Personality disorders are highly prevalent in clinical practice. With the introduction of the Diagnostic Statistical Manual - 5th Edition (DSM-5) the multi-axial system of diagnosis for mental disorders has disappeared, which has led to an increase in research on personality disorders (e.g. Emmelkamp & Meyerbröker, 2020). In this Special Issues, several recent developments are discussed.

In the first article (Crisan et al., 2023) in this Special Issue, a meta-analysis is reported investigating the results of studies on the association between adverse childhood events and cluster C personality disorders including avoidant personality disorder, dependent personality disorder and obsessive–compulsive personality disorder. Adverse childhood events included cumulative adverse experiences, childhood maltreatment, dysfunctional parental behaviours, household dysfunction and peer bullying. This meta-analysis found a strong association between childhood adversity and each specific cluster C personality disorder across studies with larger effect sizes in studies that used clinical interviews, compared to studies that used self-report questionnaires. Interestingly, this association decreased with age.

Results of a systematic review of Fanti et al. (2023) revealed that paranoia may be transdiagnostic in a variety of personality disorder diagnoses. They found evidence of mild-to-severe paranoia not only in paranoid personality disorder and schizotypal personality disorder but also in borderline personality disorder as well. In addition, they also found evidence of paranoia in a number of patients with antisocial personality disorder, avoidant personality disorder and narcissistic personality disorder.

In a study by van der Linde et al. (2023), who investigated complex dissociative disorders, questionnaires measuring personality disorder traits, schema modes and coping styles were completed by patients with avoidant personality disorder, borderline personality disorder and complex dissociative disorder. Results revealed that patients with the complex dissociative disorder—in contrast with patients with avoidant personality disorder and borderline personality disorder—were characterized by specific schizoid, schizotypal, borderline and avoidant personality traits. Interestingly, patients with complex dissociative disorder reported early maladaptive schemas in the domains of disconnection and rejection, and over-vigilance and inhibition.

Risky, self-destructive impulsivity and emotion dysregulation are core features of borderline personality disorder (Waite et al., 2024). Two studies in this Special Issue investigated altered emotional patterns in borderline personality disorder. Pyszkowska et al. (2023) studied in patients with borderline personality disorder and in patients with depression whether internalized stigmatization and emotional dysregulation may enhance avoidance strategies, including maladaptive daydreaming. Maladaptive daydreaming was associated with emotional dysregulation and negative attitudes towards oneself. Results revealed further significant differences between borderline personality disorder and depression with higher scores reported by patients with borderline personality disorder in areas of negative affect and emotional dysregulation. Lopez-Villatoro et al. (2023) investigated—using the International Affective Picture System—whether an altered emotional pattern in borderline personality disorder patients was associated with traumatic experiences and attachment bonds towards their primary caregivers. As concluded, the authors' results of this study highlight the relevance of treatment focused on traumatic attachment events for the improvement of emotional instability in patients with borderline personality disorder.

The following articles in this Special Issue are focused on evidence-based psychotherapy on patients with personality disorders. In the first study (Nielsen et al., 2023), a scoping review was conducted to identify relevant existing psychotherapy research with patients with schizotypal personality disorder. Unfortunately, very few relevant studies have been conducted with this group of patients and results are inconclusive.

Schema therapy is one of the evidence-based psychotherapies for personality disorders (Emmelkamp & Meyerbröker, 2020), but most studies have involved individual schema therapy. Wibbelink et al. (2023) investigated in a large multicentre open trial the effectiveness of group schema therapy for cluster C personality disorders. Results revealed that 30 sessions of group schema therapy resulted in significant improvements with medium to large effect sizes after 2 years for avoidant and dependent personality disorder, but results for obsessive–compulsive personality disorder are inconclusive. In the study of Khasho et al. (2023), the effectiveness of schema therapy was investigated in older adults with borderline personality disorder using a multiple baseline case series design. Results revealed that schema therapy led to a significant decrease in negative core beliefs. In addition, patients no longer fulfilled the criteria of borderline personality disorder.

Few studies have investigated the treatment of borderline problems in adolescents (e.g. Schuppert et al., 2012). In the next article in this Special Issue (Gilbey et al., 2023), 6 months of mentalization-based therapy is investigated in a therapeutic community setting with adolescents with borderline personality problems. Results indicate that participants show a reduction in self-harm and internalizing symptoms.

High rates of dropout have been widely reported in evidence-based psychotherapies for patients with borderline personality disorder. In the following study published in this Special Issue, De Freixo Ferreira et al. (2023) investigated drop-out in published randomized controlled trials in which patients with borderline personality disorder were treated with evidence-based psychotherapy. Results revealed that patients with weaker therapeutic alliance scores and higher hostility presented with higher dropout rates.

Last but not least, comorbid personality disorder has been studied as a predictor for treatment efficacy and dropout in treatments, especially with patients treated for post-traumatic stress disorder (e.g. Snoek et al., 2021). In the last study in this Special Issue, van den End et al. (2023) investigated whether co-morbid personality disorder had negative effects on treatment outcomes for post-traumatic stress disorder. Interestingly, the results were negative: personality disorder did not predict change in post-traumatic stress disorder.

人格障碍在临床实践中非常普遍。随着诊断统计手册 - 第五版（DSM-5）的推出，精神障碍的多轴诊断系统已经消失，这导致了人格障碍研究的增加（例如Emmelkamp＆Meyerbröker，2020  ）。本期特刊讨论了最近的一些进展。

在本期特刊的第一篇文章（Crisan 等人，  2023）中，报告了一项荟萃分析，调查了不良童年事件与 C 类人格障碍（包括回避型人格障碍、依赖型人格障碍和强迫症）之间关联的研究结果。 ——强迫性人格障碍。不良童年事件包括累积的不良经历、童年虐待、功能失调的父母行为、家庭功能失调和同伴欺凌。这项荟萃分析发现，与使用自我报告问卷的研究相比，使用临床访谈的研究中的效应量更大，童年时期的逆境与每种特定的 C 类人格障碍之间存在很强的关联。有趣的是，这种关联随着年龄的增长而减弱。

Fanti 等人的系统评价结果。( 2023 ) 揭示偏执狂可能在多种人格障碍诊断中具有跨诊断性。他们不仅在偏执型人格障碍和分裂型人格障碍中发现了轻度至重度偏执的证据，而且还在边缘性人格障碍中发现了轻度至重度偏执的证据。此外，他们还在一些反社会人格障碍、回避型人格障碍和自恋型人格障碍患者中发现了偏执的证据。

在范德林德等人的一项研究中。（2023）研究了复杂解离障碍，由回避型人格障碍、边缘性人格障碍和复杂解离障碍患者完成了测量人格障碍特征、图式模式和应对方式的问卷。结果显示，与回避型人格障碍和边缘性人格障碍患者相比，患有复杂解离障碍的患者具有特定的分裂样、分裂型、边缘型和回避型人格特征。有趣的是，患有复杂解离障碍的患者报告了在断开和拒绝以及过度警惕和抑制领域的早期适应不良模式。

冒险、自我毁灭的冲动和情绪失调是边缘性人格障碍的核心特征（Waite et al.,  2024）。本期特刊中的两项研究调查了边缘型人格障碍的情绪模式改变。皮什科斯卡等人。( 2023 ) 在边缘性人格障碍患者和抑郁症患者中进行了研究，内在的耻辱和情绪失调是否可能增强回避策略，包括适应不良的白日梦。适应不良的白日梦与情绪失调和对自己的消极态度有关。结果进一步揭示了边缘性人格障碍和抑郁症之间的显着差异，边缘性人格障碍患者在负面情绪和情绪失调方面得分较高。洛佩兹-维拉托罗等人。( 2023 ) 使用国际情感图片系统调查了边缘性人格障碍患者情绪模式的改变是否与创伤经历和对其主要照顾者的依恋关系有关。总之，作者的研究结果强调了以创伤性依恋事件为重点的治疗对于改善边缘性人格障碍患者情绪不稳定的相关性。

本期特刊中的以下文章重点关注人格障碍患者的循证心理治疗。在第一项研究（Nielsen 等人，  2023）中，进行了范围界定审查，以确定现有的针对精神分裂型人格障碍患者的相关心理治疗研究。不幸的是，针对这组患者进行的相关研究很少，结果尚无定论。

图式治疗是针对人格障碍的循证心理治疗之一（Emmelkamp & Meyerbröker，  2020），但大多数研究都涉及个体图式治疗。维伯林克等人。(2023) 在一项大型多中心开放试验中调查了团体图式疗法对 C 类人格障碍的有效性。结果显示，30 次团体图式治疗在 2 年后对回避型和依赖型人格障碍产生了显着改善，效果中等至较大，但对于强迫型人格障碍的结果尚无定论。在 Khasho 等人的研究中。( 2023 )，使用多基线病例系列设计研究了图式治疗在患有边缘性人格障碍的老年人中的有效性。结果显示，图式疗法导致消极核心信念显着减少。此外，患者不再符合边缘型人格障碍的标准。

很少有研究调查青少年边缘问题的治疗（例如 Schuppert 等，  2012）。在本期特刊的下一篇文章中（Gilbey 等人，  2023），在治疗社区环境中对患有边缘人格问题的青少年进行了为期 6 个月的基于心理化的治疗的研究。结果表明，参与者的自残和内化症状有所减少。

在针对边缘性人格障碍患者的循证心理治疗中，广泛报道了高辍学率。在本特刊发表的以下研究中，De Freixo Ferreira 等人。( 2023 ) 在已发表的随机对照试验中调查了退出情况，在这些试验中，边缘性人格障碍患者接受了循证心理治疗。结果显示，治疗联盟评分较弱和敌意较高的患者的退出率较高。

最后但并非最不重要的一点是，共病人格障碍已被研究作为治疗效果和治疗中途退出的预测因素，特别是对于接受创伤后应激障碍治疗的患者（例如 Snoek 等人，  2021）。在本期特刊的最后一项研究中，van den End 等人。( 2023 ) 研究了共病人格障碍是否对创伤后应激障碍的治疗结果产生负面影响。有趣的是，结果是否定的：人格障碍并不能预测创伤后应激障碍的变化。