Cluster B personality disorders are characterized by pervasive emotional dysregulation and rigid interpersonal patterns, and they remain challenging to treat. Mindful hypnotherapy (MH), which integrates mindfulness and clinical hypnosis, may offer a transdiagnostic approach to cognitive and emotional inflexibility. This randomized controlled trial compared the efficacy of MH with an active control condition in reducing symptoms of Cluster B personality disorders. One hundred and twenty adults who met DSM-5 criteria for histrionic, narcissistic, antisocial, or borderline personality disorder were randomized to MH (n = 60) or an active control (n = 60) comprising selected cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) skills. Both conditions consisted of eight weekly 60-minute individual sessions. Symptom severity was assessed pre- and post-treatment using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Post-treatment scores on each Cluster B scale were compared between groups using ANCOVA, controlling for baseline values. Relative to the active control condition, MH produced significantly greater reductions in histrionic, narcissistic, and antisocial personality disorder symptoms (all p values < .05, partial η[2] ≈ .16-.21). No significant between-group difference emerged for borderline personality disorder symptoms (p = .31). MH appears to be an effective brief intervention for histrionic, narcissistic, and antisocial personality disorders when compared with an active CBT/DBT-based control condition. Its effects on borderline personality disorder remain inconclusive and warrant further investigation in longer and more intensive treatment protocols.

Cluster B personality disorders, including Borderline, Histrionic, Narcissistic, and Antisocial personality disorders, collectively affect up to 5.5% of the population. These disorders are characterized by strong emotional responses; however, little research compares specific symptomatology with emotion regulation ability. The current study examines the relationship between subscales of the Difficulties in Emotion Regulation Scale and symptomatology across Cluster B disorders in a mixed non-clinical sample. In Study 1 (N = 325), participants completed self-report measures assessing emotion regulation and personality disorder symptoms. Primary findings showed that difficulties with emotion-related impulse control significantly predicted symptoms of all four Cluster B disorders, highlighting its importance in understanding these conditions. Study 2 (N = 530) was conducted to examine more specifically the different facets of impulsivity that are associated with these disorders. This study had participants complete self-report measures on emotion regulation, impulsivity, and personality disorder symptoms and found differential associations between facets of impulse control and Cluster B personality disorder symptoms. Impulse control difficulties also explain a large amount of variance in these disorders. These results suggest the necessity for targeted interventions focusing on impulse control and emotion regulation strategies to enhance treatment outcomes for individuals affected by Cluster B personality disorders.

Antisocial personality disorder (ASPD) is a deeply ingrained and rigid dysfunctional thought process that focuses on social irresponsibility with exploitive, delinquent, and criminal behavior with no remorse. Disregard for and violation of the rights of others are common manifestations of this personality disorder, which displays symptoms that include failure to conform to the law, inability to sustain consistent employment, deception, manipulation for personal gain, and incapacity to form stable relationships.[1] The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) classifies all ten personality disorders into three clusters (A, B, and C). ASPD falls into 1 of 4 cluster-B disorders, which also includes borderline, narcissistic, and histrionic. All of these disorders characteristically demonstrate by dramatic, emotional, and unpredictable interactions with others.[2] Antisocial personality disorder is the only personality disorder that is not diagnosable in childhood. Before the age of 18, the patient must have been previously diagnosed with conduct disorder (CD) by the age of 15 years old to justify diagnostic criteria for ASPD.[1] Many researchers and clinicians argue this diagnosis, with concerns of significant overlap with other disorders, including psychopathy. However, others counter that psychopathy is simply a subtype of ASPD, with a more severe presentation. Recent literature states that although a heterogeneous construct that can subdivide into multiple subtypes that share many similarities and are often comorbid but not synonymous, individuals with antisocial personality disorder must be characterized biologically and cognitively to ensure more accurate categorization and appropriate treatment.[3] The estimated lifetime prevalence of ASPD amongst the general population falls within 1 to 4%.[4][5] Due to the predicting factor of the initial diagnosis of conduct disorder before the age of 15, this assumption can be quite broad as CD is not always evaluated properly.[6] Gender distribution tends to be skewed towards males, with 3 to 5 times more likelihood of being diagnosed with ASPD than females, with 6% men and 2% women within the general population.[7] Substance abuse has been found to show a significant correlation to the diagnosis of antisocial personality disorder,[8] while education and intelligence displays a negative correlation,[7][9] with a higher prevalence of ASPD amongst those with lower IQs and reading levels [10]. Research shows reductions in the prevalence rate with increasing age in criminal populations,[11] as well as epidemiological samples.[7] Changes in personality traits with age and increased mortality with the behavior of ASPD have been hypothesized to justify this age-dependent alteration.[12]

Antisocial personality disorder (ASPD) is a deeply ingrained and rigid dysfunctional thought process that focuses on social irresponsibility with exploitive, delinquent, and criminal behavior with no remorse. Disregard for and the violation of others' rights are common manifestations of this personality disorder, which displays symptoms that include failure to conform to the law, inability to sustain consistent employment, deception, manipulation for personal gain, and incapacity to form stable relationships.[1] The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) classifies all ten personality disorders into three clusters (A, B, and C). Antisocial personality disorder falls into 1 of 4 cluster-B disorders, which also includes borderline, narcissistic, and histrionic. All of these disorders characteristically present with dramatic, emotional, and unpredictable interactions with others.[2] Antisocial personality disorder is the only personality disorder that is not diagnosable in childhood. Before the age of 18, the patient must have been previously diagnosed with conduct disorder (CD) by the age of 15 years old to justify diagnostic criteria for ASPD.[1] Many researchers and clinicians argue this diagnosis, with concerns of significant overlap with other disorders, including psychopathy. However, others counter that psychopathy is simply a subtype of antisocial personality disorder, with a more severe presentation. Recent literature states that although a heterogeneous construct that can subdivide into multiple subtypes that share many similarities and are often comorbid but not synonymous, individuals with ASPD must be characterized biologically and cognitively to ensure more accurate categorization and appropriate treatment.[3]

The decision of the Federal Constitutional Court permitting assisted suicide raises important questions regarding clinical and procedural standards in the care of vulnerable patients. In particular, the assessment of decision-making capacity in individuals with mental disorders presents significant challenges. This case report describes a patient with recurrent depressive disorder and histrionic personality disorder who died during day-clinic psychiatric treatment with the support of a right-to-die organization. The external psychiatric assessment was based on a single video consultation conducted twelve days prior to her death. The case illustrates how depressive symptomatology and ambivalent treatment attitudes may complicate the evaluation of a self-determined wish to die. It highlights the need for clear, context-sensitive criteria for assessing decisional autonomy, as well as reliable institutional quality assurance procedures.

Observational studies have suggested the associations between personality disorders (PDs) and cardiometabolic diseases (CMDs), though these may be biased by unmeasured confounding, including lifestyle factors or reverse causality. Mendelian randomization (MR) provides a novel approach to address these limitations by using genetic variants as instrumental variables, thereby minimizing environmental confounding and enabling causal inference. This study leverages MR to systematically evaluate causal relationships across 9 clinically relevant PDs and 8 major CMDs, offering genetic evidence to clarify previously observed epidemiological associations. Data for 9 kinds of PDs (including anankastic personality disorder, anxious personality disorder, dependent personality disorder, dissocial personality disorder, emotionally unstable personality disorder, histrionic personality disorder, paranoid personality disorder, organic personality disorder, and schizoid personality disorder) were obtained from the FinnGen consortium R10 release and data for 8 kinds of CMDs (including myocardial infarction, atrial fibrillation, type 2 diabetes, hypertension, stroke, coronary atherosclerosis, ischemic stroke and peripheral artery disease) were obtained from UK biobank. Instrumental variables were selected using single-nucleotide polymorphisms meeting a genome-wide significance threshold (P < 5 × 10[-6]) and clumped (R2 < 0.001) to ensure independence. Primary causal estimates were generated via inverse-variance weighted regression, with sensitivity analyses MR-Egger, Cochran Q intercept analysis, and leave-one-out analysis to assess robustness. Genetically predicted organic personality disorder had a positive association with coronary atherosclerosis (OR = 1.001, 95% confidence interval, 1.000-1.002, P = .029). No other significant differences (P > .05) were found. Results were stable across sensitive analyses. Our findings contrast with prior observational studies, suggesting that reported associations may reflect residual confounding from environmental or behavioral risk factors, rather than biological causation. Future research should investigate behavioral or environmental mediators underlying these epidemiological correlations.

Dissociation is a complex and transdiagnostic phenomenon defined as a disruption of, or discontinuity in, the normal, subjective integration of one or more aspects of psychological functioning. Dissociation has been identified as one of the most frequently occurring adverse effects associated with the use of esketamine nasal sprays. Individuals with high trait dissociation may be at a higher risk of experiencing an induced dissociative state and a significantly higher risk of experiencing severe induced dissociation. High esketamine-induced dissociation may act as a predictor of optimal therapeutic response, rather than solely an adverse effect. This case report describes an unusually intense and persistent dissociative reaction in a patient with histrionic personality disorder (HPD) undergoing esketamine therapy. The patient's marked dissociation upon treatment initiation raises the possibility that certain personality traits characteristic of HPD may heighten vulnerability to esketamine-induced dissociation. By explicitly examining a potential link between HPD and dissociation severity, this case highlights the importance of identifying patient-level factors that may amplify dissociative responses. Such knowledge has practical clinical implications for risk stratification, patient education regarding expected side effects, ensuring increased attention during the procedure.

BACKGROUND: Personality disorders (PD) are associated with personality beliefs (PBs). Childhood traumas (CTs) and emotional intelligence (EI) are effective in the development of PDs. However, the relationships between CTs and EI and PBs are not well known. This study examined the effects of CTs and EI on PBs. METHOD: Three hundred and eighty-seven university students who applied to the psychiatry clinic and did not receive any psychiatric diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria were recruited for the study. We applied the Childhood Trauma Scale, BarOn Emotional Intelligence Scale, and Personality Beliefs Questionnaire-Short Form to the volunteers. According to scores from the childhood trauma subscale scores, the participants divided into two groups: those with childhood trauma (CT (+), n = 180) and those without childhood trauma (CT (-), n = 207). The results will be evaluated with the SPSS ver. 22.0 program. RESULTS: EI and PB levels were higher in CT (+) than in CT (-). We found positive and significant relationships between the participants’ CT, EI, and PB levels. In all participants and also in CT (+), total levels of CTs and EI predicted paranoid, schizoid, antisocial, borderline, narcissistic, histrionic, dependent, avoidant, and passive-aggressive PBs other than obsessive-compulsive PBs. The subtypes of childhood trauma did not predict PBs in CT (+), while the EI-stress management subscale was linked to borderline, histrionic, avoidant, and passive-aggressive PBs, and the adaptability subscale was linked to dependent PBs. CONCLUSION: This research provides important contributions regarding how CTs and EI affect PBs. Given the significant impact of CT on PBs, early intervention programs should focus on promoting personality belief relationships in children who have experienced trauma. Mental health professionals and psychotherapists should integrate EI-based and emotion-focused interventions when working with individuals with trauma histories. Therapy approaches such as dialectical behavior therapy and trauma-informed cognitive-behavioral therapy may be useful in both improving EI and relational functioning in trauma survivors. TRIAL REGISTRATION: This study is registered on Clinical Trials.gov (ID: 06/05/2023- NCT05847335).

It has been posited that extremely high or extremely low levels of any personality trait in the five-factor model can be maladaptive. However, the Alternative Model of Personality Disorders in Section III of the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) is composed almost exclusively of unipolar maladaptive traits. The lack of maladaptively low neuroticism and high extraversion fails to fully cover psychopathy; the lack of maladaptively high extraversion fails to cover histrionic personality disorder; the lack of maladaptively high agreeableness fails to cover dependent personality disorder; and the lack of maladaptively high conscientiousness fails to cover obsessive-compulsive personality disorder. The goal of this study was to discern whether Five-Factor Model Personality Disorder (FFMPD) scales demonstrate incremental validity over the Personality Inventory for DSM-5 (PID-5) in capturing variance in symptom measures of each of these personality disorders. A combined sample of N = 733 completed an online questionnaire battery that included the PID-5 and FFMPD scales for psychopathy, histrionic personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder, along with symptom measures for each of these conditions. A series of hierarchical regression models was conducted in which each symptom measure was regressed on the PID-5 (entered in Step 1) and the corresponding FFMPD measure (entered in Step 2). Results suggest that adding the FFMPD measure to the models accounted for significantly more variance in its corresponding symptom measure than the PID-5 alone. Taken together, these results suggest that maladaptive variants of personality traits that are often considered healthy (e.g., low neuroticism, high extraversion) confer important information about personality disorder symptoms and functioning and should be included in the Alternative Model of Personality Disorders. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Background: Comorbid personality disorders (PDs) in patients with anorexia nervosa (AN) are associated with increased psychopathology, higher suicide risk, and poorer treatment response and outcomes. This study aimed to examine associations between gray matter (GM) volume and PDs in female adolescents with AN before and after short-term psychotherapeutic and nutritional therapy. Methods: Eighteen female adolescents with acute AN, mean age 15.9 years, underwent 3T magnetic resonance imaging before and after weight restoration. The average interval between scans was 2.6 months. Structural brain changes were analyzed using voxel-based morphometry. PDs were assessed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID II) and the Assessment of Identity Development Questionnaire. Results: SCID-II total scores showed significant positive associations with GM volume in the mid-cingulate cortex at both time points and in the left superior parietal-occipital lobule at baseline. The histrionic subscale correlated with GM volume in the thalamus bilaterally and the left superior parietal-occipital lobule in both assessments, as well as with the mid-cingulate cortex at follow-up. Borderline and antisocial subscales were associated with GM volume in the thalamus bilaterally at baseline and in the right mid-cingulate cortex at follow-up. Conclusions: PDs in female adolescent patients with AN may be specifically related to GM alterations in the thalamus, cingulate, and parieto-occipital regions, which are present during acute illness and persist after weight restoration therapy.

Background: Research on sex differences in personality disorders profiles among individuals with Alcohol Use Disorder (AUD) remains limited. This study aimed to examine sex differences in personality disorders in AUD individuals attending to an outpatient alcohol and drugs treatment unit. Methods: Persons seeking alcohol detoxification treatment were assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III) after abstinence. Both dimensional trait scores and cluster personality disorders types distribution were analyzed. A total of 216 subjects, 114 women (53%) and 102 men (47%), participated in the study. Results: No sex differences were found for paranoid, schizoid or schizotypal traits scores of Cluster A types. Women exhibited higher scores on the Cluster B histrionic trait (48 ± 22 vs. 39 ± 23, p = 0.012), with no differences in antisocial, borderline, or narcissistic trait scores. Narcissistic personality disorder was more prevalent in men than women (44% vs. 20%, p = 0.012). Cluster C dependent (52 ± 24 vs. 46 ± 20, p = 0.025) and obsessive-compulsive (54 ± 20 vs. 43 ± 19, p = 0.012) traits scores were elevated in women, but only dependent personality disorder prevalence differed categorically (38% women vs. 15% men, p = 0.012). Conclusions: Employing both dimensional and cluster approaches enriches personality disorder research in AUD. Dependent personality disorder in Cluster C robustly differentiates sexes, while personality disorder patterns in Clusters A and B show minimal sex differences when both approaches are considered.

Background This study centers on the development and validation of a psychometric scale designed to assess identity crisis and histrionic personality disorder (HPD), addressing a significant gap in current diagnostic tools. Identity crises, often characterized by confusion about one's self-concept and societal roles, commonly emerge during adolescence and can lead to maladaptive behaviors. HPD, marked by attention-seeking and emotional dysregulation, shares notable overlaps with identity crises, particularly in disrupted self-concept and a heightened dependence on external validation. Methods A multiphase process guided the scale's development, including a comprehensive literature review, expert evaluations, and pilot testing. Initially, 38 items were generated based on core theoretical constructs of identity crisis and HPD. Following expert review, the scale was refined to 28 items and pilot-tested on a diverse sample of 275 participants aged 18-25. Results Exploratory factor analysis identified five core dimensions: identity instability, dramatic expression, excessive concern with physical appearance, impulsivity, and relational intimacy. Confirmatory factor analysis further supported the model's robustness, yielding strong fit indices (Comparative Fit Index = 0.918, Root Mean Square Error of Approximation = 0.045). Conclusions The scale demonstrated excellent internal consistency (Cronbach's α = 0.94) and strong construct validity. Its multidimensional framework holds substantial value for both clinicians and researchers in assessing identity-related disturbances and HPD traits. While developed for young adults, future research should explore its applicability across broader populations and cultural contexts. This tool effectively bridges theoretical understanding with practical application, offering a foundation for targeted interventions and advancing the study of identity and personality disorders.