Psychological assessment remains a core competency in clinical psychology, yet its role in graduate training has become marginalized, with programs prioritizing brief test administration and rapid initiation of therapy over a comprehensive, integrative assessment designed to inform treatment planning. Despite calls to reestablish assessment as a cornerstone of clinical competence, few studies have examined the feasibility and clinical utility of structured, multimethod assessment models in university training clinics. This study evaluated a simplified, feasibility-oriented adaptation of Therapeutic Assessment—the Therapeutic Model of Assessment (TMA)—implemented in a university psychology clinic. A total of 194 adult patients (M = 29.5 years, 63% female) treated under the TMA model were compared with 52 patients (M = 27.8 years, 65% female) seen before its implementation. Patients in the TMA group showed significant reductions in depressive, anxious, and overall distress symptoms from the initial assessment to the feedback session. Dropout rates decreased from 37% to 16.5%, reflecting improved engagement and treatment retention. Among patients with personality pathology, dropout risk was significantly lower when TMA was implemented. Findings support the clinical utility of brief, multimethod assessment in training-clinic settings and its potential to enhance patient outcomes while reinforcing the relevance of assessment within psychology training.

The current study examined (1) whether underlying facets of Detachment and Negative Affect are associated with the different components of alexithymia, and (2) whether these associations depend on the level of perceived stress. In total, 635 students (Mage = 20.02, 87.5% female) filled out online questionnaires on alexithymia (Toronto Alexithymia Scale), pathological personality traits (Personality Inventory for DSM-V), and perceived stress (Perceived Stress Scale). Two Multivariate Analysis of Covariance (MANCOVA) were used to test the hypotheses, which included the three subscales of alexithymia (i.e., difficulty identifying feelings [DIF], difficulty describing feelings [DDF], externally oriented thinking [EOT]) as dependent variables and the three underlying facet traits of either Detachment (i.e., withdrawal, anhedonia, intimacy avoidance) or Negative Affect (i.e., emotional lability, anxiousness, separation insecurity) as independent variables. Intimacy avoidance was most consistently associated with all alexithymia components. Other facets showed dimension-specific associations: DIF was positively associated with anhedonia, anxiousness, separation insecurity, and emotional lability; DDF was positively associated with withdrawal and anxiousness, but negatively with emotional lability; and EOT was positively associated with separation insecurity. These findings highlight the importance of facet traits characteristic of interpersonal difficulties in the association with specific alexithymia subscales. These associations were not dependent on the level of perceived stress. The present results point to interpersonal avoidance and emotion-regulation difficulties as relevant processes to address in interventions. Targeting these facet-linked difficulties may therefore be particularly useful in reducing alexithymic features among individuals with elevated pathological personality traits.

In this paper, I explore a clinical case through the lens of psychoanalytic theory, drawing on the works of Anzieu, Bick, and Kernberg. By integrating theoretical insights with clinical observations, I aim to illustrate my patient’s struggle with the sensation of having thin, wounded skin—lacking its protective upper layer—a ‘skinless self’ marked by profound vulnerability and self-injury as a means of regaining control and establishing a sense of grounding. Furthermore, I examine the therapeutic process, emphasizing the roles of transference, countertransference, and the creation of a holding environment in reconstructing the Skin Ego. This paper highlights the necessity of establishing a containing environment before engaging in deeper interpretations, demonstrating how psychoanalytic psychotherapy can help stabilize a fragmented self. Ultimately, this case underscores the importance of addressing fundamental deficiencies in self-containment when working with patients experiencing severe personality pathology.

The Alternative Model for Personality Disorders (AMPD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) assesses personality pathology as a combination of impairment (Criterion A) and problematic personality traits (Criterion B). The current study explores the ability of the traditional Personality Assessment Inventory (PAI) Borderline scales combined with new PAI-derived AMPD borderline personality disorder (BPD) facets in predicting DSM BPD criteria. The DSM BPD criteria were identified by the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) and by the OMNI Borderline Personality Scale. This study employed two clinical samples (n = 143 and n = 129). Correlations among the AMPD BPD facets, PAI BOR scales and SCID-II items or OMNI Borderline scale were calculated. A series of hierarchical linear regressions with stepwise entry revealed that the combination of PAI BOR subscales and AMPD BPD facets provided the strongest prediction of SCID-II Borderline PD criteria and OMNI Borderline scale, explaining 37% and 67% of the variance, respectively. Lastly, we assessed the BPD facet total and PAI BOR full scale's ability to predict psychological health and illness severity. Clinical and research implications are discussed.

Evolutionary systems therapy for personality pathology: a proof-of-concept single-arm trial

Recent advances in the field of personality pathology have increasingly emphasized the relational and interpersonal dimensions of personality disorders. However, these frameworks often fall short in capturing broader, systemic dynamics that transcend the individual level. Taking the case of narcissism as a prototypical example, we argue that personality pathology should not be understood solely as an interpersonal phenomenon but also as a transpersonal one. We propose a new conceptual model which assumes that personality traits can be conceived of as scripts which may operate at the level of individuals, dyads, groups, and/or larger social entities. The transpersonal view is fully compatible with trait and interpersonal models, but, beyond that, it provides a framework for understanding variation, regulatory dynamics, and changing phenomena at larger levels. This expanded framework offers a novel lens for understanding the embedding and co-constitution of personality pathology—specifically narcissistic pathology—beyond the individual. Our approach foregrounds the clinical insight that any individual pathology must also be addressed in terms of its social-pathological conditions. Thus, we advocate for a diagnostic and therapeutic model that integrates the intrapersonal, interpersonal, and sociocultural aspects of personality pathology.

Despite evidence for the onset of personality disorder (PD) during adolescence, few studies have examined the internal structure of the alternative model for PDs in youth. Network analysis offers a valuable alternative to factor analytic approaches by modeling the unique associations among observed indicators, allowing for identification of central features within the network of personality pathology. This preregistered, cross-sectional study used network analysis to examine links between maladaptive personality trait domains and level of personality functioning (LPF) in adolescents to identify structurally central features of adolescent PD symptomatology. A sample of 1,441 adolescents (n = 1,174 community; n = 267 clinical) completed measures of LPF (Criterion A) and maladaptive traits (Criterion B). Network analyses were conducted separately in each sample, followed by a formal network comparison test. Both networks were densely connected and demonstrated high accuracy and stability. Centrality analyses indicated that LPF domains and subdomains yielded the highest strength centrality. Network structure and global connectivity were largely invariant across the clinical and community samples. Small differences in network structure were observed between boys and girls, and between early and late adolescents, though only at the LPF subdomain level. Findings underscore the central structural role of self and interpersonal functioning (i.e., LPF) within adolescent personality pathology networks, supporting its relevance as a potential organizing framework for understanding maladaptive personality traits. The similarity in network structure across community and clinical samples further reinforces the dimensional nature of PD in adolescents. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The diagnosis and treatment of personality disorder are both highly contentious subjects. It is argued in this article that we have misunderstood personality pathology as yet another form of mental illness that should require treatment for its alleviation or removal. But it is not a typical mental illness; personality is a stable persistent component of the self and needs a different treatment approach based on adaptation.

The Alternative Model of Personality Disorders (AMPD) in Section III of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision includes trait-based diagnostic criteria for six personality disorders (PDs). This study evaluates the predictive validity of the AMPD trait diagnostic criteria for these six PDs in capturing their Section II PD counterparts and examines whether modifications informed by meta-analytic findings (Watters et al., 2019) improve incremental validity. In community (N = 238) and community mental health samples (N = 289), we assessed Section III traits using the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition and Section II PDs using three different measurement methods-structured clinical interview, self-report, and informant report. A series of hierarchical regressions tested the extent to which proposed traits predicted their Section II counterparts and whether the inclusion of nondesignated traits or removal of proposed traits enhanced predictive validity. Findings confirmed that Section III proposed traits significantly predicted their corresponding Section II PDs. Results also revealed that some proposed traits failed to significantly contribute to their assigned PDs, while certain nonproposed traits improved predictive validity. Based on these results, we propose targeted, empirically informed modifications to the AMPD diagnostic trait sets to improve construct validity and clinical utility, particularly for avoidant, borderline, narcissistic, and obsessive-compulsive PDs. These findings underscore the need to refine the AMPD trait model to better capture the complexity of personality pathology. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Introduction: Personality disorders are enduring, maladaptive patterns that impair social and vocational functioning. The DSM-5 Alternative Model for Personality Disorders (AMPD) distinguishes Criterion A (personality functioning: identity, self-direction, empathy, intimacy) from Criterion B (maladaptive trait domains: negative affectivity, detachment, antagonism, disinhibition, psychoticism). We frame this study within Criterion B, supporting the use of a dimensional approach that complements (rather than replaces) normative models like the Five-Factor Model (FFM) and addresses cross-cultural gaps amid Saudi Arabia’s rapid sociocultural change such as the reforms associated with Vision 2030. Given Saudi Arabia’s collectivist orientation and evolving sociocultural norms under Vision 2030, the dimensional approach of the AMPD Criterion B offers a culturally sensitive lens for capturing personality pathology beyond Western-centric diagnostic models. Aim: We aimed to examine how PID-5-BF maladaptive trait domains vary across key sociodemographic factors in Saudi adults. Subjects and Methods: This was a quantitative, cross-sectional analytical study conducted among Saudi adults using the PID-5-BF Convenience sampling was performed via the dissemination of an online survey; we aimed for 377 participants and obtained 343 completed responses (~91% of the target sample). For trait assessment, we used the PID-5-BF; analyses compared domains across sociodemographic groups. Results: Females showed a higher negative affect; participants ≤ 30 years exhibited higher psychoticism than those >40; and single individuals reported lower detachment and psychoticism than their married peers. Conclusions: Gender, age, and marital status are associated with differences in maladaptive trait expression, supporting the need for culturally tailored screening and interventions in Saudi mental health services. These findings should be interpreted with caution given the fact that WhatsApp-based convenience sampling was used, which may bias the results as the respondents were more likely to live in urban areas, be educated, and be technologically proficient.

Women with attention-deficit/hyperactivity disorder (ADHD) are also often diagnosed with personality disorders, yet research on reliable and valid assessments of personality pathology in this population has been limited. In this study, the psychometric properties of the Level of Personality Functioning Scale- Brief Form - 2.0 (LPFS-BF 2.0) were examined in a sample of 171 adult women with ADHD. A two-factor structure was identified, with one factor, LPF-self, comprised of six items, reflecting impairment in self functioning; the second factor, LPF-interpersonal, comprised of six items, reflecting impairment in interpersonal functioning. LPFS-BF 2.0 factors contributed unique variance to functional impairment beyond the effects of co-occurring depression, anxiety, and ADHD. These findings suggest the LPFS-BF 2.0 may be important to include in clinical care for women with ADHD, to identify those women with ADHD who may require adjunctive intervention for personality pathology.

Dysphoria - characterised by irritable tension, pervasive discontent and aversive emotionality - is a clinically significant yet nosologically ambiguous phenomenon. It remains marginalised in major diagnostic systems (DSM-5-TR, ICD-11), relegated to a symptomatic descriptor rather than a validated entity, perpetuating diagnostic imprecision and therapeutic risks. This review argues for the formal recognition of dysphoria as a distinct transdiagnostic affective dimension. It synthesises evidence to demonstrate its neurobehavioural correlates, protean manifestations across disorders and the clinical imperative for its operationalisation within dimensional frameworks. We conducted a synthesis of evidence across neuropsychiatry, phenomenology and diagnostic research. Historical typologies (e.g. directionality (extrapunitive versus intrapunitive), temporality (paroxysmal versus chronic) and structural complexity) and contemporary dimensional models (e.g. RDoC's Negative Valence Systems) were critically examined. Dysphoria manifests heterogeneously across conditions: as paroxysmal hostility in epilepsy (e.g. interictal dysphoric disorder), affective estrangement in schizophrenia (irritability blended with detachment) and core dysregulation in personality pathology (e.g. borderline emptiness, antisocial hostility). Its exclusion as a primary construct leads to diagnostic inaccuracy (misattribution to depression or behavioural disorders) and iatrogenic harm (e.g. antidepressant-induced agitation). Historical typologies retain clinical utility for risk assessment and treatment planning. Operationalising dysphoria within dimensional frameworks is essential to elucidate its unique pathophysiology, mitigate iatrogenic harm and advance targeted interventions. Formal recognition of dysphoria as a distinct construct is an ethical and clinical imperative - failure to do so perpetuates diagnostic imprecision, therapeutic missteps and preventable suffering.

This study presents a comprehensive criminal psychological analysis and offender profiling of a series of homicide and rape offenses committed by Okubo Kiyoshi in Gunma Prefecture, Japan, between March 31 and May 10, 1971. The offender systematically targeted young women under the guise of professional engagement, resulting in 10 incidents of sexual assault, eight of which culminated in murder. Following his arrest, Okubo was convicted and subsequently executed. This case exemplifies a pattern of instrumental and sexually motivated violence, underpinned by personality pathology, paraphilic tendencies, and a history of prior offenses. The analysis delineates the psychological stages of the offense, including the latent, malignant transformation, implementation, and decline phases. Particular emphasis is placed on the role of personality disorders, revenge motivation, and the criminogenic dynamics of recidivism. The findings contribute to the understanding of serial criminal behavior and inform strategies for criminal psychological assessment and prevention.

Social anxiety in the context of the alternative DSM-5 model of personality disorder.

The Alternative Model for Personality Disorders is a dimensional model of personality disorder that describes difficulties in self- and interpersonal functioning as the common core of personality disorder and its hypothesized developmental pathway. However, empirical evidence in support of this developmental pathway is lacking, and the unique developmental relevance of self- and interpersonal functioning for the emergence of personality pathology independent from internalizing and externalizing psychopathology remains unknown. The aim of this preregistered study (which can be found in the additional online materials at https://osf.io/xqc4u) was to leverage data from the 17-year prospective Preschool Depression Study including 348 participants, oversampled for depression, to evaluate the respective predictive utility of self and interpersonal functioning for the later development of personality pathology (in a subsample of 187 participants). Self- and interpersonal functioning were operationalized with self and interpersonal items from the Preschool Age Psychiatric Assessment and Child and Adolescent Psychiatric Assessment. The final model included seven time points (Mage = 4.5-12.2, SDage = 0.8-1.1) for self-functioning and four time points (age 8 onward) for interpersonal functioning. Personality pathology in late adolescence was operationalized with the borderline personality disorder Features Scale for Children at Time Points 9 and 10 (Mage = 16.3-18.6, SDage = 1.1-1.2; n = 187). When considered separately, bivariate growth curve modeling demonstrated significant intercepts and slopes for self-functioning (standardized intercept estimate = 0.206, standardized slope estimate = 0.357), and marginally significant slopes for interpersonal trajectories with borderline personality disorder (standardized slope estimate = 0.233). When considered together, using a reduced model for trajectories, multivariate growth curve modeling showed predictive utility for self-functioning (standardized intercept estimate = 0.436, standardized slope estimate = 0.301) only, independent of internalizing and externalizing symptoms. Results point to the importance of incorporating explicit consideration of self-functioning in the conceptualization of personality, especially from a developmental point of view in service of prevention and early intervention for personality disorder. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Personality functioning, or Criterion A of the Alternative Model of Personality Disorders, captures deficits in intrapersonal and interpersonal capacities, is believed to be relatively malleable, and is associated with normal range personality (e.g., Big Five traits). Questions about changes in personality functioning are of critical relevance for theory development and psychotherapeutic treatment of personality pathology; yet, little is known about its longitudinal development. Using a sample of German-speaking young adults (N = 1,440, Mage = 25.57), we examined 1-year unconditional and event-related development in self-reported personality functioning across four metrics of change, tested predictors of heterogeneity in event-related changes, and compared findings to self-reported Big Five traits. Generally, unconditional development of all personality constructs was very similar, but there were some trait- and metric-specific differences. Life events accounted for heterogeneity in unconditional development but almost exclusively for personality functioning, suggesting it is more susceptible to external influences than most Big Five traits. Event perceptions and initial personality levels sometimes predicted individual differences in event-related changes, mostly for mean-level effects, and initial personality functioning frequently moderated event-related changes in the Big Five, whereas the reverse was less common. These findings provide further insight into the conceptual (dis)similarity of personality traits and personality functioning, inform joint theoretical frameworks, and may help advance personality disorder treatment by identifying conditions in which changes in personality pathology may be expected or best captured. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Epistemic trust describes the capacity to appropriately identify others as reliable and relevant sources of information, an ability closely linked to attachment and social learning. Epistemic disruption can manifest as heightened suspicion (mistrust) or excessive reliance (credulity) vis-à-vis others, affecting mentalizing abilities and increasing vulnerability to psychopathology and maladaptive traits. These interdependent and multidirectional dynamics are pivotal to therapeutic learning, and thus to therapeutic change. This study examined associations between epistemic trust and disruption, markers of psychopathology, therapeutic relationship quality and treatment-seeking behaviour. A naturalistic sample of 912 participants, recruited via a mental health app, completed the Epistemic Trust, Mistrust and Credulity Questionnaire, along with self-reports capturing internalising symptoms, personality functioning, maladaptive traits and the perceived therapeutic relationship within the previous 6 months. Treatment-seeking behaviour and the number of sessions utilized in the past year were further explored-both in psychotherapeutic and psychiatric contexts. Epistemic mistrust and credulity showed consistent relationships with markers of psychopathology. Higher epistemic (mis)trust correlated with more positive (negative) ratings of various aspects of the therapeutic relationship, including genuineness, realism, expectations, congruence and responsivity-over the past 6 months. Epistemic trust positively predicted the amount of psychotherapy sessions, while epistemic mistrust negatively predicted treatment-seeking, both controlled for personality dysfunction. Epistemic credulity predicted mental health app use-all assessed retrospectively (past year). The results encourage further in-depth exploration of trust-related aspects of the therapeutic alliance and investigation of mechanisms of change in therapeutic processes that may facilitate the transition from mistrust and credulity to trust. Even though the magnitude and direction of effects remain to be clarified, patients with epistemic mistrust may enter a self-reinforcing cycle of reduced openness and ineffective mentalizing, potentially impacting therapeutic effectiveness. Interventions targeting epistemic disruption and impaired personality functioning seem to be crucial for improving therapeutic outcomes, including psychopharmacological treatment effectiveness.

A paradigm shift in the assessment of personality pathology is underway, as diagnosticians move beyond traditional personality disorder categories and assess personality dysfunction using contemporary dimensional frameworks. This article describes the assessment of personality pathology in ICD-11 and the DSM-5 Alternative Model for Personality Disorders (AMPD). Recent findings in this area can be grouped into three domains: reliability, factor structure, and temporal stability of ICD-11 and AMPD constructs, convergence of personality pathology ratings with external indices of psychopathology and adjustment, and clinical utility (e.g., usefulness in rendering clinical decisions, prediction of treatment outcome). Research in this area confirms that level of personality functioning and the presence of one or more pathological personality traits predict an array of clinical outcomes, including symptom disorders (e.g., anxiety, depression), suicide risk, and psychotherapy effectiveness. Findings support the cross-cultural generalizability of these patterns, and the clinical utility of assessing personality functioning and traits in adolescents and adults.

Exploring borderline personality features in adolescents: which features best predict borderline personality disorder.

This study explores the structural properties of the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Brief Form (PID-5-BF) by applying network analysis and community detection as a data-driven alternative to traditional factor models. Traditionally, the PID-5-BF assesses personality traits across five domains-Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism-but has shown notable inconsistencies in item alignment and factorial coherence. To examine these issues, data were collected from 2,766 Italian participants (71.7% female, 28.3% male, Mage = 32.94 years, SD = 13.2). The estimated network revealed a stable structure, supported by robust centrality measures (closeness = 0.59, expected influence = 0.75, strength = 0.75). Community detection identified five empirically coherent clusters-Disinhibition, Demoralization, Detachment and Irritability, Psychosocial Alienation, and Pathological Egocentrism-suggesting an alternative organization of maladaptive traits in this population. To assess generalizability, a second analysis was conducted on a Hungarian sample (N = 355), yielding a five-structure solution with different item compositions. While the network approach emphasizes item-level associations, the specific configurations varied across samples in ways that reflect contextual influences. Nonetheless, this method offers complementary insights to traditional factorial models, highlighting how personality traits may organize differently across populations and supporting the use of network-based approaches in refining dimensional models of personality pathology. (PsycInfo Database Record (c) 2026 APA, all rights reserved).