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Shame may be a transdiagnostic marker of psychopathology and might potentially have a negative impact on treatment outcome. This scoping review maps the empirical literature on shame and psychotherapy, with a focus on individual therapy. Searching the terms shame and psychotherapy in PubMed and PsycInfo, we identified 2,520 unique records. After screening and selection, 46 empirical studies were included in the review and three themes were extracted from them: the impact of psychotherapy on shame, the impact of shame on psychotherapy, and additional shame-related themes. Narrative synthesis suggested that shame decreases after psychotherapy. In a subset of quantitative treatment evaluation studies, a preliminary meta-analysis indicated a medium size decrease in shame. The impact of shame on individual psychotherapy was more nuanced. Additional themes included but were not limited to shame-appropriate versus nonappropriate therapeutic interventions or investigations of therapists’ reactions to patients’ shame. Research gaps and recommendations for future investigations are outlined.

Recent empirical literature has suggested that pathological narcissism is related to paranoid presentations. However, the existing studies have focused only on cross-sectional methodology without investigating how paranoid tendencies may present in narcissists' daily lives. On the other hand, the network approach has recently emerged in psychopathology, proposing that psychopathology may be conceptualized as complex and dynamic network systems where symptoms are mutually interacting components over time. Building on these premises, the current study aimed to explore the dynamic associations between narcissistic states, paranoid states, and perception of the other using an Ecological Momentary Assessment methodology (EMA). A sample of 109 participants (females: N = 90; 82.6%) with a mean age of 23.9 years old (age range = 18 – 35, SD = ± 3.24) responded to smartphone prompts 4 times a day for 7 days. Participants were required to identify the most significant distressing interpersonal interaction and then assess their current paranoid states, narcissistic grandiose and vulnerable states, and momentary agentic/communal perceptions of the other person. Using multilevel vector autoregressive modeling (mlVAR), we examined different time-frame complementary network models (i.e., contemporaneous, cross-lagged, and between-subject models). The contemporaneous model indicated that state vulnerability and grandiosity were related to higher paranoid states simultaneously. Moreover, state vulnerability was related to a perception of the other as colder and more submissive, which, in turn, was positively related to paranoid states. According to the cross-lagged model, state vulnerability predicted higher state paranoia toward the other at the next prompt, whereas state paranoia predicted subsequently grandiose states. Surprisingly, the between-subject model showed that individuals experiencing higher grandiose and vulnerable states experienced, on average, more paranoia during t

The concept of personality organization, proposed by Kernberg and colleagues, has extensively contributed to the understanding and treatment of personality disorders, facilitating a paradigm shift in clinical practice. The Structured Interview for Personality Organization (STIPO-R) is a semi-structured interview designed for the dimensional assessment of personality organization as elaborated by Kernberg. In the present contribution, we tested the applicability and psychometric properties of the revised version of the Structured Interview for Personality Organization (STIPO-R) in the Italian population. In the first study, the STIPO-R was administered to 350 Italian participants, divided into 170 nonclinical participants and 180 clinical individuals. The theoretical dimensionality of the STIPO-R and the internal consistency of each scale were tested through Confirmatory Factor Analysis. Convergent validity was established using both criterion measures of maladaptive personality (Inventory of Personality Organization, IPO; Personality Inventory for DSM-5, PID-5) and general psychopathology (Symptom Checklist 90-R, SCL-90-R; Pathological Narcissism Inventory, PNI). Subsequently, a network analysis was conducted on the STIPO-R domains and subdomains to elucidate the interrelationships among personality organization components and investigate differences in their underlying structure in the community versus clinical sample. In a second study, we tested how STIPO-R performed in evaluating the personality structure in three different samples: 60 participants from the community, 45 outpatients with SUDs, and 42 inpatients with DD of SUDs and co-occurring PD. Analysis of variance (ANOVA) revealed that SUD and DD patients shared poorly integrated identity and object relations, rigid and primitive defenses, poorly integrated moral values, and higher self-directed aggression levels compared to individuals from the community sample. Moreover, DD patients were characterized by a

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.

Clinical observations and empirical findings indicate that individuals high in pathological vulnerable narcissism tend to be highly affected by negative interpersonal events, experiencing greater negative emotions, whereas grandiose individuals would tend to experience greater distress in performance-related situations. On the other hand, individuals with borderline personality are also particularly sensitive to interpersonal rejection. Ghosting is a novel interpersonal rejection phenomenon, consisting of a unilateral digital dissolution strategy where an abrupt communication interruption is perpetrated using technological channels to disengage from a relationship. However, no studies investigated how narcissistic and borderline traits may shape individuals’ reactions to ghosting. Methods In a randomized two-wave experimental study, we tested psychological reactions to ghosting in a sample of 604 young adults (mean age = 22.35 ± 2.75). Participants completed measures of borderline and vulnerable and grandiose narcissistic traits at the baseline. In the experimental session, participants were asked to identify with a scenario describing an experience of direct break-up or ghosting. Participants were randomly assigned to one of the two conditions. Following the experimental manipulation, measures of negative emotional states and state paranoia were administered. Results Findings show that participants anticipated greater negative emotions and state paranoia in the ghosting condition compared to the direct break-up condition. Moreover, pathological personality traits significantly moderated the effect of condition on shame: the differences in shame between direct break-up and ghosting were stronger in participants scoring higher in borderline and vulnerable traits, as well as grandiose traits. Moreover, ghosting predicted higher levels of sadness only in individuals with more pronounced grandiose narcissistic traits.

Ghosting is a type of interpersonal rejection involving a unilateral communication interruption without explanation, using technological channels. Vulnerable narcissism and borderline traits can increase sensitivity to interpersonal rejection and reduce tolerance to ambiguity, whereas grandiose narcissism is related to low rejection sensitivity. Yet, the influence of narcissism and borderline on responses to ghosting is unexplored. We examined the influence of pathological personality traits on psychological reactions to direct breakup and ghosting (i.e., ambiguous breakup) in a sample of 604 young adults (mean age = 22.4 ± 2.74). After measuring borderline and narcissistic traits (grandiose and vulnerable), participants were randomly assigned to one of two scenario-based conditions: direct breakup or ghosting events. Negative emotions and state paranoia were assessed after the experimental manipulation. Participants experienced greater negative emotions and state paranoia in the ghosting condition compared to direct breakup. Individuals high in vulnerable narcissism and borderline traits anticipated higher negative emotions and state paranoia. Grandiose narcissism was unrelated to such reactions. Unexpectedly, pathological personality traits did not moderate the effect of breakup ambiguity on individuals' psychological reactions. Findings suggest that the impact of pathological personality traits is reduced in front of such a socially painful stimulus as an ambiguous rejection.

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.

Introduction. Adolescence is a sensitive period for developing internalizing and externalizing problems, and extensive research has shown that borderline personality traits may significantly impact both. Conversely, the relationship between narcissistic personality traits and internalizing and externalizing problems in adolescence has been understudied. The present study examines the current contribution of borderline and narcissistic personality traits to the presence and maintenance of internalizing and externalizing problems in adolescence. Methods. We conducted a two-wave study on a sample of adolescents (N baseline = 705; 65% F; Mage = 15.84, SD = 1.31; N follow-up = 186). They were asked to complete self-reported measures of borderline and narcissistic traits at the baseline and internalizing and externalizing problems at the baseline and the follow-up. Regression analyses were performed to examine the associations of borderline and narcissistic personality traits with the presence and maintenance of internalizing and externalizing problems. To account for gender-related patterns of associations and predictions, regression models were conducted separately on males and females. Results. Borderline personality traits were significantly related to both the presence and maintenance of internalizing and externalizing problems in both males and females. Moreover, grandiose narcissistic traits showed to be predictive of externalizing problems after 12 months in males only. Discussion. The study provides evidence of a significant but differential contribution of borderline and narcissistic personality traits to the presence of co-occurring internalizing and externalizing problems in adolescents and their maintenance over time.

ntroduction: According to recent theories, personality pathology is mainly mirrored by persistent distortion and dysregulation in interpersonal processes. Consistently, paranoia is a crucial transdiagnostic feature of several Personality Disorders (PDs), to the point that recent diagnostic developments have questioned its discriminant validity. However, there is a paucity of studies investigating paranoid presentations in personality pathology, with inconsistent findings. Methods: The present study involved a nonclinical sample of 270 individuals with a mean age of 36.1 years (SD = 14.5, range = 18 – 65). Participants completed measures of pathological personality traits, paranoid dimensions, and impairment in the Self- and Interpersonal functioning. Results: Findings showed that Paranoid and Schizotypal PD traits uniquely contributed to a wide range of paranoid presentations. Conversely, other PD traits showed little evidence of significant association with paranoid presentations. Furthermore, ideas of reference partially explained the relationship between Paranoid PD traits and Self-impairment. Similarly, paranoia's cognitive component partially explained the association between Paranoid PD traits and Interpersonal impairment and the link between Schizotypal PD traits and Interpersonal impairment. Discussion: The present contribution provides evidence that individuals high in Paranoid and Schizotypal PD traits manifest a broad range of paranoid presentations, and that ideas of reference and paranoia's cognitive component play a relevant role in the impairment of their Self- and Interpersonal functioning.

Pathological narcissism implies a fragile self-view. The psychological effects of ego-relevant events in people high in pathological narcissism, however, are still uncertain. The study examined the effects of pathological narcissism on psychological reactions to ego-relevant events occurring in private or public settings. Participants (N = 410) completed measures of pathological narcissistic traits, and then they took part in a scenario-based experimental session. They were randomly assigned to four conditions: ego-threatening vs. ego-fostering events in public vs. private settings. Self-esteem and affective states before and after the experimental manipulation were measured. Results showed that vulnerable and grandiose manifestations of pathological narcissism affect differently psychological reactions to ego-relevant events. Vulnerable narcissism made people particularly sensitive to ego-threatening and ego-fostering events, especially when occurring in public settings. Grandiose narcissism was linked to a reduction in emotional responses to ego-relevant events. Findings suggest that self- and affective reactions to ego-relevant events depend on narcissistic prevailing manifestations, and that public exposure has a key role in vulnerable narcissism.

Objective: Clinical theories suggest that narcissists have a compromised self-concept. However, empirical investigation on attributes of the self that would be impaired in pathological narcissism is limited and inconsistent. The present study aims at detecting distinctive profiles of narcissistic manifestations on facets of the self that have been indicated as relevant in clinical and empirical literature on narcissism. Method: We measured adaptive and pathological narcissistic traits in a community sample of adults (N = 539). Participants also completed measures of self-uniqueness, self-authenticity, self-consistency, and self-other comparisons on agentic and communal domains. Results: Results indicate distinctive profiles of adaptive and pathological narcissistic manifestations on these facets of the self. Among the set of distinctive facets for each narcissistic manifestation, however, some showed to have a more prominent role. Adaptive and pathological narcissism were captured mostly by a greater sense and need for uniqueness that was primarily expressed by public exposure. Sense of superiority over others in the agentic domain, however, showed to have an essential role only in adaptive narcissism. Moreover, self-concept in adaptive grandiose narcissism was qualified by high levels of self-authenticity and a consistent sense of self. Self-concept in vulnerable pathological narcissism revealed greatest impairment, especially in facets of high concern regarding others’ reactions and feeling of a tenuous existence. Conclusions: The study points out that adaptive and pathological manifestations of narcissism can be profiled based on specific facets of self. Theoretical and research implications are discussed.

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. Summary: 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.

Background: the onset of the COVID-19 pandemic brought disruptive changes in everyone's everyday life, among which pervasive anxiety about the risk of infection, the fear of worsening physical symptoms, and the experience of isolation and loneliness due to lockdowns and other strict governments' rules. These kinds of repercussions of pandemic situations impact individuals' psychological wellbeing resulting in heightened perceived stress, anxiety, and depression. "Italia Ti Ascolto" (ITA) has been developed as an internet-based intervention to offer an online solution for psychological support needs. Methods: ITA is an app available on iOS and Android systems. Users complete a baseline assessment on emotion regulation strategies (cognitive reappraisal and expressive suppression), psychological stress, anxiety, depression, and perceived social support. Participants select between several one-hour long clinical groups held by expert psychotherapists. After every session, people are asked to complete a quick users' satisfaction survey. Discussion: Our contribution presents ITA's intervention protocol and discusses preliminary data on psychological variables collected at baseline. Data showed significant associations between emotion regulation strategies and depressive, anxious symptoms, and level of stress. Moreover, the role of perceived psychological support is considered. Future developments and implications for clinical practice and treatment are discussed.

The onset of the coronavirus disease 2019 (COVID-19) pandemic impacted individuals' psychological wellbeing resulting in heightened perceived stress, anxiety, and depression. However, a significant issue in accessing psychological care during a lockdown is the lack of access to in-person interventions. In this regard, research has shown the efficacy and utility of psychological app-based interventions. 'Italia Ti Ascolto' (ITA) has been developed as a population tailored internet-based intervention to offer an online professional solution for psychological support needs. The ITA app is available on iOS and Android systems. Users completed a baseline assessment on emotion regulation strategies (cognitive reappraisal and expressive suppression), psychological stress, anxiety, depression, and perceived social support. Participants could select among several one-hour long clinical groups held by expert psychotherapists. After every session, people were asked to complete a quick users' satisfaction survey. Our contribution presents ITA's intervention protocol and discusses preliminary data on psychological variables collected at baseline. Data showed significant associations between emotion regulation strategies, symptoms of depression and anxiety, and level of stress. Moreover, the role of perceived social support is considered. Future developments and implications for clinical practice and treatment are discussed.

In this contribution, we will present some findings from the “Emotional Thermometer [Termometro Emotivo]” project. The project aims at investigating the impact of COVID-19 pandemic outbreak on mental health in Italian adults. In this contribution, we present findings on short-term psychological consequences of the COVID-19 pandemic outbreak (Study 1) and real-time emotional and psychological responses (Study 2) to this exceptional situation. The first study includes a large sample of participants taken from the general population (N = 1548), who completed measures of psychological distress, emotion regulation strategies, perceived social support, and subjective perceptions of the situation. The second study includes a subsample of 823 participants who completed daily measures of emotional and psychological states for 21 days. Results from Study 1 suggest increased levels of psychological distress and post-traumatic responses to COVID-19 pandemic outbreak in participants. They also demonstrate the protective role of social support and coping strategies on individuals’ mental health. Furthermore, results from Study 2 show that participants experienced higher levels of daily negative psychological states during the COVID-19 pandemic outbreak, and inflexibility of negative emotional states. Overall, our findings stress the psychological cost of the COVID-19 pandemic outbreak in community people. As a consequence, our contribution aims at suggesting the need of paying clinical attention to potential pathological or maladaptive conditions related to the COVID-19 pandemic in community people.