Personality Disorder Symptoms Research Articles

Associations between childhood trauma and epistemic trust, attachment, mentalizing, and symptoms of borderline personality disorder.

Introduction The construct of epistemic trust (ET) has gained wide acceptance and support in the field, although there is little empirical evidence to substantiate the theoretical assumed model. Studies of the assessment of ET were conducted in community samples only and the mediating role of attachment and mentalizing in addition to ET was not investigated. This study examines the theoretical assumed relationships between ET and attachment and mentalizing as well as the mediating role of attachment, mentalizing and ET in the association between childhood adversity and borderline personality disorder (BPD) in a heterogeneous sample containing also patients. Methods The associations between ET and attachment, mentalizing, childhood maltreatment and BPD were explored in a sample of 245 participants, including subjects from the community as well as patients diagnosed with anxiety and personality disorders from two clinical samples. Multiple mediation analysis was performed to explore the mediating role of attachment (ECR-R), mentalizing (RFQ) and ET within the relationship between childhood trauma (CTQ-SF) and BPD (MSI-BPD). Results Strong relationships between ET and attachment and mentalizing were found indicating that lower degrees of ET are associated with insecure attachment and lower reflective functioning. Attachment, mentalizing, and ET together accounted for 75% of the mediation between childhood adversity and BPD. Hypomentalizing and anxious attachment accounted for the largest share of the mediation. Conclusion Our findings provide preliminary evidence for the theoretical supposed model of ET and suggest relevance of ET in the mediation between childhood adversity and PDs, although the role of ET seems smaller than assumed by recent theories.

Trauma-focused and personality disorder treatment for posttraumatic stress disorder and comorbid cluster C personality disorder: a randomized clinical trial

ABSTRACT Background: Posttraumatic stress disorder (PTSD) is associated with high rates of cluster C personality disorders (PD), which may negatively affect PTSD treatment. It is unknown whether concurrent treatment for PTSD and comorbid PD leads to superior treatment effects, compared to standard trauma-focused treatment. Objective: The objective was to test the efficacy of adding personality disorder treatment (group schema therapy; GST) to individual trauma-focused treatment (imagery rescripting; ImRs). Method: A two-arm randomized clinical trial (1:1 allocation ratio) was conducted between 2018 and 2023 at two sites of a mental health institution in the Netherlands. Raters were blind to treatment allocation. Adult outpatients with PTSD and comorbid cluster C personality disorders were randomized to receive either ImRs (12–18 sessions) or ImRs + GST (12–18 ImRs + 52–58 GST). The main outcome was PTSD severity one year after start of treatment measured with the Clinician-Administered PTSD Scale for DSM-5. Results: Of 130 patients (mean [SD] age = 40.6 [11.2], 110 [85%] females), 66 were assigned to ImRs and 64 to ImRs + GST. At 12 months, there were large decreases in PTSD severity (d ImRs = 2.42, 95%CI = 1.97–2.87; d ImRs + GST = 2.44, 95%CI = 1.99–2.90), but there was no significant difference between conditions (d = 0.02, 95%CI = −0.33–0.36, p = .944). Reductions in personality disorder symptoms and all other secondary outcomes were observed in both conditions. There were no significant differences between conditions on any of the secondary outcomes at 12 months. Conclusion: The more intensive concurrent trauma-focused and personality disorder treatment (ImRs + GST) was not superior to trauma-focused treatment alone (ImRs) for patients with PTSD and comorbid CPD. This suggests that trauma-focused treatment is the preferred primary treatment in patients presenting with both internalizing personality disorder and PTSD, reserving the stepping up to more intensive psychotherapy aimed at the personality disorder as a second line of treatment. Trial registration: ClinicalTrials.gov identifier: NCT03833531

The Relationship Between Childhood Trauma and Borderline Personality Disorder: The Mediator Effect of Insecure Attachment

Childhood trauma is a major cause of borderline personality disorder. Research shows that most patients diagnosed with borderline personality disorder report unhappy or shadowy childhood experiences in psychological assessments. Attachment may be one of the important mechanisms by which childhood trauma affects borderline personality disorder. Attachment styles have a strong influence on people. People with insecure attachment styles often show distrust of others and extreme language and behaviour. This is also a core symptom of borderline personality disorder. The aim of this study was to investigate whether insecure adult attachment styles mediate borderline personality disorder as a result of childhood trauma. In addition, a secure attachment style may have a positive effect on alleviating or even treating Borderline Personality Disorder. This study will investigate this aspect. It is hoped that this research will advance researchers' understanding of the impact of childhood trauma on Borderline Personality Disorder and its mechanisms, and provide theoretical and empirical support for interventions aimed at reducing Borderline Personality Disorder caused by childhood trauma.

Impact of Substance Use and Gender-Based Violence on Mental Health and Decision-Making under risk and under ambiguity: Insights from the Iowa Gambling Task in Incarcerated Populations

Research on inmates' decision-making, health, temperament, and psychopathology highlights the importance of mental health and rehabilitation in prisons. The study focuses on the high prevalence of mental disorders, examining personality and decision-making, particularly in those with substance abuse and domestic violence histories. It emphasizes the need for targeted interventions in correctional settings. This study assessed decision-making under ambiguity and risk in 51 male inmates from the Provincial Prison of Granada, including those with histories of drug abuse, domestic violence, or neither. Decision-making was evaluated using the Iowa Gambling Task, while mental and physical health were measured with the SF-36, personality with the TCI-R, and psychopathology with the MCMI-IV. No significant differences in decision-making were found across prisoner groups. However, those with substance abuse and domestic violence histories exhibited consistently poor decision-making. The domestic violence group scored significantly lower in Block 5 compared to those without such histories. This group also showed greater physical limitations, emotional dependency, and compulsive behaviors. The substance abuse group exhibited higher novelty seeking, antisocial behavior, aggression, borderline personality disorder symptoms, alcohol abuse, and depression. The study underscores the impact of substance abuse and domestic violence on decision-making, psychological traits, and physical health among incarcerated men. It highlights the need for tailored interventions to address specific cognitive and behavioral issues, which could enhance rehabilitation outcomes and reduce recidivism.

Features of working with clients with paranoid adaptation

This article continues the cycle of materials on personality adaptations. The author examines the definitions and symptoms of paranoid personality disorder according to DSM-V and ICD-10 in order to differentiate the disorder itself and paranoid personality adaptation. Further, based on the work of Nancy McWilliams “Psychoanalytic Diagnostics” and the theory of personality adaptations by Joines and Stewart, the paranoid personality structure, paranoid adaptation and the processes that occur in therapy with clients who have this adaptation are described. The author gives recommendations on working with such clients and emphasizes that the most important thing in working with them is to create a safe psychotherapeutic alliance, since the issue of trust is a priority for a client with paranoid adaptation.

The place of subjective emptiness in the structure of personality

BackgroundSubjective emptiness is a transdiagnostic clinical dimension related to suicide, distress, and other maladaptive outcomes. Although it is typically conceptualized as a symptom of borderline personality disorder, it has a different pattern of correlates than other symptoms of that phenotype and is present in individuals with other diagnoses. The goals of this study were to replicate and extend previous findings regarding the place of emptiness as a standalone construct within a relatively comprehensive array of personality features.MethodA sample of 992 anonymous participants (M = 45.37 years, SD = 16.53) who were census-matched to the US population completed an online survey including measures of emptiness, normal-range and maladaptive trait domains and aspects, as well as interpersonal values and problems.ResultsOverall, the pattern of correlations suggests that people who report feelings of emptiness tend to have negative emotions, be socially withdrawn, and are low in energy.ConclusionThese findings highlight the relevance of subjective emptiness beyond the borderline category, replicate previous findings regarding the personality and psychopathology correlates of subjective emptiness, and portray a particular profile of personality that represents a risk factor for the experience of subjective emptiness.

The impact of demoralization on the stability of personality traits in a clinical sample.

This study examined whether reductions in the severity of personality disorders (PD) mainly reflect changes in personality traits or rather an alleviation of a demoralized state involving nonspecific unpleasant affect. We used 4 years of longitudinal data from the Collaborative Longitudinal Personality Disorders Study, in which patients (N = 419) completed the Neuroticism-Extraversion-Openness Personality Inventory-Revised (NEO-PI-R) three times over 4 years (at baseline and at 6-month and 4-year follow-up assessments). We compared the NEO Demoralization scale with NEO-PI-R domain scales adjusted for demoralization-related items to determine whether changes in demoralization are more pronounced than changes in adjusted personality traits. Results showed that adjusted Neuroticism and Demoralization changed at similar rates and both changed more than other traits. These changes were most pronounced in the first 6 months and tapered thereafter. Rank-order correlations were somewhat lower for Demoralization than adjusted traits. Our findings suggest that decreases in PD symptoms over time have to do with reductions in negative affect and that Demoralization as assessed via a subset of NEO-PI-R items is limited in its ability to distinguish negative affect from trait Neuroticism. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prediction of borderline personality disorder based on childhood trauma with the mediating role of experiential avoidance.

Traits of borderline personality disorder are important for the determination of the prognosis of mental illnesses and in evaluating risks of negativity as well as impulsivity. But, there is a lack of information about the distribution characteristics of borderline personality disorder traits and symptoms within clinical groups. The goal of the current study was to predict borderline personality disorder based on childhood trauma, using experiential avoidance as a mediator. All male patients hospitalized in local psychiatric health centers with a diagnosis of borderline personality disorder comprised the statistical population of the current study. The number of 60 patients were selected by the purposeful sampling method. The questionnaire included the Childhood Trauma Questionnaire (CTQ), the Experiential Avoidance Questionnaire (AAQ-II), and the Borderline Personality Disorder Symptoms (BSL-23). The results demonstrated that there is a considerable and positive relationship between childhood trauma and experiential avoidance (r = 0.711, p< 0.01). In the mediating model, childhood trauma had significant direct predictive effects on borderline personality disorder (β = 0.546, p< 0.01). Also, between childhood trauma and BPD, experienced avoidance acts as a moderating factor. (β = 0.304, p< 0.01).

Investigating the transdiagnostic potential of rumination in relation to Cluster B personality disorder symptoms.

This study examined several forms of repetitive negative thinking in relation to measures of Cluster B disorders to identify unique and co-occurring cognitive mechanisms contributing to these symptom presentations. MTurk participants (N = 725; 53% men; 76% White) completed categorical and dimensional trait-based measures of Cluster B disorders alongside six measures of rumination and worry. Oversampling strategies were used during participant recruitment to obtain a sample with clinically relevant personality features. Path analyses examined each form of repetitive negative thinking in relation to Cluster B measures while controlling for shared variance between each construct. Anger rumination demonstrated notable relations across all four Cluster B personality disorders. Similarly, sadness rumination was positively associated with all four Cluster B personality disorders. Self-critical rumination and depressive rumination were uniquely associated with borderline symptoms. Worry demonstrated negative associations with measures of narcissistic, histrionic, and antisocial/psychopathy symptoms. Findings expand previous research by highlighting probable transdiagnostic and distinguishing cognitive process contributing to the presentation of Cluster B personality pathology. However, partialling the influence of overlapping constructs presents notable challenges in identifying and interpreting unique relations between various forms of repetitive negative thinking and Cluster B symptoms. Future research investigating these relations within outpatient and inpatient samples may provide avenues for the development of effective cognitive-based interventions for treating these symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring the Relationship Between Prolonged Grief and Borderline Personality Symptoms.

Prolonged grief disorder (PGD) is a new diagnosis that is often mistaken for other psychopathologies. We report a case of PGD in a patient who screened positive for personality disorder. Both PGD and personality disorder symptoms were much improved after a course of prolonged grief disorder therapy. A bereaved woman in her mid-20s sought treatment for depression 9 months after the death of her father. Her depressive symptoms responded well to antidepressant medication and a brief course of interpersonal psychotherapy. However, prolonged grief symptoms persisted at a clinically significant level. Elements of her history, as well as her score of 9 out of 10 on the McLean Screening Instrument for Borderline Personality Disorder, indicated a possible diagnosis of borderline personality disorder. Yet, after completing a course of prolonged grief disorder therapy, both her grief and borderline symptoms were much reduced. This case raises the possibility of an association between prolonged grief and borderline symptoms. Disruption of attachment relationships provides a possible way of understanding this association. The case we present raises the possibility that prolonged grief disorder may better explain symptoms in some patients presenting with borderline personality disorder symptoms.

Identity disturbance in dimensional and categorical models of personality disorder: The incremental value of self-rated identity and narrative identity.

Identity disturbance is increasingly considered to drive personality disorder (PD) onset. Previous research has investigated how identity relates to PD using either self-report scales or narratives to assess identity. Few studies have investigated how both operationalizations relate to one another and to models of PD. More so, no study has investigated whether a narrative identity assessment offers additional explanatory power in understanding PD, beyond what is captured by a self-rated identity assessment, or vice versa. We aimed to address these gaps by administering a rating scale measuring (mal)adaptive identity alongside a prompt to write a narrative about a turning point event to 331 individuals aged 18-30 (72.2% female, Mage = 22.56). Using this multimethod approach, we investigated (a) associations of narrative identity dimensions (agency, communion, exploratory processing) with self-rated identity, self- and interpersonal dysfunction, and symptoms of borderline and antisocial PD, and (b) whether these narrative identity dimensions could explain unique variance in self- and interpersonal dysfunction, and borderline and antisocial PD symptoms, above and beyond self-rated identity, and vice versa. Results revealed significant associations among narrative identity, self-rated identity, and models of PD. Furthermore, communion demonstrated incremental value in explaining PD features, beyond what was accounted for by self-rated identity. However, narrative identity did not offer additional explanatory power in understanding self- and interpersonal dysfunction, beyond self-rated identity. Self-rated identity showed incremental value in explaining all PD models, beyond narrative identity. These results emphasize the importance of employing different methodologies for assessing identity in elucidating how identity disturbance manifests in personality pathology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotion dysregulation, dissociation, and borderline personality disorder symptoms as correlates of maladaptive daydreaming in a general sample: The crucial role of experiential avoidance

Maladaptive daydreaming (MD) is defined as a long-hour fantasizing that disrupts the individual's daily functioning and enables an escape from unpleasant internal experiences. Previous studies indicate the significant role of daydreaming in emotion dysregulation. Considering the emotionality in people with borderline personality disorder (BPD), it can be assumed that MD functions as one of the strategies for coping with emotions in this group. The study aimed to explore the co-occurrence of MD with BPD symptoms. Additionally, the study will examine the role of BPD symptoms, experiential avoidance (EA), emotion dysregulation, and dissociation in the maintenance of MD. The sample included 167 adults (136 women, 28 men, 3 other/non-binary). MD symptoms correlated positively with BPD symptoms, dissociation, emotion dysregulation, and experiential avoidance. Two models explaining the symptoms of MD were compared. Model 1 did not include EA - after adding this variable, the fit of model 2 increased (SRMR = 0.095). EA predicted emotional dysregulation and dissociation, which in turn explained MD symptoms. The results allow for clinical cues for specialists and interventions focused on developing acceptance in treating MD and BPD symptoms.

The Relationship Between Feelings of Emptiness and Self-Harm Among Thai Patients Exhibiting Borderline Personality Disorder Symptoms: The Mediating Role of the Inner Strengths.

Background and Objectives: Fifty percent of individuals with borderline personality disorder (BPD) experience self-harm. One of the crucial factors related to self-harm is feelings of emptiness. While inner strengths, such as the Five Precepts, meditation, and equanimity, have been identified as potential buffers against negative mental health outcomes in BPD, their role in mediating the relationship between feelings of emptiness and self-harm is not well-documented. This study aimed to explore how these inner strengths mediate the relationship between feelings of emptiness and self-harm in individuals exhibiting BPD symptoms. Materials and Methods: A total of 302 Thai participants exhibiting BPD symptoms completed several assessments: the SCID-II Personality Disorder Questionnaire for BPD to assess feelings of emptiness and self-harm, the Inner-Strength-Based Inventory (i-SBI) to evaluate the Five Precepts, meditation, and equanimity, and the Outcome Inventory Depression (OI-Depression) to assess depression. Mean and standard deviation were used for continuous variables, such as age and OI-Depression. A t-test assessed mean differences in continuous variables between the self-harm group and the non-self-harm group. Chi-square tests examined differences in categorical variables with three or more levels, such as education. Pearson's correlation and linear regression analyzed relationships between continuous variables, including i-SBI and OI-Depression scores. Mediation analysis was performed using IBM SPSS and AMOS, with self-harm as the outcome variable, feelings of emptiness as the predictor, and inner strengths as mediators. Results: The participants had a mean age of 36.56, with 65.4% being female. The analysis showed that the Five Precepts, meditation, and equanimity significantly mediated the relationship between feelings of emptiness and self-harm, with a standardized coefficient of β = 0.534 (95% CI = 0.417 to 0.647, p < 0.001). The indirect effect of feelings of emptiness through these inner strengths was significant (β = 0.034, 95% CI = 0.009 to 0.075, p = 0.005). The mediation model explained 38% of the variance in self-harm with a 3% increase, albeit small but significant. Conclusions: This study highlights that inner strengths negatively mediate the relationship between feelings of emptiness and self-harm, indicating that as these inner strengths increase, the direct impact of feelings of emptiness on self-harm decreases. These findings suggest that targeting inner strengths as protective factors could be a valuable strategy in developing interventions aimed at reducing self-harm by addressing the underlying emotional challenges associated with BPD.

Compulsive buying disorder: Conceptualization based on addictive, impulsive, and obsessive-compulsive features and comorbidity

BackgroundThis study sought to examine the conceptualization of compulsive buying disorder in a sample of adults drawn from the community and its associated mental health correlates. MethodsAn online survey of “Personality, Mental Health, and Well-Being” was distributed to 300 adults aged 18–75 years. The survey measured a range of behaviors, such as buying behavior, alcohol and drug use, impulse control disorders, and dimensional constructs of impulsivity and obsessive-compulsiveness. ResultsA total of 294 participants (54.7% female) completed the survey and were included in the analysis. The overall frequency of probable compulsive buying disorder was 5.4% (n = 16). Compared to adults without compulsive buying disorder, those with probable compulsive buying disorder were significantly less likely to identify as heterosexual and were significantly more likely to endorse attention-deficit hyperactivity disorder, drug use problems, symptoms of borderline personality disorder, binge eating disorder, and had higher levels of compulsivity plus impulsivity. ConclusionCompulsive buying disorder appears to be fairly common in adults and appears to have symptom or diagnostic overlap with obsessive-compulsive problems, addictive disorders, and impulse control disorders. Findings highlight the need for careful clinical screening to identify often overlooked comorbidities and treat them on an individual patient basis, as well as the need to conduct high-quality clinical trials for compulsive buying disorder itself and to explore its presentation longitudinally at large scale.

The phenomenon of “emptiness” in modern psychiatry

The article analyses a new psychopathological phenomenon of “emptiness” for classical psychiatry, which is compared with clinical manifestations of emptiness, boredom, apathy, and melancholy. A conclusion is made about the uniqueness of this symptom is drawn. The relationship between the phenomenon of “emptiness” and other diagnostically significant symptoms of borderline personality disorder (BPD) is examined, as is its influence on suicidal and self-harming behavior. It is argued that “emptiness” reflects the mechanism of dissociative depersonalization, and that the wide representation of dissociative symptoms within BPD in conjunction with the “emptiness” phenomenon makes it promising to consider BPD and its individual symptoms a “new hysteria”.

Contextual-compassion training for borderline personality disorder with long lasting symptoms: A randomized clinical trial

Long-term follow-up studies have shown that the symptoms of borderline personality disorder (BPD) tend to remit over time. However, many patients present long lasting symptoms (LLS), including low mood, emptiness, and persistent impairment in psychosocial adjustment. Given the high rate of LLS in BPD patients, new treatment strategies are needed. We conducted a randomized clinical trial (RCT) to evaluate the efficacy of a novel intervention that combines self-compassion and contextual-based skills for patients with persistent symptoms. Sixty BPD individuals with LLS who had received dialectical behavior therapy skills training (DBT-ST) in the previous six months were recruited and randomized to receive the experimental intervention or treatment as usual (TAU) for 12 weeks. All participants were evaluated pre- and post-intervention and at 3-months follow-up. The primary outcome measure was self-reported well-being. Other clinical variables were also evaluated, including depressive symptoms, BPD symptoms, functionality, self-compassion, and self-criticism. Participants in the experimental arm showed a significant increase in indicators of well-being (e.g., happiness and quality of life) and a significant decrease in depressive symptoms. These results were sustained—and even continued to improve—at the three-month follow-up. No significant changes were observed in BPD severity, self-criticism, or self-compassion. More RCTs are needed to test the efficacy of new interventions targeting this population with persistent symptoms, not only to reduce symptoms but also to promote well-being and personal recovery.

Chronotype, sleep quality, impulsivity and aggression in patients with borderline personality disorder and healthy controls

ABSTRACT Impulsivity, aggression, and suicide are the major clinical symptoms of borderline personality disorder (BPD). Although previous studies indicated poor sleep quality and its relationship with clinical symptoms in patients with BPD, chronotype, an important sleep parameter, was not investigated in these patients. This study aimed to analyze chronotype and its relationship with clinical symptoms in patients with BPD. Participants in this study consisted of 68 BPD patients and 65 healthy controls. Subjective sleep characteristics, impulsivity, aggression, suicide probability, and chronotype were assessed using the Pittsburgh Sleep Quality Index (PSQI), Barratt Impulsivity Scale, Buss-Perry Aggression Scale (BPAQ), Suicide Probability Scale, and Morningness – Eveningness Questionnaire, respectively. PSQI total and subscale scores subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, and daytime drowsiness were significantly higher in the BPD group (p < 0.001). There was a positive correlation between the PSQI total score and the BPAQ total score (r = 0.268, p = 0.027). The rate of evening type was significantly higher in the control group (p = 0.004). Suicide attempts and the subscale of suicide probability hopelessness, suicidal ideation, and negative self-evaluation scores were significantly higher in evening type BPD patients. (p = 0.017, p = 0.009, p = 0.001, p = 0.047). Sleep quality is associated with aggression, and the eveningness chronotype is associated with suicide. It may be useful to focus on sleep problems in treating BPD patients.

Mediation models of the interaction between Internet gaming disorder and psychological pain and symptoms of anxiety, depression, and borderline personality disorder

Introduction: The prevalence of Internet gaming disorder (IGD) ranges from approximately 2% to 27.5% in the world population and 5.5% in the Polish population. Research findings indicate that IGD may be associated with depression, ADHD, anxiety, autism spectrum, and aggressive behaviours. However, there is a lack of research on the relationship between IGD and borderline personality disorder and psychological pain (psychache). The aim of this study is to examine the relationships between IGD and symptoms of anxiety, depression, psychological pain, borderline personality disorder and determining the role of psychological pain as a mediator of the above-mentioned links.; Methods: A sample of Polish gamers (n=201) was assessed using clinical scales (HADS, IGD-20, BPD Checklist) to evaluate the severity of depression, anxiety, IGD, and borderline personality symptoms. Additionally, the psychological pain scale was administered to assess relationship with IGD via mediation models. Results: Regression analysis in a mediation model revealed that IGD significantly predicted anxiety and depression, while borderline personality disorder was a significant predictor of IGD. Moreover, a bidirectional relationship between IGD and psychological pain had been demonstrated–IGD was a significant predictor of psychological pain and vice versa. Psychological pain also mediated the relationship between IGD and anxiety and depression, as well as the relationship between borderline personality symptoms and IGD. Conclusions: In the diagnostic and therapeutic process of people suffering from IGD, the co-occurrence of IGD with psychological pain, depression, anxiety and borderline personality disorder should be considered. Further scientific exploration is required to assess the associations between IGD and clinical variables and psychological pain.

Capturing the experience of borderline personality disorder symptoms in the daily lives of women with eating disorders.

Capturing the experience of borderline personality disorder symptoms in the daily lives of women with eating disorders.

Going Underground: Demographics, Services, and Best Practices Endorsed by Practitioners Providing Support for Naturalistic Psychedelic Use

ABSTRACT Psychedelic-assisted therapy (PAT) has shown preliminary efficacy for psychiatric and physical health conditions. Although some people report naturalistic psychedelic use with so-called “underground” practitioners, little is known about PAT that occurs outside of controlled clinical settings or perspectives of these practitioners. We conducted an anonymous online survey of individuals who reported providing psychedelic support services (e.g. trip sitting and/or preparatory/follow-up psychotherapy) in naturalistic settings. We investigated demographics, including education and licensing, details about services provided, and reported client outcomes. Among 107 participants, 40.2% held a full or in-progress license and 44.9% had not obtained a relevant graduate degree. Almost all participants reported pre-screening clients before treatment, offering preparation, integration, and trip-sitting services, and most employed a range of therapeutic modalities, centering primarily on non-directive approaches. Participants reported that clients most commonly consumed psilocybin, and treated numerous conditions, primarily aligning with indications targeted in psychedelic clinical research. Perceptions of clients’ symptom changes were largely positive, although a small proportion reported worsened personality disorder symptoms. Further research delineating client and practitioner perspectives of naturalistic PAT services is warranted, and such work may shed light on the benefits and risks specific to naturalistic PAT as well as inform best practices for practitioners.