E H Kvarstein, K Bremer, Å L Baltzersen, A Ekberg, E Normann-Eide, D A Ulvestad, G Pedersen, T Wilberg
{"title":"Sustainability of Mentalization-Based Treatment Programs for Poorly Functioning Patients With Borderline Personality Disorder. Can We Really Keep It Up?","authors":"E H Kvarstein, K Bremer, Å L Baltzersen, A Ekberg, E Normann-Eide, D A Ulvestad, G Pedersen, T Wilberg","doi":"10.1002/pmh.70036","DOIUrl":"10.1002/pmh.70036","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":"19 4","pages":"e70036"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erik Simonsen, Martin Vestergaard, Lise Møller, Sune Bo, Mickey Kongerslev, Lene Halling Hastrup, Ole Jakob Storebø, Stig Poulsen, Emma Beck, Mie Sedoc Jørgensen
{"title":"Prediction of Non-Remission in a 5-Year Follow-Up of Borderline Personality Disorder in Adolescence.","authors":"Erik Simonsen, Martin Vestergaard, Lise Møller, Sune Bo, Mickey Kongerslev, Lene Halling Hastrup, Ole Jakob Storebø, Stig Poulsen, Emma Beck, Mie Sedoc Jørgensen","doi":"10.1002/pmh.70041","DOIUrl":"10.1002/pmh.70041","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":"19 4","pages":"e70041"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12475959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Historical Nonsuicidal Self-Injury and Current Coping Strategies: The Role of Emotion Regulation.","authors":"Hannah Bradley, Faith Orchard, Faith Matcham","doi":"10.1002/pmh.70035","DOIUrl":"10.1002/pmh.70035","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":"19 4","pages":"e70035"},"PeriodicalIF":2.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patrick T Guerrera, Wendemi Sawadogo, Snehal S Baviskar, Julie Pham, Nirali Patel, John W Cyrus
{"title":"Association Between Social Determinants of Health and Borderline Personality Disorder: A Systematic Review.","authors":"Patrick T Guerrera, Wendemi Sawadogo, Snehal S Baviskar, Julie Pham, Nirali Patel, John W Cyrus","doi":"10.1002/pmh.70042","DOIUrl":"10.1002/pmh.70042","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":"19 4","pages":"e70042"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Validation of the Personality Disorder Severity for ICD-11 (PDS-ICD-11) Scale in a Danish Mixed Clinical and Prison Treatment Sample.","authors":"Rachael Martin, Martin Sellbom, Bo Bach","doi":"10.1002/pmh.70039","DOIUrl":"10.1002/pmh.70039","url":null,"abstract":"<p><p>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<sub>age</sub> = 34.57, SD<sub>age</sub> = 9.27) or in a rehabilitation program (n = 132; 64% males; M<sub>age</sub> = 39.47, SD<sub>age</sub> = 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.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":"19 4","pages":"e70039"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Borderline Personality Disorder vs. PTSD: Exploring the Influence of Labels and Gender on Psychologists' Attitudes.","authors":"Susan Hannan","doi":"10.1002/pmh.70047","DOIUrl":"10.1002/pmh.70047","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":"19 4","pages":"e70047"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter L A Schiemainski, Julia I Kunz, Sophie Nagl, Johannes Wolf, Stephan Goerigk, Andrea Jobst, Frank Padberg, Matthias A Reinhard
{"title":"Interpersonal Problems and the Alternative Model of Personality Disorders: An Investigation Using the Interpersonal Circumplex.","authors":"Peter L A Schiemainski, Julia I Kunz, Sophie Nagl, Johannes Wolf, Stephan Goerigk, Andrea Jobst, Frank Padberg, Matthias A Reinhard","doi":"10.1002/pmh.70045","DOIUrl":"10.1002/pmh.70045","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":"19 4","pages":"e70045"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yujie Zhang, Spencer X Chen, Martina Smit, Alexander L Chapman
{"title":"Feasibility and Efficacy of Brief DBT Intervention for Adults With Borderline Personality Disorder/Traits: A Systematic Review.","authors":"Yujie Zhang, Spencer X Chen, Martina Smit, Alexander L Chapman","doi":"10.1002/pmh.70034","DOIUrl":"10.1002/pmh.70034","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":"19 4","pages":"e70034"},"PeriodicalIF":2.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeffrey R Vittengl, Eunyoe Ro, Robin B Jarrett, Lee Anna Clark
{"title":"Mania Symptoms' Complex Relations With Psychosocial Dysfunction and Personality Traits: The Role of Positive and Negative Affect.","authors":"Jeffrey R Vittengl, Eunyoe Ro, Robin B Jarrett, Lee Anna Clark","doi":"10.1002/pmh.70046","DOIUrl":"10.1002/pmh.70046","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":"19 4","pages":"e70046"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Johannes Zimmermann, André Kerber, Susanne Hörz-Sagstetter, Christopher J Hopwood, Ludwig Ohse
{"title":"The Total Score of the Level of Personality Functioning Scale Is Empirically and Theoretically Well-Justified: A Reply to Zavlis (2025).","authors":"Johannes Zimmermann, André Kerber, Susanne Hörz-Sagstetter, Christopher J Hopwood, Ludwig Ohse","doi":"10.1002/pmh.70049","DOIUrl":"10.1002/pmh.70049","url":null,"abstract":"","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":"19 4","pages":"e70049"},"PeriodicalIF":2.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12589701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}