Establishing Levels of Personality Functioning Using the Structured Interview of Personality Organization (STIPO-R): a Latent Profile Analysis.

Both the new ICD-11 and the latest Alternative DSM-5 Model for Personality Disorders focus on self and interpersonal functioning as the central feature of personality pathology, also acknowledging that personality disorders are organized along a dimensional continuum of severity. This revised understanding is in line with long-standing psychodynamic conceptualisations of personality pathology, in particular Kernberg's object relations model of personality organization. Despite existing evidence for the clinical utility of the derived Structured Interview of Personality Organization (STIPO-R), empirical support for the identification of clear cut-points between the different levels of personality functioning is missing. For this purpose, a total of 764 adult participants were recruited across two clinical (outpatient and inpatient) settings (n = 250) and two non-clinical (university students and general community) samples (n = 514). Results from the mixture modeling suggested the existence of five groups across the clinical and non-clinical samples that covered: healthy personality functioning, maladaptive personality rigidity, and mild, moderate, and severe levels of personality pathology. All five indicators of personality organization were found to be reliable predictors of personality pathology. Of the five STIPO-R indicators, Aggression and Moral Values had the most discriminative power for differentiating between the Mild, Moderate, and Severe personality disorder groups. Implications of these findings are discussed.

Interpersonal perceptions in treatment sessions: Pathological narcissism predicts self-rater discrepancies.

OBJECTIVE: Evidence suggests that pathological narcissism impacts psychotherapy process and outcome. This study investigates whether traits of pathological narcissism account for distinctiveness (construal) of patients' interpersonal perceptions in treatment settings. METHODS: Patients enrolled in psychological/psychotherapeutic treatment (N = 150) described a segment of a session in a written format and subsequently assessed both self- and clinician's behavior on the dimensions of dominance and hostility (patient-reported ratings), along with their pathological narcissistic traits. Three independent raters also assessed interpersonal behaviors (observer-reported ratings) based on the written session descriptions. Indices of construal were defined by the residuals of self-reported (net of observer-reported) ratings and were regressed onto pathological narcissistic traits. RESULTS: No association emerged between pathological narcissism and construal in patients' perceptions of their clinicians. However, grandiose traits of pathological narcissism were related to distinctively perceiving oneself as more dominant, while vulnerable traits were related to distinctively perceiving oneself as more hostile. The former association (but not the latter) also held after incorporating additional observer ratings to investigate the robustness of the results. CONCLUSION: Findings are discussed in light of treatment-related self-enhancement and self-concealment processes.

In search of hidden threats: A scoping review on paranoid presentations in personality disorders.

Recent diagnostic developments suggest that paranoia is a transdiagnostic characteristic common to several personality disorders rather than a personality disorder per se. Nonetheless, empirical literature fails to provide comprehensive and univocal findings on whether and how paranoid presentations relate to different personality disorders. In the present scoping review, we map the empirical literature on paranoid presentations in personality disorders, considering the entire spectrum of paranoid manifestations (i.e., the paranoia hierarchy). In selecting original quantitative studies on paranoid presentations in personality-disordered patients, we screened 4,433 records in PsycArticles, PsycInfo and PUBMED. We eventually included 47 eligible studies in the review. Our synthesis indicates consistent empirical evidence of a wide range of paranoid presentations in Paranoid, Schizotypal and Borderline personality disorders. Conversely, little empirical literature exists on paranoid presentations in other personality disorders. Preliminary findings suggest broad-severity paranoid presentations, ranging from milder to severe forms, in Paranoid, Schizotypal and Borderline personality disorders. There is also some evidence of milder forms of paranoia in Avoidant, Antisocial and Narcissistic personality disorders. Conversely, there is poor evidence of paranoid presentations in Schizoid, Histrionic, Dependent or Obsessive-compulsive personality disorders. Research gaps and recommendations for improving empirical research on paranoid presentations in personality disorders are discussed.

Narcissistic Personality Traits and Sexual Dysfunction in Women: The Role of Body Image Self-Consciousness.

BACKGROUND: Individuals with narcissistic traits, specifically vulnerable ones, are more prone to experiencing concerns related to self-worth and physical appearance and to showing heightened sensitivity to appearance evaluation. Negative body image and body image self-consciousness may, in turn, undermine sexual functioning, especially when apprehension is related to body appearance in sexual contexts. METHODS: We aimed to evaluate the associations between self-reported pathological narcissistic traits, both grandiose and vulnerable, and sexual functioning in a large sample of nonclinical women (N = 656). Furthermore, we tested the mediating role of body image self-consciousness in these associations. OUTCOMES: Sexual functioning was measured through the Female Sexual Function Index. RESULTS: The results highlight that vulnerable narcissistic traits are associated with lower sexual functioning, this association being mediated by higher levels of body image self-consciousness. Conversely, grandiose narcissistic traits are linked to lower body image self-consciousness and, consequently, higher levels of sexual functioning. CLINICAL IMPLICATIONS: Considering the link between body image self-consciousness and sexuality is of utmost importance in clinical practice with women, as well as in promoting positive body appreciation. Clinicians working with individuals presenting with pathological personality traits should consider including an assessment of their sexual functioning. S Pavanello Decaro, M Di Sarno, A Anzani, et al. Narcissistic Personality Traits and Sexual Dysfunction in Women: The Role of Body Image Self-Consciousness. J Sex Med 2021;18:1891-1898.

Personality Disorders in Time of Pandemic.

PURPOSE OF REVIEW: We report evidence on the negative psychological effects of pandemics in people with personality disorders (PDs) and on the role of personality pathology in compliance with mitigation-related behaviors. Considering the paucity of studies, after a description of the main features of PDs, on the basis of the current literature on pandemic and quarantine mental health impact, we trace some clinical hypotheses. RECENT FINDINGS: Paranoid traits and detachment (cluster A) might lead to worse psychological outcomes. Cluster B patients may show more intense stress-related reactions and react strongly to social distancing, especially considering borderline personality disorder. Cluster C patients might be particularly prone to anxiety and stress due to fear of contagion and may be less flexible in adaptation to new routines. Evidence on compliance with mitigation measures is mixed, with lower compliance in cluster B patients and higher in cluster C ones. We suggest that PD patients might be particularly affected by pandemics. Furthermore, they might react differently, according to their main diagnosis. Similarly, compliance with mitigation measures may differ according to specific PDs. Our results should be considered as a starting point to reflect on therapeutic strategies to be adopted in the post-COVID-19 situation.

The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence.

PURPOSE OF REVIEW: We aim to provide quantitative evidence on the psychological impact of epidemic/pandemic outbreaks (i.e., SARS, MERS, COVID-19, ebola, and influenza A) on healthcare workers (HCWs). RECENT FINDINGS: Forty-four studies are included in this review. Between 11 and 73.4% of HCWs, mainly including physicians, nurses, and auxiliary staff, reported post-traumatic stress symptoms during outbreaks, with symptoms lasting after 1-3 years in 10-40%. Depressive symptoms are reported in 27.5-50.7%, insomnia symptoms in 34-36.1%, and severe anxiety symptoms in 45%. General psychiatric symptoms during outbreaks have a range comprised between 17.3 and 75.3%; high levels of stress related to working are reported in 18.1 to 80.1%. Several individual and work-related features can be considered risk or protective factors, such as personality characteristics, the level of exposure to affected patients, and organizational support. Empirical evidence underlines the need to address the detrimental effects of epidemic/pandemic outbreaks on HCWs' mental health. Recommendations should include the assessment and promotion of coping strategies and resilience, special attention to frontline HCWs, provision of adequate protective supplies, and organization of online support services.

Enthusiastic Acts of Evil: The Assessment of Sadistic Personality in Polish and Italian Populations.

Subclinical sadism has received substantial attention in recent research as a trait that predicts a variety of malevolent behaviors. The objective of this study was to assess the 'psychometric robustness and portability' of the Assessment of Sadistic Personality (ASP). We examined the convergent and discriminant validity, and invariance of translated versions of the ASP within community samples of Polish and Italian individuals. The study included 568 individuals (340 women and 228 men) residing in Italy (Mage = 23.57, SDage = 2.55) and 556 individuals (411 women, 144 men, 1 other) residing in Poland (Mage = 23.48, SDage = 4.60). For cultural invariance purposes, data from a Canadian sample comprising 638 students were used. To establish convergent and discriminant validity, participants completed measures of sadism, the Dark Triad, the Big Five, interpersonal reactivity, and maladaptive traits described in the DSM-5. Across both samples, convergent and discriminant validity were supported. Configural and partial metric invariance were satisfied, and following implementation of alignment optimization, latent mean differences were evaluated between countries. Results of the study supported the psychometric qualities of the ASP across different cultures and languages, and the utility of the ASP as a valid measure extending beyond university samples.

Using the Structured Interview of Personality Organization for DSM-5 Level of Personality Functioning Rating Performed by Inexperienced Raters.

We argue that clinical information related to an object-relations model of personality pathology can be used by untrained and clinically inexperienced students to rate personality-disordered patients on the Level of Personality Functioning Scale (LPFS). To do so, 73 clinically inexperienced undergraduate students were asked to assess personality functioning of 10 female inpatients using the LPFS from audio recordings of the Structured Interview of Personality Organization (STIPO). LPFS ratings showed acceptable interrater reliability. Moreover, LPFS ratings were significantly associated with external measures of severity of personality pathology (number of DSM-IV-TR personality disorders) as assessed by experienced clinicians. Finally, the students' ratings were also associated with the level of personality organization as measured by experienced clinicians using the STIPO. Our findings confirm that untrained raters can reliably assess personality pathology by rating the LPFS based on material from the STIPO. Implications related to the use of the STIPO as a tool for the assessment of personality pathology according to the DSM-5 Alternative model are discussed.

Dimensions of personality structure among patients with substance use disorders and co-occurring personality disorders: a comparison with psychiatric outpatients and healthy controls.

BACKGROUND: Although dual diagnosis has been a topic of great scientific interest for a long time, few studies have investigated the personality traits that characterize patients suffering from substance use disorders and co-occurring personality disorders through a dimensional approach. The present study aimed to evaluate structural personality profiles among dual-diagnosis inpatients to identify specific personality impairments associated with dual diagnosis. METHODS: The present study involved 97 participants divided into three groups: 37 dual-diagnosis inpatients, 30 psychiatric outpatients and 30 nonclinical controls. Dimensions of personality functioning were assessed and differences between groups were tested using Kernberg's dimensional model of personality. RESULTS: Results showed that dual diagnosis was associated with the presence of difficulties in three main dimensions of personality functioning. Dual-diagnosis inpatients reported a poorly integrated identity with difficulties in the capacity to invest, poorly integrated moral values, and high levels of self-direct and other-direct aggression. CONCLUSIONS: The present study highlighted that a dimensional approach to the study of dual diagnosis may clarify the personality functioning of patients suffering from this pathological condition. The use of the dimensional approach could help to advance research on dual diagnosis, and it could have important implications on clinical treatment programs for dual-diagnosis inpatients.

Nonsuicidal self-injury as an affect-regulation strategy and the moderating role of impulsivity.

BACKGROUND: Nonsuicidal self-injury (NSSI) is used to cope with negative affect states. We investigated the association between impulsivity and this affect-regulation process. METHOD: Affect states associated with NSSI and impulsivity traits were evaluated in 30 Italian adolescent self-injurers (63.3% female, mean age = 16.63, SD = 0.56). RESULTS: Nonsuicidal self-injury was associated with decreases in affective arousal, but impulsivity moderated other affective changes. High impulsivity was associated with increases in negative high-arousal affects after NSSI, whereas low impulsivity was associated with increases in positive affects after NSSI. CONCLUSION: Impulsivity traits influenced the success or failure of the NSSI affect-regulation process.

Biopsychosocial well-being of nursing home residents during the COVID-19 pandemic: A 3-year longitudinal study.

The COVID-19 pandemic was not only a biological challenge, but it also took a toll on the psychological and social well-being of older adults, especially those in nursing homes. This study aims to uncover the impact of the pandemic on the biopsychosocial well-being of nursing home residents, including the role of COVID-19 positivity and social contacts. Using a sample of 247 individuals in two Northern Italian nursing homes over 3 years (2018-2021), the study analyzed a broad range of biopsychosocial variables and traced the frequency of social contacts during the lockdown. The results showed a concerning trend of worsening well-being over time during the pandemic, irrespective of COVID-19 positivity. Surprisingly, the frequency of contacts with family caregivers did not seem to have a protective role, and worsening conditions were associated with an increase in subsequent social contacts. These findings shed light on the dynamics of the biopsychosocial well-being of institutionalized individuals, and they have significant public health implications. By disentangling the roles of the pandemic period, COVID-19 positivity, and social contacts, this study provides insights into the worsening of neuropsychiatric symptoms, as well as functional and clinical indicators, in nursing home residents. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Unpacking the p-factor. Associations Between Maladaptive Personality Traits and General Psychopathology in Female and Male Adolescents.

Adolescence is a period of rapid physical, psychological, and neural maturation that makes youth vulnerable to emerging psychopathology, highlighting the need for improved identification of psychopathology risk indicators. Recently, a higher-order latent psychopathology factor (p-factor) was identified that explains latent liability for psychopathology beyond internalizing and externalizing difficulties. However, recent proposals suggest reconceptualizing the p-factor model in terms of impairments in personality encompassing difficulties in both self-regulation (borderline features) and self-esteem (narcissistic features), but this remains untested. To address this, this study examined the p-factor structure and the contribution of borderline and narcissistic features using two cross-sectional data collections. In Study 1, 974 cisgender adolescents (63% assigned females at birth; age range: 13-19; Mage = 16.68, SD = 1.40) reported on internalizing and externalizing problems (YSR) to test via structural equation models (SEM) different theoretical models for adolescent psychopathology. In Study 2, 725 cisgender adolescents (64.5% assigned females at birth; age range: 13-19; Mage = 16.22, SD = 1.32) reported internalizing and externalizing problems (YSR), borderline personality features (BPFSC-11), and narcissistic personality traits (PNI), to explore, via SEM, the contribution of borderline and narcissistic traits to the p-factor and accounting for gender differences. Results confirmed the utility of a bi-factor model in adolescence. Furthermore, findings highlighted the contribution of borderline features and narcissistic vulnerability to general psychopathology. The study provides the first evidence supporting a p-factor model reconceptualized in terms of personality impairments encompassing difficulties in self-regulation and self-esteem in adolescents.

Can clinical and subclinical forms of narcissism be considered risk factors for suicide-related outcomes? A systematic review.

BACKGROUND: Clinical and subclinical forms of narcissism may increase suicide risk. However, little is known and there are controversies on this topic. This systematic review aims at providing an overview of studies investigating this association. METHODS: We used PubMed, Scopus, and PsycInfo databases and followed PRISMA. We focused on cohort, case-control, cross-sectional and case series studies. We referred to both clinical (i.e., narcissistic personality disorder (NPD) and/or NPD criteria) and subclinical forms (i.e., grandiose and vulnerable narcissistic traits) of narcissism. Moreover, we considered: Suicidal Ideation (SI), Non-Suicidal Self-Injury(s) (NSSI), Deliberate Self-Harm (DSH), Suicide Attempt(s) (SA), Suicide Risk (SR), and Capability for Suicide. RESULTS: We included 47 studies. Lack of association between NPD diagnosis/criteria and suicide-related outcomes (SI) or mixed results (SA) were found. Higher homogeneity emerged when considering narcissistic traits. Vulnerable narcissism was associated with SI, less impulsive NSSI, and DSH. Grandiose narcissism was associated with severe NSSI and multiple SA with high intent to die, but it was protective against SI and SR. Vulnerable narcissism seemed to be associated with suicide-related outcomes characterized by low intent to die, while grandiose narcissism seemed to be a risk factor for outcomes with high planning and severity. LIMITATIONS: Between-study heterogeneity and lack of longitudinal studies. CONCLUSIONS: Assessing suicide risk in subjects with clinical or subclinical forms of narcissism may be useful. Moreover, considering the most vulnerable form of narcissism, and not just the grandiose one, may contribute to a more nuanced risk stratification and to the identification of distinct therapeutic approaches.

The peaks and valleys of narcissism: The factor structure of narcissistic states and their relations to trait measures.

Although interindividual differences in narcissism are well studied, little is known about assessing narcissism at the within-person level. To fill this research gap, we investigated whether the narcissism construct is represented in the same way at the between- and within-person levels. We analyzed four established narcissism measures across multiple studies. In each of the studies, participants completed narcissism measures in ecological momentary assessment or daily diary studies. Equivalent construct representation across between- and within-person narcissism (i.e., cross-level measurement invariance) was found. State narcissism measures showed convergent validities for the trait narcissism scales. Moreover, we also found that antagonistic narcissism was most strongly related to within-person variability in narcissism. Our investigation sheds new light on the structure and assessment of narcissism on the within-person level by providing a comprehensive examination of its measurement. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Maladaptive Personality Traits and Internalizing and Externalizing Problems: The Role of Borderline and Narcissistic Features in Adolescence.

Objective: Research has shown the importance of delving into the variables associated with externalizing and internalizing behaviors in adolescence, highlighting gender-related differences in their presentations. This two-wave longitudinal study aims to address gaps in understanding the concurrent contribution of borderline and narcissistic personality traits to the presence and maintenance of internalizing and externalizing problems in adolescence. Method: We recruited 705 adolescents (65% females; age range 13-19 years old; Mage = 15.84, SD = 1.31) to self-report on behavioral problems (YSR-112), borderline (BPFSC-11) and narcissistic traits (PNI) at baseline and again on behavioral problems after 12 months. Results: Data highlighted significant differences between males and females for all variables except externalizing problems. Hierarchical regression models showed that borderline traits are a prominent risk factor for all behavioral problems in males and females at baseline and after 12 months. Moreover, regardless of gender, higher grandiose narcissism contributes to lower internalizing problems only when the direct contribution of vulnerable presentations of narcissism is considered. Grandiose narcissism is also a risk factor for externalizing problems after 12 months in females, whereas vulnerable narcissism significantly increases the likelihood of internalizing trajectories improving over 12 months. Conclusions: This study provides more evidence of the associations between maladaptive personality traits and adolescent internalizing and externalizing problems: (1) confirming that borderline traits are crucial beyond gender, (2) stressing the importance of considering both grandiose and vulnerable narcissistic traits, and (3) highlighting the adaptive value of narcissistic vulnerability in capturing the adolescent crisis. The implications for clinical practice and intervention are also discussed.

Attachment styles, mental health, and trauma during the first wave of COVID-19 pandemic in an Italian adult population.

The COVID-19 pandemic has negatively impacted adults' mental health around the world. Various studies highlighted the role of sociodemographic risk factors, including age, gender, and level of education, in increasing this impact. Although insecure attachment styles are considered a vulnerability factor for psychopathology and difficulties in coping with stressful situations, few studies have examined the role of attachment styles in relation to psychological responses to the COVID-19 pandemic. This study aims to investigate the role of attachment styles in affecting psychopathological problems and post-traumatic symptoms during the COVID-19 pandemic in a sample of Italian adults (N=1548). During the first lockdown in Italy, the Attachment Style Questionnaire, the Impact of Event Scale-Revised, and Symptom Checklist 90-Revised were administered to the participants to assess attachment styles, trauma-related symptoms, and psychopathological problems. The results showed that 41% of the participants had symptoms of clinical and subclinical relevance during the pandemic. Anxious and avoidant insecure attachment styles predicted psychopathological problems and post-traumatic symptoms, whereas secure attachment style was a protective factor. Our results highlighted the significant role played by the quality of attachment styles on adult mental health during the pandemic, providing valuable elements for targeted psychological support interventions.

Measurement Invariance of the Pathological Narcissism Inventory and Multimethod Examination of Narcissistic Presentations in Community and Clinical Samples.

The Pathological Narcissism Inventory (PNI) is extensively used in recent empirical literature on pathological narcissism. However, most studies using the PNI are community-based, and no studies have used the PNI to investigate narcissistic presentations in personality disordered patients. This study investigates measurement invariance of the PNI in community participants and patients with personality disorders, and examines differences of narcissistic presentations in these samples through a multimethod approach. Results show that the PNI can be used reliably to measure and compare traits of pathological narcissism in community participants and patients with personality disorders. Personality disordered patients show higher traits reflecting vulnerable narcissism and overt manifestations of grandiose narcissism, compared with controls. Finally, network analysis indicates that traits of grandiose fantasies and entitlement rage have a central role in defining manifestations of PNI pathological narcissism, regardless of the presence of an underlying personality disorder. Research and clinical implications are discussed.

Analysis of healthcare workers' mental health during the COVID-19 pandemic: Evidence from a three-wave longitudinal study.

The "Healthcare workers' wellbeing [Benessere Operatori]" project is an exploratory longitudinal study assessing healthcare workers' mental health at three different time points over a 14-month period during the COVID-19 pandemic. We collected socio-demographic and work-related information and assessed the perceived social support, coping strategies, and levels of depression, anxiety, insomnia, anger, burnout, and PTSD symptoms. In total, 325 Italian healthcare workers (i.e. physicians, nurses, other healthcare workers, and clerks) participated in the first initial survey and either the second or third subsequent survey. Participants reported subclinical levels of psychiatric symptoms that remained mostly unchanged across time, except for an increase in stress, depression, state anger, and emotional exhaustion symptoms. Despite subclinical levels, healthcare workers' distress can adversely affect the quality of care, patient satisfaction, and medical error rates. Therefore, implementing interventions to improve healthcare workers' wellbeing is required.

Adolescent nonsuicidal self-injury: the effects of personality traits, family relationships and maltreatment on the presence and severity of behaviours.

Personality traits, family environment and maltreatment episodes are often associated with nonsuicidal self-injury (NSSI); however, research on these associations has shown mixed results. The aim of the present study was to clarify the effects of these factors on the presence and the severity of NSSI among a sample of Italian students who attended secondary schools (N = 267, mean age = 17.03 SD = 0.866). The results showed that personality traits, family environment and maltreatment differently predicted the presence and the severity of NSSI. Self-injurers were more impulsive and aggressive than non-self-injurers and reported poorer relationship quality with their mothers and more sexual and physical abuse episodes than non-self-injurers. Conversely, the frequency of NSSI behaviours was predicted by the presence of less impulsiveness, more anxiety and aggressiveness, poorer relationship quality with both parents and a lower degree of identification with the father. Finally, more frequent self-injurers also reported more sexual abuses and neglect episodes than less frequent self-injurers.

What If I Feel Rejected? Borderline Personality, Pathological Narcissism, and Social Rejection in Daily Life.

The authors investigate whether and how borderline and pathological narcissistic traits differ in their associations with trait and state rejection sensitivity, and with affective reactions to experiences of social rejection occurring in daily life. Community adults (N = 189) completed baseline measures of rejection sensitivity, borderline personality, and pathological narcissism, and daily measures of perceived social rejection and affective states for 7 days. Vulnerable narcissism was the main driver of negative anticipated emotions for social rejection. Borderline personality made people prone to experiencing social rejection in daily life. Moreover, borderline personality traits predicted greater self-directed aggressive impulses when experiencing social rejection. Grandiose narcissism showed only a negative association with anticipatory anxiety for rejection. These findings highlight that sensitivity to social rejection is crucial in both borderline personality and pathological narcissism.