Personality Disorder Research Articles

Examining the needs, outcomes and current treatment pathways of 2461 people with treatment-resistant depression: mixed-methods study.

A substantial subset of patients with major depressive disorder (MDD) experience treatment-resistant depression (TRD), typically defined as failure to respond to at least two sequential antidepressant trials at adequate dose and length. To examine clinical and service-level associations of TRD, and the experiences of people with TRD and clinicians involved in their care within a large, diverse National Health Service trust in the UK. This mixed-methods study integrated quantitative analysis of electronic health records with thematic analysis of semi-structured interviews. Chi-squared tests and one-way analysis of variance were used to assess associations between lines of antidepressant treatments and sociodemographic and clinical variables, and binary logistic regression was used to identify associations of TRD status. Nearly half (48%) of MDD patients met TRD criteria, with 36.9% having trialled ≥4 antidepressant treatments. People with TRD had higher rates of recurrent depression (odds ratio = 1.24, 95% CI: 1.05-1.45, P = 0.008), comorbid anxiety disorders (odds ratio = 1.21, 95% CI: 1.03-1.41, P = 0.019), personality disorders (odds ratio=1.35, 95% CI: 1.10-1.65, P = 0.003), self-harm (odds ratio = 1.76, 95% CI: 1.06-2.93, P = 0.029) and cardiovascular diseases (odds ratio = 1.46, 95% CI: 1.02-2.07, P = 0.0374). Greater treatment resistance was linked to increased economic inactivity and functional loss. Qualitative findings revealed severe emotional distress and frustration with existing treatments, as well as organisational and illness-related barriers to effective care. TRD is characterised by increasing mental and physical morbidity and functional decline, with individuals experiencing barriers to effective care. Improved pathways, service structures and more effective biological and psychological interventions are needed.

Renaming schizophrenia: why, how, and what next?

The debate over renaming schizophrenia has gained international momentum, driven by concerns about stigma and scientific accuracy. This review examines the arguments for and against renaming schizophrenia, highlighting research data from the US and international efforts. Proponents argue that the current term perpetuates stigma, is scientifically outdated, and that stakeholders, including those with lived experience, favor a name change. Opponents, however, caution that renaming might not reduce stigma and could complicate access to care. Stigma associated with schizophrenia leads to significant discrimination in healthcare, employment, and social interactions. Moreover, the term inaccurately suggests a 'split' in the brain, contributing to public misconceptions. Survey data from various countries reveal substantial support for renaming, with some evidence suggesting that new terms can reduce stigma and improve treatment engagement. Historical precedents, such as the renaming of multiple personality disorder to dissociative identity disorder, show that such changes can occur without disrupting care. The review concludes that while renaming schizophrenia could align the term with contemporary science and reduce stigma, a systematic, consensus-building approach involving diverse stakeholders is essential. Future steps should focus on finding an appropriate name that reflects the illness's core aspects and ensures optimal care.

Dialectical behaviour therapy in the treatment of borderline personality disorder: a commentary

Dialectical behaviour therapy in the treatment of borderline personality disorder: a commentary

Secure care hospital evaluation of manualised interpersonal art-psychotherapy (SCHEMA): A randomised controlled trial protocol

Background Within the criminal Justice System in the UK one-third of prisoners self-identified as having a learning difficulty and/or disability. This is broadly consistent with formal assessment of the needs of offenders, with 29% of the offender population having a learning disability. In the UK, NHS and private/independent sector secure care (Forensic) provides assessment and treatment for men and women who have come into contact within the Criminal Justice System and have mental health needs, a personality disorder, and/a learning disability. Patients in these services are often detained under the Mental Health Act (1983) and/or have licence conditions that have been set by the Ministry of Justice. Interpersonal art psychotherapy was developed within secure care as an accessible psychological intervention for adults with mild intellectual disabilities or borderline intellectual functioning. A feasibility randomised controlled trial of interpersonal art psychotherapy showed that assessment of key feasibility objectives were met and the trial procedures were acceptable, indicating progression to a definitive trial. Methods This is a two-arm single blind randomised controlled trial of effectiveness comparing manualised interpersonal art psychotherapy and Usual Care (UC) to UC. The Randomised Controlled Trial (RCT) will be conducted in a minimum of 10 secure care hospitals (NHS & Independent) with secure care (Forensic) facilities and will recruit 150 participants. The trial design includes an integrated assessment of cost-effectiveness. Results Individuals with intellectual disabilities and borderline intellectual functioning were involved in the design and set up of the trial. The trial is currently open to recruitment for participants from eight NHS and private/independent secure care sites in the UK. Conclusions A full report of study results will be published on completion of the trial. The trial has been registered ISRCTN57406593 (ISRCTN registry, 2024). This published protocol corresponds with version 6, dated 12.08.2024.

A Case of Disseminated Neurocysticercosis with Neuropsychiatric Symptoms

Abstract Neurocysticercosis (NCC), the most common type of neuroparasitosis, is a condition in which the central nervous system (CNS) is infested with the pork tapeworm Taenia solium cysticercosis’ larvae. NCC is the most widespread parasitic CNS disease worldwide, affecting more than 50 million individuals. It is prevalent in Latin America, most of Asia, Sub-Saharan Africa, and parts of Oceania. A variety of psychiatric problems induced by NCC, such as delirium, perceptive sensory changes, anxiety, depression, and personality disorders, have been identified. We report the case of a 48-year-old male presented with complaints of headache, two episodes of seizure, low mood, and forgetfulness who was later diagnosed with NCC.

Dialectical Behavior Therapy in Autism.

Recent research indicates that Dialectical Behavior Therapy (DBT) is feasible, acceptable, and effective for autistic adults. This review aims to provide conceptual arguments and empirical evidence to support DBT as a relevant therapeutic alternative for autistic individuals experiencing emotion dysregulation (ED). ED is frequent in autism whereby it is associated with severe mental health challenges. However, appropriate therapeutic options are limited. Currently, DBT has amassed the most evidence for treatment of ED across a range of clinical conditions, although it was originally developed for borderline personality disorder (BPD). In the context of autism, there is evidence supporting the efficacy of DBT for ED, life-threatening behaviors and depression, but adaptations are likely to improve its dissemination and acceptability. While similar biosocial factors seem to be involved in ED in BPD and autism, alexithymia is prominent in autism and autistic features such as sensory sensitivity and social overload also contribute to ED in autistic adults. Given the significant impact of ED on the well-being of autistic adults, there is an urgent need to enhance our understanding of the mechanisms involved in ED in autism and the adaptations likely to improve the acceptability and dissemination of DBT for autistic people.

Separation Anxiety and Personality Domains in a Dimensional Perspective: A Cross-Sectional Study in a Sample of Adults with Personality Disorders.

Recent developments have highlighted the importance of separation anxiety across the lifespan, positioning it as a longitudinal psychopathological dimension. Few studies in the past decade, have explored this correlation within the context of other psychiatric disorders. This study aims to assess the presence of childhood and adulthood separation anxiety in a sample of adults with personality disorders, and its potential contribution to specific personality domains. A sample of 102 patients (39% male, 61% female) with a principal diagnosis of "Unspecified Personality Disorders" according to the Diagnostic and Statistical Manual of Mental Disorders - 5° edition - text revision (DSM-5-TR) was recruited. The patients were assessed using the following instruments: the Structured Clinical Interview for Separation Anxiety Symptoms and the Personality Inventory for DSM-5-Brief Form (PID-5-BF). Correlation and linear regression analyses were performed. Both childhood and adulthood separation anxiety were positively correlated with all PID-5 domains except "Antagonism" (p = 0.352/0.067). The linear regression analysis showed that only adult separation anxiety was a direct predictor of the personality domains "Negative Affectivity" (p = 0.002), "Detachment" (p = 0.008), and "Psychoticism" (p = 0.028). Our study is the first to highlight the potentially crucial role of adult separation anxiety levels in personality disorders. Unexpectedly, childhood separation anxiety did not predict personality domains. The presence of separation anxiety should be considered a potential developmental obstacle to a healthy transition toward a well-rounded adult personality organization.

Further Validation and Test-Retest Reliability of the Spanish Version of the Standardised Assessment of Personality - Abbreviated Scale (SAPAS) for Personality Disorder Screening in Community Mental Health Settings.

Personality Disorders (PDs) are a critical public health issue frequently misdiagnosed and underdiagnosed in mental health services. The purpose of this study is to demonstrate the reliability, validity and repeatability of the Spanish version of the Standardised Assessment of Personality - Abbreviated Scale (SAPAS), a short and self-administered scale for PD diagnosis and screening. This longitudinal study was performed using a 107-patient sample who attended community mental health services and outpatient clinics. A Receiver Operating Characteristic (ROC) curve was utilized to determine concurrent validity by comparing the SAPAS with the International Personality Disorder Examination (IPDE), thus establishing sensitivity, specificity, and predictive value for several cut-off points. Repeatability was measured by calculating an Intraclass Correlation Coefficient (ICC) between an initial SAPAS administration and a second one carried out 30 days later. The Area Under the Curve (AUC) was found to be 0.84. A cut-off point of 3 provided 90% sensitivity and 52% specificity and correctly classified 71% of the cases. The ICC for the two SAPAS measures was 0.88. Our Spanish translation for the SAPAS proves to be a reliable, valid and consistent PD screening tool in mental health settings.

Metacognitive Interpersonal Therapy-Eating Disorders (MIT-ED) Versus CBT-E for Adults: A Proof-of-Concept Randomized Controlled Trial.

There is an urgent need for psychological therapies in Eating Disorders (ED) that target both eating disorder symptoms and broader aspects of psychological functioning, such as personality disorder (PD) features. We integrated Metacognitive Interpersonal Therapy, developed for treating PDs, with existing CBT techniques for eating disorders (MIT-ED). This psychotherapy targets aspects of ED that are not included in the transdiagnostic CBT-E model, specifically poor metacognition and interpersonal schemas. A proof-of-concept randomized clinical trial (RCT) recruited 21 individuals with non-underweight ED (Bulimia Nervosa, Binge Eating Disorder and ED Not Otherwise Specified) to 20 individual psychotherapy sessions of MIT-ED or CBT-E. Outcomes addressed ED-related characteristics and PD diagnosis. Measures were taken at baseline, 10 sessions, 20 sessions, and 3 months after treatment completion. MIT-ED had excellent retention to treatment with 1 drop-out compared to 6 for CBT-E. Descriptive analyses using completer analyses (n = 14) indicated that both MIT-ED and CBT-E resulted in reduced ED symptoms, impairment, and binge eating, and improved ED-related attitudes, although there was no difference between treatment arms. MIT-ED achieved more remissions from PD diagnosis. MIT-ED appeared to be a promising effective treatment for non-underweight ED. If replicated in larger samples, it would offer an alternative approach to enhancing recovery in ED.

Current status and influencing factors of social participation in patients undergoing maintenance haemodialysis: a Cross-sectional study following the international classification of functioning, disability, and health framework

BackgroundMaintenance haemodialysis (MHD) has emerged as a primary treatment modality in individuals with end-stage kidney disease. However, haemodialysis not only affects physiological well-being but also significantly influences patients’ social engagement and quality of life. Consequently, investigating the present status and repercussions on social participation among individuals undergoing MHD has evolved as a crucial area of research. This study aimed to investigate the current status of social participation among patients undergoing MHD and analyse the influencing factors, providing a theoretical basis for clinical intervention.MethodsThis cross-sectional study utilised a convenience sampling method to select 441 patients undergoing maintenance haemodialysis (MHD) at seven tertiary hospitals in Lianyungang between January and May 2024 as survey participants. The study employed a general information questionnaire along with several assessment tools, including the Chinese version of the Impact on Participation and Autonomy; Social Support Rating Scale; Hospital Anxiety and Depression Scale; Pittsburgh Sleep Quality Index; Chinese version of the Functional Assessment of Chronic Illness Therapy-Fatigue; and Medical Outcomes Study Health Status Short Form. Patients with end-stage renal disease aged ≥ 18 years and undergoing MHD for ≥ 3 months were included. Those with other severe illnesses, psychiatric disorders, personality disorders, or inability to cooperate with the study were excluded. Multivariate linear regression analysis was used to identify factors influencing social participation in MHD patients.ResultsThe total score of social participation among patients on MHD was 54. Multiple linear regression analysis indicated that, based on the International Classification of Functioning, Disability, and Health framework, total scores of depression, total scores of social support, age, total scores of the fatigue scale, smoking history, and employment status were the main influencing factors of social participation in patients on MHD (P < 0.05).ConclusionsThe level of social participation among patients on MHD was moderate and in need of enhancement. Healthcare providers should prioritise older, unemployed patients and improve their social participation and quality of life by addressing issues such as fatigue, depression, and enhancing social support.

Childhood trauma and Axis I disorders in borderline personality disorder: a correlational study

BackgroundAxis 1 disorders often occur in combination with borderline personality disorders (BPD), which complicates treatment and diagnosis. Also, childhood trauma is found to be an underlying factor in patients with BPD. Considering the various statistics and the importance of accompaniment, this study aims to determine the prevalence of Axis 1 disorders in BPD and evaluate the association with childhood trauma.Materials and methodsIn this descriptive-analytical study, 239 patients with BPD were examined among patients referred to the psychiatric hospital in Sari, North of Iran. To confirm the diagnosis, the semi-structured clinical interview for DSM-IV (SCID-1) was performed, and the history of childhood trauma was assessed with the Early Trauma Inventory-Self Report. Data after collection was entered into SPSS software and using descriptive statistics like absolute and relative abundance. Mean and standard deviation and inferential statistics were analyzed.ResultsThe prevalence of major depressive disorder (MDD) was 59.8%, obsessive–compulsive disorder (OCD) 53.1%, generalized anxiety disorder (GAD) 17.6%, and phobias 23.4% in BPD. There was also a significant association between childhood emotional trauma and MDD (P = 0.03) and substance use disorder (SUD, P = 0.008), neglect trauma with post-traumatic stress disorder (PTSD, P = 0.03), phobia (P = 0.001) and GAD (P = 0.02), and physical and sexual trauma with SUD (P = 0.02).ConclusionAxis 1 disorders are common in patients with BPD. Childhood trauma with its effects on the brain of children and adolescents can lead to chronic disabilities in coping with arousal fluctuations and consequently to increased emotional disturbances including BPD and depression, which in turn leads to self-injurious behavior.

Trait dissociation in borderline personality disorder: influence on immediate therapy outcomes, follow-up assessments, and self-harm patterns

ABSTRACT Background: Dissociative symptoms are suggested to compete with the effectiveness of psychotherapeutic treatment and frequently co-occur with early life trauma and self-harm patterns, including self-injury, suicidal ideation, and suicide attempts, which are characteristic for borderline personality disorder (BPD). Objective: We explore the connections between dissociation and other BPD features like self-harm and childhood traumatization and examine the impact of trait dissociation on both immediate and follow-up psychotherapy outcomes. Method: In this naturalistic prospective evaluation study, we investigated psychopathology including general psychological distress (SCL-90), depression (BDI-II), and borderline-specific pathology (BSL) in 131 patients with BPD pre and post of a certified 8-week inpatient Dialectical Behaviour Therapy (DBT), as well as 3- and 6-month post inpatient treatment. Prior to therapy, we evaluated trait dissociation (Dissociative Experience Scale), early life trauma (Childhood Trauma Questionnaire), and self-harm patterns (clinical interview). We performed a network analysis to explore the interplay between dissociation, self-harm, and childhood traumatization. To analyse the influence of dissociation on treatment outcomes, we employed linear mixed models. Results: Psychopathology (SCL-90, BDI-II and BSL) exhibited significant reductions at post-treatment and follow-up assessments when compared to baseline measurements. Higher levels of trait dissociation were consistently related to higher psychopathology but did not suggest poorer symptom reduction during DBT. However, trait dissociation predicted reduced 6-month follow-up benefits from DBT, regardless of the baseline symptom burden. The network analysis revealed a close association between self-injury and derealization/depersonalization, while the frequency of suicide attempts was more closely connected to childhood emotional abuse, which was identified as a central node of the network. Conclusions: Dissociation was not related to poorer outcomes regarding inpatient DBT. However, trait dissociation predicted reduced follow-up benefits, highlighting the need to address dissociation during psychotherapeutic interventions. Based on the estimated network structure, treating dissociative symptoms could potentially mitigate self-injury while especially childhood emotional abuse was linked with suicide attempts.

Childhood Maltreatment, Internalizing and Externalizing Symptoms, and Later Drug Use.

Numerous studies have reported associations between child maltreatment and drug use and abuse. We ask whether internalizing and externalizing symptoms during young adulthood mediate the relationship between childhood maltreatment and illicit drug use and use of prescribed medications later in middle adulthood. Utilizing a prospective cohort design, a large group of court-substantiated cases of childhood maltreatment (ages 0 -11) and demographically matched controls were followed into adulthood. Internalizing symptoms (depression and anxiety), externalizing symptoms (antisocial personality disorder), and drug abuse and dependence symptoms were assessed in young adulthood (Mage = 29) in interviews during 1989-1995 (N = 1,196). Information about the use of illicit drugs and prescribed medications was obtained in middle adulthood in interviews during 2003-2005 (N = 807, Mage = 41). Parallel mediation models were tested for depression and anxiety separately using path analysis. Childhood maltreatment predicted more internalizing and externalizing symptoms during young adulthood. Internalizing symptoms during young adulthood mediated the effect of childhood maltreatment on prescription drug use in middle adulthood, whereas externalizing symptoms mediated the relationship between childhood maltreatment and illicit drug use in middle adulthood, despite controls for drug abuse/dependence symptoms in young adulthood. These new findings suggest that efforts should be directed at reducing internalizing symptoms of anxiety and depression and externalizing symptoms in maltreated children to reduce risk for drug use later in life. The unique mediating effects of internalizing versus externalizing symptoms on prescription drug and illicit drug use, respectively, suggest the need for tailored interventions for different kinds of drug use.

‘Right now I feel ok but more so that I am surviving not thriving’: experiences of parenting with a current or ex-partner with borderline personality disorder

ABSTRACT Objective Parenting with a diagnosis of borderline personality disorder (BPD) can be both challenging and rewarding. Characteristics of BPD include inconsistent behavioural responses to stress, and difficulties in interpersonal relationships and understanding one's own and others' mental states, which can lead to challenging relational environments. Family members of people with BPD can experience increased burden, grief, and their own mental health concerns. Despite this, little research exists regarding the experiences of people who parent with a person with BPD. Therefore, we aimed to explore people's experiences of parenting with a current or ex-partner with BPD to gain insight into their wellbeing and support needs. Method Four people shared their experiences through semi-structured interviews or a qualitative online survey. Individual experiences were described in case studies and collective experiences analysed using reflexive thematic analysis. Results Five common themes were generated: (1) ‘Increased Responsibility’, (2) ‘Self-care Suffers’, (3) ‘Information and Supports are Lacking or Self-initiated’, (4) ‘Relational Challenges’ and (5) ‘Importance of Love, Connection, Understanding and Acceptance’. Discussion This study contributes valuable information about parenting in the context of BPD and hopes to inform future research and service provision to optimise appropriate support and facilitate positive outcomes for families. The findings demonstrate the need for family-focused practice that includes current partners in the treatment of people with borderline personality disorder and tailored parenting interventions. Information and support should also be provided for people who parent with an ex-partner who has borderline personality disorder.

A multicenter cross-sectional study of gambling disorder among patients with methamphetamine use disorder in drug rehabilitation centers: prevalence, correlates, and network analysis

BackgroundThis study sought to investigate the prevalence, correlates, and network structure of the manifested symptoms in gambling disorder (GD) among methamphetamine (MA) use disorder (MUD) patients in China.MethodsWe interviewed 1069 patients using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA), Chinese version. Besides MA and other substance use disorders, GD was also ascertained by SSADDA. Other psychiatric diagnoses were ascertained, including major depressive episodes (MDEs), antisocial personality disorder, suicide and self-harm, and environmental factors, including childhood experiences.ResultsOf 1069 participants, 711 met the DSM-5 diagnostic criteria for MUD. Among the 711 participants with MUD, 52.3% met DSM-5 diagnostic criteria for GD. We found that alcohol use together with MA, childhood violent experiences, MDEs, severe MUD, and gambling duration significantly differed between MUD participants with and without GD. In the GD-MUD network, the central symptoms were gambling preoccupation (GD1), giving up important activities (MUD6), financial trouble (GD9), and MA tolerance (MUD5). MA tolerance (MUD5) also served as a bridge symptom across the network, exhibiting substantial associations with gambling preoccupation (GD1).ConclusionGD is prevalent among individuals in treatment for MUD in China. Network analysis suggests that gambling preoccupation and MA tolerance represent central features, and that MA tolerance serves as a bridge across GD and MUD.

Toward Integrated Treatment for Co-Occurring Borderline Personality Disorder and Eating Disorders: A Clinician Perspective.

It is common practice in Australia for co-occurring borderline personality disorder (BPD) and eating disorders (ED) to be treated separately. The objective of this research was to review features these disorders share, evidence-based approaches used for treating these disorders in isolation, clinicians' experiences of delivering treatment for co-occurring BPD and ED, and finally to explore integrated approaches to treating this dual diagnosis. A qualitative approach was used to examine interview transcripts of 10 clinicians employed at specialist outpatient services for severe BPD or severe ED. Interview transcripts were analyzed using thematic analysis. Nominated features shared by BPD and ED were emotion dysregulation, impulsivity, and interpersonal difficulties. Clinicians endorsed a range of therapeutic approaches for this dual diagnosis patient group, as well as an eclectic approach utilizing a combination of treatment features. Most clinicians proposed an ideal program duration of 6-12 months, with group and individually focused therapy complementing one another to address underlying behavioural drivers and confer lasting clinical benefits. This study distills the importance of adopting integrated treatments for people with this dual diagnosis to optimize treatment outcomes. Future research could include soliciting client perspectives on using an integrated treatment approach for this dual diagnosis and trials of this approachto assess acceptability, feasibility, and longer-term outcomes. This study highlights the merit of concurrently addressing the complex interplay between EDs and BPD via an integrated treatment approach. Streamlining the therapeutic approach can address underlying features of these disorders, improve clinical formulation, and optimize patient outcomes.

Special section: Self-other distinction in personality disorders.

Problems with self- and interpersonal functioning are defining features of personality disorders (PDs) that seem to stem from impairments in self-other distinction (SOD), that is, the sociocognitive capacity to distinguish between one's own and others' mental and physical experiences. There has been recent renewed interest in this topic across a wide range of fields, from clinical psychology to social neuroscience and experimental psychology. This special section on "Self-Other Distinction in Personality Disorders" is therefore very timely, particularly given the shift to dimensional views of personality pathology with an emphasis on impairment in self and relatedness. In this editorial, we first summarize the various research traditions concerning the potential role of SOD impairment in PDs, including recent advancements in social neuroscience and experimental psychology focusing on the mechanisms that might underlie SOD. We then discuss the main contributions of the five highly innovative articles in this special section. Together, these articles highlight the potential value of a focus on PDs through the lens of SOD impairments in order to better understand key features of this group of disorders, such as emotional contagion, perspective-taking difficulties, blurred embodied self-other boundaries, and self-other coordination difficulties. Our increasing insights into SOD problems can also be expected to increase the effectiveness of treatments for PDs and related conditions. Yet, much work remains to be done in this area, and we end this editorial by discussing a number of potential avenues for translational research in this regard. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Systematic review: REM sleep, dysphoric dreams and nightmares as transdiagnostic features of psychiatric disorders with emotion dysregulation - Clinical implications.

Systematic review: REM sleep, dysphoric dreams and nightmares as transdiagnostic features of psychiatric disorders with emotion dysregulation - Clinical implications.

Mentalisation-based treatment for antisocial personality disorder in males convicted of an offence on community probation in England and Wales (Mentalization for Offending Adult Males, MOAM): a multicentre, assessor-blinded, randomised controlled trial.

Mentalisation-based treatment for antisocial personality disorder in males convicted of an offence on community probation in England and Wales (Mentalization for Offending Adult Males, MOAM): a multicentre, assessor-blinded, randomised controlled trial.

Efficacy and effectiveness of therapist-guided internet versus face-to-face cognitive behavioural therapy for depression via counterfactual inference using naturalistic registers and machine learning in Finland: a retrospective cohort study.

Efficacy and effectiveness of therapist-guided internet versus face-to-face cognitive behavioural therapy for depression via counterfactual inference using naturalistic registers and machine learning in Finland: a retrospective cohort study.