Although the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders (5th ed.; PID-5) was initially designed to assess the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) trait model, a modified scoring algorithm was developed to evaluate the International Statistical Classification of Diseases and Related Health Problems (11th ed.; ICD-11) trait model constructs. This meta-analysis aimed to examine the internal (structural and discriminant types) and external (convergent and criterion types) validity of the PID-5 to measure the ICD-11 trait model constructs (the PID ICD scale). Systematic searches in PubMed, Scopus, PsycNET, and Google Scholar were used to screen all articles published between January 2013 and October 2024. Given the high heterogeneity in the results of the included studies, the random-effects method was used for all pooled estimates. Ten medium to high-quality reports consisting of 12,840 people (2,551 psychiatric patients and 10,289 nonpatients) were entered into the meta-analysis. The pooled estimates supported the five-factor structure with good model fit indices (root-mean-square error of approximation = .06, comparative fit index = .97, Tucker-Lewis index = .93, standardized root-mean-square residual = .02). Alpha coefficients were between .86 and .93 for all factors (Mdn = 0.89) and the factor intercorrelations were between .11 and .49. The expected correlations were found between the factors and symptoms of 10 personality disorders (all between -.07 and .62). The mean scores of all factors were significantly higher in the clinical than nonclinical sample (d between 0.68 and 1.37) and the Area Under the receiver operating characteristic Curve values were significant (all between .65 and .83). We tentatively suggest that the PID ICD may function as an applicable questionnaire with generally acceptable internal and external validity, while noting that the Anankastia scale-particularly the perseveration subfacet-warrants extra caution in interpretation due to its poor convergence with regular ICD scales. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Background: Common and distinct features of personality disorders (PDs) and attention deficit hyperactivity disorder (ADHD) have long been the subject of research. However, most studies relied on categorical rather than dimensional models, which are becoming increasingly integrated into contemporary psychiatric nosology and may offer more nuanced insights. The present study aimed to examine the common structure of dimensional PD, according to the alternative DSM-5 model for PDs (personality functioning and pathological personality traits), and ADHD symptoms. Methods: In a preregistered study, a clinical sample of adults (n = 2,567) completed self-report measures assessing personality functioning, pathological personality traits (negative affectivity, detachment, antagonism, disinhibition, psychoticism, and anankastia), and ADHD symptoms (inattention, hyperactivity/impulsivity, and executive functioning). Structural equation modeling was employed to examine the latent structure and shared variance among these constructs using confirmatory and exploratory factor models, including models with a general factor of personality pathology. Results: ADHD symptoms were strongly correlated with personality functioning and showed moderate-to-strong associations with pathological personality traits, with disinhibition remaining the only trait domain substantially correlated with ADHD symptoms after controlling for a general personality pathology factor. In exploratory models, ADHD symptoms showed two distinct loading patterns among disinhibition facets: one factor was mainly defined by inattention and distractibility, with additional but weaker loadings of hyperactivity/impulsivity, whereas the other reflected executive functioning and irresponsibility. Conclusion: The findings suggest substantial overlap between dimensional PD and ADHD symptoms. In clinical practice, individuals with suspected PD or ADHD may benefit from integrated dimensional assessments of both conditions.

OBJECTIVE:While links between chronic somatic diseases and mental health are well documented, associations with maladaptive personality traits as defined by DSM-5 or ICD-11 have not been systematically examined. This study investigates whether maladaptive traits are associated with common chronic somatic diseases and whether these patterns are highly specific or generalize across traits, reflecting general severity of personality disorder (PD). METHODS:Data from a large, representative German cohort (N = 4737; mean age = 54.13 years; 50.2% female; GESIS Panel, 2017-2019) were analyzed. Associations between maladaptive traits and self-reported physician-diagnosed diseases (e.g., rheumatic spectrum diseases, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular conditions) were assessed using multiple logistic regressions, controlling for sex, age, smoking status, physical activity, alcohol consumption, and body mass index (BMI). RESULTS:General severity of PD showed strongest associations across most investigated conditions (ORs 1.25-1.84). Specific trait-disease links were also observed such as negative affectivity with hypertension (OR = 1.20, 95% CI: 1.09-1.32), and detachment with stroke (OR = 1.84, 95% CI: 1.38-2.44). Further, maladaptive personality traits correlated with higher BMI and adverse health behaviors such as smoking, frequent doctor visits and sick days. CONCLUSIONS:General severity of PD appears to index broad somatic vulnerability or burden, while specific maladaptive personality traits may show condition-specific links. These findings underscore the clinical relevance of integrating psychological assessments into somatic care. Future research should explore underlying biological mechanisms and examine moderators and mediators linking personality dysfunction with somatic disease.

Common factors and facilitative interpersonal skills are central to mental health treatment outcomes, yet existing assessments remain fragmented across constructs, modalities, and rater perspectives. We developed and validated the Cross-Modal Inventory for Common Factors and Facilitative Interpersonal Skills (CMICF), a brief patient-reported measure for psychotherapeutic and psychiatric settings. Data came from two clinical samples receiving mental health treatment (construction: N = 707; validation: N = 1,230; øage = 36.7[18-79], 78.7% female). An initial 101-item pool covering 14 evidence-based relational and interpersonal skill domains was reduced using ant colony optimization and expert-guided scale merging. The final 33-item instrument comprised nine factors: alliance bond capacity, goals/collaboration, congruence, emotional expression, hope/positive expectations, treatment credibility, managing countertransference, rupture-repair responsiveness, and verbal fluency. Confirmatory factor analyses showed excellent model fit in the construction sample (CFI = .974, RMSEA = .036, SRMR = .029) and validation sample (CFI = .959, RMSEA = .045, SRMR = .036). Internal consistency was good to excellent for most subscales (ω = .73–.91), except congruence (ω = .58). Configural, metric, scalar, and strict invariance were supported across treatment settings and personality dysfunction severity. Convergent validity was demonstrated through theoretically consistent associations with established measures of alliance and related relational constructs. Discriminant validity was supported by small negative associations with psychopathology (all |r| < .30). Alliance bond capacity showed partly strong intercorrelations, indicating that specific relational processes may be anchored in the overall therapeutic bond. The CMICF provides a psychometrically robust, cross-modal assessment of relational common factors and facilitative interpersonal skills from the patient perspective in psychotherapy and psychiatric care.

Since the introduction of the dimensional assessment of personality functioning (PF) in DSM-5 and ICD-11, impairments in PF have consistently been related to transdiagnostic risk-factors for mental health. However, ecological momentary assessment (EMA) investigating PF in relation to affect-event dynamics and other psychopathology are scarce. Leveraging EMA data from 16,038 mental health app users, this study examines how baseline impairments in PF, within-person affect-event dynamics, and depression predict longitudinal outcomes in PF impairment and depression severity. We hypothesized a central role of PF in these relationships. Within the first month of usage, on average, 69.3 (range 31-142) mood assessments and 63.3 (range 25 - 133) event assessments were available per user. Dynamic structural equation models (DSEM) showed that baseline depression was associated with weakened or even negative concurrent and cross-lagged links between mood and positive events, including lower inertia and reduced likelihood of positive events. In contrast, baseline PF impairment was associated with persistence, emotional impact and volatility of interpersonal conflict events as well as with greater mood instability. Over a one-year follow-up (N = 1,464; M = 1,236 assessments per user), DSEM identified different patterns: Future PF impairment and depression were both predicted by less concurrent mood-positive event associations, less positive event volatility, and baseline average mood/events. Among affect-event dynamics, cross-lagged effects of interpersonal conflicts on mood explained the highest unique variance of future PF impairment (ΔR2 5.9%). Notably, baseline PF exhibited the strongest overall predictive utility (ΔR2 = 19.5%), followed by baseline depression symptoms (ΔR2 = 11.9%) with PF showing higher variance explanation in future depression severity than vice versa. Results offer specific targets for interventions: assessment of PF could help to inform decisions regarding duration, goals, and intervention strategies beyond the treatment of personality disorders. We contextualize the results within the limitations of the study, notably the use of a single method.

Since the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and the 11th revision of the International Classification of Diseases introduced dimensional assessment of personality functioning (PF), PF impairments have been linked to transdiagnostic mental-health risk factors. Using ecological momentary assessment data from 16,038 mental health app users, we tested whether baseline PF impairment, affect-event dynamics, and depression predict future PF impairment and depression severity, hypothesizing a central role of PF. In the first month, users completed 69.3 mood (range 31-142) and 63.3 event assessments (25-133) on average. Dynamic structural equation models linked baseline depression to lower concurrent and cross-lagged mood-positive event links, lower inertia, and reduced likelihood of positive events. In contrast, baseline PF impairment related to persistence, emotional impact, and volatility of interpersonal conflict and greater mood instability. Over 1-year follow-up (N = 1,464, M = 1,236 assessments per user), future PF impairment and depression were predicted by weaker concurrent mood-positive event links, lower volatility of positive events, and baseline average mood/events. Among affect-event dynamics, cross-lagged effects of interpersonal conflicts on mood explained the highest unique variance in future PF impairment (ΔR2 = 5.9%). Baseline PF showed the strongest overall predictive utility (ΔR2 = 19.5%), followed by baseline depression (ΔR2 = 11.9%); PF explained more variance in future depression than vice versa. PF assessment may inform duration, goals, and strategies of treatments beyond those focused on personality disorders. Results are interpreted considering limitations, particularly the single-method design. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

BACKGROUND:Epistemic trust describes the capacity to appropriately identify others as reliable and relevant sources of information, an ability closely linked to attachment and social learning. Epistemic disruption can manifest as heightened suspicion (mistrust) or excessive reliance (credulity) vis-à-vis others, affecting mentalizing abilities and increasing vulnerability to psychopathology and maladaptive traits. These interdependent and multidirectional dynamics are pivotal to therapeutic learning, and thus to therapeutic change. OBJECTIVE:This study examined associations between epistemic trust and disruption, markers of psychopathology, therapeutic relationship quality and treatment-seeking behaviour. METHOD:A naturalistic sample of 912 participants, recruited via a mental health app, completed the Epistemic Trust, Mistrust and Credulity Questionnaire, along with self-reports capturing internalising symptoms, personality functioning, maladaptive traits and the perceived therapeutic relationship within the previous 6 months. Treatment-seeking behaviour and the number of sessions utilized in the past year were further explored-both in psychotherapeutic and psychiatric contexts. FINDINGS:Epistemic mistrust and credulity showed consistent relationships with markers of psychopathology. Higher epistemic (mis)trust correlated with more positive (negative) ratings of various aspects of the therapeutic relationship, including genuineness, realism, expectations, congruence and responsivity-over the past 6 months. Epistemic trust positively predicted the amount of psychotherapy sessions, while epistemic mistrust negatively predicted treatment-seeking, both controlled for personality dysfunction. Epistemic credulity predicted mental health app use-all assessed retrospectively (past year). CONCLUSION:The results encourage further in-depth exploration of trust-related aspects of the therapeutic alliance and investigation of mechanisms of change in therapeutic processes that may facilitate the transition from mistrust and credulity to trust. CLINICAL IMPLICATIONS:Even though the magnitude and direction of effects remain to be clarified, patients with epistemic mistrust may enter a self-reinforcing cycle of reduced openness and ineffective mentalizing, potentially impacting therapeutic effectiveness. Interventions targeting epistemic disruption and impaired personality functioning seem to be crucial for improving therapeutic outcomes, including psychopharmacological treatment effectiveness.

Personality disorders (PDs) are commonly associated with impairments in social cognition, particularly facial emotion recognition. However, evidence also suggests deficits in more basic cognitive functions, including lower-order face processing (e.g., detection of non-emotional facial features) and indicators of general intelligence (e.g., crystallized intelligence). We examined associations of facial emotion recognition, lower-order face processing, and crystallized intelligence with personality pathology, considering both categorical and dimensional PD models and distinguishing general personality pathology (personality functioning) from specific personality pathology (pathological personality traits and specific PDs). We further tested whether associations between personality functioning and facial emotion recognition were accounted for by lower-order face processing or crystallized intelligence. In a clinical sample (n = 219), cognitive abilities were assessed using performance-based measures, and personality pathology was assessed using interviews and self-reports. Structural equation modeling, including correlated factor and bifactor-(S-1) models, was applied to separate general from specific personality pathology variance. General personality pathology showed strong negative associations with facial emotion recognition and small-to-moderate negative associations with lower-order face processing and crystallized intelligence. Associations with specific personality pathology were substantially attenuated when controlling for general personality pathology. The link between personality functioning and facial emotion recognition was only minimally accounted for by lower-order face processing or crystallized intelligence. These findings indicate that cognitive deficits in PD primarily reflect severity rather than disorder-specific variance, while also pointing to partially independent cognitive domains linked to general personality dysfunction. Our study suggests that dimensional models provide a more nuanced framework for understanding cognitive impairment in personality pathology.

This study evaluated the latent structure and conceptual validity of the Research Domain Criteria (RDoC), General Health, and Clinical/Psychosocial clusters of the German Center for Mental Health (DZPG) Minimum Data Set (MDS). It aimed to determine whether these clusters represent interpretable constructs and demonstrate cross-group comparability across clinical and non-clinical populations, providing a data-driven basis for item selection within a Delphi consensus process. Two subsamples were analyzed: a representative sample (N = 2,287) and a clinic-recruited sample (N = 322) from six DZPG sites. Multi-group confirmatory factor analyses tested the latent structure and assessed configural, metric, and scalar measurement invariance between non-clinical vs. clinical/help-seeking groups. All three MDS clusters demonstrated excellent baseline model fit (RDoC: CFI = .990, RMSEA = .037; General Health: CFI = .993, RMSEA = .037; Clinical/Psychosocial factors: CFI = .992, RMSEA = .026). Analyses confirmed configural and scalar invariance across all clusters but indicated non-invariance at the metric level for the General Health cluster. The results provide initial evidence for the structural validity and cross-group comparability of the RDoC and Clinical/Psychosocial clusters, while indicating limitations regarding metric non-invariance within the General Health cluster. They informed a Delphi consensus process and support the MDS as a scalable framework for diverse populations, particularly relevant for the DZPG’s effort to harmonize mental health data across institutions and contexts.

: Dimensional assessment of personality functioning (PF) plays a pivotal role in modern conceptualizations of psychopathology and is recognized as a central criterion for personality disorders in DSM-5 and ICD-11. This paper provides an overview of the conceptual and theoretical foundations of PF, including its link to early relational experiences and personality dynamics. Emerging evidence suggests PF as a promising framework in debates around a general factor of psychopathology, offering consistency and clarity in understanding transdiagnostic severity as well as specific clinical phenotypes. Clinically, PF serves as a flexible and evidence-based framework for tailoring interventions to individual needs, transcending theoretical orientations and intervention methods. Open questions remain, for example, regarding the interaction of PF with personality traits, relational patterns, and treatment processes. Zusammenfassung: Die dimensionale Diagnostik von Pers & ouml;nlichkeitsfunktion (PF) spielt eine zentrale Rolle in modernen Konzepten der Psychopathologie und wird als zentrales Kriterium f & uuml;r Pers & ouml;nlichkeitsst & ouml;rungen in DSM-5 und ICD-11 anerkannt. Dieser Artikel bietet einen & Uuml;berblick & uuml;ber die konzeptionellen und theoretischen Grundlagen von PF, einschlie ss lich ihres Zusammenhangs mit fr & uuml;hen Beziehungserfahrungen und Pers & ouml;nlichkeitsdynamik. Studienergebnisse deuten darauf hin, dass PF ein vielversprechender Rahmen f & uuml;r Diskussionen um einen allgemeinen Faktor der Psychopathologie ist, und bietet Konsistenz und Klarheit beim transdiagnostisches Verst & auml;ndnis von Schweregradabsch & auml;tzungen sowie spezifischen klinischen Ph & auml;notypen. Klinisch kann PF & uuml;ber unterschiedliche theoretische Orientierungen und Interventionsmethoden hinweg als flexibler und evidenzbasierter Rahmen f & uuml;r die Anpassung von Interventionen an individuelle Bed & uuml;rfnisse verwendet werden. Offene Fragen bestehen unter anderem hinsichtlich der Interaktion von PF mit Pers & ouml;nlichkeitsmerkmalen, Beziehungsmustern und Behandlungsprozessen.

OBJECTIVE:To investigate (a) the prevalence of industry sponsorship (InS), researchers' financial conflicts of interest (RFCOI) and researcher allegiance (RA) in clinical trials of internet-based interventions (IBI) for depression and (b) their possible relation with treatment effects. METHOD:We conducted a systematic review and meta-analysis of 94 comparisons of therapist-guided or self-guided IBI with a passive control group. RESULTS:InS was present in 13 (38.24%) out of 34 comparisons of commercial IBI; RFCOI was present in 29 (30.85%), RA in 75 (79.79%) out of all 94 comparisons. In primary meta-regressions, presence of InS and RFCOI was significantly associated with larger treatment effects, while presence of RA was not. Overall, sensitivity analyses showed consistent results, but suggested differential results for trials of therapist-guided and self-guided IBI: While InS and RFCOI showed larger effects in trials of self-guided IBI, no effect was found for trials of therapist-guided IBI. CONCLUSION:InS, RFCOI, and RA are prevalent and should receive more attention in IBI research. The role of RA on outcome warrants further investigation because this meta-analysis did not include comparative trials. Small effect sizes in trials without InS or RFCOI suggest that current meta-analytic efficacy estimates of self-guided IBI for depression are overestimated.

Both Kernberg's model of personality organization and the alternative model for personality disorders (AMPD) in the Diagnostic and Statistical Manual of Mental Disorders-5th edition provide a multidimensional framework for assessing personality pathology, while having a dual focus on general and specific personality pathology. The present study was the first to investigate the empirical convergence between measures of personality organization and the AMPD (personality functioning and pathological personality traits), considering general and specific personality pathology. A mixed clinical sample completed self-reports for personality organization, personality functioning and pathological personality traits, as well as an interview for personality organization. Two bifactor models with three specific exploratory factors were estimated, comprising a self-report model based on domain scores using exploratory factor analysis (n = 336) and a multi-method model predominantly based on subdomain scores applying exploratory structural equation modelling (n = 277). Both bifactor models yielded strong general factors with high loadings of the personality organization domains identity and primitive defences, as well as the personality functioning domains. The specific factors suggest convergence between other-directed aggression (personality organization), restricted moral functioning (personality organization) and antagonism (pathological personality traits), between diminished reality testing (personality organization) and psychoticism (pathological personality traits) and between maladaptive object relations (personality organization), impaired interpersonal functioning (personality functioning) and detachment (pathological personality traits). It can be concluded that measures of personality organization and the AMPD strongly converge regarding both general and specific personality pathology. Kernberg's model of personality organization may serve as a valuable complement to the AMPD, guiding forthcoming research and the clinical assessment of personality pathology.

Introduction Mental disorders are among the leading causes of the global burden of disease and are often associated with severe functional impairment and high societal costs. Psychotherapeutic, psychopharmacological and internet-based mental health interventions have proven to be helpful, but challenges remain, including only moderate response rates, high relapse rates and barriers to accessing mental healthcare. Much of the existing evidence stems from studies conducted in controlled, often standardised settings that only partially reflect real-world conditions, contributing to a ‘scientist-practitioner gap’. Moreover, the mechanisms of change, such as the interaction between treatment intensity, common factors (eg, the therapeutic relationship) and specific intervention techniques, have not been sufficiently investigated. In particular, the relationship of changes in personality functioning (PF) with mental and physical health has not yet been extensively researched.Methods and analysis The PSYMPACT (Psychological Impact Factors of Mental Health Treatments) study will use a longitudinal study design with a naturalistic sample (N ≈ 3000) to examine changes in psychopathology, PF and allostatic load in psychotherapeutic, psychopharmacological and internet-based treatments. The aim is to identify factors contributing to improvements and deteriorations in mental and physical health across different settings, including common and specific factors. Additionally, to provide patient perspectives, qualitative interviews will be conducted with individuals with varying levels of severity of mental health problems. Allostatic load will be assessed using repeated hair cortisol measurements. Furthermore, ecological momentary assessment will be used to examine the diurnal variability of PF as well as its more momentary correlates and longer-term outcomes. The central research questions and aims include (1) the assessment of common factors across different treatment settings, (2) associations of specific and common factors with improvements in mental health, including PF, (3 and 4) the importance of treatment intensity and interaction effects with common and specific factors, (5) the association of changes in psychopathology with changes in allostatic load, (6) the trait and state variability of PF, (7) the identification of patients who deteriorate under specific treatments and (8) patients’ perspectives on the effectiveness of different treatment modalities.Ethics and dissemination Approval was obtained from the Ethics Committee of the Department of Education and Psychology at the Freie Universität Berlin, Germany. Results will be submitted to peer-reviewed specialised journals and presented at national and international conferences.Registration details Before data collection started in November 2024, the study was registered in the German Clinical Trials Register (https://www.drks.de/search/de/trial/DRKS00035560).

Background: Decades of research on the dimensional nature of personality disorder (PD) have led to the replacement of categorical PD diagnoses by a dimensional assessment of PD severity (PDS) in ICD-11, which essentially corresponds to personality functioning in the alternative DSM-5 model for PDs. Besides advancing the focus in the diagnosis of PD on impairments in self and interpersonal functioning, this shift also urges clinicians and researchers worldwide to get familiar with new diagnostic approaches. Aims: This study investigated which PDS dimensions among different assessment methods and conceptualizations have the most predictive value for overall PDS. Methods: Using semi-structured interviews and self-reports of personality functioning, personality organization, and personality structure in clinical samples of different settings in Switzerland and Germany (n = 534), we calculated a latent general factor for PDS (g-PDS) by applying a correlated trait correlated method – 1 model. Results: Our results showed that four interview-assessed PDS dimensions - defense mechanisms, desire and capacity for closeness, sense of self, and comprehension and appreciation of others’ experiences and motivations account for 91.1% of variance of g-PDS, with a combination of either two of these four dimensions already explaining between 81.7% and 88.9%. Regarding self-reports, the dimensions depth and duration of connections, self-perception, object perception, and attachment capacity to internal objects predicted 61.3% of the variance of a latent interview-based score, with all investigated self-reported dimensions together adding up to 65.2% variance explanation. Conclusions: Taken together, our data suggest that focusing on specific dimensions, such as intimacy and identity, in time-limited settings might be viable in determining PDS efficiently.

Objective: The Personality Inventory for DSM-5 (PID-5) is a widely used scale to evaluate the dimensional constructs of two trait models proposed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11). The present meta-analysis first aimed to examine the factor structure, reliability, and congruence coefficients of the Persian version of the PID-5 to assess both trait models. The second aim was to evaluate the factor structure and reliability of the Persian version of the Personality Inventory for DSM-5-Brief Form (PID-5-BF). Method: A systematic search was conducted in PubMed, Magiran, and SID to find records in English and Farsi from January 2013 to December 2023. According to the PRISMA, data from nine medium- to high-quality reports including 7,608 participants were analyzed using the random-effects method. Quality of studies, heterogeneity, and publication bias were reported. Results: The five-factor structure of the PID-5 to measure both trait models was supported by the pooled estimates of factor loadings. The alpha coefficient median for the DSM-5 model was 0.83 (range: 0.82-0.90), and the congruence coefficient median was .91 (range: 0.80-0.97). The ICD-11 alpha median was .78 (range: 0.68-0.91), and congruency median was 0.90 (range: 0.71-0.96). The factor loadings for negative affectivity, detachment, antagonism, disinhibition, and psychoticism on the PID-5-BF were 0.44-0.69, 0.38-0.67, 0.46-0.72, 0.42-0.70, and 0.44-0.76, respectively, and the alpha median was 0.73 (range: 0.65-0.76). Conclusion: Since both the original and brief versions of the PID-5 are valid and strongly similar to international structures, the clinical and research applications of these questionnaires are recommended to mental health professionals in Iran.

Background: Recent clinical trials suggest promising antidepressant effects of psilocybin, despite methodological challenges. While various studies have investigated distinct mechanisms and proposed theoretical opinions, a comprehensive understanding of psilocybin’s neurobiological and psychological antidepressant mechanisms is lacking. Aims: Systematically review potential antidepressant neurobiological and psychological mechanisms of psilocybin. Methods: Search terms were generated based on existing evidence of psilocybin’s effects related to antidepressant mechanisms. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, 15 studies were systematically reviewed, exploring various therapeutic change principles such as brain dynamics, emotion regulation, cognition, self-referential processing, connectedness, and interpersonal functioning. Results: Within a supportive setting, psilocybin promoted openness, cognitive and neural flexibility, and greater ability and acceptance of emotional experiences. A renewed sense of connectedness to the self, others, and the world emerged as a key experience. Imaging studies consistently found altered brain dynamics, characterized by reduced global and within default mode network connectivity, alongside increased between-network connectivity. Conclusions: Together, these changes may create a fertile yet vulnerable window for change, emphasizing the importance of a supportive set, setting, and therapeutic guidance. The results suggest that psilocybin, within a supportive context, may induce antidepressant effects by leveraging the interplay between neurobiological mechanisms and common psychotherapeutic factors. This complements the view of purely pharmacological effects, supporting a multileveled approach that reflects various relevant dimensions of therapeutic change, including neurobiological, psychological, and environmental factors.

Psychiatric diagnostics struggle to capture the complexity of mental disorders, thereby hampering individualized treatment and personalized psychiatry. Conventional classification systems like DSM-5 and ICD-11 impose rigid categories that inadequately reflect multifactorial, dynamic, and comorbid conditions. To address this limitation, alternative frameworks such as dimensional models and domain ontologies for structured knowledge representation have emerged, yet they often remain isolated and non-interoperable. We present the Meta Mesh Ontology (MMO) as an integrative framework unifying heterogeneous psychiatric knowledge bases through a modular, BFO-compliant structure. The MMO ensures semantic and structural consistency across biological, psychological, and social domains, enabling harmonized data representation and cross-domain reasoning. Its interoperability with established ontologies and informatics standards facilitates integration of multimodal data from clinical, environmental, and sensor sources. By bridging diverse taxonomies such as HiTOP and RDoC, the MMO establishes a scalable foundation for data harmonization and personalized, multidimensional diagnostics in mental health research and practice. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research was funded by internal institutional resources of the University Hospital Jena. No external grant funding was received for this study. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data necessary to interpret, replicate, and build upon the findings of this study are available. The authoritative ontology artifacts (RDF/XML/OWL) for the Meta Mesh Ontology (MMO) and its Core Domain Framework (CDF) are publicly available in the GitHub repositories. The Supplementary Information provides the complete human-readable definitions of all MMO and CDF classes referenced in the manuscript. Beyond the ontology artifacts, no additional datasets were generated or analyzed for this study.