Contingent self-esteem, or the notion that self-worth is tied to successes or failures, is theorized to be important to narcissism. Contingent self-esteem likely manifests as a dynamic between transient states (e.g., emotions) and feelings of self-worth. The current study examined whether narcissism was associated with the link between negative affect and self-esteem. Participants ( = 862) came from two samples of undergraduates and one of community individuals. Participants completed trait-based assessments of narcissism and an ecological momentary assessment protocol capturing state-level negative affect and self-esteem. Grandiosity was associated with higher average momentary self-esteem (β = .12). Vulnerability and contingent self-esteem were associated with higher momentary averages of negative affect (βs = .23; 20, respectively) and lower momentary averages of self-esteem (βs = -.37; -.32, respectively). Vulnerability and contingent self-esteem also amplified the negative affect and self-esteem link (βs = -0.10 and -0.11, respectively). The findings suggest that contingent self-esteem is an important process underlying narcissism.

Research has sought to understand the relationship among childhood maltreatment, maladaptive personality, and antisocial behaviors. However, most of the literature overlooks possible gender differences by using primarily male samples. The current study examined these relationships, focusing on the mediating role of personality dysfunction, in samples of women who are incarcerated ( = 200) and undergraduate students ( = 187). Correlations revealed moderate to strong associations among childhood trauma, personality psychopathology, and antisocial behavior ( = .31-.66). The findings demonstrated a mediation pathway from childhood trauma to BPD (β = .37) and ASPD/psychopathy (βs = .25-.34) to antisocial behavior (βs = .35-.67). This study provides a comprehensive understanding of the associations among childhood trauma, personality psychopathology, and antisocial behavior. Additionally, it expands existing research by presenting a mediation model, demonstrating the role of personality dysfunction in mediating the relationship between childhood maltreatment and antisocial behavior in women.

The Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0) was developed as a screening tool for personality functioning. Its generalizability and comparability across groups with diverse mental health histories have not been explored yet. This study examined configural, metric, scalar, and strict measurement invariance of the scale between treatment-seeking ( = 1113) and non-treatment-seeking ( = 690) groups. Results supported the invariance of the two-factor structure of the LPFS-BF 2.0 and demonstrated good psychometric properties in both groups. The findings provide evidence of the generalizability and construct equivalence of the LPFS-BF 2.0. The scale effectively captured both healthy functioning and disturbances. Associations with the severity of psychopathology symptoms and meaningful differences in severity classification across groups further supported its validity. At the same time, findings suggested that LPFS-BF 2.0, especially self-functioning, might be an overall indicator of mental health difficulties severity rather than being specific to the severity of personality dysfunction.

Identity impairment is central to personality pathology generally, but less is known about how identity impairment appears differently across personality pathology. The AMPD lists a criterion for disorder-specific identity impairment for each personality disorder (PD), but these criteria have not been adequately empirically examined. = 305 university students completed self-report measures of personality pathology (traditional and AMPD conceptualizations) and identity impairment (identity diffusion). We explored which identity diffusion items associated most strongly with each PD scale. Results were mixed. Predictions were partially supported in that at least one expected identity diffusion item emerged as most strongly associated with antisocial, avoidant, and borderline PDs. For narcissistic, obsessive-compulsive, and schizotypal PDs, predictions were not supported. Results were somewhat consistent between Section II and AMPD scales for most PDs, except avoidant and obsessive-compulsive PD. We emphasize the need for further empirical study on disorder-specific identity impairment across personality pathology.

Maladaptive personality trait domains of negative affectivity, antagonism, and disinhibition undergird the borderline personality disorder (BPD) diagnosis according to the Alternative Model for Personality Disorders (AMPD). The current study compared the associations among clinicians' ratings of maladaptive personality traits, categorical BPD diagnostic criteria, and the global BPD diagnosis in response to a clinical vignette using a large, diverse sample ( = 426) of licensed mental health care practitioners in the United States and Canada. Negative affectivity emerged as the most consistent predictor of BPD criteria and the global diagnosis. At the trait facet level, emotional lability was the most consistent independent predictor of BPD criteria and diagnosis. These findings suggest that clinicians' agreement with BPD diagnostic criteria corresponds with their perceptions of the patients as experiencing problems related to instability of emotional experiences, feelings of nervousness and frequent worry, and a tendency to engage in dangerous and risky behaviors.

A large body of research supports the efficacy of dialectical behavior therapy (DBT) for the treatment of borderline personality disorder (BPD). This study examined the trajectory of symptomatology change throughout a 12-month BPD intervention in 152 outpatients with BPD who experienced active suicidal ideation. Borderline symptoms were assessed weekly by therapists and every 3 months by outpatients. Analyses of linear mixed-effects models revealed a significant effect of intervention on reducing the frequency of BPD-related behaviors evaluated by both therapists and outpatients. Completers exhibited continuous reductions in symptomatology across treatment, with a tipping point between the sixth and ninth months. Reduced symptomatology was particularly pronounced for self-harm, suicidal threat, suicidal ideation, binge eating, risky behavior, and anger outbursts. However, addictive behaviors were more resistant to change over time. These findings open new avenues for further understanding of the mechanisms of change underpinning psychotherapy treatment for BPD and shed light on potential treatment-resistant BPD symptoms.

An individual's awareness of their own and others' emotional experience is a key construct in several psychotherapy models, including for clients with personality disorders. Research into emotional awareness in personality disorders and their treatment has been scarce, yet it seems important to understand how these processes change in psychotherapy and how this change explains symptom reduction, in particular by conceptualizing situation-bound fluctuations of emotional awareness. In this current perspective article, we establish a theoretical consensus on models of emotional awareness and discuss current open research questions related to emotional awareness in clients with personality disorders. We conclude with the hypothesis that increased emotional awareness is a central mechanism of change in psychotherapies for personality disorders.

Difficulties in emotional regulation are central to borderline personality disorder (BPD), which is characterized by heightened emotional reactivity and prolonged recovery from anger, often exacerbated by rumination. In this study, we examine the role of respiratory sinus arrhythmia (RSA) as a vital indicator of parasympathetic nervous system activity in BPD patients exposed to anger-inducing films. We recruited 35 BPD patients and 35 healthy controls, collecting self-reported emotional symptoms and physiological data during baseline, induction, recovery, and relaxation sessions. The findings revealed that BPD participants exhibited significantly slower RSA recovery from anger, underscoring its critical role in emotional regulation. Furthermore, relaxation techniques were found to enhance emotional recovery, suggesting that lower parasympathetic activation during anger makes individuals with BPD more susceptible to intense emotions. This study highlights the importance of RSA in understanding the emotional recovery process in BPD.

Borderline personality disorder (BPD) shows strong associations with the general factor of personality disorders, which is proposed to reflect the level of impairment in personality functioning as defined by Criterion A in the Alternative Model for Personality Disorders. Limited evidence regarding the convergent validity between BPD and Criterion A, particularly in developmental contexts, poses a barrier to integrating categorical and dimensional models of personality disorders. To address this, we employed a latent variable cross-lagged panel model to examine the longitudinal associations between BPD features and personality functioning in a two-wave adolescent cohort. Results revealed a unidirectional cross-lagged effect from BPD features to subsequent personality functioning impairments, suggesting that BPD may serve as a developmental marker of broader personality pathology. However, the absence of a reciprocal longitudinal effect raises questions about the sensitivity of personality functioning in capturing the developmental emergence of BPD symptomatology over time.

According to narrative identity theory, the meaning and importance given to childhood events within one's life story (i.e., autobiographical reasoning [AR]) may help explain why only some individuals who experience childhood maltreatment (CM) develop borderline personality (BP) pathology. We test this hypothesis by examining whether AR about childhood emotional experiences, particularly perceived event centrality and meaning-making, moderate relations between CM and BP symptoms, BP traits, and posttraumatic stress disorder (PTSD) symptoms in a diverse sample of 216 young women with a previous mental health diagnosis. Participants wrote recollections of negative emotional childhood events, rated the centrality of each recollection, and described the meaning of these events in their life story. Lower event centrality and positive meaning-making predicted less BP but not PTSD symptoms, with event centrality buffering the impact of CM. Findings highlight the potential utility of narrative identity theory, particularly AR, in understanding and treating BPD in the context of childhood maltreatment.

While research has demonstrated the relationship between psychopathy and intimate partner violence (IPV) perpetration, evidence is mixed regarding how psychopathy facets relate to different forms of IPV perpetration. Literature has also underexplored how psychopathy relates to IPV victimization. To address these gaps, we investigated specificity in relationships between four psychopathy facets (interpersonal, affective, lifestyle, antisocial) and three types of IPV perpetration and victimization experiences (physical, psychological, sexual) across three samples. Zero-order correlations and regressions were conducted separately, followed by tests synthesizing the results. Across samples, correlations revealed small-to-moderate relationships between psychopathy facets and IPVs while multiple regressions revealed minimal-to-small unique effects of the facets. Findings highlight (a) that the lifestyle facet demonstrated the most consistent correlations with IPV experiences across samples while the other facets showed sample-specific relationships, and (b) that the limited unique effects of psychopathy facets implicate what they have in common as relevant to IPV experiences.

Poor relationship quality common among individuals with borderline personality disorder (BPD) may result, in part, from biased interpersonal decision-making. We examined memory biases for hypothetical interpersonal partner choices varying in the degree of familiarity. In Part 1 of our study, participants ( = 192) were asked to choose between novel or familiar partners based on lists of traits across six vignettes, and in Part 2, they completed a trait recognition task 36-60 hours later. Lower perceived social support was associated with a memory bias toward novel (over familiar) partners. BPD features were negatively related to an overall interpersonal memory bias (i.e., remembering both partners more negatively). However, when accounting for idiographic valence ratings, BPD features were positively related to this bias among those also low in social support. Memory biases may be related to partner choices associated with BPD features; however, it is critical to assess the role of perceived social support.

Research has shown racial differences in borderline personality disorder trait presentation between diagnosed Black women and White women. However, no studies have examined if these differences were generalizable to men and individuals with lower borderline severity. We sought to examine how gender and race affected the presentation of borderline traits across the severity continuum. Participants ( = 196) answered a series of surveys examining comorbid externalizing and internalizing traits. Differences were mostly nonsignificant with few exceptions. Higher physical aggression was observed among Black than among White participants. Gender differences also emerged with higher overall and physical aggression observed among men, and higher rejection sensitivity observed among women. Borderline trait severity was significantly associated with most internalizing and externalizing traits across all racial and gender groups. Our findings suggest a need for more diverse sampling in borderline research to fully capture the extent to which its various mechanisms manifest.

We aimed to investigate the relationships of personality disorder (PD) severity and five maladaptive personality domains with narcissistic grandiosity and narcissistic vulnerability among 398 Croatian adult psychiatric patients. They completed the following self-report questionnaires: the Personality Disorder Severity Scale, the Personality Assessment Questionnaire for and the Pathological Narcissism Inventory. Narcissistic grandiosity showed meaningful associations with the Disinhibition and Anankastia domains. Conversely, narcissistic vulnerability was significantly more strongly associated with PD severity and the Negative Affectivity domain, and it also showed meaningful associations with the Disinhibition, Anankastia, and Dissociality domains. An even more nuanced picture emerged on the facet-level of pathological narcissism, while some novel findings were obtained pertaining to gender differences in the above-mentioned relations. Future studies utilizing additional multidimensional measures of pathological narcissism and gender-sensitive assessment are warranted.

The present systematic review and meta-analysis sought to assess the internal structure and consistency of the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0) across different populations and cultures. Studies identified through systematic research were subjected to eligibility criteria, resulting in 30 included studies and 110 effect sizes. Study characteristics were tabulated, their methodological quality was assessed, and findings were synthesized using a random-effects meta-analysis. Findings overall supported the internal structure of the LPFS-BF 2.0 and indicated sound internal consistency for the total scale. Moderator analyses indicated that internal consistency differed minimally by index type, sample type, gender, age, country, and language. The findings overall suggest that the LPFS-BF 2.0 assesses a coherent and internally consistent construct, making it a potentially useful tool for evaluating personality functioning across diverse populations. Future investigations should further explore interrater reliability, test-retest stability, and alignment with interview-based personality disorder severity.

The Alternative Model for Personality Disorders identifies the level of personality functioning (LPF) as the entry criterion for personality disorder. The Level of Personality Functioning-Brief Form 2.0 (LPFS-BF 2.0) has demonstrated adequate psychometric properties, although mixed evidence on its factor structure and the lack of established clinical cutoffs limit its utility. In the present study, we first examined the factor structure of the LPFS-BF 2.0 using data from 365 young adults. Next, we examined the measure's convergent and discriminant validity, clinical utility, and cutoff score in a mixed college ( = 94) and clinical ( = 70) sample. Results revealed acceptable fit of a bifactor model with an essentially unidimensional structure and general support for convergent and discriminant validity. The LPFS-BF 2.0 distinguished those above versus below the clinical cutoff of the Semi-Structured Interview for Personality Functioning with strong sensitivity and specificity. The LPFS-BF 2.0 appears psychometrically sound and clinically useful in capturing personality dysfunction.

Across the lifespan, suicide mortality rates are highest among older adults, yet research on self-harm in later life remains limited. This study explores how self-reported maladaptive personality traits (measured by the PID-5-BF+M) are associated with self-harm in older adults, and whether there are potential differences according to the type of self-harm behaviors (indirect, direct, and the co-occurrence of these two) in this age group. From a convenience sample of 790 adults aged 60 years and older, 102 participants were selected using a matched-pair design. Regression models showed that three personality domains (i.e., Negative Affectivity, Antagonism, and Psychoticism) and eight personality facets were related with self-harm in older adults. Boxplots showed differences between maladaptive personality scores depending on self-harm type. Presence of elevated PID-5-BF+M scores may help clinicians identify elevated self-harm risk in older adults. Future research should differentiate between types of self-harm, as the associated risk factors may vary.

To compare the effectiveness of the fifth edition Section II personality disorder (PD) model, and of the Alternative Model for Personality Disorders (AMPD) model in characterizing vulnerable (VN) and grandiose (GN) narcissism, a sample of clinical psychotherapy participants ( = 369) was administered the Schedule for Nonadaptive and Adaptive Personality-2, the Levels of Personality Functioning Scale-Self Report (LPFS-SR), the Personality Inventory for the Five-Factor Narcissism Inventory-Short Form (FFNI-SF), and the Pathological Narcissism Inventory (PNI). In multiple regression models, the LPFS-SR scales and the Personality Inventory for (PID-5) domain scales explained 34.6% and 23.7% more variance than the self-reports of the 10 Section II PD symptom counts in the FFNI-SF and PNI GN scores, respectively. Similarly, AMPD measures outperformed self-reported symptom counts of the 10 Section II PDs, accounting for 28.8% and 22.6% more variance in the FFNI-SF and PNI VN scale scores, respectively.

The linguistic equivalence of the Personality Inventory for (PID-5) has never been investigated using a within-subject design, that is, among bilingual individuals. Also, the stability-equivalence of the PID-5 using two linguistic versions is unknown. Thus, this within-subject, test-retest study aims at (a) establishing the measurement invariance of the PID-5 among bilinguals, and (b) providing indices of stability-equivalence using distinct versions with tight confidence intervals. Data from a sample of bilingual participants ( = 605), who were administered the PID-5 over a 1-2-week interval in French and English, were utilized. The PID-5 reached the (full) strong invariance level using longitudinal invariance analyses, indicating that the PID-5 structure is the same and that scores are interchangeable, while controlling for sampling confounds. The indices of stability-equivalence were high across traits. The PID-5 yields scores reflective of genuine differences, at least at the domain level, providing solid ground to study personality across societies.

Patients with personality disorders (PDs) often struggle in life after treatment, even when symptomatic remission is achieved. The question arises of whether current outcome measurements are relevant for patients and people around them. To address this, we used concept mapping, a mixed-method approach, to construct a framework of recovery from the perspectives of patients, their significant others, and therapists ( = 39). Participants brainstormed what recovery involved and then prioritied and clustered these ideas ( = 61). Data were analyzed using multidimensional scaling and hierarchical cluster analysis, resulting in 45 statements grouped into four themes: understanding and recognizing yourself, regulating emotions, giving direction to your life, and connecting with others. Understanding and recognizing yourself was identified as the most important area of change. This study offers an evidence-based framework for recovery in PD, providing a foundation for developing outcome measurements that reflect the needs of patients and their significant others beyond symptom reduction.