Evidence suggests a relationship between alexithymia and self-report measures of interoception. As measures of alexithymia often include items that may pick up on interoceptive difficulty, however, it is possible that previously reported associations are driven by a lack of independence of measurement. Here, we explored the effect of removing sensation-related items from the Toronto Alexithymia Questionnaire (TAS-20) on the association between the TAS-20 and self-report measures of interoceptive accuracy (Studies 1 and 2; N = 330 and N = 476, respectively) and attention (Study 2). In both studies, removal of sensation-related items significantly reduced associations between the self-report measures of interoception and alexithymia. This effect was specific to the removal of sensation-related items (removing a random set of items did not result in a reduction in the size of the association). Importantly, relationships between alexithymia and self-reported interoception remained after item removal. Although effects were modest, it is recommended that future studies exploring relationships with self-report measures of interoception-particularly in relation to constructs where sensation-related items may broadly feature-should implement sensitivity analyses or employ alternative instruments that exclude sensation-related items, to ensure associations are not driven by a lack of independence of measurement.

The current study examined how psychiatric labels-BPD vs. PTSD-and client gender influence psychologists' attitudes toward a mock client, holding constant variables such as symptom presentation, relational difficulties, and trauma history. Prior research suggests that BPD is heavily stigmatized, partly due to negative stereotypes, gender bias, and the historical misuse of the borderline label. In this online experimental study, a random sample of 267 psychologists was randomly assigned to read one of four vignettes describing a female or male client diagnosed with either BPD or PTSD. The demographics of the sample were largely representative of the general population of licensed psychologists in the United States; however, individuals identifying as Hispanic and Black were under-represented. After reading the vignette, participants completed an adapted Attitudes to Personality Disorders Questionnaire and several single-item questions that captured critical aspects of clinical judgment. Overall, although psychologists reported generally positive attitudes, subtle biases toward the BPD label and gender differences in diagnostic perceptions were evident. The study highlights the need for continued efforts to address diagnostic stigma and gender bias in clinical practice, as well as for future research to examine the nuanced factors that contribute to BPD-related stigma.

A central feature of personality disorders (PDs) is interpersonal problems, which can be effectively conceptualized using the interpersonal circumplex (IPC). This study replicates and extends previous research on the relationship between the dimensional DSM-5 Alternative Model for Personality Disorders (AMPD) and interpersonal problems, as there are only a few studies in this area. The Structural Summary Method (SSM) was used in a sample of 168 psychiatric inpatients who completed Criterion A and B measures according to the AMPD: The Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1), the Level of Personality Functioning Scale (LPFS-BF 2.0), and the Personality Inventory for DSM-5 (PID-5-BF+). Additionally, general and specific interpersonal problems were assessed with the Inventory of Interpersonal Problems (IIP-C). We found associations of both Criteria A and B of the AMPD with general interpersonal distress. Criterion A domains did not map cleanly onto the IPC's meta-concepts of agency and communion; only a subset yielded interpretable circumplex profiles, primarily in the interpersonal functioning domain. Criterion B domains generally showed clearer and more specific associations, with most mapping onto domineering and cold interpersonal problems but showing little association with nonassertive or maladaptive warm problems. These results support and extend previous evidence of empirical links between the AMPD and the IPC, highlighting the IIP-C's value for comprehensive assessment of interpersonal problems in PD. Further research is needed to clarify the overlap and distinctions between these models and to identify the interpersonal problems most relevant for treatment planning.

The International Classification of Diseases, 11th Edition (ICD-11) has adopted a new model for the diagnosis of personality disorder (PD), and novel measures have therefore been developed to assist in its assessment. This study examined the psychometric properties of the Personality Disorder Severity ICD-11 (PDS-ICD-11) scale in a mixed sample of Danish adults in prison (n = 101; 100% males; M = 34.57, SD = 9.27) or in a rehabilitation program (n = 132; 64% males; M = 39.47, SD = 11.60) with co-occurring substance use dependency and personality pathology. Participants were administered the PDS-ICD-11, Level of Personality Functioning Scale-Brief Form 2.0 (LPFS 2.0), World Health Organization Well-being Index (WHO-5), Symptom Checklist-90-Revised (SCL-90-R), Personality Inventory for DSM-5 Short Form (PID-5-SF) and the Schema Mode Inventory (SMI). The PDS-ICD-11 items conformed to a unidimensional structure, and the total score demonstrated relevant associations with severity indexes, maladaptive personality traits, well-being and dysfunctional schema modes. The PDS-ICD-11 was similarly correlated with both internalising and externalising measures of personality dysfunction across the sample, with the incarcerated sample demonstrating stronger associations with externalising personality traits. Overall, these findings support the validity and utility of the PDS-ICD-11 for the assessment of ICD-11 PD in externalising forensic and rehabilitation samples.

The 11th revision of the International Classification of Diseases defines the severity of dysfunction as a core diagnostic criterion for personality disorders. This study examined the psychometric properties of the Czech adaptation of the Personality Disorder Severity-ICD-11 (PDS-ICD-11) scale. The sample consisted of 1704 participants (72.4% women) in community (n = 612) and treatment-seeking (n = 1092) groups. Results supported the unidimensionality of the PDS-ICD-11, good internal consistency, and expected associations with a validated measure of severity (Levels of Personality Function Scale-Brief Form 2.0; LPFS-BF 2.0), as well as with pathological traits and quality of life measures. Compared with the LPFS-BF 2.0, the PDS-ICD-11 demonstrated stronger associations with quality of life (small effect size) and was a better predictor of treatment-seeking status; however, it explained less variance in pathological traits, except for negative affectivity. Neither severity measure showed a balanced representation of trait domains, suggesting a need for refinement. Overall, the Czech PDS-ICD-11 offers a valid and efficient tool for screening the severity of personality dysfunction, with utility in both research and clinical settings.

Supporting individuals to develop adaptive coping strategies is critical to improve health and wellbeing. A history of nonsuicidal self-harm (NSSI) is linked with increased risk of maladaptive coping strategies. We aimed to identify whether emotion regulation (ER) mediated the relationship between historical NSSI behaviours and coping strategy use in adults from the general population. Participants reported their lifetime frequency of NSSI; then they completed self-report measures of emotion regulation, maladaptive coping strategy use (behavioural disengagement, self-blame and substance use) and adaptive coping strategy use (active coping, instrumental support use and emotional support use). Regression analyses investigated relationships between historical NSSI and coping strategies, with mediation analysis testing for the mediating role of ER. A total of 303 individuals participated: 180 with a history of NSSI and 123 without. Results indicated that poor emotion regulation mediated the relationship between having a history of NSSI and the use of maladaptive coping strategies; however, there was no notable association between adaptive coping strategies and historical NSSI. These findings highlight the necessity for ER development in people with a history of NSSI and suggest important avenues for future research, including exploring the role of ER to support NSSI cessation.

Although callous-unemotional (CU) traits are linked with antisocial behavior, affected youth still engage in some prosocial behaviors. The factors contributing to prosocial behavior in these youth are relatively unknown. Relevant factors (known to inversely associate with CU traits and positively associated with prosocial behavior) are complex affective theory of mind (aToM) and cognitive control. In line with recent work demonstrating that cognitive control influences complex aToM in youth with CU traits, we investigated whether its impact moderates the association between CU traits and both a behavioral measure of prosocial behavior and a self-reported measure of prosocial motivation (prosocial rewards). Participants (n = 81, 52% female) completed self-reports and a behavioral paradigm to assess prosocial motivations and behavior alongside CU traits. Results revealed that CU traits were negatively associated with prosocial rewards and goals. And, of primary interest, cognitive control's impact on aToM moderated the association between CU traits and both prosocial rewards and prosocial behavior. Findings suggest that vulnerability to cognitive load-reflected by decrements in aToM-predicts lower prosocial behavior, whereas those that are more resilient to cognitive demands are more likely to engage in prosocial behavior. This demonstrates that the level of resilience to cognitive demands on complex aToM accuracy is an important contextual factor for understanding prosocial behavior in youth with CU traits.

Though positive effects of mentalization-based treatment (MBT) for patients with severe borderline personality disorder (BPD) are increasingly documented, less is known about the sustainability of specialized treatment standards and the maintenance of positive outcomes over time. This study aimed to investigate the organizational and clinical sustainability of an outpatient MBT program across two successive treatment periods. The study compares outpatients referred to MBT in a tertiary-level, specialist mental health service in 2009-2011 (Period I: n = 96) versus 2011-2015 (Period II: n = 89). Organizational quality was based on the MBT quality manual (2019). By structured clinical interviews and repeated self-reports, comparisons included baseline characteristics of eligible patients, clinical outcomes during treatment, therapeutic alliance, therapist countertransferences, and treatment adherence. The MBT team, organization, and systems for quality assurance held satisfactory standards and stability across the two time periods largely compatible with manual recommendations. Patient selection to MBT was in accordance with the targeted patient group, admitting poorly functioning young adults with BPD in both periods. Period II included patients with more severe BPD and self-harming behaviors. Clinical improvement rendered effect sizes in the large range irrespective of time period, and overall 70% remission rates of self-harming. Patient-reported alliance to therapists and therapist-reported countertransference responses were stable with satisfactory levels in both periods. Both periods had low rates of drop-out, though higher in Period II. Results support positive effects and sustainability of MBT for poorly functioning BPD patients treated in a tertiary outpatient MBT-unit within a supportive and stable organizational environment.

Intimate partner violence (IPV) is a global health concern, with increasing efforts focused on detection and prevention. Coercive control has been identified as a 'golden thread' linking risk profiles and violence perpetration. Narcissistic pathology is often implicated in control and violence, but research linking narcissism with aggression and abuse has been inconsistent. Most research on narcissism focuses on symptomatology, whereas contemporary diagnostic frameworks emphasise a dimensional approach to personality disorder 'severity'. No study has examined the association between pathological narcissism, violence and coercive control while accounting for overall personality pathology. Individuals in relationships with relatives high in narcissism (N = 135; 71% romantic partners, 22% family members; average relationship length = 20 years) completed informant measures of pathological narcissism and personality disorder severity, as well as self-report measures of abuse and coercive control. Relatives were rated highly in both grandiose and vulnerable narcissism features, as well as displaying prominent impairments in personality functioning. Correlation analysis indicated dimensional personality disorder severity was significantly and moderately associated with both abuse and coercive control. Pathological narcissism was significantly associated with coercive control but not abuse. Specific narcissism subfactors (exploitativeness, grandiose fantasy and entitlement rage) showed positive, weak associations with either coercive control or abuse. Within the context of high narcissistic symptomatology, personality disorder severity may be a risk factor for coercive control and IPV. Clinical implications suggest the relevance of incorporating a focus on personality in psychological interventions targeted at reducing IPV and coercive control.

Standard, comprehensive dialectical behavioral therapy (DBT) has been well established as an effective and evidence-based treatment for borderline personality disorder (BPD). As a comprehensive and longer term treatment (e.g., 6-12 months or more), DBT can be challenging to implement in resource-strapped public healthcare settings. The purpose of this systematic review was to examine existing literature to assess the efficacy and feasibility of abbreviated DBT programs (16 weeks or fewer in duration, no more than one group session per week). Literature searches yielded 22 studies (20 journal articles and 2 dissertations) meeting criteria for inclusion. Findings indicated that abbreviated forms of DBT are overall effective in improving symptoms of BPD, general psychiatric symptoms including depression and anxiety, and general functioning. Attrition rates varied widely (between 0% and 60%). Of note, the majority of studies reviewed were observational, had small sample sizes, and used varied outcome measures focusing on preintervention and postintervention symptom scores. In this article, we discuss the current state of the literature and suggest future directions for the efficient implementation of DBT.

Mania symptoms are impairing, multidimensional, and complexly related to other mood and psychopathology dimensions. For example, manic activation (e.g., restlessness and flight of ideas) and euphoria (e.g., expansive and grandiose mood) correlate with both dysphoria (e.g., depressed mood and worry) and well-being (e.g., hopefulness and energy). This empirical overlap may distort or obscure mania's observed relations to psychosocial dysfunction and personality traits. Adults (N = 605; M = 46 years old; 57% women), recruited from community mental health centers and by random telephone dialing, completed mood (Inventory of Depression and Anxiety Symptomatology), personality (Personality Inventory for DSM-5; Schedule for Nonadaptive and Adaptive Personality), and psychosocial functioning (e.g., Disability Assessment Schedule; Social Functioning Questionnaire) measures. We tested cross-sectional relations of manic activation and euphoria with functioning and trait dimensions. Using linear correlation and regression analyses, we interpreted results significant at p < 0.01 with effect size r ≥ 0.10. Part correlations (controlling for dysphoria or well-being) that were stronger or reversed compared to whole correlations indicated statistical suppression. Manic activation correlated widely with dysfunction (e.g., disability and social problems) and traits (e.g., negative affectivity, disinhibition, and psychoticism). Well-being suppressed manic euphoria's relations, particularly with dysfunction, negative affectivity, disinhibition, and psychoticism. Dysphoria also suppressed manic activation's relations with trait positive temperament and related dimensions. The full extent of manic euphoria and activation's relations with psychosocial dysfunction and personality became clear only after accounting for concurrent well-being or dysphoria. The placement of mania in multidimensional symptom assessment systems may advance by considering these suppression situations.

In a 5-year longitudinal follow-up study of adolescents (N = 97) treated for borderline personality disorder (BPD), we examined the characteristics of the persistent BPD group (N = 23), the stability of BPD criteria from baseline to 5 years, and the predictors of remission (N = 74). Significantly more participants in the persistent BPD group, compared to the remitted group, had depression, bipolar disorder, schizophrenia, or another personality disorder, received psychotropic medication, and were less likely to be in a relationship or in education. All nine diagnostic criteria of BPD exhibited extremely low stability over time across groups. Prior sexual abuse, conduct disorder, and high levels of general BPD psychopathology at baseline predicted persistent BPD at the 5-year follow-up. These findings suggest that while the status from late adolescence to young adulthood on each diagnostic criterion for BPD is highly variable over time, clinicians need to be aware that adolescents with high overall levels of BPD symptoms, a record of sexual abuse, and co-occurring externalizing behaviors are at increased risk of a poor prognosis.

Borderline personality disorder (BPD) is a common and serious mental health condition characterized by emotional instability, impulsive behavior, and difficulties in interpersonal relationships. This review aimed to comprehensively summarize the current stage of knowledge on the association between social determinants of health (SDoH) and BPD. MEDLINE (PubMed), Embase, and PsycINFO databases were searched from inception to May 2025. We included peer-reviewed studies written in English that assess the association between SDoH and BPD. Each article was screened by two reviewers, and disagreements were resolved by a third reviewer. A narrative synthesis was used to summarize the studies, grouped by the domain of SDoH. Of the 3983 articles screened, 29 were included in this review. The majority of the studies (59.3%) were conducted in the United States, with the social and community context emerging as the most frequently represented domain. A bidirectional relationship was observed between SDoH and BPD, where unfavorable SDoH triggers or worsen BPD symptoms, and BPD can limit access to favorable SDoH. There is a significant and bidirectional relationship between SDoH and BPD. Addressing SDoH is essential for prevention, recovery, and long-term well-being among individuals with borderline personality disorder.

Multiple family group (MFG) therapy is a psychoeducational intervention designed for caregivers of individuals with borderline personality disorder (BPD). This study is the first to compare MFG therapy with treatment as usual (TAU). The objectives were to assess MFG therapy's impact on caregivers' social functioning, perceived support from mental health professionals, coping and communication skills development, and overall satisfaction with the program. A randomized controlled trial (RCT) was conducted at the West Community Mental Health Center in Bologna, Italy. This study enrolled 57 caregivers of 48 adult patients diagnosed with BPD. Participants were randomly assigned to the MFG or TAU intervention. Psychometric assessments were conducted at baseline (T0) and 6 months (T1). Between-group differences in improvements were analyzed using independent sample t-tests and linear mixed model (LMM) analyses to account for unequal group sizes and missing data. Compared to the TAU group, caregivers completing the MFG program reported significant improvements at T1 in social functioning, perceived support from mental health professionals, and family coping skills, including improved access to information and a marked reduction in avoidance behaviors. LMM analysis showed that MFG participants improved more over time in social support, communication, and service satisfaction than controls. This study highlights that MFG therapy has strong potential for improving social functioning and coping skills among caregivers of individuals with BPD. These findings support the feasibility and clinical relevance of integrating MFG programs into generalist mental health services.

Growing literatures highlight shared childhood predictors for future borderline personality disorder (BPD) and major depressive disorder (MDD). However, few longitudinal studies have examined both BPD and MDD as simultaneous outcomes. Childhood personality traits and poor peer relationships constitute transdiagnostic phenomena that could impact risk for later BPD and MDD. The current study examined whether school-age peer relationships mediated associations between preschool Big Five traits and adolescent BPD and/or MDD. Preschool Big Five traits were assessed through observational coding. School-age peer relationships were assessed via clinical interview, with separate child and parent reports. The Borderline Personality Features Scale for Children measured BPD symptoms in adolescence. The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) measured MDD symptoms in adolescence. Structural equation models with manifest composite variables were performed in a sample (n = 153) from the Preschool Depression Study, a prospective longitudinal study with assessments from preschool through adolescence. Lower preschool conscientiousness predicted adolescent BPD. Lower preschool conscientiousness also predicted poorer school-age peer relationships. In MDD models, preschool agreeableness and conscientiousness predicted better parent-reported school-age peer relationships, but not adolescent MDD. Mediation was not significant in the BPD or MDD models. This study identified preschool conscientiousness as one important factor relating to school-age peer relationships and future BPD, but not MDD. Our findings suggest that these pathways may be unique to BPD development and highlight the need for additional research targeting early personality and peer processes.

The LPFS-BF 2.0 (Level of Personality Functioning-Brief Form 2.0) is a brief self-report instrument that was developed in order to gain a quick first impression of personality dysfunction and was designed to align with the Level of Personality Scale as outlined in the DSM-5 Alternative Model for Personality Disorders (AMPD). In the current study, we used a factor analytic framework to evaluate the longitudinal measurement invariance of the Norwegian version of the LPFS-BF 2.0 in a sample of 1030 patients referred for personality disorder treatment with the R package lavaan. Additionally, we estimated item response theory (IRT) parameters for the 12 items, as well as local reliability, in order to facilitate comparisons with other studies. We found support for partial measurement invariance. Three items showed different thresholds across time points. However, these differences were minor and did not have a substantial impact on the estimated factor scores. The discrimination parameters were lower than could be expected for an instrument used in a clinical setting. Taking these findings together, we conclude that although the LPFS-BF 2.0 seems to measure the same latent trait across time, the items do not discriminate well between patients with high and low scores in a Norwegian population of adults seeking treatment for PD. Important next steps would be to estimate IRT parameters for comparable patient samples from other countries to assess the generalizability of our findings and to compare the LPFS-BF 2.0 scores to scores obtained through a clinical interview that aligns with the AMPD.

For the SIPP-118, a widely used instrument for measuring the severity of personality disorders in 16 facets and five domains, T-scores, and percentile rank scores were established. Various approaches based on classical test theory and item response theory (IRT) for establishing T-scores were compared, which are assumed to achieve in-creasing levels of accuracy. Three approaches were evaluated: (1) a simple linear conversion of raw scores to T-scores, (2) a normalizing conversion (Rankit), and (3) an approach based on IRT. We compared T-scores resulting from these approaches with IRT-based factor scores. The findings show that the linear approach produced distorted T-scores for many facets of the SIPP-118, especially in the lower, more pathological range of scores. The Rankit and IRT-based approaches yielded in practice almost identical T-scores and both corresponded quite well with factor scores that were actually based on an IRT model for these facets or domain scores. Implications for the practice of establishing T-scores are discussed. IRT provided the most accurate trait estimates, but it requires a complex calculation that takes into account item parameters and the individual's response pattern. Regression-based IRT-score approximations and Rankit-based T-scores yielded adequate estimates as well.

The stigma of personality disorder is longstanding, widespread, prodigious, and harmful. Fortunately, recent advances in our understanding of personality pathology, as well as an increasing interest in stigma, have demonstrated the importance of destigmatization and have catalyzed significant research in this area. In this special issue of Personality and Mental Health, we spotlight the stigma of personality disorders to understand the current research landscape in this area, and to chart a direction for future research. Each of the nine papers included here advances our understanding of stigma, including its manifestation, impacts, and potential solutions. Collectively, they show significant progress in the study of personality disorders stigma, support the importance of destigmatizing personality pathology, and highlight pathways for future research.