Brin F. S. Grenyer

There is a need for a parenting intervention that specifically addresses the concerns for parents with borderline personality disorder (BPD) due to the challenges that these parents experience and the stigma that surrounds parenting with BPD. Such interventions may also prevent intergenerational transmission of psychopathology and support clinicians to provide care within a personality disorder framework. This study aims to evaluate the effectiveness of a brief parenting group intervention for parents with BPD. The design was a parallel randomized controlled trial (RCT) with two arms: the brief parenting intervention group and a treatment as usual (TAU) group. Participants were parents with a diagnosis of BPD who were parenting at least one child between birth and 5 years old. Participants were randomised to either the brief parenting group intervention (Coming up for AIR (CUFA)) through a public mental health service or to TAU. Participants, clinicians, and researchers were not blind to the allocation. It was hypothesised that the CUFA parenting intervention would reduce self-reported parenting stress (primary outcome) and improve parental mental health (secondary outcome) compared to TAU. Participants (N = 93) were randomly allocated to the parenting intervention (n = 45) and TAU (n = 48). For the analyses of the per protocol sample 25 participants in the CUFA parenting intervention and 21 participants in the TAU condition were included. Multi-level analysis on the intention to treat sample indicated that the CUFA parenting intervention (dpre−post = 1.29) significantly reduced parenting stress compared to TAU (dpre−post = 0.01). This finding was replicated in the per protocol sample. A brief parenting intervention can have a positive effect on reducing parenting stress and improving parental mental health. Offering a parenting intervention needs a supportive and integrated approach to lower barriers for service attendance. Future research may investigate the effect on child wellbeing. It is important and in line with treatment guidelines to offer a parenting intervention to people with BPD. Trial registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), number ACTRN12620001257954.

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

Objectives: Early childhood autobiographical memories told by people with Borderline Personality Disorder (BPD) may provide insight into emotional, identity and interpersonal functioning deficits underlying the disorder. We aimed to analyse verbatim transcripts of these memories coded by the Core Conflictual Relationship Theme (CCRT) and Experiencing Scale (EXP). Design: This study employed a controlled, between‐subjects study design. Methods: Sixty‐four individuals (32 with diagnosed BPD and 32 age‐ and gender‐matched controls) were interviewed to generate autobiographical memories using the Adult Attachment Interview. The CCRT method was used to identify themes within relationships and was coded for self (identity) and other (interpersonal) processes, and the EXP scored capacity to communicate internal emotional experiences. Results: Significant differences were found between BPD and Control participants in their emotional, interpersonal and self‐perceptions within autobiographical events. BPD self‐descriptions were more psychologically rigid, with significantly lower EXP scores, suggesting poorer capacity to verbalize and emotionally integrate internal experiences and relationships. In addition, BPD participants' CCRTs had significantly less harmonious language, experiencing others as more attacking and less supportive and the self as more withdrawn and determined by others. Impairments were marked by a more helpless external locus of control in relationships. Conclusions: Studying autobiographical narratives provided specific insight into core underlying deficits of BPD. Specifically, individuals with BPD may have more challenges in developing trust, fostering agency and managing negative expectations. The use of autobiographical memory recall to help inform individuals' relationship themes and internal emotional awareness could help tailor treatment for BPD.

Remission and recovery from borderline personality disorder (BPD) is difficult, yet achievable, yet not all people benefit. Peers with lived experience of recovery from BPD as co-therapists may increase engagement, reduce stigma and strengthen hopefulness. We evaluated a peer and clinician co-led group therapy (AIR Peers) for consumers with BPD. Eighty-three participants (88% female, M age = 36yrs) were randomized into either AIR Peers therapy (n = 43) or treatment as usual (TAU; n = 40). The intervention was co-designed by people with lived experience and clinicians. It involved 12 hours of group therapy over a 6-week period (2hrs/week). Weekly topics included discussion of stigma, self-compassion, self-care, creative recovery and "building your best life." Intention to treat multilevel modeling analysis indicated that the AIR Peers group showed a significant reduction in BPD symptoms (primary outcome) and improvement in mental health ratings (secondary outcome), whereas no change was present in the TAU group. Self-report ratings indicated therapy success, helpfulness, and satisfaction. Quantitative and qualitative ratings of group and therapist alliance and group engagement were positive. Peer and clinician co-facilitated therapy groups may contribute to novel and effective approaches for people living with BPD on their recovery journey. Australian New Zealand Clinical Trials Registry identifier: ACTRN12621000183886.

Background: Narcissistic personality disorder (NPD) is known to comprise two distinct but connected phenotypes related to ‘grandiosity’ and ‘vulnerability’, respectively. While evidence suggests differing countertransference responses to narcissism subtype expression, no study has examined this using a qualitative methodology and explored associations with ratings of personality disorder severity.Method: Mental health clinicians (N = 180, 67% female, age = 38.9), completed qualitative clinical reflections and ratings of overall personality disorder severity towards two hypothetical vignettes displaying pathological narcissism (‘grandiose’ and ‘vulnerable’ narcissism respectively), as well as a rating of attitudes towards patients in their routine practice who resemble these vignettes.Results: Distinct qualitative themes were identified between narcissistic subtype, with grandiose narcissism evoking anger, lack of empathy and hopelessness, compared to sympathy, sadness and discomfort in vulnerable narcissism. In terms of diagnostic category, the grandiose vignette was predominately identified as ‘narcissistic personality disorder’ (97%), whereas the vulnerable vignette was a mixture of ‘depressive disorder’ (29%), ‘narcissistic personality disorder’ (24%), ‘trauma and stressor related disorders’ (21%) and ‘borderline personality disorder’ (21%). Attitude scores differed significantly between subtypes, with more negative attitudes towards narcissistic grandiosity than narcissistic vulnerability. The grandiose vignette was also rated as displaying more overall personality impairment, with an association observed between negative clinician attitude scores and increased ratings of personality disorder severity.Discussion: Two potential pathways are outlined to interpret these findings. The first is that inordinate stigma towards narcissistic grandiosity negatively biases clinicians when working with these patients due to feelings of anger and frustration. The second is that clinicians are drawn to minimise pathology of vulnerable patients due to their feelings of sadness and empathy. We propose that effective diagnosis and psychotherapy for pathological narcissism rely on clinicians' ability to balance these two dilemmas and resist either extreme.

Individuals with borderline personality disorder (BPD) often hold pervasive and negative self-views and experience feelings of low connectedness toward others despite effective treatment. This study aimed to identify neural and affective mechanisms of identity disturbance in BPD that contribute to difficulties in relating to others. Participants diagnosed with BPD (N = 34) and nonclinical controls (NCC; N = 35) completed a within-subject social feedback task inside a magnetic resonance imaging scanner. Participants received character evaluations, supposedly from a panel of three members who provided either predominantly negative, intermediate, or positive feedback. Multilevel analysis and event-related functional magnetic resonance imaging analysis compared the BPD and NCC group on mood, affiliation, and neural responses to the feedback and the panel. Results indicate that people with BPD had more negative self-views and reported lower mood after negative and intermediate feedback compared to NCC. People with BPD also felt less close to the member providing predominantly positive feedback compared to NCC, which appeared to be mediated by degree of fearful attachment. People with BPD showed altered bold responses to social feedback in temporal parietal junction and the anterior cingulate cortex compared to NCC. Findings indicate that people with BPD experience pervasive negative self-views that may interfere with forming relationships. New interactions may reinforce a fearful pattern of relating as existing (negative) views of the self are activated and subject to confirmation. These complexities have important clinical implications for the therapeutic alliance. Balancing a supportive and expressive stance may foster the therapeutic alliance while challenging negative self-views. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

While the majority of personality disorder research focuses on adults, research shows that borderline personality disorder (BPD) often emerges in adolescence, highlighting the importance of early intervention for this population. Despite this, there are limited intervention programs tailored specifically for adolescents with BPD, and no research has explored the effectiveness of online therapist-assisted interventions for BPD in adolescents. As such, this pilot study aimed to address this gap in the literature by exploring the effectiveness of a therapist-assisted online intervention (AIR Therapy) with adolescents with BPD. The intervention involved 6 online weekly learning modules in conjunction with a weekly telehealth consultation session with a clinician. Modules included: introduction to AIR therapy, mindfulness and managing distress, emotions, self and identity, our interpersonal skills, and self-care. Participants were 12 adolescents (83.3% female, M age = 15 years) and 12 clinicians (100% female, M age = 34.3 years) recruited naturalistically from publicly funded mental health services located in rural and remote locations. Adolescents were compared on BPD symptom severity, mental health symptoms and quality of life at baseline and follow-up. Measures and semi-structured interviews were also completed evaluating the effectiveness and acceptability of the intervention at follow-up. Both adolescents and clinicians rated the intervention positively in terms of its effectiveness and acceptability. Paired-sample t-tests showed significant improvement in BPD symptoms, mental health and health satisfaction from intake to end of therapy. Adolescents’ qualitative responses revealed themes of improving self-regulation and coping, ease of the online workbook, and the value of clinician interaction. Additionally, clinicians’ responses highlighted themes of adding structure to therapy, the value of a brief intervention, enhancing self-insight and helping adolescents build skills that they can utilise in everyday life. Both adolescents and clinicians also highlighted suggested areas for improvement. The structured online therapist-assisted intervention in the early treatment of BPD was acceptable and helpful for participants and their clinicians in this rural and remote real-world setting. This intervention may also be particularly suited for newer or trainee clinicians, providing structured tools for use with a challenging population.

Borderline personality disorder (BPD) is a psychological disorder that is diagnosed predominantly in females yet is equally as prevalent in males. Many empirical research studies on the treatment of BPD have been conducted with only female participants. We aimed to investigate the impact of current treatments for BPD on men compared to women. Using data from a larger ongoing longitudinal study, we matched 48 males with 48 females in treatment on age, overall functioning and psychological distress at intake and then accessed their progress in treatment after 12 months. Controlling for the initial scores at baseline, analysis of covariance (ANCOVA) analysis found significant differences in outcome measures at 12‐months follow‐up. Females had significantly greater improvements in BPD severity and greater improvements in internalizing symptoms such as chronic feelings of emptiness. Females also reported significantly greater satisfaction and ratings of health at follow‐up. These findings suggest that current treatment as usual for BPD could be more effective for women compared to men. Results from the study highlight the need for future studies to investigate the experience of males in current BPD treatment and to identify potential areas for modification to better cater to this population.

Modern diagnostic and classification frameworks such as the ICD‐11 and DSM‐5‐AMPD have adopted a dimensional approach to diagnosing personality disorder using a dual “severity” and “trait” model. As narcissistic personality has historically struggled to be adequately captured in dominant diagnostic systems, this study investigated the utility of the new ICD‐11 framework in capturing diverse narcissistic expressions. Participants were mental health clinicians (N = 180, 67% female, age = 38.9), who completed ratings of ICD‐11 personality severity, trait domains and a clinical reflection for two hypothetical case vignettes reflecting either prototypical “grandiose” or “vulnerable” narcissism. The majority of clinicians (82%) endorsed a diagnosis of personality disorder for both grandiose and vulnerable vignettes. Discriminant elements of personality impairment included rigid, unrealistically positive self‐view, low empathy and high conflict with others for grandiosity, and incoherent identity, low self‐esteem and hypervigilant, avoidant relations with others for vulnerability. Regarding trait profile, grandiose narcissism was predominately dissocial whereas vulnerable narcissism was primarily associated with negative affectivity and detachment. Qualitative responses highlight distinct clinical themes for each presentation. These findings suggest that clinicians using the ICD‐11 framework are able to identify common core elements of personality dysfunction in grandiose and vulnerable narcissism while also recognizing their distinctive differences.