The 5th version of DSM introduced an Alternative Model for Personality Disorders (AMPD), which conceptualizes personality pathology as result of impairments in personality functioning and maladaptive personality traits. As well-known, personality disorders represent a common psychiatric comorbidity in Temporal Lobe Epilepsy (TLE) and Functional Seizures (FS). This study aims to characterize personality pathology in these populations according to DSM-5 AMPD using the Level of Personality Functioning Scale-Brief Form 2.0 and Personality Inventory for DSM-5. Furthermore, association between pathological personality traits and psychopathological or clinical variables was also explored. Ninety individuals with TLE and 61 with FS, along with 66 healthy controls prospectively underwent an extensive personality assessment as well as a psychopathological and behavioral evaluation. A pathological personality profile was identified more frequently in TLE (30/90,33.3 %) and FS (18/61,29.5 %) rather than in HC (10/66,15.2 %), with increased odds in both groups (TLE = 2.71;FS = 2.53). In detail, personality trait-specified profiles were the most common in TLE (37.5 %), whereas borderline personality profiles predominated in FS (43.5 %). Across both TLE and FS populations, individuals with concomitant pathological personality profiles showed higher levels of depression (TLE:p < 0.001;FS:p < 0.001), anxiety (TLE:p < 0.001;FS:p = 0.02), alexithymia (TLE:p < 0.001;FS:p = 0.002), dissociative symptoms (TLE:p < 0.001;FS:p = 0.03), impulsivity (TLE:p = 0.002;FS:p = 0.03), and emotional dysregulation (TLE:p < 0.001;FS:p = 0.003). A non-significant trend toward a higher prevalence of pathological personality profiles was observed in TLE individuals with recurrent seizures (OR = 2.29;p = 0.07). In conclusion, dimensional personality assessment revealed a great prevalence of pathological personality profile in TLE and FS, highlighting distinct distributions and strong association with broader psychopathological burden, supporting its clinical value in routine evaluation of these populations.
The digital legacy in end-of-life care: Unspectacular and meaningless, or not enough recognized? An online survey on the attitudes and personal experiences of professionals and volunteers. The digital era has transformed the way individuals construct and perpetuate their identities, leaving an indelible mark not only in the analogue but also in the digital realm. The digital legacy, comprising online artefacts and virtual traces, plays a pivotal role in shaping one's personality and life narrative. Recognizing its impact on the bereaved and the dying and understanding the nuances of digital legacy are crucial for providing meaningful end-of-life care. Despite the increasing importance of this phenomenon, there is a substantial research gap, and a comprehensive discussion regarding the relevance of digital legacy for dignified and value-oriented end-of-life support is lacking in Germany. Based on the recommendations of the German Federal Ministry of Justice regarding the handling of digital legacy, a 34-item questionnaire was developed. A nationwide online survey was conducted using a random sample. Participants were recruited through palliative and hospice organizations with the aim of capturing attitudes, perceived needs, competency requirements, personal experiences and assessments of various professional and occupational groups, including nursing, medicine, social work, and volunteering. The collected data were analysed using descriptive statistics, and four free-text options integrated into the survey were evaluated through content analysis. A total of 396 people participated in the survey, mainly professionals (42.3%) and volunteers (30.8%). For approximately one-quarter of the respondents (26.9%), clear identification was not possible, and they made use of the option 'other'. The majority of respondents were female (82.3%), over 50 years old (74.5%) and had > 5 years of professional or work experience (75.7%), predominantly in outpatient care (66.0%). The study showed that the majority of respondents considered the relevance of the digital legacy as high. Moreover, according to 85.8% of the respondents, it does not receive enough attention in end-of-life care. The way in which digital legacies are dealt with varied considerably and were ambivalent in some cases. There is uncertainty with regard to professional responsibilities and the need for guidance, although most respondents perceived their own skills as inadequate and sought to broaden or deepen their knowledge (90.1%). Additionally, there was little engagement with one's own digital legacy. The free-text responses illustrated a lack of awareness, uncertainty and the desire for further training and supporting materials. The discrepancy between the recognized importance and the lack of direct engagement with one's own digital legacy, as well as the uncertainties in supporting people at the end of their lives, becomes clear and underscores the need for specific programmes that close existing knowledge gaps and promote awareness of how to handle the digital legacy in a valuable and dignified manner in the context of end-of-life care.
Maladaptive personality traits are viewed as risk factors for personality pathology and are predictive of poor psychological and interpersonal functioning. The study of pathological personality traits has gained increasing popularity, but our knowledge on their association with emotion regulation (ER) processes is limited. The present cross-sectional study investigated how pathological profiles relate to the regular and contextual selection and subjective effectiveness of a variety of ER strategies based on the Process Model and the Cognitive ER Questionnaire. Participants (N = 412, M age = 22.87) completed measures of the Personality Inventory for DSM-5, and habitual ER use and effectiveness, and ER use in hypothetical scenarios. Four profiles were obtained using Latent Profile Analysis, which differed in their ER patterns. The Resilient and Undercontrolled profiles consistently favored more adaptive strategies (such as Acceptance and Planning) and rated them as effective. The Anti-resilient group employed less adaptive strategies (such as Rumination), regularly and in different contexts, and tended to consider them more effective. The Overcontrolled profile showed a mixed pattern, relying on adaptive and maladaptive strategies, with a tendency to perceive adaptive strategies as less effective. Our findings document the regulation patterns of pathological profiles and offer a more nuanced understanding of their emotion regulation processes on a regular and situational basis.
Depressive Symptoms in Adolescence: On the Significance of Impaired Personality Functioning, Intrapsychic Conflicts, Defense Styles, and Mentalizing Ability According to psychodynamic theories, early relational experiences with primary caregivers shape the development of fundamental psychological capacities. Adverse relational experiences can lead to impaired personality functioning (psychic structure), intrapsychic conflicts, maladaptive defense styles, and limitations in mentalizing abilities, which in turn are associated with an increased risk of depressive symptoms. The aim of this study is to examine the contribution of these psychodynamic constructs to the prediction of depressive symptoms in adolescents and to investigate group differences between youths with and without depressive symptoms. N = 606 adolescents aged 16-21 years (M = 18.49, SD = 1.70; 69.1% female) took part in an online survey. Depressive symptoms were assessed using the PHQ-8, personality functioning with the OPD-KJ2 Structure Questionnaire, conflicts with the OPD-KJ2 Conflict Questionnaire, defense styles with the DSQ-22-A, and mentalizing abilities with the RFQ-6. The multiple regression analysis showed that greater impairment of personality functioning (β = .70) and lower adaptive defense styles (β = -.07) significantly predicted the severity of depressive symptoms (R2 = .55). The MANCOVA revealed significant group differences across all psychodynamic variables: adolescents with depressive symptoms reported greater impairments in all four dimensions of personality functioning and in mentalizing ability, higher conflict levels, as well as lower adaptive and higher maladaptive defense styles compared to the control group. These findings support psychodynamic theories and highlight the relevance of assessing psychodynamic constructs for clinical decision-making and treatment planning. Zusammenfassung Gemas psychodynamischen Theorien pragen fruhe Beziehungserfahrungen mit primaren Bezugspersonen die Entwicklung grundlegender psychischer Fahigkeiten. Ungunstige Beziehungserfahrungen konnen zu strukturellen Beeintrachtigungen, intrapsychischen Konflikten, maladaptiven Abwehrstilen und Einschrankungen der Mentalisierungsfahigkeit fuhren, welche wiederum mit einem erhohten Risiko fur depressive Symptome assoziiert sind. Ziel der Studie ist es, den Beitrag dieser psychodynamischen Merkmale zur Vorhersage depressiver Symptome bei Adoleszenten zu untersuchen und Gruppenunterschiede zwischen Jugendlichen mit und ohne klinisch relevante depressive Symptomatik zu prufen. In einer querschnittlichen Online-Befragung wurden die Daten von N = 606 16- bis 21-Jahrigen (Alter M = 18,49, SD = 1,70; 69,1 % weiblich) erfasst. Depressive Symptome wurden mittels PHQ-8, Struktur mit dem OPD-KJ2-Strukturfragebogen, Konflikte mit dem OPD-KJ2-Konfliktfragebogen, Abwehrstile mit dem DSQ-22-A und Mentalisierungsfahigkeit mit dem RFQ-6 erhoben. Die multiple Regressionsanalyse zeigte, dass starkere strukturelle Beeintrachtigungen (β = ,70) und geringere adaptive Abwehrstile (β = -,07) eine hohrere Auspragung depressiver Symptome pradizierten (R2 = .55). Die MANCOVA ergab signifikante Gruppenunterschiede fur alle erfassten psychodynamischen Merkmale: Adoleszente mit depressiver Symptomatik berichteten starkere Beeintrachtigungen in allen vier Strukturdimensionen und der Mentalisierungsfahigkeit, hohere Konfliktbelastung sowie geringere adaptive und starkere maladaptive Abwehrstile als die Vergleichsgruppe. Die Ergebnisse stutzen die Annahmen psychodynamischer Theorien und betonen die Relevanz der Diagnostik psychodynamischer Merkmale bei Indikationsstellung und Therapieplanung.
Mentalizing is a multifaceted construct central to personality pathology, and a person-centered approach may clarify how imbalances between self-and other-mentalizing relate to its expression and severity. Ninety-nine adults from clinical and community samples completed diagnostic interviews and validated measures of mentalizing, personality functioning, and maladaptive traits. Cluster analysis was applied to indices of self-and other-mentalizing. Three profiles emerged: (1) low self-mentalizing with hypermentalizing of others, (2) relatively preserved self-mentalizing with ineffective other-mentalizing, and (3) broadly effective mentalizing. Cluster 1 showed the highest severity of personality pathology and greater clinical burden reflected in higher rates of psychiatric hospitalization and treatment referral. Cluster 3 showed the lowest levels of pathology and clinical burden. No cluster differences were found in sociodemographic indicators. Distinct mentalizing profiles are differentially associated with personality pathology and clinical burden, highlighting the central role of impairments in self-mentalizing and hypermentalizing of others.
Social robots (SRs) are innovative tools in health care, offering both medical and psychological support for patients with heart failure (HF). For successful implementation, patient acceptability of SRs is crucial. Living in urban areas and having a lower comorbidity burden have been linked to higher acceptability; however, the role of psychological factors remains underexplored. This study aimed to examine the associations between negative (eg, depression and anxiety) and positive (eg, optimism) psychological factors and personality traits (eg, openness and extraversion) with SR acceptability in patients with HF. Patients with HF watched brief videos about SRs and completed validated measures of depressive symptoms (Patient Health Questionnaire-9), anxiety symptoms (Generalized Anxiety Disorder-7), positive psychological well-being (Brief Inventory of Thriving), and personality traits (Ten-Item Personality Inventory). Medical information was extracted from patients' records. SR acceptability was assessed using the Unified Theory of Acceptance and Use of Technology (UTAUT). Pearson correlations and multiple linear regression, adjusted for age, sex, smart technology experience, urbanicity, and comorbidities, were conducted. Of the 101 patients (women: n=36, 35.6%, mean age 68, SD 10 y), 23% (23/101) scored in the clinical range for depression, and 17% (17/101) scored in the clinical range for anxiety. Well-being scores were moderate, and conscientiousness and agreeableness were the most common. UTAUT behavioral intention was moderate; 69% (67/97) of participants were likely to use an SR if available. Well-being scores correlated positively with SR acceptability in 4 of 5 UTAUT subscales, whereas no significant bivariate associations were observed for psychological distress or personality traits. In the multiple regression models, higher Brief Inventory of Thriving scores were associated with increased SR acceptability, including UTAUT facilitating conditions (B=0.17; P=.01) and behavioral intention (B=0.17; P=.04), independent of depressive and anxiety symptoms. Psychological well-being is associated with determinants of SR acceptability in patients with HF, while psychological distress and personality traits are not associated with these determinants. These patient-level factors ought to be examined more closely before SR implementation.
Grit is a critical determinant of long-term success during adolescence, yet the developmental pathways associated with developing this trait through physical activities remain underexplored. This study investigated the longitudinal relationships among exercise time, creative personality, and grit, specifically examining whether creative personality mediates the developmental link between physical activity and grit in middle school students. Data were drawn from the Korean Children and Youth Panel Survey (KCYPS 2018), including 2,325 middle school students tracked over three waves. A latent growth mediation model was employed to assess the longitudinal associations between the developmental trajectories of exercise time and grit, with creative personality as a mediating variable. Exercise time was positively associated with both creative personality and grit at their baseline levels. Trajectories of exercise time were significantly associated with the patterns of creative personality and grit over the three-year period. Mediation analyses indicated that creative personality significantly mediated the relationship between exercise participation and grit development. Specifically, engagement in physical activity was associated with a more sustained creative personality, which in turn was associated with a favorable trajectory for grit among adolescents. Physical activity may serve as a supportive factor for supporting grit by being positively linked to creative personality during early adolescence. These findings suggest that to promote youth resilience and goal orientation, practitioners and educators could consider integrated programs that combine structured physical engagement with opportunities for fostering creative traits.
Recent advances in psychiatric nosology replace categorical personality disorder diagnoses with dimensional frameworks characterized by level of personality functioning (LPF) and maladaptive traits. Increased emphasis on the assessment of self-functioning with LPF has led scholars to advocate for the inclusion of narrative identity into these models. The current study aimed to examine the utility of narrative identity for the assessment of LPF, and as an aid alongside LPF in predicting a relevant clinical outcome-functional impairment. Life story narratives, alongside measures of LPF and functional impairment, were collected from 141 emerging adults (Mage = 20.70, SD = 2.08) drawn from a mixed college and clinical sample with borderline personality disorder. Maladaptive LPF was significantly associated with greater narrative deterioration and lower levels of agency, communion, and growth at the bivariate level. Regression analyzes revealed that narrative agency significantly predicted more adaptive self-reported LPF, whereas narrative deterioration predicted more maladaptive interview-rated LPF. Best subsets regression revealed that narrative deterioration, alongside self-reported and interview-rated LPF, explained the most variance in functional impairment with minimal model bias. Results highlight the utility of narrative identity for the assessment of LPF and as an aid to LPF in predicting functional impairment.
Clinicians often experience frustration and uncertainty when working with patients with personality disorder (PD). Several evidence-based treatments are available, some deriving from psychodynamic theory. Despite the clinical relevance of confidence in managing such encounters, no validated measure of clinicians' confidence in assessing, structuring treatment, and applying psychodynamic skills in the work with PD patients exists. This study reports the development and validation of the Clinical Confidence and Psychodynamic skills in Personality Disorder Questionnaire (CCPPDQ). The CCPPDQ is a 13-item self-administered questionnaire. 314 psychiatrists and psychiatry residents from the United Kingdom, Italy, India, and Malaysia completed it during applied transference focused psychotherapy (TFP) training (2022-2024). Exploratory and confirmatory factor analyses identified and confirmed the underlying structure. Internal consistency, test-retest reliability, and convergent validity with the Attitudes to Personality Disorder Questionnaire (APDQ) were assessed. Gender differences and predictors of CCPPDQ scores were also analyzed. Analyses supported a two-factor structure: Confidence in Assessment and Structuring Treatment (CAST) and Confidence in Applying Psychodynamic Techniques (CAPT), accounting for 58.5% of total variance. The CCPPDQ showed excellent internal consistency (ω = 0.93) and strong test-retest reliability (ICC = 0.92). Convergent validity was supported by positive correlations with APDQ total and subscale scores, particularly Enjoyment and Security. Regression analyses identified age, gender, and APDQ scores as significant predictors of CCPPDQ outcomes. The CCPPDQ is a reliable tool for assessing clinicians' confidence in working with PD patients. Its subscales capture meaningful aspects of psychodynamic practice, offering utility for training, supervision, and research.
BACKGROUND: Borderline Personality Disorder (BPD) is a complex psychiatric condition that significantly impacts not only individuals but also wider society. Despite the absence of licensed medication for BPD, there is substantial evidence of high rates of prescribing and polypharmacy within this population. This has raised concerns, given the potential adverse effects of psychotropics. This study aimed to explore the potential factors influencing prescribing decisions in patients with BPD. METHOD: We conducted semi-structured interviews with healthcare professionals involved in prescribing for individuals with BPD. Participants included doctors, non-medical prescribers, and pharmacists from both primary and secondary care settings. Data was analysed using thematic analysis utilising both inductive and deductive approaches. FINDINGS: Twenty interviews were completed, generating five key themes believed to influence prescribing decisions. These themes indicate that prescribing occurs at least in part to manage specific symptoms; address perceived risks; maintain or strengthen the therapeutic relationship; compensate for the lack of alternative treatment options; and respect patient autonomy and choice. CONCLUSIONS: Participants highlighted the complexities involved in treating individuals with BPD, indicating that prescribing decisions were often more than simple risk-benefit assessments of the prescribed medication. In particular, they highlighted the challenge of balancing risks while maintaining a therapeutic relationship. Additionally, the findings indicate that a patient's preference for medication may lead prescribers to embrace a greater risk tolerance when prescribing. TRIAL REGISTRATION: The study was registered with and received a favourable outcome from the Human Research Authority (IRAS 330510) and was approved at the London - Camberwell St Giles Research Ethics Committee (REC) on the 12th of December 2023.
Borderline personality disorder (BPD) is highly stigmatized. Stigma, including clinicians' resistance, stigmatizing attitudes, and discriminatory beliefs, could be mitigated by a better knowledge of the disorder. This study evaluates the impact of a one-day training session on stigmatization by health personnel (HP). This two-center study prospectively included 172 HP who completed a face-to-face interactive training day embodying dialectical and destigmatizing positions. Elements of psychoeducation, emotional dysregulation model and practical tools were presented. Stigma attitudes and open-mindedness were assessed by the Opening Minds Stigma Scale for Health Care Providers self-questionnaire (OMS-HC); and beliefs (feeling of incompetence, pejorative perception of prognosis, guilt) by a custom Beliefs Questionnaire (BQ). Scores before and immediately after the training were compared using Student's paired t-test. Most HP worked in psychiatry (69%) and had no prior education on BPD (89%). Nurses were most represented (35%), ahead of nursing assistants (22%), psychologists (18%), and psychiatrists (10%). All scores decreased after training (p < 0.001): total OMS-HC (MD ± SD=-4 ± 8), attitude sub-score (2 ± 4), disclosure sub-score (1 ± 4); total BQ (6 ± 9), nurse feeling of incompetence sub-score (4 ± 4) and pejorative perception of prognosis sub-score (-2 ± 3). A one-day training session reduces HPs' stigmatizing attitudes and beliefs and has a positive impact on knowledge and open-mindedness about BPD patients. Training can lean on education about BPD nature, treatment and prognosis, experience-sharing with practical cases, and testimonies. It would enable compassionate and destigmatizing care. Further research is needed about the clinical impact of BPD training and its wider implementation in mental healthcare settings.
Borderline personality disorder (BPD) is a common mental health condition that remains highly stigmatized in health care settings. Numerous reviews have examined stigma related to BPD, yet findings remain varied across methodologies and focus areas. The objective of this umbrella scoping review was to synthesize existing literature by mapping the volume, scope, and characteristics of published reviews. Methodological quality was assessed using the JBI checklist and reported using PRISMA-ScR guidelines. A comprehensive search was conducted across six databases. Fourteen reviews met eligibility criteria, and the methodological approaches were highly heterogeneous. Data were synthesized and analysed using thematic analysis. Five broad themes emerged: (1) attitudes and perceptions of HCP, (2) diagnostic labelling of BPD, (3) internalization of stigma, (4) inadequate institutional structures, and (5) stigma reduction initiatives. Most reviews originated from the UK (n = 8) and Australia (n = 4). Social stigma, particularly negative attitudes among health care providers, was the dominant focus, while structural stigma was rarely addressed despite its recognized importance. Educational interventions have shown varying success, and individuals with BPD continue to face discrimination and restricted access to care. Stigma, often reinforced by the diagnostic label, remains a structural barrier to equitable health care. These findings highlight the need for systemic approaches to stigma reduction, integration of stigma reduction education into clinical training, and policy reforms to improve access and quality of care for individuals with BPD.
Understanding the psychological characteristics of contemporary medical students is essential for effective educational design and learner support. This study aimed to identify medical students' personality types using a geometric personality assessment tool (GEOPIA), determine whether differences exist by gender, age, or academic level, and explore the practical utility of such profiling for supporting educational practices in medical school settings. The 40-item Korean Geometric Psychological Assessment (GEOPIA) was administered to 1,173 students across 5 Korean medical schools. GEOPIA classifies individuals into 4 primary types-Round (sociable, relationship-oriented), Triangle (task-oriented, challenging), Box (prudent, stability-seeking), and Curve (creative, sensitive). Frequency analyses and χ2 tests were conducted. Of the 1,016 respondents (response rate, 86.61%), 981 were included in the final analysis. The most common primary type was Round (40.3%), followed by Box (31.7%), Triangle (15.2%), and Curve (12.8%). Across the 12 combined profiles, Round-Box (21.9%) was the most prevalent, followed by Box-Round (19.0%) and Round-Triangle (9.7%). No significant differences were observed by gender (χ2=6.360, P=0.095, Cramer's V=0.082), age (χ2=8.314, P=0.091, Cramer's V=0.065), or academic level (χ2=18.044, P=0.260, Cramer's V=0.078). GEOPIA may provide a practical tool for identifying learner characteristics and supporting educational decision-making in medical school settings. In instructional design, personality-type data can inform group formation, activity planning, and assignment structure. In student support, the tool offers instructors and advisors a quick way to understand learners' characteristics, which may help guide individualized counseling and promote effective learning experiences.
To explore trainee Advanced Nurse Practitioners' clinical experience and professional preparedness in managing personality disorder presentations within primary care. A qualitative descriptive study using semi-structured interviews and inductive thematic analysis. Between July and December 2024, 10 trainees enrolled at Ulster University completed online semi-structured interviews. Data were analysed using Braun and Clarke's reflective thematic analysis framework, with rigour enhanced through triangulation. Four themes emerged: perceptions of patient attendance and engagement, workplace challenges, reflections on clinical experience and educational readiness. Participants described feeling underprepared for consultations, particularly around assessment, diagnosis and intervention. Limited training, time constraints, lack of clear pathways and systemic barriers were highlighted. Emotional strain and uncertainty often influenced clinical encounters. Participants emphasised the need for targeted continuing professional development, structured mentorship and crisis management training to build confidence and competence. Trainees face significant challenges in providing care for individuals with personality disorder in primary care. Missed opportunities in care were linked to limited training, systemic constraints and the emotional complexity of presentations. Strengthening psychiatric content in advanced practitioner curricula, alongside mentorship and organisational support, is essential for safe and effective practice. This study demonstrates the need for personality disorder-specific education, access to interdisciplinary mentorship and policy-level changes to support effective care in community settings. The study adhered to COREQ reporting guidelines. This study did not include patient or public involvement in its design, conduct or reporting.
Although the association between psychopathy and interpersonal dysfunction is well established, few studies have examined this relationship at the symptom level. Emerging research indicates that examining specific psychopathic symptoms yields nuanced insights into their associations with interpersonal outcomes. Building on this research, the current study assessed whether individual symptoms of psychopathy offer meaningful, incremental value in predicting interpersonal dysfunction in a community sample (N = 250). Multiple methods of assessment were used, including the clinician-rated Comprehensive Assessment of Psychopathic Personality Symptom Rating Scale, alongside informant-reported, self-reported, and objective outcome measures. Results indicated that symptom-based assessment of psychopathy added incremental validity over higher-order domains. Items demonstrated significant associations with indicators of interpersonal dysfunction, superior model fit in regression analyses and higher importance in dominance analyses. Our findings underscore the need for future research to adopt multimethod approaches, emphasizing individual psychopathic symptoms to enhance understanding of psychopathy and its impact on interpersonal functioning.
To perform a retrospective analysis of the treatment of patients with schizotypal disorder (STD) with onset in childhood and adolescence. Using random sampling, the study included 139 patients with schizotypal disorder (STD) diagnosed in childhood or adolescence during inpatient treatment from 1999 to 2018 and subsequently followed up by psychiatrists. The following assessment tools were used: the Positive and Negative Syndrome Scale (PANSS) and the Personal and Social Performance (PSP) scale. In 37 (26.6%) patients, the STD transformed into schizophrenia. The STD sample included 102 (73.4%) patients with a clinical presentation meeting the diagnostic criteria for schizotypal disorder (F21) according to ICD-10 at the time of the study. Based on the predominant symptoms, four types of STD were identified: with polymorphic disorders (type I); with a predominance of psychopathy-like disorders (type II); with a predominance of neurosis-like disorders (type III); with a predominance of negative disorders (type IV). The daily doses of neuroleptics (as chlorpromazine equivalent doses) varied over wide ranges, with different types of STD not statistically different from each other. The maintenance dose was higher than the acute dose in 63 (65.6%) patients, lower in 31 (32.3%) patients, and equal to the acute dose in 2 (2.1%) patients. 53.9% of patients received regular therapy, 8.8% refused treatment. The highest adherence to treatment was found in patients with types I (69.6%) and III (66.7%), the lowest in those with types II (45.5%) and IV (16.7%), without significant differences (χ²=4.638, p=0.2). STD therapy, especially in children and adolescents, has insufficient evidence base and requires confirmation of efficacy in large randomized studies. The results emphasize the importance of a personalized approach to pharmacotherapy with careful monitoring of side effects. Psychotherapeutic and rehabilitation interventions are promising but need further standardization and validation. Ретроспективный анализ терапии пациентов с шизотипическим расстройством (ШТР), начавшимся в детском и подростковом возрасте. Методом случайной выборки были катамнестически обследованы 139 пациентов с диагнозом шизотипического расстройства (ШТР), впервые выставленным в детско-подростковом возрасте во время стационарного лечения с 1999 по 2018 г., и в дальнейшем регулярно наблюдавшихся психиатрами. Использовались следующие инструменты оценки состояния: шкала оценки позитивных и негативных синдромов (PANSS), шкала личностного и социального функционирования (PSP). У 37 (26,6%) пациентов отмечена трансформация ШТР в шизофрению. В выборку ШТР вошли 102 (73,4%) пациента с клинической картиной, соответствующей диагностическим критериям шизотипического расстройства (F21) по МКБ-10 на момент проведения исследования. На основании ведущей симптоматики было выделено четыре типа ШТР: с полиморфными расстройствами (I тип); с преобладанием психопатоподобных расстройств (II тип); с преобладанием неврозоподобных расстройств (III тип); с доминированием негативных расстройств (IV тип). Суточные дозы нейролептиков в пересчете на хлорпромазиновый эквивалент (ХЭ) варьировали в широких диапазонах при разных типах ШТР, статистически не отличались друг от друга. Поддерживающая доза превышала купирующую у 63 (65,6%) пациентов, у 31 (32,3%) — была ниже, у 2 (2,1%) — дозы были равны. Регулярная терапия отмечена у 53,9% пациентов, отказ от терапии — у 8,8%. Наивысшая приверженность лечению выявлена при I (69,6%) и III (66,7%) типах ШТР, наименьшая — при II (45,5%) и IV (16,7%) типах, без статистически значимых различий (χ²=4,638, p=0,2). Терапия ШТР, особенно в детско-подростковом возрасте, имеет недостаточную доказательную базу и требует подтверждения эффективности в крупных рандомизированных исследованиях. Полученные результаты подчеркивают важность персонализированного подхода к фармакотерапии с тщательным мониторингом побочных эффектов. Психотерапевтические и реабилитационные вмешательства представляются перспективными, но нуждаются в дальнейшей стандартизации и валидации.
Although schema therapy (ST) is an effective intervention for individuals with personality disorders (PDs), its mechanisms of change are not yet well delineated. Understanding these mechanisms is essential for determining the key processes that optimize treatment efficacy. This study investigated mechanisms of change in day treatment group ST (DT-GST) for patients with severe PDs. PD severity was the primary outcome in a multiple-baseline single-case design, assessed before and after DT-GST, alongside idiosyncratic negative core beliefs measured weekly over 30 weeks. Secondary outcomes were early maladaptive schemas (EMS) and schema modes (SMs), measured pre- and post-treatment. Mechanisms of change were examined through visual inspection, correlations and randomization tests. Changes in PD severity moderately correlated with changes in negative core beliefs (r = 0.57), but not with SMs. Negative core beliefs correlated positively with the Vulnerable Child (r = 0.76), Punitive Parent (r = 0.78), Demanding Parent (r = 0.61) and Detached Self-Soother (r = 0.58) modes and negatively with the Happy Child (r = -0.77) and Healthy Adult (r = -0.57) modes. Meaningful change occurred across all treatment phases, with the greatest therapeutic progress in the second and third phases. This study highlights the central role of idiosyncratic negative core beliefs in reducing PD severity while also underscoring the importance of changes in SMs. Findings suggest that ST should prioritize reducing the Vulnerable Child mode and its associated EMS while reinforcing adaptive Healthy Adult and Happy Child modes and diminishing maladaptive Parent and detachment-related coping modes. Further longitudinal research with repeated assessments is needed to clarify mechanisms of change in ST.
Standardized diagnostic interviews (SDIs) are structured assessments based on established criteria to improve the consistency and reliability of diagnoses. The pooled test-retest reliability of SDIs for adult psychiatric disorders is unknown. To estimate the test-retest reliability of SDIs used to classify common adult psychiatric disorders, examine variations in test-retest reliability between disorders, and assess prespecified factors associated with between-study heterogeneity. MEDLINE, Embase, Emcare, PsycINFO, and Applied Social Sciences Index and Abstracts were searched without date or language limitations from inception until September 2025. References of eligible articles and relevant reviews were also screened. Primary studies that evaluated test-retest reliability of SDIs assessing adult psychiatric disorders were selected. Disorders were selected based on estimated prevalence in the general adult population, clinical relevance, and frequent appearance in SDIs. Data were extracted and study quality was assessed based on the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Multilevel random-effects meta-analysis and meta-regression were performed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Test-retest reliability estimates (Cohen κ) of SDI-based adult psychiatric disorder diagnoses. Pooled estimates were calculated for 5 groups of mental disorders (anxiety, bipolar, depressive, personality, and nonaffective psychoses) and 8 groups of substance use disorders (SUDs; alcohol, cannabis, cocaine, hallucinogens, opioids, sedatives, stimulants, and tobacco). Fifty-seven studies were analyzed, 46 of which were included in the meta-analysis (535 κ estimates; N = 8146 participants [mean age range, 22.0-54.3 years]). The pooled estimate of SDI test-retest reliability was κ = 0.69 (95% CI, 0.66-0.72), with substantial between-study heterogeneity (Q534 = 23 578.7; P < .001; I2 = 93%). Reliability was higher for SUDs than for mental disorders (κ = 0.72 [95% CI, 0.69-0.72; 292 estimates] vs 0.65 [95% CI, 0.61-0.69; 243 estimates]; z = 3.74; P < .001) and varied among disorder types. Reliability for mental disorders ranged from κ = 0.55 (95% CI, 0.44-0.66) for nonaffective psychoses to κ = 0.74 (95% CI, 0.56-0.91) for bipolar disorders. Reliability for SUDs ranged from κ = 0.59 (95% CI, 0.49-0.70) for hallucinogens to κ = 0.81 (95% CI, 0.74-0.88) for opioids. Univariate meta-regression indicated that diagnostic criteria partially explained between-study variation in SUDs, whereas methodological quality indicators (eg, small sample size and retest interval) did not. In this systematic review and meta-analysis, SDIs showed moderate and heterogenous test-retest reliability that varied substantially across common adult psychiatric disorders. The findings indicated that structural standardization alone may not be sufficient to ensure consistent psychiatric diagnosis and highlighted the importance of considering contextual and phenomenological information into diagnostic assessment and research practice.
Moral disengagement among young people, a key mechanism underlying cyber aggression, has drawn scholarly attention. Understanding its relationship with personality traits may inform prevention and intervention strategies. This study examined the associations between Type D personality dimensions-negative affectivity and social inhibition-and moral disengagement and assessed whether these associations differed by sex. This secondary analysis was based on data from 400 South Korean undergraduates who participated in a larger study on cyber aggression. Participants completed the Type D Personality Scale-14 and the Moral Disengagement Scale and reported their internet use patterns, including gaming, communication, studying, shopping, and content consumption. Hierarchical regression analyses identified factors associated with moral disengagement. Among males, negative affectivity showed the strongest association, followed by gaming use, whereas social inhibition and the negative affectivity-social inhibition interaction were not significant. Among females, negative affectivity was significantly associated with moral disengagement, and the negative affectivity-social inhibition interaction was significant, whereas the main effect of social inhibition was not significant after including the interaction term. These findings suggest that negative affectivity, the affective dimension of Type D personality, may be a more important correlate of moral disengagement than social inhibition. Gaming use may also represent a relevant contextual factor for males. Overall, prevention and intervention strategies for moral disengagement among university students should consider negative affectivity, social inhibition, online activities such as gaming, and sex differences.
Psychologists have long studied people's responses to adverse life events. Certain ways of telling a story of suffering, favored by a person's culture, may be more adaptive than others. The present study explores the culturally sanctioned script for how to tell the story of the lowest point in one's life. The present study introduces the Psycho-Social Script for Suffering (PSSS), a four-step narrative sequence through which a story of suffering features (1) situational context, (2) emotional expression, (3) closure, and (4) positive meaning. From a sample of 158 Black and white American midlife adults interviewed at three time points over 9 years, the authors coded 426 low point stories for the four narrative themes and analyzed their relationship to self-report measures. Narrating low point stories with higher levels of PSSS was positively associated with measures of well-being, maturity, and adaptive personality traits. Moreover, with a significant main effect of time, PSSS increased over the 9 years as indicative of a developmental sequence in midlife. The longitudinal analysis and rigorous mixed-methods approach offer novel insights into the potential benefits of narrating suffering in a way that resonates with culturally accepted discursive norms.