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Open research questions in Personality Disorders and Psychopathology

255 unresolved questions extracted from the limitations and future-work sections of 4,078 Personality Disorders and Psychopathology papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Targeting interoceptive processes may represent a promising therapeutic approach to improve emotion regulation and clinical outcomes, particularly in patients with co-occurring BPD, and warrants further investigation in this clinical population.

    Interoception and borderline personality disorder in female adolescents with restrictive eating disorders · 2026 · DOI

  • Lastly, the measure- ment of EF was limited to a single sustained attention task (Leiter-R), which does not capture the full breadth of the multidimensional construct.

    Testing the Dimensional Model of Adversity and Psychopathology: the Mediating Roles of Executive Functioning and Emotion Regulation · 2026 · DOI

  • Future research is needed to establish clinical cut-offs normed across countries and to investigate different factors that impact assessment, presentation, or interventions for CD and CU traits (Perlstein et al.

    Applying a Network Approach To Characterize Gender Differences in Conduct Problems and Callous-Unemotional Traits among Children from Two Countries · 2026 · DOI

  • Furthermore, future studies should examine additional variables—such as psychological flexibility, ruminative thinking patterns, and other relevant personality to cognitive traits—that may contribute traits–difficulties formulations within level symptom in emotion framework using alternative or extended model structures. While using the total score is a psychometrically valid approach for assessing overall distress, it is a limitation of the current study, as it does not allow for a more nuanced analysis of depression, anxiety, and stress as independent constructs. Therefore, the proposed model should be replicated in more diverse and demographically balanced samples to enhance external validity.

    The Mediating Role of Difficulties in Emotion Regulation in the Relationship Between Sociotropy, Autonomy, and Psychological Symptoms · 2026 · DOI

  • This complex of symptoms is not limited to affecting the person’s psychological state, but also significantly complicates their so- cial and professional adaptation. Pharmacologi- cal treatment of BPD has shown mixed results, emphasizing the need for an individualized ap- proach to pharmacotherapy with careful weigh- ing of potential risks and benefits for each pa- tient.

    Clinical features, diagnosis, and approaches to the treatment of borderline personality disorder · 2026 · DOI

  • Both studies used a cross-sectional design. Although mediation analyses are presented, temporal ordering cannot be established, limiting the ability to draw causal conclusions. Any interpretation suggesting mechanisms or directional effects should therefore be made with caution. As suggested by Barthelmäs et al. (2024), future studies examining emotional crying might employ daily diary approaches that are less susceptible to recall bias. However, the present design also has advantages that experimental studies do not offer. Affect improvement in laboratory settings is typically tied to a specific scenario (e.g., Gračanin et al., 2015), whereas we were able to examine affect improvement at a more general level. Additionally, we examined a selective sample limited to individuals from the United States with selfreported mental health status. Consequently, further research is needed to determine the extent to which the findings can be generalized to other regions and populations.

    On the Relation Between Maladaptive Personality Traits and Emotional Crying · 2026 · DOI

  • The notion of the psychopathic personality has been around for centuries (Hervé, 2017). Indeed, biblical, classical, and medieval texts describe individuals of societal consequence due to their poor behavioral control, stimulation-seeking, egotism, callousness, and predilection for rule violation that appears relatively refractory to punishment (e.g., Cleckley, 1941; McCord & McCord, 1964). While psychopathy itself has been established as a clinical disorder since the early 1900s, there have been debates and inconsistencies in its operationalization since that time (see Hare & Neumann, 2010). Indeed, in 1937 Braude claimed that “there is scarcely a theme in psychiatry more controversial and more in need of terra firma” (p. 238), noting the myriad of terms used to designate the classification of ‘psychopath’ (“moral insanity, constitutional immorality, constitutional psychopathic inferiority, constitutional psychopathy, sociopath, and psychosatipath;” p. 238). Similarly, Wilson and Persor (1939) noted that “the term psychopathic personality is applied to the members of an extremely heterogeneous group of ‘halfcrazy’ individuals…Borderline psychotics, sexual perverts, hoboes, habitual drunkards, drug addicts, cranks, malingerers, criminals, misanthropes, and a host of other misfits… find themselves labeled constitutional psychopathic inferiors, or, less formidably, psychopathic personalities” (p. 122). Associated issues involving heterogeneity of the syndrome are also well-established. For example, Henderson (1947) argued for at least three psychopathy subtypes (i.e., “the aggressive”, “the inadequate”, and “the creative”), all of which were characterized by impulsive behavior, “primitive reactions” to social frustrations, and “deep feelings of impotence” in social situations. Alternatively, Karpman (1941) proposed that there were two types of psychopathy: symptomatic/secondary psychopathy, which he posited developed in response to environmental factors and psychological trauma and was characterized by emotional disturbance and neurotic conflicts, and idiopathic/primary psychopathy, which he felt was constitutional in nature and was characterized by a fundamental absence of emotional responses. Overall, while the social deviance and cost of psychopathy has long been recognized, until the mid-twentieth century there was little consensus as to what the term ‘psychopath’ denoted. As such, there was no unifying framework for what constructs were being measured and how they related to one another in terms of etiological mechanisms. Cleckley’s (1941) The Mask of Sanity was published against this background. In it, Cleckley set forth a set of sixteen criteria for what one reviewer would call “a particular variety of psychopathic personality” (p.

    Contributions of the PCL/-R to the Construct Validation and Mechanistic Understanding of the Cleckley Psychopath · 2026 · DOI

  • Use of various measures of psychopathy without attempts to reconcile conceptual or theoretical differences in assessments likely contributes to mixed findings regarding the structure of psychopathy, with results of null findings then interpreted as evidence against a given theory (e.g., Gunschera et al., 2023). It is worth noting that in their review of the neural correlates of psychopathy, Pujara et al. (2013) highlighted that integrating findings across studies and reconciling inconsistencies across studies is hindered by use of differing definitions of psychopathy, discrepant assessment methods, and inclusion of or focus on different subtypes. They also note that synthesis across studies is undermined by divergent analytical approaches based on conceptual understandings (i.e., group-based analyses based on the assumption that psychopathy relates to a unique mechanism of dysfunction versus dimensional analyses based on the assumption that psychopathy reflects variations in traits along graded continua). Since study results can differ as a function of approach (i.e., a college sample where psychopathy is being understood as relatively higher scores on a set of traits but where the rate of psychopathy as it would be understood in a clinical setting is very low), differences in the neuroimaging findings are difficult to interpret. We call for the iterative development and refinement of psychopathy assessment measures and theories in a way that ensures transparency of the construct being measured, whether that is Cleckleyan psychopathy or subcomponents of the psychopathy syndrome. We propose that such clarity and synthesis across different approaches will facilitate replicability and advancement while reducing null findings. Journal of Psychopathology and Behavioral Assessment (2026) 48:131 3 13 Page 12 of 17 Research efforts must also endeavor to adopt a sociocultural perspective by exploring factors of individual and cultural diversity to better outline mechanisms and variations of the psychopathy syndrome. It is well-established that the PCL/-R performs differently cross-culturally (Cooke et al. 2005a), and there may indeed be ethnic and cultural variations in the manifestation of psychopathy (Cooke et al. 2005b; Fanti et al. 2018; Sullivan and Kosson 2006). Research demonstrates inconsistent findings in White/non- Hispanic male offenders compared to people of color or women.

    Contributions of the PCL/-R to the Construct Validation and Mechanistic Understanding of the Cleckley Psychopath · 2026 · DOI

  • There are a number of limitations to our study. First, the sample was composed entirely of undergraduate students, and aside from the included measures the level of personal- ity problems in the sample is not known. Thus, even though samples of college students have been studied with the LPFS-SR in other countries, making conclusions about cul- tural factors is constrained by the extent to which this sam- ple is representative of the Algerian population. It is also not possible to discern the extent to which observed discrepan- cies with prior results might be the result of translation prob- lems, cultural differences, or simply a failure to replicate previous findings. Additional research with other assess- ment techniques (such as clinical interviews or rating scales) could help clarify such issues.

    Development and validation of the Arabic translation of the Level of Personality Functioning Scale—Self-Report (LPFS-SR) · 2026 · DOI

  • The naturalistic design is in accordance with the overall study aim seeking to explore utility of treatment applied within health services for patients with PD. It is therefore a particular strength of this study that data reflects treatments delivered in regular specialist mental health services across different geographical regions. The sample reflects the distribution of personality problems among patients seeking treatment within PD mental health services. However, it does not represent all types of PDs and does not include all mental health services in Norway. Furthermore, patients were primarily young adults and mostly female. In further accordance with the stated objectives, the data sample is large and includes detailed clinical information relevant for the study of PD. However, this design does not allow for causal interpretations. Unmeasured factors such as clinician preference and organizational differences between sites may also have influenced treatment assignments and limits causal interpretations of comparative outcome trajectories.

    Improvement of personality functioning in patients with personality disorders: a comparative study of mentalization-based treatment versus non-manualized treatments · 2026 · DOI

  • Several methodological limitations should be considered when interpreting these findings. The modest number of studies per outcome (k = 2–8) limited statistical power for subgroup and moderator analyses, and findings regarding differential efficacy across intervention types should therefore be regarded as explor- atory rather than definitive. Relatedly, all included trials were open-label—unavoidable in psychotherapy research—which introduces potential for performance and detection bias. The predominant reliance on self-report measures may have amplified expectancy effects; future trials incorporating clinician-rated or behavioral outcomes could yield more objective efficacy estimates. The demographic composition of included samples also limits generalizability. The predominance of female participants (81%), while reflecting clinical epidemiology, leaves treatment efficacy in male adolescents poorly characterized, and the concentration of studies in Western, high-income countries raises questions about cross-cultural applicability. Heterogeneity in control conditions is a further concern: comparisons ranged from waitlist to treatment- as-usual to active comparators, and trials using less active controls likely overestimate true treatment effects. Most studies also had relatively short follow-up periods (≤12 months), precluding de- finitive conclusions about long-term durability, though the avail- able longer-term data point to concerning erosion of gains. Finally, despite the use of robust variance estimation, residual statistical dependencies from multiple effect sizes within studies cannot be ruled out. Beyond methodological heterogeneity in the included trials, our synthesis also reflects an underlying conceptual heterogeneity in how BPD is defined in adolescence. Included trials operationalized BPD in different ways, ranging from full DSM-IV/5 BPD diagnoses via structured interview to subthreshold criterion counts or cutoff- based screening, and the populations described by these different operationalizations are not perfectly equivalent. This conceptual heterogeneity, compounded by the universally high rate of psychi- atric comorbidity in adolescent BPD samples, places a fundamental limit on the extent to which any meta-analytic synthesis (including ours) can characterize “treatment efficacy for BPD” as a single FIGURE 12 Risk of bias assessment summary (intention-to-treat analysis). Risk of bias summary showing the percentage of studies at low risk (green), with some concerns (yellow), and high risk (red) across each domain. Overall, approximately 50% of studies were judged as low risk of bias, with the most common concerns arising from deviations from intended interventions and selection of the reported result.

    Efficacy of psychological interventions for adolescents with borderline personality disorder: a systematic review and meta-analysis · 2026 · DOI

  • Despite established dose‐response effects of ACEs on mental health, the specificity of ACE pattern effects remains understudied, especially on executive function.

    Beyond Cumulative Scores: Distinct Patterns of Adverse Childhood Experiences and Their Differential Impact on Emotion, Borderline Personality Traits, and Executive Function · 2024 · DOI

  • BACKGROUND: Studies of the medium- to long-term clinical and functional course for treatment-seeking adolescents with borderline personality disorder (BPD) are lacking.

    The course of borderline personality disorder from adolescence to early adulthood: A 5-year follow-up study · 2024 · DOI

  • The current research recommends the following: Studying many variables related to life orientation in blind adolescents, studying many factors affecting the degree of life orientation in blind adolescents, conducting further studies on personality disorders in blind adolescents, and designing many intervention programs that rely on the third wave of cognitive therapy.

    التـوجـه نحو الحيـاة لدى المـراهقـين ذوي الإعـاقـة البصـريـة الشـديـدة ذوي اضطراب الشخصية التجنبية: دراسة وصفية إكلينيكية Life orientation among severely visually impaired adolescents with avoidant personality disorder: A clinical descriptive study · 2023 · DOI

  • The present study aimed to explore the link between anxiety, depression, psychological resilience, and somatization in individuals diagnosed with Antisocial Personality Disorder (ASPD), a significant psychiatric condition of both individual and societal importance, whose origins remain unknown.

    Anxiety, Depression, Somatization and Psychological Resilience in Patients with Antisocial Personality Disorder · 2023 · DOI

  • Although research on epigenetic modifications in BPD is scarce, a growing body of evidence supports the importance of oxytocin - the "social peptide" underlying attachment - in the etiology of BPD.

    Borderline personality – from psychoanalysis to epigenetics. Biological basis of attachment · 2023 · DOI

  • Although borderline personality disorder (BPD) is arguably characterized by issues in a number of these domains, it has not been systematically examined through the lens of existential therapy.

    A Systematic Review of Existential Concerns in Borderline Personality Disorder · 2023 · DOI

  • In addition, Study 2 demonstrated that the AIDA could successfully discriminate between adolescent inpatients with and without BPD, as well as healthy controls, and established preliminary clinical cutoffs that should be replicated in future studies.

    The Assessment of Identity Development in Adolescence (AIDA) Questionnaire: First Psychometric Evaluation in Two North American Samples of Young People · 2022 · DOI

  • BACKGROUND: Current "gold standard" treatments for social anxiety disorder (SAD) are limited by the limited emphasis of key etiological factors in conceptualization, and many individuals with SAD experience residual symptoms posttreatment.

    An exploratory investigation of schema modes in social anxiety disorder: Empirical findings and case conceptualization · 2022 · DOI

  • Despite the recognized importance of mild to borderline intellectual disability (MBID) among offender populations, there is insufficient understanding of its prevalence and associations with other social-psychiatric problems.

    Intellectual Disability among Violent Repeat Offenders and Its Relation with Psychopathology and Self-Sufficiency · 2021 · DOI

  • Limited information is available concerning the specificity of the forms and functions of aggressive behavior exhibited by boys with fragile X syndrome (FXS).

    Examining the Specificity of Forms and Functions of Aggressive Behavior in Boys With Fragile X Syndrome · 2020 · DOI

  • Despite the fact that family involvement is encouraged in early interventions for borderline personality disorder (BPD), there is a limited knowledge on the experience of caring for adolescents with BPD.

    Burden and Treatment Satisfaction among Caregivers of Adolescents with Borderline Personality Disorder · 2020 · DOI

  • Previous research has repeatedly demonstrated positive associations between negative affect (NA) and borderline personality disorder (BPD) symptoms in daily life, but studies have rarely addressed potential effects of positive affect (PA).

    Positive Affect Is Associated With Decreased Symptom Severity in the Daily Lives of Individuals With Borderline Personality Disorder · 2019 · DOI

  • However, little is known about the possible developmental mechanisms that might explain the association between rejection sensitivity and BPD features.

    Rejection Sensitivity and Borderline Personality Disorder Features: The Mediating Roles of Attachment Anxiety, Need to Belong, and Self-Criticism · 2019 · DOI

  • BACKGROUND: Despite the recent popularity of the classification for maladaptive traits proposed by the DSM-5, little is known about the implications of these traits in adolescent populations.

    Maladaptative personality traits in adolescence: behavioural, emotional and motivational correlates of the PID-5-BF scales · 2019 · DOI

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255 open questions have been extracted from the limitations and future-work passages of 4,078 Personality Disorders and Psychopathology papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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