when evaluating disqualifications for conscription in these groups. [ABSTRACT FROM AUTHOR]

AbstractObjective:Method:Results:Conclusion:There are significant temporal and financial barriers for individuals with personality disorders (PD) receiving evidence-based psychological treatments. Emerging research indicates Group Schema Therapy (GST) may be an accessible, efficient, and cost-effective PD intervention, however, there has been no synthesis of the available evidence to date. This review therefore aimed to investigate the efficacy of GST for PDs by systematically synthesizing available literature.Five electronic databases were screened with resulting studies subjected to a specific eligibility criteria, which yielded fourteen relevant studies. Characteristics were extracted and methodological quality rigorously assessed.Strong support was evidenced for GST’s ability to reduce Cluster B and C symptomology, particularly for Borderline and Avoidant PD. GST appeared to improve global symptom severity, quality of life and functional capacity, as well as treatment targets such as schemas and modes.Although not without limitations and a moderate risk of bias, the current body of evidence supports GST as a potential solution to current service deficits in economical and evidence-based care for individuals with PD. Implications for treatment and future research are discussed. [ABSTRACT FROM AUTHOR]

Background: Several studies have observed that mentalization-based treatment (MBT) is an effective treatment for borderline personality disorder (BPD), but its effectiveness for other personality disorders (PDs) has hardly been examined. Additionally, the evidence supporting the claim that MBT improves mentalizing capacity is scarce. The present study examined whether (i) patients with a broad range of PDs enrolled in an MBT program would improve on several outcome measures (ii) mentalizing capacity would improve over time; (iii) patients with BPD would improve more than those with non-borderline PDs. Method: Personality disorders, psychiatric symptoms, social functioning, maladaptive personality functioning and mentalizing capacity were measured in a group of individuals with various PDs (n = 46) that received MBT. Assessments were made at baseline and after 6, 12, and 18 months of treatment. The severity of psychiatric symptoms, measured using the Outcome Questionnaire 45, was the primary outcome variable. Results: Overall, enrollment in the MBT program was associated with a decrease in psychiatric symptoms and an improvement of personality functioning, social functioning for a mixed group of PDs (all p's ≤ .01). Bigger effect sizes were observed for BPD patients (n = 25) than for patients with non-BPD (n = 21), but the difference failed to reach statistical significance (p = 0.06). A primary analysis showed that the decrease in psychiatric symptoms was significant in BPD patients (p = 0.01), not in non-BPD (p = 0.19) patients. However, a sufficiently powered secondary analysis with imputed data showed that non-BPD patients reported a significant decrease in psychiatric symptoms too (p = 0.01). Mentalizing capacity of the whole group improved over time (d =.68 on the Toronto Alexithymia Scale and 1.46 on the Social Cognition and Object Relations System). Discussion: These results suggest that MBT coincides with symptomatic and functional improvement across a broad range of PDs and shows that MBT is associated with improvements in mentalizing capacity. As the study is not experimental in design, we cannot make causal claims. Conclusion: Mentalization-based treatment may be an effective treatment for patients with a broad range of PDs. Trial registration: The study design was approved by the Leiden University Ethical Committee. [ABSTRACT FROM AUTHOR]

Objective Method Results Conclusions Distress tolerance (DT)—willingness to face internal discomforts—has a fuzzy boundary with neuroticism (low emotional stability), raising questions about its independent role in models of personality and mental health.We investigated DT's overlap with neuroticism and other Big Five factors in a structural model of personality and personality disorder features in samples of university students (N = 1025), emotional disorder patients (N = 225), and substance‐use patients (N = 210).In exploratory factor analyses, we found that DT indicators clustered with neuroticism and were essentially unrelated to other Big Five domains. Big Five personality dimensions collectively explained approximately 40%–70% of variation in DT, across different samples and methods of quantifying shared variance.We conclude that DT and neuroticism are near neighbors in empirical space and speculate that much of the observed correlation between DT and mental health outcomes in the literature may be carried by shared neuroticism variance. We suggest that clearer distinctions between the two constructs in empirical research could improve our understanding of DT's unique role in the development and treatment of psychopathology. [ABSTRACT FROM AUTHOR]

Therapy for personality disorder can be understood as a process of enhancing attachment security. This study tests the theory that individuals in a secure forensic mental health setting with a diagnosis of personality disorder who have undertaken psychological therapy will report secure patterns of attachment in their relationship with their therapist. It uses a novel pattern matching approach that assesses the behavioural, cognitive and affective markers of attachment security in a group of patients undergoing therapy. Eight behavioural, cognitive and affective characteristics of secure attachment were identified. Ten patients completed a semi-structured interview about their experiences in therapy and key relationships, and their responses were reviewed for evidence of these eight characteristics. Nine out of ten participants were judged to have demonstrated a pattern of six or more of the eight characteristics of secure attachment. This study supports the theory that treatment for this group of patients works by developing patient-therapist attachments. A focus on attachment issues should, therefore, be a core aspect of therapy. [ABSTRACT FROM AUTHOR]

Objectives: The research aimed to evaluate an exploratory Compassion Focused Group Psychotherapy Programme and the impact on participants' experiences of self‐criticism, usage of services and general wellbeing. Participants included patients with a history of complex attachment and relational trauma (A&RT), who might attract a diagnosis of personality disorder. Design: This study utilised a quasi‐experimental non‐randomised within subject controlled design for the evaluation of the efficacy of the programme. Methods: Participants were recruited from tertiary care services. The programme consisted of a 12‐week Preparation and Engagement intervention (PEG) which was Compassionate Mind Training and Psychoeducation, followed by a 40‐week Compassion Focused Trauma Group intervention. The cohort was then followed up after 12 months during which period they received treatment as usual. A comprehensive selection of self‐report measures was administered at various points during the therapeutic process and following completion of the group interventions. Results: The results of the research showed that the provision of a long‐term, slow‐paced, Compassion Focused Group Psychotherapy intervention, resulted in significant changes across all measures which were maintained at 12‐month follow‐up. These significant results were maintained following intention to treat and reliable change analyses. These data were supported by a significant reduction in service usage and a significant increase in engagement in employment and education. Conclusions: This study has identified that within Compassion Focused Group Psychotherapy, there is a therapeutic process of establishing group‐based safeness as a necessary precursor to cultivating compassion and reworking early shame‐based trauma memories. [ABSTRACT FROM AUTHOR]

Recent work has nested the Alternative Model for Personality Disorders (AMPD) within several theoretical paradigms of personality and clinical psychology (e.g., multivariate, psychodynamic). This has both spurred on additional research and aided in practical application. Connecting the model to other theoretical heuristics may lead to further advances. One candidate for such a theory is that of evolutionary psychology, which attempts to provide explanations of human behavior (including personality traits) rooted in adaptation. In this article, we review and integrate the theoretical and empirical literature on the AMPD and evolutionary psychology, providing a synthesis of the two models in the hope of furthering the research and application of both. [ABSTRACT FROM AUTHOR]

In the ICD-11, PD and CPTSD overlap in impaired aspects of self- and interpersonal functioning, with implications for assessment and treatment. This article aimed to explore the relationship between CPTSD and PD features. A trauma-exposed community sample in Denmark (N = 470) completed the ITQ, PDS-ICD-11, and BTQ. Data were analyzed using exploratory structural equation modeling. Both two- and three-factor models were viable. In the two-factor model, both disturbances in self-organization (DSO) and PD items belonged to the same disturbed self-interpersonal functioning factor. Both factors predicted quality of life and functioning and were predicted by number of life events. In the three-factor model (PTSD, DSO, and PD), there was some overlap between DSO and PD items. Number of life events predicted belonging to the PTSD and DSO classes but not the PD class. The findings demonstrate clear overlapping and differentiating features. Multiple traumas and functioning in self-concept and relationships appear to differentiate. [ABSTRACT FROM AUTHOR]

Impaired parental reflective functioning (PRF), i.e. difficulties in understanding one's child in terms of mental states, may constitute a risk for children's development and wellbeing. Impaired PRF has been linked to parental psychopathology, however no study has investigated PRF in adult patients with personality disorders (PDs). We examined PRF in a sample of adult outpatients with diagnosed PDs compared with healthy controls (HCs), and explored associations between PRF and symptoms of psychopathology and interpersonal problems in parents with PD. A convenience sample of treatment-seeking outpatients with PDs (n = 34) were assessed with questionnaires measuring PRF (The Parental Reflective Functioning Questionnaire (PRFQ)), symptoms of psychopathology (Symptom Checklist Revised (SCL-90-R)) and interpersonal problems (Inventory of Interpersonal Problems (IIP)). PRF scores were compared with reported means of HCs (n = 156) pooled from a previous study. Parents with PD reported higher levels of pre-mentalizing and lower levels of certainty about mental states compared with HCs. Both groups reported high levels of interest and curiosity and did not differ significantly in this regard. Exploratory analyses showed that low levels of certainty about mental states was associated with high levels of depressive and psychotic symptoms and submissive types of interpersonal problems (social-avoidance and non-assertiveness). Our findings provide preliminary evidence that patients with PD have impairments in PRF compared with HCs. The findings stress the importance of assessing the multidimensional nature of PRF in parents with PD. [ABSTRACT FROM AUTHOR]

Objectives: The high prevalence of borderline personality disorder, along with comorbid psychiatric disorders and impulsive reactions (suicide attempts, self-mutilation, substance use, and impulsive behaviors) increase the need for effective psychological interventions. In this study, the effectiveness of dialectical behavior skills training based on the Soler method and family education with individual therapies are compared in this group of patients. Methods: In this single-blind case study, eight cases were selected through a targeted sampling method based on the inclusion and exclusion criteria. The participants were divided into two groups: Intervention individually and individual intervention with family education. Both group members and the family members of the second group received dialectical behavior skills training based on the Soler model. The participants completed the borderline personality inventory, self-harm inventory, and Barratt impulsivity scale in four stages: At the beginning of the sessions, in the middle of the treatment, at the end of the treatment, and three months after treatment. Results: The data were analyzed using the Wilcoxon test, Friedman test, and Mann-Whitney U test. The results indicate the effectiveness of the dialectical behavior skills training method based on the Soler model in reducing symptoms of borderline personality disorder and selfmutilation, as well as emotion regulation improvement at the significant level of P=0.05. Discussion: This treatment is recommended as an effective and short-term method for controlling symptoms of borderline personality disorder. Family education, in addition to dialectical behavior therapy, has been shown to have a positive effect on reducing symptoms in patients. [ABSTRACT FROM AUTHOR]

Introduction: We conducted a systematic review to evaluate the quality and extent of evidence on associations between personality disorders (PDs) and musculoskeletal disorders (MSDs) in population-based studies, since these disorders are leading causes of disease burden worldwide. Methods: A search strategy of published, peer-reviewed and gray literature was developed in consultation with a liaison librarian and implemented for Embase, CINAHL Complete, Medline Complete, and PsycINFO via the EBSCOhost platform from 1990 to the present and CORDIS and ProQuest Dissertations & Theses Global, respectively. The inclusion criteria were as follows: I) general population participants aged =15 years; II) self-report, probable PD based on positive screen, or threshold PD according to the DSM-IV/5 (groupings: any, Clusters A/B/C, specific PD) or ICD-10/11; III) MSDs identified by self-report or ICD criteria (arthritis, back/neck conditions, fibromyalgia, osteopenia/osteoporosis) and III) cohort, case-control, and cross-sectional study designs. Two reviewers independently screened articles and extracted the data. Critical appraisal was undertaken using the Joanna Briggs Institute checklists for systematic reviews of etiology and risk. A descriptive synthesis presents the characteristics of included studies, critical appraisal results, and descriptions of the main findings. This review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: There were 11 peer-reviewed, published articles included in this review (n = 9 cross-sectional and n = 2 case-control studies); participants were =18 years in these studies. No published gray literature was identified. Semistructured interviews were the most common method to ascertain PDs; all studies utilized self-reported measures to identify MSDs. Overall, we detected limited and conflicting evidence for associations between PDs and MSDs. Discussion: The main result may be explained by lack of population-based longitudinal evidence, heterogenous groupings of PD, and few comparable cross-sectional and case-control studies. Strengths of the review include a comprehensive search strategy and a discussion of mechanisms underlying possible associations between PDs and MSDs. Conclusions: The quality of most studies included in this review that examined associations between PD and MSDs in general population adults was high. However, the results demonstrated limited and conflicting evidence for these associations, in part, due to lack of comparable evidence, which should be addressed in future research. [ABSTRACT FROM AUTHOR]

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This Viewpoint paper argues for a peer trade-off model of personality disorder (PD) traits during adolescence that allows for both positive (e.g., popularity, peer acceptance) and negative (e.g., peer rejection, peer victimization, peer exclusion) peer outcomes. The need for new interpersonal (dsy)function models of PD traits during adolescence is urgent because most research has focused on internalizing and externalizing psychopathology, as well as adults, who differ from adolescents in the value that they place on different social behaviors. Available clinical treatments for PD traits have also been based on findings with adults. Thus, new models are not only needed but would have profound etiological, diagnostic, and treatment implications. We describe preliminary findings that support our proposed peer trade-off model. In conclusion, we describe promising new directions to further evaluate the model and advance knowledge about PD traits during adolescence. [ABSTRACT FROM AUTHOR]

The International Classification of Diseases, 11th Edition (ICD-11) includes a new personality disorder (PD) severity diagnosis that may be further characterized using up to five trait domain specifiers. Most of the previous studies have investigated the ICD-11 trait domains using self-report measures. The present study aimed to validate ICD-11 PD trait domains using a multimethod design in a community mental health sample (n = 336). We conducted two confirmatory factor analyses to examine the factor structure of the ICD-11 PD trait model, utilizing clinician-rating, self-report, and informant-report measures. Finally, we examined associations between clinician-rated, self-reported, and informant-reported ICD-11 trait domains with external criteria, specifically traditional PD symptoms and the five-factor model of normal personality. All clinician-rated, self-reported, and informant-reported domain scores loaded meaningfully on their expected factors when controlling for nontrivial method factors. Generally, the trait domains exhibited meaningful associations with conceptually relevant external criteria, although the anankastia domain exhibited more variability in its pattern of correlations across methods. Overall, the ICD-11 trait domain model shows promising reliability and validity, indicating good progress within the field of PD assessment toward a more useful PD operationalization. Public Significance Statement: The International Classification of Diseases, 11th Edition, has a new diagnostic system for personality disorder, which includes dimensional personality traits. Further validation of this system is necessary to ensure that it works well in practice. The present study provides support for validity of the International Classification of Diseases, 11th Edition personality trait model. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to revise and update the MMPI-2-RF personality disorder (PD) syndrome scales for the Minnesota Multiphasic Personality Inventory–3 (MMPI-3). Study 1 describes the development of the MMPI-3 PD syndrome scales in three separate samples of community participants (n = 1,591), university students (n = 1,660), and outpatient mental health patients (n = 1,537). The authors independently evaluated each of the 72 new MMPI-3 items and rated them for appropriateness for scale inclusion and used various statistical procedures for final item selection. Ultimately, all 10 scales were revised, with nine incorporating items that were new to the MMPI-3. In Study 2, we subsequently validated the new MMPI-3 PD Syndrome scales against measures of traditional PD measures, trait measures of the Alternative Diagnostic and Statistical Manual of Mental Disorders, fifth edition-5 model of personality disorders (AMPD) and the five-factor model (FFM) of personality, and specific criterion measures of externalizing, psychopathy, narcissism, emotional dysregulation, and self-harm, in two samples of university students (ns = 489 and 645). With some exceptions, the results were generally supportive of the convergent and discriminant validities of the MMPI-3 PD Syndrome scales. The Histrionic PD scale in particular was associated with questionable results and diverged most strongly from the theoretical construct it was originally meant to reflect. Further continuous validation of the scales is needed, especially in clinical samples, but the findings to date are promising. Public Significance Statement: This research developed a new set of scales to assess for personality disorder symptoms on the Minnesota Multiphasic Personality Inventory–3 (MMPI-3)—one of the most frequently used psychological tests in clinical practice. The study results showed promising validity for these scales. [ABSTRACT FROM AUTHOR]

Schizotypal personality pathology (SZP) is a persistent and debilitating problem for a substantial number of people. Research on SZP has typically emphasized its biological and more specifically genetic origins. However, recent research has highlighted the potential influence of trauma on SZP. This research is promising, although it has thus far focused primarily on type of trauma (e.g., different types of abuse vs. neglect in childhood) rather than who perpetrated the trauma. Previous studies on both personality pathology in general and psychotic-spectrum experiences characteristic of SZP in particular have highlighted the influence of trauma perpetrated by someone with whom the trauma survivor was close (i.e., betrayal trauma), although this has not yet been examined with respect to SZP specifically. In this study we examined this, evaluating the influence of trauma with varying degrees of betrayal on SZP in a sample of adults (N = 364) using structural equation modeling. Results suggest that interpersonal trauma in general was associated with higher levels of SZP. Findings further indicate that for women but not men, trauma with a high degree of betrayal was uniquely associated with SZP. These results underscore the potential role of trauma in SZP and have implications for future research on and intervention with people with high levels of SZP. [ABSTRACT FROM AUTHOR]

Sara was a 65‐year‐old Caucasian woman who requested art therapy after the death of her partner. She had experienced incest by her father and verbal abuse by her mother until she left home at 21. Her life was characterized by broken relationships due to alienating anger outbursts and an interrupted work history; she met three criteria for narcissistic personality disorder. Sara initially was socially isolated and intellectualizing. She desired recognition but was fearful of exposure. The Expressive Therapies Continuum (ETC) theoretical framework, which consisted of a gradual progression from cognitively‐dominated sessions to more emotionally focused processing, guided the therapeutic work. The ETC theory encourages transparency and collaboration between therapist and client regarding therapeutic tasks and goals, and provides a framework for addressing and repairing ruptures in the therapeutic alliance. Art therapy began with the cognitive tasks which Sara completed relatively comfortably, then encouraged integration of emotion via expressive writing, diagrams, and body mapping. Through careful attention to repair of ruptures by directly discussing and adapting the direction and tasks of therapy, Sara slowly was able to experience emotions other than anger. She integrated cognitive and emotional insights about her life and developed empathy for her childhood self. At termination Sara had cultivated two friendships and met only one criterion of NPD. Limitations of this case study include a lack of research evidence for ETC‐guided art therapy with NPD clients and by the retrospective approach. Future research efforts could provide this support by encouraging clinicians to conduct prospective case study research. [ABSTRACT FROM AUTHOR]

Chronic suicidal ideations can be consistently present as part of the individual's sense of identity and self-regulation or as a reoccurring pattern to control intense feelings and communicate and relate experiences or intentions. While they can be the precursor to self-harm and suicide attempts, requiring a thorough risk assessment, they can also represent a way to control, avoid, or contain intolerable feelings and experiences. In addition, suicidal ideations can be either deeply internalized and hidden or indirectly or directly conveyed to others. This article focuses on understanding and approaching chronic suicidal ideations that specifically relate to self- and interpersonal characterological functioning, i.e., sense of identity, self-regulation, emotion regulation, and interpersonal intentions. Suicidal ideations must be identified and assessed both in terms of intention, i.e., motivation, plans, and means to harm oneself or end one's life, as well as in terms of function, i.e., related to selfregulatory strategies for counterbalancing or protecting against overwhelming, painful, and frightening external, interpersonal, or internal experiences. Therapeutic strategies and challenges will be discussed, including engaging patients in the therapeutic alliance and building consistency, trust, and reliability. [ABSTRACT FROM AUTHOR]

Introduction: High dropout and low treatment attendance rates among patients with posttraumatic stress disorder (PTSD) and personality disorders (PDs) continue to pose a significant challenge. Despite numerous studies focusing on enhancing treatment attendance, the identification of consistent and reliable predictors in patients with PTSD and comorbid PDs remains limited. Objectives: This study aims to investigate a wide range of potential predictors of treatment attendance, encompassing demographic, patient-severity, treatment, and therapist-related variables in patients with PTSD and comorbid borderline and/or cluster C PDs. Methods: Utilizing data from 255 patients participating in two randomized controlled trials comparing trauma-focused treatment with or without concurrent PD treatment, candidate predictors were individually analyzed in univariate regression models. Significant predictors were then combined in a multiple ordinal regression model. Results: In total, 40% of patients attended fewer trauma-focused treatment sessions than the minimum recommended in treatment guidelines. Out of the 38 candidate predictors examined, five significant, independent predictors of treatment attendance emerged in a multiple ordinal regression model. Higher baseline PTSD severity (OR = 1.04, p = .036), higher education level (OR = 1.22, p = .009) and a stronger patient-rated working alliance (OR = 1.72, p = .047) with the therapist predicted higher treatment attendance. Conversely, inadequate social support from friends (OR = 0.90, p = .042) and concurrent PD treatment and trauma-focused treatment (OR = 0.52, p = .022) were associated with lower treatment attendance. Conclusions: In conclusion, this constitutes the first study investigating predictors of treatment attendance in patients with PTSD and comorbid PDs. The results highlight the complexity of pinpointing reliable predictors. Nevertheless, the identification of five predictors provides valuable insights, aiding clinicians in customizing treatment strategies for individual patients and enhancing overall treatment attendance.