This narrative review examines the relationship between pathological narcissism and intimacy. Empirical studies provide some evidence supporting intimacy impairment in pathological narcissism, though this conclusion is undercut by the indirectness of the intimacy measures used thus far. In addition, this review focused on putative mechanisms of intimacy impairment based on studies in the following areas: interpersonal functioning (interpersonal patterns, interpersonal regulatory processes, attachment styles, rejection sensitivity, romantic patterns), self-functioning (self-regulatory interpersonal processes, entitlement, perfectionism), and motivational factors. The paper discusses putative mechanisms in light of methodological limitations, including paucity of studies that used observational and performance measures, limitations of reliance on self-report measures of pathological narcissism, a paucity of studies, and indirect measures of intimacy. The review also discusses paradoxical findings and proposes an explanatory hypothesis to account for inconsistencies among different studies. Studies suggest distinct, yet partially overlapping mechanisms associated with intimacy impairment in grandiose versus vulnerable narcissism. Future studies should utilize clinical samples, longitudinal and experimental designs, as well as observation, interview, and experimental measures of intimacy and its mechanisms. More studies are warranted to test conclusions from this review.
Non-suicidal self-injury (NSSI) is a widespread phenomenon in adolescence. Although NSSI is conceptually distinct from suicidal behavior, the two conditions frequently co-occur and may share underlying psychopathological pathways. In particular, borderline personality disorder (BPD) has long been considered a key factor in the emergence and persistence of NSSI. However, recent evidence suggests that other dimensions of personality pathology, together with mood disorders and suicidal ideation, may significantly influence the onset, severity, and course of self-injurious behaviors in adolescence. Clarifying these relationships is crucial for clinical assessment and prevention strategies. We examined 118 adolescents admitted to a pediatric hospital for suicidal ideation or attempts. Standardized interviews (C-SSRS, K-SADS, SCID-II) were administered to assess suicidal ideation, NSSI characteristics, personality pathology, and mood disorders. NSSI was evaluated in terms of presence, duration, frequency, and severity over a 9-month observation window. Correlational, linear, and logistic regression were conducted to examine associations between NSSI outcomes and personality pathology, mood disorders, early life adversity, and suicidal ideation. Borderline personality features emerged as significant predictors of NSSI severity and duration, whereas broader non-borderline personality pathology specifically predicted repetitive high-frequency self-harm patterns. Suicidal ideation was associated with prolonged duration of NSSI but did not independently predict high-frequency self-harm. Mood disorders showed limited independent predictive value. These findings suggests differentiated pathways linking personality pathology and suicidal ideation to distinct clinical dimensions of adolescent NSSI. Integrating the assessment of personality dysfunction with evaluation of suicidal ideation may enhance clinical management and prevention strategies for adolescents at risk.
The Difficulties in Emotion Regulation Scale–Expanded (DERS-X) assesses difficulties in regulating negative and positive emotions. However, cross-cultural evidence for its factor structure and relevance to affective symptoms remains limited. This psychometric validation study translated, adapted, and evaluated the Persian DERS-X in Iranian community and clinical samples. Study 1 included 562 community participants (mean age = 26.72, standard deviation [SD] = 10.09), and Study 2 included 171 clinical participants with diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (mean age = 30.57, SD = 10.60). Analyses examined factor structure, reliability, group comparability, and external associations. We evaluated the added role of positive-emotion difficulties after negative-emotion difficulties were considered, and the added value of the Persian DERS-X beyond related measures. Across both samples, the 11 correlated first-order subscale model showed the best fit and was retained as the preferred structure. Broader composite scores were treated as observed summaries. Internal consistency was adequate to strong, and broader scores showed stronger temporal stability than subscales. Latent factor correlations indicated that DERS-X dimensions were generally distinguishable, although some related subscales overlapped in the clinical sample. Scalar invariance was supported across gender, age, and clinical status. Scores showed expected associations with emotional intelligence, experiential avoidance, and related emotion-regulation measures. Positive-emotion difficulties added information for distress outcomes in the community sample and depressive symptoms in the clinical sample. The scale also added information beyond related measures. Findings extend cross-cultural evidence for DERS-X score interpretations and support the Persian version as an 11-dimensional measure for research and clinically informed assessment of negative- and positive-emotion regulation difficulties.
While psychotherapy is the standard form of treatment for borderline personality disorder (BPD), there are no pharmacological medications approved to treat this condition. Many individuals with BPD also experience depression and suicidal ideation, highlighting the need for effective interventions. One potential treatment option is ketamine, some formulations of which have already been approved for treating treatment-resistant depression and severe suicidal ideation. We conducted a systematic review examining the safety and potential benefits of intravenous and intranasal racemic ketamine in adults formally diagnosed with BPD or with elevated borderline features. The primary outcomes were depression, BPD symptoms, and suicidality, while the secondary outcome was the adverse effects of ketamine treatment. We searched MEDLINE, Embase, and CENTRAL for relevant studies published up to February 2026. Five studies met the inclusion criteria, consisting of two randomized controlled trials (RCTs) and three cohort studies. Four studies evaluated intravenous ketamine, while one evaluated intranasal racemic ketamine. Across four studies, 81 participants identified as having BPD received ketamine; one additional study included 31 ketamine-treated participants with elevated borderline features without a confirmed BPD diagnosis. The studies differed substantially in design, method of BPD ascertainment, ketamine protocol, comparator, and outcome measurement. Across the studies, ketamine appeared to be generally well tolerated over short follow-up in supervised settings, although transient side effects, including dissociation, were reported. Several studies reported reductions in depressive symptoms or suicidal ideation following treatment; however, most were not designed or adequately powered to evaluate efficacy specifically in BPD. Comparative findings were inconsistent and did not establish equivalent treatment response between participants with and without borderline pathology. Evidence regarding improvement in BPD symptoms was sparse. The current evidence is insufficient to determine whether ketamine has a clinically meaningful role in treating depression, BPD symptoms, and suicidality in patients with BPD, but further study appears warranted. The available findings are limited by small samples, heterogeneous populations and treatment protocols, exploratory or retrospective analyses, and short follow-up periods. Ketamine treatment specifically targeting BPD should therefore be considered investigational. Adequately powered, BPD-specific randomized trials with standardized outcomes and longer follow-up are required before conclusions regarding efficacy, safety, or clinical implementation can be made.
Abstract Background Non-suicidal self-injury (NSSI) is a transdiagnostic symptom associated with substantial clinical burden and increased risk of suicidal behavior. Although NSSI occurs across a wide range of psychiatric disorders, research has consistently linked it to maladaptive personality traits. However, most studies have compared individuals with NSSI to healthy controls, limiting our understanding of which personality traits are specifically associated with NSSI. The inclusion of clinical control groups may therefore help clarify which personality traits are associated with NSSI rather than with psychopathology more broadly. This study aimed to investigate whether individuals with psychiatric disorders and active NSSI differ in personality traits, as assessed with the Personality Inventory for DSM-5 (PID-5), compared to those with prior but no active NSSI and those without a history of NSSI. Methods 231 individuals at a psychiatric outpatient unit completed the PID-5 and the Inventory of Statements About Self-injury and were assessed with regards to demographic information, psychiatric illness and previous suicide attempts. Symptom levels of depression and anxiety were measured. Participants were divided into groups of active NSSI (≥ 5 episodes in the past 12 months; n = 123), previous NSSI (≥ 5 episodes, but none in the past 12 months; n = 68) and no previous history of NSSI ( n = 40). Results Participants with active NSSI scored significantly higher in negative affectivity (F(2, 224) = 10.33, p < .001, η p ² = 0.08) and psychoticism (F(2, 224) = 8.91, p < .001, ηp² = 0.07), compared to those with a previous history of NSSI and those with no previous history of NSSI. The analyses were adjusted for age, sex assigned at birth and symptoms of depression and anxiety. Conclusions Active NSSI seems to be associated with increased traits of negative affectivity and psychoticism. This study contributes with new knowledge regarding NSSI and personality traits, which may guide future research on mechanisms, etiology, and treatment approaches. Trial registration The study was registered on Clinical Trials: NCT04905797, registration date April 29, 2021.
