• PIRS
• Psychodynamic Intervention Rating Scale
• expressive–supportive continuum
• psychological interventions
• verbal intervention

• Humans
• Mental Disorders/diagnosis
• Mental Disorders/therapy
• Psychotherapeutic Processes
• Psychotherapy, Psychodynamic/methods

• Humans
• Male
• Adult
• Body Dysmorphic Disorders/therapy
• Body Dysmorphic Disorders/psychology
• Body Dysmorphic Disorders/diagnosis
• Psychoanalytic Therapy/methods
• Psychophysiologic Disorders/therapy
• Psychophysiologic Disorders/psychology
• Psychophysiologic Disorders/diagnosis
• Personality Assessment

• Correctional settings
• Forensic populations
• Forensic psychology
• Personality
• Personality assessment inventory

• Humans
• Personality Assessment
• Substance-Related Disorders/psychology
• Recidivism
• Forensic Psychology
• Correctional Facilities
• Prisoners/psychology
• Forensic Psychiatry
• Personality Inventory
• Mental Disorders/diagnosis
• Mental Disorders/psychology
• Aggression
• Personality Disorders/diagnosis
• Personality Disorders/psychology

• Adolescence
• Attachment
• Childhood Trauma
• Gender
• Mental Disorders
• Personality Disorders

• Adult
• Humans
• Male
• Adolescent
• Female
• Mental Disorders
• Personality Disorders/epidemiology
• Personality Disorders/diagnosis
• Personality Disorders/psychology
• Emotions
• Inpatients
• Sex Factors

• University of Innsbruck and Medical University of Innsbruck

• assessment
• borderline personality disorder
• childhood abuse
• mood and anxiety disorders
• post-traumatic stress disorder
• trauma

• 2011163 United States-Israel Binational Science Foundation

• depression
• endocannabinoid system
• personality disorders
• psychological comorbidities
• resistant migraine

• Humans
• Adult
• Middle Aged
• Endocannabinoids/metabolism
• Cross-Sectional Studies
• Mental Disorders
• Receptors, Cannabinoid/metabolism
• Personality Disorders
• Personality
• Migraine Disorders/genetics

• PRQ
• SWAP-200
• clinician-patient relational patterns
• personality traits
• psychotherapy
• therapeutic alliance

• Bayesian network
• Delphi
• artificial intelligence
• decision support system
• knowledge engineering
• personality disorder
• probabilistic graphical model

• CPAP-Q
• Child personality
• Diagnosis
• Emerging personality patterns

• Data collection
• Narrative inquiry
• Self-esteem regulation
• Semi-structured interview method

• CPNI
• assessment
• childhood personality
• diagnosis
• personality disorder

• AMPD
• SWAP
• clinical ratings
• level of personality functioning
• “Madeline G.”

A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders (BPD) are still insufficiently understood. Evidence of differences between different types of therapies has been questioned.

To study repetitive interaction patterns in patients with BPD undergoing either psychoanalysis or psychodynamic therapy.

Psychoanalysis (PSA) or psychodynamic psychotherapy (PDT) was administered to 10 patients each, the two groups were matched. Therapy regimens were applied according to care as usual/manualized including quality control and supervision as usual. Randomization to one of the groups was done after baseline assessment. During classical PSA (n = 10) and PDT (n = 10), semiannually, recordings (audio or video) of five consecutive therapy sessions were taken over three years for an ex-post analysis. The patients' characteristics, such as affect parameters [Affect regulation and experience Q-sort (AREQ)], quality of object relations (quality of object relations scale) and personality traits [Shedler-Westen Assessment Procedure (SWAP-200)] were analyzed retrospectively by independent raters. Therapeutic action (psychotherapy process Q-sort) and affective (re)actions of the patients (AREQ) were then analyzed in relation to changes found in the patients' characteristics.

During the first year of therapy (PSA: n = 10; PDT: n = 9), the therapeutic method PSA was associated with significant improvements in the variable "SWAP Borderline", while in PDT change was not significantly different to baseline (PSA: P = 0.04; PDT: P = 0.33). Long-term results and follow up was available for seven participants in PSA and for five in PDT after three years; change in SWAP borderline for the whole sample was not significant at this time point when confronting to baseline (P = 0.545). However, differences between PSA and PDT were significant when analyzing the “mean change” in the SWAP Borderline variable after one year of therapy (P = 0.024): PSA led to slightly increased BPD symptoms, while PDT to a decrease; for the long run, variance of observed change was higher in PSA than in PDT (SD_PSA ± 9.29 vs SD_PDT ± 7.94). Our assumption that transference interpretations, closely followed by affective changes in the patient, could be useful modes of interaction was reproducible in our findings, especially when looking at the descriptive findings in the long-term data. The analysis of repetitive interaction structures demonstrated a very specific "time-lag" between therapeutic intervention and a corresponding increase in positive affect in successful therapy cases.

Exploring the change processes in the patients' characteristics and linking these changes to specific treatment strategies is of clinical importance when starting treatment and for its long-term progress.

• Psychoanalysis
• Psychodynamic psychotherapy
• Borderline personality disorder
• Affect regulation
• Affect regulation and experience Q-sort
• Transference

Monoclonal antibodies (mABs) targeting the calcitonin gene-related peptide (CGRP) pathway represent the first disease-specific preventive migraine therapy. Growing evidence suggests that they are effective in the preventive treatment of difficult-to-treat patients. In this study, we evaluated the psychological predictors of the outcome of treatment with the anti-CGRP monoclonal antibody erenumab in patients with chronic migraine (CM).

Seventy-five patients with CM who had already failed at least 3 preventive therapies received erenumab every 28 days for a period of 12 months. Before the first administration, patients received a full psychological evaluation using The Structured Clinical Interview for DSM-5 Clinician Version (SCID-5-CV) to assess personality disturbances (primary outcome), mood and anxiety disorders, and as well specific questionnaires to evaluate alexithymia traits, childhood traumas, and current stressors (secondary outcomes).

After 12 months of treatment, 53 patients reported a reduction of at least 50% in headache days/per month (Responders), whereas 22 did not (Non Responders). When compared to Responders, Non Responders were characterized by a higher prevalence of personality disorders belonging to Cluster C (avoidant, dependent, and obsessive-compulsive) (77% vs 37%, p = .001). Non Responders were also characterized by a higher prevalence of anxiety disorders (90% vs 60%, p = 0.007), showed more alexithymic traits (51.7 ± 13.7 vs 42.9 ± 14.3, p = 0.017), and reported a higher number of 'at least serious' current stressors (3.2 ± 4.0 vs 0.8 ± 1.4, p < .0001) than Responders. At the multivariate analysis, higher prevalence of Cluster C personality disorders (OR 3.697; p = 0.05) and higher number of ‘at least serious’ life events (OR 1.382; p = 0.017) arose as prognostic factors of erenumab failure.

Erenumab confirmed its effectiveness in a population of difficult-to-treat migraine. The presence of “anxious-fearful” personality together with current stressors and anxiety represent negative predictors of treatment outcome.

The study protocol was registered at clinicaltrials.gov (NCT04361721).

• Alexithymia
• Anti-CGRP monoclonal antibody
• Anxiety
• Chronic migraine
• Open label
• Personality
• Stressful event

Defense mechanisms are relevant indicators of psychological functioning and vulnerability to psychopathology. Their evaluation can unveil individuals' unconscious strategies for mediating reactions to emotional conflict and external stressors. At the beginning of their journey toward gender reassignment, individuals diagnosed with gender dysphoria (GD) may experience conflict and stressful experiences that trigger a wide range of defense mechanisms. Mature defenses may strengthen these individuals as they travel along this important path, while neurotic and immature defenses may exacerbate their body dissatisfaction (BD) and hinder their processing of change. Only a few studies have investigated self-reported defensive functioning in transgender people, finding a higher frequency of maladaptive defense mechanisms relative to controls. The present study was the first to apply an in-depth clinician-rated tool to assess the entire hierarchy of defense mechanisms within a sample of transgender people. Defensive functioning and personality organization were assessed in 36 individuals diagnosed with GD (14 trans women, 22 trans men, mean age 23.47 years), using the Defense Mechanisms Rating Scales (Perry, 1990) and the Shedler-Westen Assessment Procedure-200 (Shedler et al., 2014). Body uneasiness was assessed using the Body Uneasiness Test (BUT; Cuzzolaro et al., 2006). The findings showed that defensive functioning correlated positively with healthy personality functioning and negatively with BD. Compared to cisgender controls, participants with GD who presented greater defensive functioning were found to be more immature and to demonstrate significant differences in many levels of functioning. The clinical implications of the results suggest that psychological interventions aimed at improving defensive functioning in individuals with GD will be important in helping them manage the challenges posed by their gender transition.

• body satisfaction
• defense mechanisms
• gender dysphoria
• personality
• transgender

• comorbidity
• eating disorders
• personality
• symptom severity
• therapy outcome

• CPAP-Q
• child personality
• diagnosis
• emerging personality patterns

• Adolescent
• Adult
• Child
• Humans
• Infant
• Personality
• Personality Assessment
• Personality Disorders
• Q-Sort
• Reproducibility of Results

• Alliance
• Emotion in therapy
• Personality disorders

• Clinical significance
• Eating disorders
• Personality disorders
• Residential treatment
• Therapy outcome

• Anorexia Nervosa/therapy
• Bulimia Nervosa/therapy
• Female
• Humans
• Longitudinal Studies
• Personality
• Personality Disorders
• Residential Treatment

• Università degli Studi di Roma La Sapienza

• adolescence
• clinical high risk (CHR) for psychosis
• early detection & prevention
• personality
• personality traits

People with pathological narcisism, with their conflicted sense of grandiosity and vulnerability, often pose a variety of therapeutic challenges, which may impede these patients’ ability to benefit from psychotherapy. To offer a case illustration and provide insight into the intrinsic difficulties of working with this patient group, we examined the treatment of a fictional character, Alex, from the TV series In Treatment. Based on the Shedler-Westen Assessment Procedure-200 we diagnosed Alex with pathological narcissism, and evaluated the treatment process (seven sessions) by reporting on measurements of session-by-session change in explicit working alliance, implicit language alliance, and ruptures and repairs. Over the course of treatment, the working alliance (Working Alliance Inventory-Observer scale) fluctuated with a particularly low bond at session five, identified as a rupture (Rupture Resolution Rating System). Language analysis (Linguistic Inquiry and Word Count) showed that the unconscious aspects of the alliance started to deteriorate just before the rupture occurred. The results illustrate how therapists might be pulled to collude with narcissistic patients’ grandiosity, with the risk of neglecting their vulnerability. This fictional portrayal of a treatment with a narcissistic patient may be widely shared with researchers, students and therapists alike, offering a common locus of scholarly attention, and an innovative tool for teaching. Given the lack of empirical treatments for pathological narcissism and the great therapeutic challenges narcissistic patients present, further research and development of clinical guidelines are warranted.

• Alliance
• In Treatment
• Narcissism
• Rupture

Medication-overuse headache (MOH) is a type of chronic headache, whose mechanisms are still unknown. The impact of psychological factors has been matter of debate from different perspectives. The role of personality and personality pathology in processes involved in MOH development has been advanced but was poorly studied. The hypothesis of addiction-like behaviors sustaining the drug misuse has been examined and reached contrasting findings.

This study is aimed at detecting personality and its disorders (PDs) in MOH, with a specific attention to the addiction aspect.

Eighty-eight MOH patients have been compared with two clinical populations including 99 patients with substance use disorder (SUD) and 91 with PDs using the Shedler-Westen Assessment Procedure-200 (SWAP-200), a clinician-report tool that assesses both normal and pathological personality. MANCOVAs were performed to evaluate personality differences among MOH, SUD, and PD groups, controlling for age and gender.

MOH patients were predominantly women and older. They showed lower traits of the SWAP-200's cluster A and B disorders than SUD and PD patients, who presented more severe levels of personality impairment. No differences in the SWAP-200's cluster C have been found, indicating common personality features in these populations. At levels of specific PDs, MOH patients showed higher obsessive and dysphoric traits and better overall psychological functioning than SUD and PD patients.

Although MOH, SUD, and PD populations have been evaluated in multiple sites with different levels of expertise, the study supported the presence of a specific constellation of personality in MOH patients including obsessive (perfectionist) and dysphoric characteristics, as well as good enough psychological resources. No similarities to drug-addicted and personality-disordered patients were found. Practitioners' careful understanding of the personality characteristics of MOH patients may be useful to provide a road map for the implementation of more effective treatment strategies and intervention programs.

• countertransference
• dropout
• psychotherapeutic alliance
• psychotherapeutic failures
• psychotherapeutic treatments

• Anxiety
• Clinical utility
• Depression
• Diagnosis
• Prototype matching
• Validity

• Adult
• Anxiety Disorders/diagnosis
• Diagnostic and Statistical Manual of Mental Disorders
• Female
• Humans
• Male
• Middle Aged
• Mood Disorders/diagnosis
• Psychiatric Status Rating Scales/standards
• Reproducibility of Results

• Psychoanalytical principles
• diagnostic classification systems
• evidence-based medicine

• PDM-2
• personality organizations
• personality styles
• therapists' emotional responses

• Adult
• Attitude of Health Personnel
• Countertransference
• Diagnostic and Statistical Manual of Mental Disorders
• Emotions
• Female
• Humans
• Male
• Middle Aged
• Personality
• Personality Disorders
• Professional-Patient Relations
• Surveys and Questionnaires

• Attachment
• Avoidance
• ECR-R
• RQ
• SWAP
• Social anxiety

Single case studies are at the origin of both theory development and research in the field of psychoanalysis and psychotherapy. While clinical case studies are the hallmark of psychoanalytic theory and practice, their scientific value has been strongly criticized. To address problems with the subjective bias of retrospective therapist reports and uncontrollability of clinical case studies, systematic approaches to investigate psychotherapy process and outcome at the level of the single case have been developed. Such empirical case studies are also able to bridge the famous gap between academic research and clinical practice as they provide clinically relevant insights into how psychotherapy works. This study presents a review of psychoanalytic empirical case studies published in ISI-ranked journals and maps the characteristics of the study, therapist, patient en therapies that are investigated. Empirical case studies increased in quantity and quality (amount of information and systematization) over time. While future studies could pay more attention to providing contextual information on therapist characteristics and informed consent considerations, the available literature provides a basis to conduct meta-studies of single cases and as such contribute to knowledge aggregation.

• empirical single case studies
• psychoanalysis
• psychodynamic psychotherapy
• review
• single case archive

• Mediation analysis
• Mentalization
• Personality functioning
• SWAP-200

• Adaptation, Psychological/physiology
• Adolescent
• Adult
• Female
• Humans
• Male
• Object Attachment
• Personality
• Personality Disorders/diagnosis
• Personality Disorders/psychology
• Psychiatric Status Rating Scales
• Theory of Mind/physiology
• Young Adult

• Gender Dysphoria
• Personality
• SWAP-200
• Transsexualism

• Female
• Gender Dysphoria/complications
• Humans
• Male
• Personality Assessment
• Personality Disorders/etiology
• Personality Disorders/psychology
• Psychometrics

• Rorschach Inkblot Task
• SWAP-200
• grandiosity
• narcissism

• Blatt’s anaclitic and introjective configurations
• Personality change
• Shedler-Westen Assessment Procedure profiles

Introduction: This study focuses on the relationship between personality configurations and depressive experiences. More specifically, the aim of this study is to investigate the relationship between self-criticism and dependency and personality styles or disorders, exploring the association between personality features and depressive symptoms. The two-configurations model of personality developed by Blatt (2004, 2008) is adopted as a reference point in sharing a valid framework and in understanding the results.

Methods: Five instruments are administered to 51 participants with a diagnosis of depressive disorder, in accordance with DSM-IV-TR (American Psychiatric Association, 2000): Self-criticism and dependency dimensions of depression are measured with the Depressive Experiences Questionnaire (DEQ); self-reported depression is assessed with the Beck Depression Inventory-II (BDI-II); observer-rated depression is assessed with the Hamilton Depression Rating Scale (HDRS); personality is assessed with the Clinical Diagnostic Interview (CDI) and the Shedler Westen Assessment Procedure-200 (SWAP-200).

Results: Only self-criticism, and not dependency, is associated with depressive symptoms. In addition, the SWAP Borderline PD Scale and the Dysphoric: Emotionally dysregulated Q-factor emerge as significant in predicting depression.

Conclusions: Findings support the assumption that depressive personality configurations can enhance the vulnerability to developing depression. Theoretical and clinical implications of these results are discussed.

• dependency
• depressive personality
• depressive symptomatology
• self-criticism
• vulnerability

• Control-Mastery Theory
• assessment, guilt
• clinician report
• factor analysis

• Adult
• Female
• Guilt
• Humans
• Interpersonal Relations
• Male
• Psychiatric Status Rating Scales
• Psychometrics/methods
• Reproducibility of Results
• Surveys and Questionnaires
• Survival/psychology

Parental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents' addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18–24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing EF and adopting a trauma-focused approach.

• drug-addicted youth
• executive function
• exposure to drugs
• personality disorder
• trauma

• assessment
• systematic clinical interview
• structured clinical interview
• validity

• Adult
• Aged
• Case-Control Studies
• Cerebrovascular Disorders/complications
• Cerebrovascular Disorders/psychology
• Depressive Disorder/diagnosis
• Depressive Disorder/etiology
• Depressive Disorder/psychology
• Female
• Humans
• Male
• Middle Aged
• Personality
• Psychiatric Status Rating Scales
• Psychological Tests
• Self Report
• Surveys and Questionnaires