Objectives: Our first objective was to compare the prevalence of symptomatic disorders (formerly Axis I disorders) over 24 years of prospective follow-up among patients with borderline personality disorder (BPD) and other personality disordered comparison subjects as well as recovered vs nonrecovered borderline patients. Our second objective was to assess the relationship between the absence of 5 major classes of symptomatic disorders over time and the likelihood of concurrent recovery among borderline patients.
Methods: The McLean Study of Adult Development (MSAD) is a naturalistic prospective follow-up study of 362 inpatients assessed at 12 contiguous 2-year follow-up waves. Symptomatic disorders were assessed at each follow-up using the Structured Clinical Interview for DSM-III-R Axis I Disorders. Generalized estimating equations were used to assess all outcomes. Data were collected from June 1992 to December 2018.
Results: Patients with BPD had significantly higher rates of all 5 types of disorders studied than comparison subjects. However, the prevalence of these disorders declined significantly over time at similar rates for both study groups. This finding was similar for recovered and nonrecovered borderline patients. When the absence of these types of comorbid disorders was used to predict recovery status, substance use disorders were a substantially stronger predictor of recovery than the other 4 classes of disorders (relative risk ratio: 2.53, P < .001).
Conclusions: The results of this study suggest that symptomatic disorders co occur less commonly with BPD over time, particularly for recovered borderline patients. They also suggest that the absence of substance use disorders is the strongest predictor of achieving recovery from BPD.

OBJECTIVE: To analyze patients with drug-resistant focal epilepsy from temporal (TLE) and extra-temporal origin (ETE) and to compare the prevalence of psychiatric comorbid disorders and impulsivity between them and a control group.
METHODS: Consecutively studied patients with TLE and ETE confirmed with Video-EEG were included. Standardized psychiatric assessment was conducted using the Structured Clinical Interview for Axis I and II diagnosis of DSM-IV (SCID I-II), the Barrat-11 scale for impulsivity, and Beck inventory for depression. Parametric and nonparametric tests were performed.
RESULTS: Seventy-three patients with temporal lobe epilepsy (TLE), 21 extra-temporal epilepsy (ETE) and 58 healthy control subjects were included. Both groups of patients showed a high frequency of Axis I comorbid psychiatric disorders: Depression was the most frequent disorder followed by Anxiety Disorders. Furthermore, Axis II (Personality disorders) were also diagnosed, similarly in both groups of patients (p > 0.05). In addition, both TLE and ETE groups presented higher impulsivity scores compared with the control group (p < 0.01). ETE showed a tendency to a higher impulsivity in the motor factor (p = 0.05). Among patients with TLE, a left laterality of the epileptogenic zone, and the presence of comorbid psychiatric disorders (depression), were found as independent factors associated with higher impulsivity (p < 0.05).
CONCLUSIONS: Comorbid depression associated with higher impulsivity are important issues to consider in behavioral and clinical evaluation of patients with drug-resistant focal epilepsies, with the aim to set up a prompt treatment.

This publication presents an analysis of the psychological concepts, involved in the construction of clinical models of schizophrenia; in particular - the new clinical-biological paradigm of schizophrenia (reflecting the data of own psychometric studies). Based on the analysis, 3 modes of interaction between clinical and psychological constructs in the construction of models of schizophrenia were identified. The conceptualization of clinical models was carried out from the perspective of the contribution of psychological and psychometric constructs - allowing to expand theoretical ideas about the dynamics of views on the clinical construct of schizophrenia.
В настоящей публикации представлен анализ психологических концепций, послуживших основой для построения основных клинических моделей шизофрении, в частности новой клинико-биологической парадигмы шизофрении (с отражением данных собственных психометрических исследований). На основании проведенного анализа выделены 3 модуса взаимодействия клинических и психологических конструктов при построении моделей шизофрении. Проведена концептуализация клинических моделей с позиции вклада психолого-психометрических конструктов, позволяющая расширить теоретические представления о динамике воззрений на клинический конструкт шизофрении.

Measurement feedback systems (MFS) providing insight in treatment progress can improve mental healthcare outcomes. However, there is no uniform measurement feedback system that could be used to measure treatment progress for personality disorders (PD). This study compared two types of measures: a generic measure for symptom severity (Brief Symptom Index, BSI) and a specific measure for personality functioning (Severity Indices of Personality Problems, SIPP) at different points in time in order to provide insight in the most suitable measuring moment for a MFS for PD. This study is conducted in a sample of 996 Dutch PD patients (mean age 33.51 (SD 10.42), 73.1% female). Symptom severity and personality functioning were assessed before and multiple times during treatment, using a timespan of 24 months. Outcomes were examined over time using multilevel modeling. Symptom severity (generic measure) and personality functioning (specific measure) improved equally after 24 months. However, during these 24 months, different patterns of change were observed for symptom severity compared to severity of personality problems. In general, symptom severity decreased most during the 1st months of treatment, whereas personality functioning improved only after 6 months of treatment. A generic instrument of symptom severity is able to measure early changes in symptom distress but may not be able to measure longer term changes in personality functioning. The authors discuss policy implications for benchmarking using specific measures in the treatment of personality disorders.

There is an inevitable limit to understanding the internal experience of patients with whom therapists work in psychotherapy. The farther their experience is from that of their therapist, the more challenging this endeavor can be. Accepting that therapists cannot exactly know a patient\'s internal experience invites them to explore novel ways of appreciating another person\'s way of perceiving relationships, deriving meaning from them, and using their experience to motivate behavior. The concept of umwelt can be used as a metaphor to help therapists imagine the internal world of their patients, as shaped by patients\' developmental, interpersonal, and traumatic experiences. Umwelt refers to the unique worldview created by a species\' idiosyncratic perceptual organs and survival strategies. This first Psychotherapy Musings describes the concept of umwelt, applies it to the case of a patient with difficult-to-treat mental health problems, and explicates the benefit of this novel perspective.

The escalating global concerns surrounding radicalization and violent extremism necessitate a comprehensive understanding and explanation. Identifying the risk factors associated with radicalism and violent extremism is critical to the development of risk assessment, prevention, and intervention strategies. It is imperative to distinguish these risks from civic responsibilities (i.e., activism) to safeguard individual rights. This study aims to examine the association between well-established risk factors for violence-personality disorder symptoms-and violent extremist attitudes, radicalism, and activism. Findings indicate that antisocial personality disorder symptoms were linked to violent extremist attitudes and radicalism, whereas obsessive-compulsive disorder symptoms were related to activism. This suggests that obsessive-compulsive personality disorder may signify a readiness for legal and nonviolent political action; in contrast, antisocial personality disorder symptoms signify a readiness for extremist violence and illegal political action.

Personality pathology is associated with emotional problems that are potentially attributable to problematic emotion regulation strategy patterns. We evaluated the emotion regulation strategies associated with the pathological personality traits in the Alternative Model of Personality Disorders (AMPD). A total of 504 participants completed measures of AMPD traits and strategy usage, which were analyzed using hierarchical regressions and latent profile analysis (LPA). Regression results demonstrated that each trait was associated with a unique strategy pattern: negative affect with emotional overengagement, detachment with socialemotional avoidance, antagonism with emotional externalization/avoidance, disinhibition with emotional avoidance and overengagement, and psychoticism with strategies linked to psychotic/dissociative experiences. The LPA identified three profiles with heightened AMPD traits: an internalizing/distressed profile, an externalizing/distressed profile, and a schizoid-schizotypal profile; each had a unique strategy pattern that varied depending on trait composition. This research highlights the relevance of emotion regulation strategy patterns in the assessment, conceptualization, and treatment of personality pathology.

With the shift to the dimensional model of personality pathology, the need for measures assessing personality functioning in adolescence has emerged. The Levels of Personality Functioning Questionnaire 12-18 (LoPF-Q 12-18) was developed specifically for adolescents, tailoring the Alternative Model of Personality Disorders in the DSM-5. Using the Lithuanian LoPF-Q 1218, we further investigate its validity by reexamining its factorial structure and extending convergent, discriminant, and incremental validity analyses. A total of 1,048 community-based and clinically referred 12-18-year-old adolescents completed the LoPF-Q 12-18 along with other self-report measures of personality pathology, psychopathological symptoms, and psychosocial functioning. In line with previous findings, the results supported the bifactor model consisting of a strong general factor and little multidimensionality caused by the group factors, overall suggesting an essentially unidimensional structure. Further analyses provided additional information on the construct validity of the LoPF-Q 12-18.

Personality disorder (PD) is particularly common in adolescents, which underscores the significance of early screening, diagnosis, and intervention. To date, the definition of PD in the new ICD-11 has not yet been investigated in adolescents. This study therefore aimed to investigate the unidimensionality and criterion validity of self-reported ICD-11 PD features in Peruvian adolescents using the Personality Disorder Severity ICD-11 (PDS-ICD-11) scale. A total of 1,073 students (63% female; age range 12-16 years) were administered the PDS-ICD-11 scale along with criterion measures of personality pathology and symptom distress. The PDS-ICD-11 score showed adequate unidimensionality and conceptually meaningful associations with external criterion variables. The findings indicate that ICD-11 PD features, as measured with the PDS-ICD-11 scale, are structurally and conceptually sound when employed with adolescents. Norm-based cutoffs derived from the present study may be used for clinical interpretation. The PDS-ICD-11 may be employed as an efficient screening tool for personality dysfunction in adolescents.

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 (dImRs = 2.42, 95%CI = 1.97-2.87; dImRs + 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.
Concurrent trauma-focused and personality disorder treatment was not superior to only trauma-focused treatment for patients with posttraumatic stress disorder (PTSD) and comorbid cluster C personality disorders.Large reductions in PTSD severity and medium-to-large reductions in all secondary outcomes, including personality disorder symptoms, were observed in both treatment arms.These findings are remarkable, given the higher therapy dosage and specialized treatment for personality disorder comorbidity in the combined treatment arm.