Category: Personality Disorders

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Personality disorders and human evolution

personality disorders and human evolution

Personality disorders and human evolution is the focus of a new meta-synthesis we just published. The study presents a systematic review that integrates quantitative and qualitative methods to identify the most important insights from an evolutionary perspective on personality disorders.

Recent clinical evidence is beginning to confirm what many theorists have long suspected: an evolutionary lens provides indispensable tools for understanding personality disorders. A new integrative meta-synthesis of 50 key studies—spanning both quantitative data and qualitative narratives—has mapped the current state of this field.

The research identifies three primary “evolutionary models” that help clinicians move beyond mere symptom checklists:

  1. Evolutionary Mismatch: Traits that were once adaptive in ancestral environments but conflict with modern life.
  2. Emergency Mode: Personality patterns as “survival” strategies triggered by high-threat environments.
  3. Extremes of Variation: Disorders viewed as the statistical “tails” of normal, functional human diversity.

While the empirical data is still growing, this perspective offers a robust framework for clinicians to understand why these patterns exist, leading to more compassionate and effective therapeutic interventions. Among the studies, the model we are working on for the conceptualization and treatment of personality disorders also emerges.

Cheli, S., Bui, S., & Brüne, M. (2026). Personality Disorders and Human Evolution: An Integrative Meta-synthesis. Evolutionary Psychological Science (Online pubblication). https://doi.org/10.1007/s40806-026-00473-7

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New Evidence for Evolutionary Systems Therapy

Evolutionary Systems Therapy, Evolution and Personality Lab

A paper has just been published reporting new evidence for Evolutionary Systems Therapy. The study was designed to extend what we already knew, investigating its feasibility and potential clinical utility.
Previously, an RCT and several case series had suggested the possible efficacy of Evolutionary Systems Therapy in the treatment of schizotypal traits. In this study, we compared its efficacy for other traits and the viability of the conceptualization model used.
Evolutionary Systems Therapy presupposes the existence of three interpersonal styles corresponding to the three major spectrums of psychopathology (defensive style corresponding to the spectrum of schizotypy or thought disorders; affiliative style corresponding to the internalizing spectrum; dismissing style corresponding to the externalizing spectrum). These three styles are not considered to be excluded from these spectrums but are instead identified during “difficult” times.
This new study reports new evidence for Evolutionary Systems Therapy. First, the correspondence between styles and their corresponding spectrums has been confirmed. Second, the efficacy previously demonstrated in the schizotypal spectrum was also confirmed in the other two spectrums.
Of interest was the fact that the target age was that of greatest risk for personality disorders: the 16-25 age group. This choice was intended to minimize the bias associated with the study’s small sample size and focus attention on those most at risk.

Cheli, S., Brüne, M., Goldzweig, G., Bui, S., Velicogna, F., & Cavalletti, V. (2026). Evolutionary systems therapy for personality pathology: a proof-of-concept single-arm trial. Current Psychology, 45, 375 (2026). https://doi.org/10.1007/s12144-025-08606-0 (Preprint and Supplementary Material are freely accessible at https://osf.io/urjdz/overview)

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Personality disorders and evolutionary psychopathology

Personality disorders and evolutionary psychopathology offers an intriguing perspective. Martin Brüne and I wrote a chapter on a new book published by Cambridge University Press.

“Personality” is considered as a set of individual characteristics and behavioral dispositions based on both temperamental (partially genetic-driven) and developmental (partially culture-driven) components that are relatively stable across time and context. We suggest that these two intertwined components progressively shape autopoietic processes operating at an individual and a social level in accordance with the theory of evolution and its application to human behavior. We discuss existing evidence linking personality traits to the manifestations of personality disorders and diverse forms of psychopathology. Particular attention is dedicated to the evolutionary concept referred to as Life History Theory, considering its utility in predicting the development of personality traits. We also emphasize the need to explore sources of critique and further research, suggesting that a multifaceted approach to the understanding of personality dimensions is crucial.

We hope this chapter may foster research on personality disorders and evolutionary psychopathology. For those interested in the topic here’s our Lab on personality and evolution!

Cheli, S., & Brüne, M. (2025). When Do Personality Traits Become Pathological?: An Epistemological and Evolutionary View. In K. Banicki & P. Zachar (Eds.), Conceptualizing Personality Disorder: Perspectives from Philosophy, Psychological Science, and Psychiatry (pp. 160–178). chapter, Cambridge: Cambridge University Press.

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Evolution and Personality

Evolution and Personality in Pula

On Friday I presented the research of our Evolution and Personality Lab in Pula. The Mind & Brain Congress is a congress of psychiatry and neurology that takes place every year in the Croatian city. This year one of the invited symposiums was on “Personality development and pathology in an evolutionary perspective”. Martin Brüne (Ruhr-University Bochum), Darko Marčinko (Zaghreb University) and I discussed the research of our teams in this area. In short, it was like having our own Evolution and Personality Lab in Pula!

In my presentation I presented the evolutionarily informed conceptualization model that we have been using for a few years and the evidence collected so far. You can see the slides in the video.

First, I motivated the clinical utility of an evolutionarily informed model to personality pathology. Second, I presented data on the inter-reter reliabily, perceived utility and cross-cultural validity of the model. Third, I summarized data on treatment based on this model, namely Evolutionary Systems Therapy.

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A meta-analysis of treatments for Cluster A

Cluster A Personality Disorders

Our Evolution and Personality Lab just published a meta-analysis of treatments for Cluster A of personality disorders. The paper has been published by the APA journal Personality Disorders: Theory, Research and Treatment. Here, we disprove the hypothesis that patients with Cluster A personality disorders are poorly adherent to treatments and that these are not effective. Our data suggest that with respect to these outcomes, Cluster A is not dissimilar from other clusters.

Despite an overall prevalence of about 4% and a possible association with well-studied conditions such as schizotypy, little is known about effective treatments for Cluster A personality disorders (PDs), that is, para- noid, schizoid, and schizotypal PD. The aim of this systematic review and meta-analysis was to conduct a narrative synthesis of existing randomized controlled trials and explore the effectiveness of psychosocial and pharmacological treatments for these disorders. Nineteen studies including 468 participants diagnosed with any one of the three Cluster A PDs were included in the systematic review. Data from 291 (k = 5) and 213 (k = 5) participants were included in two different meta-analyses evaluating the reduction of distinctive clin- ical features and the increase of general functioning following treatment, respectively. All the treatments in meta-analyses reported a low overall attrition rate (0.23). The two meta-analyses showed medium-to-large effect sizes (g = .60–.91), but were limited by small sample sizes and large heterogeneity. Collected findings suggest that treatments for paranoid, schizoid, and schizotypal PD may be feasible and effective. We discuss implications for further research.

This systematic review and meta-analysis aimed to explore the feasibility and effectiveness of existing psychosocial and pharmaco- logical treatments for all the Cluster A PDs, that is, PPD, SZPD, and SPD. Despite the heterogeneity of the studies and the limited sample sizes, important findings emerge. Both the narrative synthesis and the two meta-analyses invalidated the hypothesis that patients with these disorders are unlikely to complete treatments and that treat- ments are not safe. Our results suggest that the level of feasibility and safety of treatments for Cluster A PDs are similar to those for all other PDs. Existing treatments also appear to be sufficiently effective in reducing distinctive clinical features and increasing general functioning. Numerous constraints of generality urge the development of new research to identify robust mechanisms of change and effective treatments.

Cheli, S., Wisepape, C. N., Witten, C. D. Y., Floridi, M., Cavalletti, V., Hasson-Ohayon, I., Brüne, M., & Ottaviani, C. (2025). Psychosocial and pharmacological interventions for cluster a personality disorders: A systematic review and two exploratory meta-analyses. Personality Disorders: Theory, Research, and Treatment. Advance online publication. https://doi.org/10.1037/per0000732

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Complex cases and comorbidities between personality and eating disorders

Complex cases and comorbidities between personality and eating disorders are tricky challanges for the clinician. Indeed, patients live their experience and (rightly!) have little interest in psychiatry, psychopathology and psychotherapy manuals. The condition of a single disorder is rare. And even in the case of complex symptoms such as eating disorders it is important to consider the functioning of the personality as a whole.

Journal of Clinical Psychology has recently accepted a paper I worked on together with an amazing international team: Veronica Cavalletti (Tages Charity, Florence), Francesco Gazzillo (University of La Sapienza, Rome), Martin Brüne (Bochum University, Bochum), and Paul Hewitt (University of British Columbia, Vancouver). Here we present a clear-cut example of complex cases and comorbidities between personality and eating disorders.

In this case study we present the course of the psychotherapy of Myriam, a 19-year old female with a severe personality disorder and comorbid eating disorder. During the initial assessment she reported high levels of neuroticism that parallel the diagnosis of obsessive-compulsive personality disorder, borderline personality disorder, and anorexia nervosa. Myriam showed a severely impaired personality functioning defined by perfectionism, self-criticism, interpersonal guilt and overcontrol. Her daily experience was shaped by a self-recriminative inner dialogue associated with maladaptive patterns in the form of food, water and sleep restrictions, self-harm behaviors, and suicidal ideation. She accessed an integrative treatment based on individual (Evolutionary Systems Therapy) and group psychotherapy (Mindful Compassion for Perfectionism). At the end of 14-month intervention she remitted from all the categorical diagnoses and showed reliable changes in several measures. These outcomes were maintained at 3-month follow-up. We describe the integrative conceptualization based on Myriam’s perfectionistic self-recrimination patterns, and the consequent treatment that targeted these patterns rather than focusing on symptom reduction exclusively.

The picture presents the conceptualization of the client based on the Evolutionary Systems Therapy.

For those interested in, the preprint of the paper is freely available and and the published version will have only minimal differences due to production process:

Cheli, S., Cavalletti, V., Gazzillo, F., Brüne, M., & Hewitt P.L. (2024). I don’t deserve anything good: Perfectionistic self-recrimination in a case of comorbid personality and eating disorder. Journal of Clinical Psychology. Preprint available on Authorea, July 16, 2024. https://doi.org/10.22541/au.172114929.99232229/v1 (DOI: 10.1002/jclp.23753).

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CFT for Personality Disorders – Retreat

CFT for Personality Disorders

Just concluded the first edition of a retreat for mental health professionals interested in applying Compassion Focused Therapy (CFT) in personality disorders.

Despite CFT is genuinely transdiagnostic and usuful in targeting maladpative interpersonal schemas, little is known about its application in treating those struggling with personality disorders.

Thus, I organized this retreat where to present an evolutionary model of conceptualization of personality disorders and those tecniques that I found extremely useful when working with personality disorders. I also presented my work in this field with a specific focus on schizotypal, perfectionistic, narcisistic and borderline traits.

The retreat was located in an amazing center near Florence, surrounded by woods and vineyards! For two days, about 30 partecipants worked on mindful compassion, chairwork imagery, and so on.

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Adolescents with schizotypal traits: A cases series

Adolescents with schizotypal traits, schizotypy, simone cheli

In a cases series with five adolescents we tested a treatment for adolescents with schizotypal traits. The intervention was previously designed and tested with adults, namely Evolutionary Systems Therapy for Schizotypy (ESTS).

ESTS is an integrative form of psychotherapy that comprises an evolutionarily based conceptualization with compassion focused and metacognitvely oritented approaches. We recently published the findings of a randomized controlled trial where we showed promising results. 75% of patients remitted from diagnosis and drop-out rates was below 10%.

In this new cases series we suggest how ESTS may be a feasible treatment for adolescents with schizotypal traits. All the partecipants concluded the study and the rate of missing sessions was below 10%. Moreover, 4 out of 5 patients remitted from diagnosis at the end of the schedule 6-month treatment, 1 out of 5 after an extended 9-month intervention.

A post-hoc interview showed how the adolescents described the intervention as effective, substainable and consistent with their goals. By considering how limited informat we have about effective treatments for adolescents with personality pathology (almost nothing for those struggling with schizotypal traits), we are really excited by these findings. Despite the preliminary nature of the study, the proposed model is elegible for larger sample size studies.

Simone Cheli, Gil Goldzweig, Paul H. Lysaker, Francesca Chiarello, Courtney Wiesepape & Veronica Cavalletti (2023) An evolutionarily informed therapy for adolescents with prominent schizotypal traits: a pilot five case series, Psychosis, DOI: 10.1080/17522439.2023.2199325

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Mindful Compassion for Perfectionism: A new RCT!

Mindful compassion for perfectionism

Last week I posted about Roz Shafran’s paper on perfectionism, now I’m again here talking about the same topic! Another interesting news, so I hope I won’t bore you! Clinicaltrial.gov (the worldwide database of funded clinical studies) has reviewed and published today our protocol of the new randomized controlled trial (RCT) on Mindful Compassion for Perfectionism (MCP).

As Shafran suggested, there are only three interventions specifically tailored on perfectionistic traits: cognitive behavioral therapy for perfectionism (Shafran et al., 2023), dynamic relational therapy (Hewitt et al., 2019), and MCP (Cheli et al., 2022). MCP is a form of group psychotherapy that integrates the conceptualization model of dynamic relational therapy with experiential techniques informed by or directly derived from Compassion Focused Therapy (Gilbert et al., 2014). Veronica Cavalletti and I developed this integrative intervention with the scientific support of Paul Hewitt.

To date, some case series have confirmed the feasibility of the MCP. This new RCT is aimed at pilot-testing the effectiveness of the proposed intervention. The study is a waiting-list controlled trial. We are going to start recruiting by nex Monday and have the first group as soon as possible!

National Library of Medicine (U.S.). (2023, January- ). Mindful Compassion for Perfectionism (MCP). Identifier NCT00103181. https://clinicaltrials.gov/ct2/show/NCT00103181

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Effective treatments for perfectionism

Perfectionism

Roz Shafran and colleagues just published an overview of existing effective treatments for perfectionism. They presented their own model and then discussed the existing alternatives.

I was very surprised and happy to see how our protocol was one of the three interventions specifically tailored on perfectionistic traits! In short, Shafran was summarizing evidence and roots of the model with strongest evidence: that is, Cognitive Behavioral Therapy for Perfectionism. This is a tailored form of CBT targeting maladpative beliefs and biases in those struggling with perfectionism. The second model reviewed was the Dynamic Relational Therapy developed by Paul Hewitt and colleagues. Hewitt suggests to consider perfectionism as a set of interpersonal styles comprising of spefici traits, interpersonal and intrapersonal components. Finally, Shafran presented our Mindful Compassion for Perfectionism that integrates the Dynamic Relational Therapy with Compassion Focused Therapy.

As I anticipated, our model is far from being considered evidence-based. We published two cases series (see pubblications) where reporting preliminary evidence for the feasibility of the model, and we are now outlining a randomized controlled trial to better understand its clinical utility. Cavalletti, Hewitt, Flett and I published a first paper introducing the group format and its rationale, and then a second cases series about.

I appreciated Shafran’s recognition, which confirms the importance of specific interventions for specific traits or psychopathological manifestations.

Shafran, R., Egan, S.J., & Wade, T.D: (2023). Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism, Behaviour Research and Therapy,
104258. https://doi.org/10.1016/j.brat.2023.104258

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