Personality Disorder Research Articles

Psilocybin mushroom stewardship: A qualitative inquiry into practices and priorities of “underground” psilocybin mushroom practitioners

AbstractBackground and AimsNetworks of so-called underground, or illegal, psilocybin mushroom practitioners are popularly known to exist, though few systematic investigations of their practices have been conducted. We sought to uncover the experiences of a hidden community of psilocybin practitioners in order to inform scientific and policy dialogues about safe and effective practices in this area.MethodsAn academic-community partnered research team used snowball sampling to recruit 17 underground psilocybin practitioners in a western U.S. state for in-depth individual interviews focused on training, protocols, practices, and policy priorities. Combined deductive and inductive analysis with three independent coders was completed using NVivo v12.ResultsPractitioners were white (76.5%), female-identified (64.7%), aged 31 to 50 (64.7%), non-therapists by training (58.8%), and moderately to highly experienced facilitators. All described multiple years of often difficult personal inner-directed work with psilocybin before guiding others. Benefits ranged from reduction in symptoms of depression, obsessive-compulsive disorder, and addictions to greater self-knowledge, reduced death anxiety, and a greater ability to experience joy. Client screening protocols revealed precautions for persons with severe trauma backgrounds, personality disorders, or lacking social support. Moving too quickly into a high dose mushroom session without adequate preparation or internal resourcing was perceived as a significant risk for harm. Practitioners' direct personal relationship with mushrooms was highlighted as critical to safe practice. Policy priorities centered on respectful reciprocity, defined as an ethos of giving back rather than extraction, and equitable access.ConclusionsWhile some psychedelic research actively examines the role of the mystical-type experience in clients' positive outcomes, findings from underground practitioners suggest an even greater role of mysticism, relationality, and expanded concepts of holistic healing that can inform the development of best practice paradigms of an emerging profession.

“Vulnerability can breed strength”: The role of borderline personality disorder severity in movement synchrony among patients with major depressive disorder

“Vulnerability can breed strength”: The role of borderline personality disorder severity in movement synchrony among patients with major depressive disorder

A Qualitative Study of the Lived Treatment Experiences of Women With an Eating Disorder and Comorbid Borderline Personality Disorder.

Having both an eating disorder (ED) and borderline personality disorder (BPD) is associated with heightened clinical complexity, high levels of distress, and challenges in treatment. This study sought to qualitatively investigate the experiences of women with an ED and comorbid BPD as they undergo ED treatment, aiming to better understand factors that shape their perceptions of care. Fourteen women with both an ED and BPD in treatment at a public-sector ED clinic were recruited to participate in an open-ended qualitative interview about their lived treatment experiences. Five overarching themes (with seven subthemes) emerged from the qualitative analysis: (1) Difficulties with emotions as a key factor underlying both ED and BPD; (2) Perceptions of BPD in ED maintenance and treatment; (3) Relational dynamics in treatment; (4) Treatment is "never enough"; and (5) The importance of treating the ED and BPD together. This study highlights the lived experiences of women with both an ED and BPD. Patients expressed the need for ED treatment to target emotion dysregulation, interpersonal difficulties, and their attachment to their therapists and to treatment. This study provides insights into the experiences of patients with BPD of ED treatment that may help guide the approach to care in such individuals.

Enhancing the Social Network: Multimodal Treatment for Comorbid Borderline Personality Disorder and Alcohol Use Disorder.

More than half of all people with borderline personality disorder will develop alcohol use disorder in their lifetime. These disorders mutually reinforce each other, with a higher risk for treatment failure and poor outcomes, including suicide, yet no widely available treatments have been found to be effective for both diagnoses concurrently, leaving patients and clinicians alike stranded between two clinical domains that rarely overlap despite shared features. In the absence of alternatives, good psychiatric management (GPM) capitalizes on standard-of-care interventions using generic clinical tools that do not require specialization. In an effort to broaden and stabilize the social networks of connections for patients with interpersonal hypersensitivity, GPM relies on a multimodal approach that combines the indicated pharmacological and psychosocial interventions for the treatment of alcohol use disorder with a common-factors approach for borderline personality disorder. This multimodal approach emphasizes psychoeducation, social rehabilitation, management of suicidality, and active management of these frequently comorbid conditions. In this article, the authors describe GPM's strategy of stabilizing and broadening the patient's social network to target the core interpersonal and stress hypersensitivity. To do this, clinicians can use interventions for significant others combined with empirically supported and widely available mutual-help groups, such as Alcoholics Anonymous, that structure and regulate relational instabilities with community norms, standards, roles, and procedures. GPM also promotes family interventions for both conditions to reduce conflict and increase support within existing relationships, thereby strengthening patients' capacity to work on their sobriety and borderline personality disorder by mitigating aloneness and its effects.

Optimal control strategies for taming TikTok addiction: a mathematical model and analysis

Abstract Optimal control theory is an extension of the calculus of variations. It is a mathematical optimization method for deriving control strategies for a dynamic system. In this paper, the system of differential equations for which we aim to utilize control theory is TikTok, which is one of the most attractive internet platforms. TikTok has garnered immense popularity, surpassing other social media platforms. However, its addictive nature has raised concerns about mental health, including depression, eating disorders, anxiety, self-obsession, and narcissistic personality disorder among its users. This paper introduces a mathematical model for TikTok, considering the usage of this app as an epidemic. The model is rigorously validated through stability analysis of both local and global equilibrium. Moreover, disease-free and non-trivial equilibrium scenarios are discussed by calculating their reproduction numbers. This study aims to raise awareness of TikTok’s potential misuse and explore control theory solutions to mitigate addiction. Additionally, statistical data is used to visualize the numerical results and analyze the impact of control parameters on the TikTok model.

Associations between antidepressants and risk of suicidal behaviour and violent crimes in personality disorder.

Associations between antidepressants and risk of suicidal behaviour and violent crimes in personality disorder.

Editorial: Personality disorders in youth: from early diagnosis to treatment

Editorial: Personality disorders in youth: from early diagnosis to treatment

“Heart-sink patients”: Attitudes of mental health professionals toward individuals with a diagnosis of borderline personality disorder—A qualitative evidence synthesis.

“Heart-sink patients”: Attitudes of mental health professionals toward individuals with a diagnosis of borderline personality disorder—A qualitative evidence synthesis.

Screening for borderline personality symptoms amongst adult offenders attending rehabilitation programmes

There is a paucity of research into rates of borderline personality disorder in Australian forensic settings. This paper aimed to describe self-reported borderline personality symptoms within a South Australian offender cohort attending rehabilitation programmes in the prison or community. A retrospective audit of N = 576 offender records was undertaken between February 2021 and August 2023. Offenders routinely completed the McLean Screening Instrument for Borderline Personality Disorder on entry to rehabilitation programmes. Respondents who endorsed 7 or more items on this screener were categorised into a ‘high borderline symptom’ group and compared across key demographics. The sample was predominantly men (n = 546) with 33% categorised into the ‘high borderline symptoms’ group, compared to 20% of women assessed (n = 30). Findings suggest high rates of borderline personality symptoms amongst this cohort, which has implications for engagement in rehabilitation programmes, staff training and education, and opportunities for reducing recidivism.

Impairment in personality functioning predicts young adult suicidal ideation and suicide attempt above and beyond depressive symptoms.

Interpersonal factors and depression are believed to be some of the main drivers of suicidal thoughts and behaviors, but other factors may be equally or more important. Drawing on psychodynamic (mentalization) theory, we propose that personality functioning, in particular an incoherent sense of self, may be an important driver of suicidal thoughts and behaviors over and above factors of interpersonal functioning and depression. To evaluate this, we examined associations between personality functioning and suicidal ideation and suicide attempt in young adults. Participants (N=153; Mage=20.93) were recruited from a college sample (N=90) and a clinical sample with borderline personality disorder (N=63). Personality functioning (self and interpersonal components) was measured with the Level of Personality Functioning Scale - Brief Form 2.0. Suicidal ideation was measured with the Personality Assessment Inventory. Suicide attempt history was assessed with the Columbia-Suicide Severity Rating Scale. Depression symptoms were measured with the Symptom Checklist 90. Regressions examined relationships between personality functioning, depression symptoms, and suicidal ideation or attempt while controlling for age and gender. Overall personality functioning was significantly associated with suicidal ideation (β=.584, p<.001) and suicide attempt (β=.384, p<.001). Overall personality functioning was a stronger predictor than depression symptoms, age, and gender when included in the same model predicting suicidal ideation or attempt. Both the self and interpersonal components of personality functioning were significantly associated with suicidal ideation and attempt, with larger effect sizes for self-functioning. Findings underscore the importance of considering personality functioning, especially self-functioning, in suicide risk assessment and treatment.

Meaning in Life as an Outcome of Inpatient or Day-Hospital Psychotherapy for Personality Disorder.

Psychotherapy may contribute to the experience of meaning in life. This study investigated meaning in life among patients with personality disorders during inpatient or day-hospital psychotherapy. Meaning in life was approached from two conceptual perspectives: personality functioning with an emphasis on self-direction and existential psychology. We investigated changes in the sense of meaning in life and accounted for changes in depressive symptoms and identity and interpersonal pathology. Using pre-post measures, Livesley's General Assessment of Personality Disorder, especially, the Lack-of-Meaning-Purpose-and-Direction subscale and Steger's Meaning-in-Life Presence subscale were administered to 75 patients with personality disorders during inpatient or day-hospital psychotherapy for 8-12 months. Regression models showed that levels of the lack and presence of meaning decreased and increased during treatment, respectively, controlled for changes in depressive symptoms. Decreased identity pathology was significantly associated with changes in the lack or presence of meaning. Meaning in life may act as an outcome variable in intensive psychotherapy for personality disorders. The development of identity and self-direction may restore or create the ability to give life meaning.

Early maladaptive schemas as mediators between childhood maltreatment and adult psychopathology in psychiatric inpatients.

Early maladaptive schemas are well-established mechanisms between childhood maltreatment (i.e., abuse and neglect) and psychopathology in adulthood. However, research has not yet examined the unique contribution of childhood maltreatment, while controlling for the family dysfunction-related experiences, in shaping specific EMS domains and their associations with distinct psychopathological outcomes. Our aim was to examine the unique role of childhood maltreatment, while controlling for the effects of family dysfunction on early maladaptive schemas and subsequently on personality disorders and psychological distress using structural equation modelling and network analysis. A total of 2,011 unique inpatients aged 18 to 80 years (M = 39.7, SD = 14.18; 53.4% women) admitted to the Alexianen Zorggroep Tienen Psychiatric Hospital between 2011 and 2021 were included in this study. Self-report questionnaires were completed as part of the hospital admission process. Data were analyzed using structural equation modeling and network analysis. The results showed positive associations between childhood maltreatment, family dysfunction, early maladaptive schema domains, symptoms of personality disorders, and psychological distress. Accounting for the effects of family dysfunction-related experiences, early maladaptive schema played a significant mediating role in the association between childhood maltreatment and psychopathological outcomes. The results highlighted the central role of the domains disconnection/rejection and impaired autonomy/performance for personality disorders and psychological distress. There were no significant gender-specific differences in the network of relationships between the variables. These results demonstrate the key role of EMS in the domains of disconnection/rejection and impaired autonomy/performance in the association between childhood maltreatment and personality pathology and psychological distress in psychiatric inpatients. Clinical implications, study limitations, and recommendations for future research are discussed.

Paraphilias, problematic sexual behaviours and personality disorder-To what extent are they linked?

Since DSM-III, mental disorders have been classified based on overt symptoms and behaviours rather than underlying psychological and personality processes. This study examines the occurrence of personality dysfunction in individuals with paraphilic disorders and problematic sexual behaviours. The Shedler-Westen Assessment Procedure (SWAP-200), a clinician-rated assessment measure of personality disorders, was administered in a sample of 303 patients referred to a specialist forensic psychotherapy clinic. Sixty-six percent (N =200) of the sample were diagnosable with traits of one or more DSM-5 personality disorders, and 35% (N =106) were diagnosable with categorical DSM-5 personality disorders. When an alternative set of empirically derived personality diagnoses was examined, 94% (N =285) had significant traits of the personality syndromes, and 62% (N =188) of the sample met criteria for categorical diagnoses. Paraphilic fantasies and behaviours may be linked to underlying personality pathology, suggesting implications for assessment and treatment.

The use of Experience Sampling Method in psychopharmacological studies: A systematic review.

The Experience Sampling Method (ESM) is increasingly used to validate and assess treatment effects. We conducted a systematic review to update, and extend, the previous review by Bos et al. (2015), by performing literature searches in PubMed, PsycInfo, and EMBASE. Search queries included every DSM-disorder, ATC-listed psychotropic medication, and multiple search-terms for ESM. Studies included medicated psychiatric patients who filled-out ambulatory prompts ≥2/day. Templates served to distil research themes. The majority of the 79 included studies involved substance use- (n = 47), mood- (n = 17), and psychotic disorders (n = 11). Less studied were anxiety disorders and PTSD (n = 3), and ADHD (n = 1). We identified six research themes:1)Effects of psychopharmacological treatment on symptoms and factors influencing outcome, 2)Fluctuations of psychiatric symptoms in medicated patients, 3)Prediction of relapse, exacerbation of symptoms or medication non-compliance, 4)Added value of ESM compared to care as usual, 5)Using ESM to establish treatment response-trajectories, 6)Acceptability and feasibility of newly-devised ESM-applications. This review reveals that ESM is predominantly used in psychopharmacological studies to monitor treatment effects and establish fluctuations of momentary psychiatric symptoms. Future research might facilitate personalising psychopharmacological prescribing decisions using ESM. Currently underrepresented patient groups include elderly patients, and personality disorders. Finally, to facilitate ESM-implementation multiple context-levels should be optimised.

Application of microarray patches for the transdermal administration of psychedelics drugs in micro-doses

Throughout history, psychedelic compounds have been used for religious, spiritual and recreational purposes. A plethora of studies have reported the use of psychedelic compounds in the treatment of various conditions, such as alcoholism, addictions, depressive state to borderline schizophrenia, personality disorder, among other mental disorders. Psychedelic microdosing, a common technique in recent years, involves the consumption of small doses of psychedelic drugs for therapeutic purposes. This study investigated the potential of hydrogel-forming microarray patches (HF-MAPs) to deliver N,N-dimethyltryptamine (DMT), 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT), and mescaline (MES) in small doses through the skin. To this purpose, HF-MAPs were prepared using poly(vinyl alcohol) (PVA) and poly(vinyl pyrrolidone) (PVP), using citric acid as the crosslinker. Two different reservoirs, containing PVP and PVA as the main components and poly(ethylene)glycol 400 (PEG400) and glycerol as plasticising agents, were used to deliver all the drugs from the HF-MAPs. Franz cells studies in excised neonatal porcine skin demonstrated that the permeation of DMT, 5-MeO-DMT and MES was better from the PEG400 reservoir, showing a permeation of 60.71 %, 59.61 % and 41.85 % respectively. Pharmacokinetic studies in rats showed that HF-MAP technology as a strategy for microdosing psychedelic compounds was also demonstrated with DMT. AUCt0-final for the HF-MAP cohort (7186 ± 1296 ng/mL*h) was significantly greater than the IM cohort (1803 ± 53.25 ng/mL*h) (p = 0.0020), with a relative bioavailability of ∼ 72 %. Considering their pharmacokinetic profile, the frequency of DMT dosing could be reduced with HF-MAP when compared to the IM route.

National Implementation of a Crisis Resolution Home Treatment (CRHT) Team in Malta: Insights From the First Two Years of Operation.

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.

The societal costs of avoidant personality disorder.

The study aims to estimate the societal costs of avoidant personality disorder (AvPD). Cross-sectional data on AvPD patients during 2017-2020 were retrieved from the quality register of the Norwegian Network for Personality Disorders. Cost estimations were based on a bottom-up approach, using a structured interview covering the 6-month period prior to initial assessment. Unit costs were retrieved from public records. The human capital approach was used to calculate productivity losses. Diagnoses were determined according to DSM-5 by semi-structured diagnostic interviews (SCID-5-PD). Mean societal costs were €19,378 for the total group (N = 410). The subgroup with a single diagnosis (n = 270) incurred €18,818, whereas the subgroup with at least one comorbid PD (n = 140) incurred €20,458. The difference between the two subgroups was not statistically significant. The largest cost component was productivity loss (69%), whereas health service costs constituted 31%. The main contributors to societal costs from the health service cost components were inpatient treatment (18%) and individual outpatient treatment (11%). In conclusion, societal costs for AvPD patients were high, on the same level as borderline PD, schizotypal PD, and schizophrenia, and higher than anxiety disorders, depression, and rheumatoid arthritis. In the future, development of effective AvPD treatment programs enhancing personality functioning and workforce participation is important in order reduce the cost of illness.

Experience of childhood adversity and maladaptive personality traits: Magnitude and specificity of the association in a clinical sample of adult outpatients.

The relationship between the experience of childhood adversity (CA) and the development of personality disorders (PDs) has been well documented. The dimensional PD alternative model (AMPD) has been introduced in nosography in 2013, and so far it is been used for CA research mostly on non-clinical samples. We included in our study 137 psychiatric outpatients who were screened for history of maternal antipathy (MA), paternal antipathy (PA), maternal neglect (MN), paternal neglect (PN), maternal physical abuse (MPA), paternal physical abuse (PPA) and sexual abuse (SA) using the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and underwent personality assessment using the Personality Inventory for DSM-5. Applying CECA.Q cut-off scores, rates of participants reporting CA were as follows: 14.6% MA; 13.9% PA; 13.1% MN; 10.2% PN; 25.5% MPA; 24.8% PPA; and 22.6% SA. In multivariate regression models, accounting for age, gender and exposure to other types of CA, exposure to MA was associated with increased negative affect, detachment, disinhibition and psychoticism; exposure to PA with increased disinhibition; and exposure to SA with increased antagonism, disinhibition and psychoticism. All effect sizes were small, except for a moderate effect of SA on psychoticism. Results pointed to a small but specific and independent effect of MA on most maladaptive personality traits; a possible specific role of the paternal figure for externalizing traits; and a moderate effect of SA on psychoticism. The cumulative exposure to multiple CAs significantly predicted all maladaptive personality traits, with much larger effect sizes compared to those calculated for single CAs. CA explained the higher proportion of variance for antagonism and psychoticism. In conclusion, exposure to specific forms of childhood abuse was associated with specific maladaptive traits in psychiatric outpatients, even if the effect of cumulative multiple CAs was larger.

Obsessive-compulsive personality disorder increases cognitive inflexibility in people with coronary artery disease.

Cardiovascular diseases such as coronary artery disease (CAD) have a high prevalence of psychiatric comorbidities, that may impact clinically relevant outcomes (e.g., cognitive impairment and executive dysfunction). Obsessive-compulsive personality disorder (OCPD) is a common psychiatric comorbidity in CAD. It has a distinct cognitive profile characterised by inflexible thinking and executive dysfunction, which in turn may affect treatment adherence. However, the impact of OCPD on cognitive functioning in CAD is under-researched. We aimed to investigate the impact of OCPD on executive function in individuals with CAD undergoing rehabilitation, using cognitive tests relating to inflexibility and executive planning. Seventy-eight adults (median age 59 [53.0-66.0] years) with CAD were tested within three days of hospital admission for cardiac rehabilitation occurring within two weeks of experiencing an episode of unstable angina or myocardial infarction. The Compulsive Personality Assessment Scale (CPAS) was used to evaluate OCPD traits. Neurocognitive testing was performed using the Cambridge Automated Neuropsychological Test Battery (CANTAB) including tests of set shifting (Intra-Extra Dimensional [IED] Set Shifting), and executive planning (Stockings of Cambridge [SOC]). Ten individuals with CAD fulfilled the operational criteria for DSM-5 OCPD. Individuals with comorbid OCPD made more IED intra-dimensional shift reversal errors (2.0 [2.0-4.0] vs. 1.0 [1.0-2.0], p=.004), reflecting a difficulty inhibiting previously learnt responses. When all participants were analysed as a group, negative associations were found between individual OCPD traits and other aspects of cognitive performance. Hoarding trait was associated with increased initial thinking time on the SOC at five moves (ρ=0.242, p=.033), while the need for control and rigidity traits were each associated with increased initial thinking time on the SOC at two moves (respectively, ρ=0.259, p=.022; ρ=0.239, p=.035), reflecting slower executive planning. A preoccupation with details trait was associated with fewer errors on a compound discrimination stage of the IED (ρ=-0.251, p=.026). After controlling these correlations for gender and age, significant associations remained with hoarding (β=0.243, p=.036), need for control (β=0.341, p=.005) and rigidity (β=0.259, p=.038) traits. Preliminary evidence suggests that individuals with CAD and comorbid OCPD traits show greater inflexibility than those without OCPD. Several OCPD traits were associated with slower planning, even after controlling them for age and gender. This may have implications for the success of rehabilitation.

The Association of Borderline Personality Disorder Traits Among Justice-Involved Adolescents who Misuse Opioids From Divorced/Separated Homes

The Association of Borderline Personality Disorder Traits Among Justice-Involved Adolescents who Misuse Opioids From Divorced/Separated Homes