Psychedelic Therapy for Personality Disorders

Psychedelic therapy has shown promising results for many mental health disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and eating disorders. Although research has not yet broadly explored psychedelic-assisted treatments for personality disorders, there is an ongoing debate on their potential effect on the symptoms and mechanism of these disorders.

“The exciting feature of this research was the fact that improvements occurred without the psychedelic drug’s hallucinogenic effect.”

— Aysu Naz Atalay, MSc

Read more to find out about psychedelics and their potential for treating personality disorders.

Understanding Personality Disorders

Personality disorders (PD) are mental health conditions characterized by patterns of thoughts, emotions, and actions that affect individuals’ lives, interpersonal relationships, and the way they perceive themselves. People who have PD might have difficulties with adaptation, flexibility, stability, and emotional regulation. The initial feature of PD is rooted patterns of thought and behavior, which typically begin in early adulthood and keep appearing later in life. Some examples of PD are Borderline Personality Disorder (BPD), Narcissistic Personality Disorder (NPD), and Antisocial Personality Disorder (ASPD).

The causes of PD are not entirely known, although genetic, environmental, and social factors play a crucial role. Also, childhood trauma and trauma, neglect, and abuse that occurred in early childhood are significant factors for the development of PDs, along with many other mental health conditions.

Current Treatment Options 

Due to long-standing patterns of behavior, it could be pretty challenging to treat PDs. The current treatments are pharmacotherapy, such as antidepressants and mood stabilizers, along with distinct types of psychotherapy, such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and psychodynamic therapy. Medications often help manage symptoms such as anxiety, depression, or rapid mood shifts, although they show only limited effectiveness in treatment since PDs are multifaceted conditions. 

Psychedelic Therapy and Personality Disorders

Classical psychedelics, such as psilocybin, dimethyltryptamine (DMT, naturally present in ayahuasca), and lysergic acid diethylamide (LSD), alter brain mechanisms by affecting the 5-H2A receptor. This interaction induces ego dissolution, which can support changes in behavior and thought patterns. Creating shifts in buried emotions and trauma can help with behaviors with disorders like BPD. Further, the ability to make changes in self-perception could be helpful for disorders like Narcissistic Personality Disorder (NPD), where there is a distorted self-view.

Research is still in its early phases, although there are some studies already exploring psychedelic therapy in the context of personality disorders.

Studies on LSD Microdosing and Online Platform Data

Felix Müller and his colleagues conducted research in the treatment of PDs using repetitive doses of LSD. In the case report, repeated and low doses of LSD, so-called “microdosing,” showed long-term psychological improvements and significant reductions in symptoms related to emotional instability, impulsivity, and relational difficulties, which are critical traits of specific personality disorders. The exciting feature of this research was the fact that improvements occurred without the psychedelic drug’s hallucinogenic effect.

Most recent research focused on data collected from online platforms. It showed improvements in psychosocial functions and emotional regulations in people who have PD, as well as reductions in anxiety and depression symptoms. They explored increased psychological functioning based on self-reported data, although the research was limited in sample size and lacked clustering between PDs.

In the following video, Rick Zeifman, PhD, shares his thoughts on the potential effects of psychedelic therapy for those who have personality disorders. We already know psychedelic therapy works nicely for affective symptoms, such as people with life-treated diseases like cancer. In that case, there is a chance that it helps with affective symptoms of personality disorders, specifically in the case of borderline, where the emotions are intense and often cause a burden to the person. Further, Zeifman notes that psychedelics could help change how the person responds and meets with their feelings. Previous research has shown psychedelics show increased acceptance and understanding of emotions on deeper levels, as well as increasing connectedness. Therefore, combined with suitable therapy, psychedelics might help with having a more balanced approach to emotions for people with PD.

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Additionally, psychedelic therapy proved to be helpful with addiction and lowered substance abuse for many patients. A significant symptom of PD is substance abuse and a tendency to addiction. It might reduce specific symptoms and help with the disorder’s improvements.

MDMA-Assisted Therapy for Borderline Personality Disorder

MDMA is a synthetic compound that is related to amphetamines. It is often associated with feelings such as emotional openness and increased empathy, and it helps individuals process unresolved traumas in therapeutic settings. MDMA showed promises for PTSD, alcohol use disorder, anxiety, and depression associated with life-threatening diseases.

Although those two conditions significantly differ, the overlaps of PTSD and borderline personality disorder are the history of trauma and abuse, emotional dysregulation, interpersonal conflicts, and intrusive thoughts. Further, BPD is associated with past traumatic experiences and high stress associated with it. Since MDMA is promising for treating PTSD, there is also hope that it could be helpful for BPD.

In his recent research, Rick Zeifman explored psychedelics as an intervention for BPD. Typically, clinicians treat BPD with pharmacotherapy combined with dialectic-behavioral therapy, transference psychotherapy, and mentalization-based therapy. However, these treatments have some limitations in efficacy. Zeifman notes that the target actions of psychedelics on BPD could be dysregulations in behavior, emotions, social relationships, and self-identity, which psychedelics have shown promising results previously.

In this review article on MDMA-assisted therapy for BPD, they suggested a potential treatment of trauma targeting in people with BPD with the help of MDMA’s mechanism of action, such as helping with affective symptoms, ignorance of emotions, and dealing with processing of challenging experiences that might have caused BPD in the first place. MDMA may shift rigid structures and dysfunctional perception, although more research is needed. Combined with therapy, it can enforce trust between the patient and the therapist, leading to a safer space for expressing and processing emotions. Overall, MDMA combined with psychotherapy can be a mechanism for treating BPD, although the inclusion of BPD patients in clinical trials is needed to have a definite conclusion.

Conclusion

There is a significant gap in the literature on psychedelic effects on individuals with PD. Researchers frequently exclude them from the research criteria, creating a need for more research to understand their impact on specific conditions.

There are also challenges to consider, such as the heightened effect of psychedelics on emotions, which might be distressing for people with personality disorders since they also experience intense emotions. Given the fact that emotional volatility and cognitive distortions are typical in PDs, people who have those symptoms can experience intense emotions during a psychedelic session. Therefore, proper support and understanding of both the nature of these disorders and psychedelic action is needed.

For instance, professionals specifically trained in this regard could facilitate it to avoid potential risks. Further, a controlled and safe environment is crucial for the effectiveness of therapy and mindfulness practices as part of the integration process.

Clinical studies and conceptual research are needed to understand how psychedelics would potentially create cognitive and emotional shifts in people who live with personality disorders.

References

• American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5™, 5th Ed. American Psychiatric Publishing, Inc.. https://doi.org/10.1176/appi.books.9780890425596.
• Müller, F., Mühlhauser, M., Holze, F., Lang, U. E., Walter, M., Liechti, M. E., & Borgwardt, S. (2020). Treatment of a Complex Personality Disorder Using Repeated Doses of LSD—a Case Report on Significant Improvements in the Absence of Acute Drug Effects. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.573953.
• Gordon, A. R., Carrithers, B. M., Pagni, B. A., Kettner, H., Marrocu, A., Nayak, S., Weiss, B. J., Carhart-Harris, R. L., Roberts, D. E., & Zeifman, R. J. (2024). The Effect of Psychedelics on Individuals with a Personality Disorder: Results from Two Prospective Cohort Studies. Research Gate. http://dx.doi.org/10.21203/rs.3.rs-4203641/v1.
• Carhart-Harris, R. L., Erritzoe, D., Haijen, E., Kaelen, M., & Watts, R. (2017). Psychedelics and Connectedness. Psychopharmacology, 235, 547-550. https://doi.org/10.1007/s00213-017-4701-y.
• Parmar, A., & Kaloiya, G. (2018). Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review. Indian Journal of Psychological Medicine, 40(6), 517-527. https://doi.org/10.4103/ijpsym.ijpsym_164_18.
• Zeifman, R. J., & Wagner, A. C. (2019). Exploring the Case for Research on Incorporating Psychedelics Within Interventions for Borderline Personality Disorder. Journal of Contextual Behavioral Science, 15, 1-11. https://doi.org/10.1016/j.jcbs.2019.11.001.
• Traynor, J. M., Roberts, D. E., Ross, S., Zeifman, R., & Choi-Kain, L. (2022). MDMA-Assisted Psychotherapy for Borderline Personality Disorder. Focus the Journal of Lifelong Learning in Psychiatry, 20(4), 358-367. https://doi.org/10.1176/appi.focus.20220056.