A new case report describes a 37-year-old woman with severe personality disorders and ADHD who showed marked improvement over a year of specialised psychotherapy, during which she also self-administered psychedelic drugs. By the end of the year, she no longer met the diagnostic criteria for narcissistic or paranoid personality disorder, and her borderline symptoms and emotional instability had eased. The authors say the findings raise the question of whether psychedelics might aid psychotherapy for personality disorders, a possibility they say requires testing in further pilot studies.
Personality disorders are deeply ingrained patterns of thinking, feeling, and behaving that deviate from cultural expectations and cause significant distress or impairment. Individuals with these conditions often struggle with a distorted sense of self, extreme mood swings and turbulent relationships. Narcissistic personality disorder involves fragile self-esteem regulated by grandiosity or vulnerability to criticism, while borderline personality disorder is marked by fears of abandonment, impulsivity and rapid shifts in mood.
Paranoid personality disorder involves pervasive distrust and suspicion of others, while antisocial personality disorder features a persistent disregard for the rights of others. Talk therapy remains the primary treatment for these conditions as no medications have been specifically approved to address core personality pathology.
In recent years, psychiatrists and psychologists have begun exploring whether psychedelic substances such as psilocybin and MDMA might assist in treating stubborn mental health conditions. This can involve macrodosing, where a large dose induces a powerful mind‑altering experience, or microdosing, which uses tiny, repeated doses that do not trigger hallucinations.
Earlier work noted that psychedelics might influence targets shared by existing therapies, including emotional regulation, self‑compassion and social functioning, potentially aligning with approaches used for borderline personality disorder. A separate study of clinicians highlighted trauma‑related parallels between PTSD and borderline personality disorder, suggesting that MDMA‑assisted therapy overlaps with dialectical behaviour therapy, a skills‑based treatment developed for borderline pathology.
Actual clinical data on using psychedelics for personality disorders have remained limited. Before the new study, the only published case of its kind, to the authors’ knowledge, described a 39-year-old woman with treatment‑resistant depression and a complex personality disorder who received escalating weekly LSD doses in a hospital setting, experiencing rapid reductions in emotional instability, depressed mood and suicidal thoughts for about a week after each dose, even without a hallucinatory trip or specialised talk therapy.
To add to the limited evidence, Martin Blay of the ADDIPSY Outpatient Addictology and Psychiatry Center in Lyon and Université Paris‑Saclay, with colleagues Inès Benmakhlouf and Mario Speranza, traced the trajectory of a patient who combined structured psychotherapy with her own independent psychedelic regimen.
The case focuses on a 37-year-old woman, identified as Mrs. P, who sought treatment at an outpatient centre for severe personality pathology, ADHD and cannabis use disorder. She reported a history of severe physical and emotional abuse from her parents in childhood, an attempted rape in 2016, and estrangement from her family. Her relatives had histories including schizophrenia, bipolar disorder and depressive disorders. Her psychiatric care began in 2009 after a suicide attempt, and she was initially diagnosed with bipolar disorder, followed by more than a decade of uneventful medication and psychoanalytic therapy.
In late 2021, clinicians revised her diagnosis to mixed personality disorder and ADHD, and she completed a year of dialectical behaviour therapy without improvement before arriving at the authors’ clinic. At intake she was highly agitated, spoke rapidly and reported severe emotional outbursts, frequent conflicts with her partner, suicidal behaviours and deep mistrust toward others. Baseline assessments using the Structured Clinical Interview for DSM‑IV Personality Disorders showed she met thresholds for borderline, antisocial, narcissistic and paranoid personality disorders.
The treatment team proposed weekly individual therapy alongside methylphenidate to manage hyperactivity. The psychotherapy followed Good Psychiatric Management, a structured approach that helps patients relate their symptoms to interpersonal sensitivity and daily stressors. She also joined a six‑week psychoeducation group for narcissistic personality disorder. Mrs. P initially refused all psychiatric medication, accepted the psychotherapy, and disclosed that she had begun purchasing psychedelics online to self‑administer alongside therapy.
Concerns about safety were raised given her family history of schizophrenia, as psychedelics can trigger psychotic episodes in vulnerable individuals. Nevertheless, Mrs. P insisted she would take the substances regardless, and the clinicians chose to proceed with psychotherapy while openly discussing her experiences to safeguard the therapeutic alliance. Weekly sessions reviewed recent emotional outbursts, practised mentalising, linked current reactions to past traumas and set practical goals for emotional regulation.
During treatment, Mrs. P logged her psychedelic use, noting dates, doses, substances and insights, while abstaining from cannabis and other drugs for the year. Most cycles were microdosing, with a dose every two to three days of psilocybin truffles, an LSD analogue called 1cP‑LSD, or a mescaline analogue called methallylescaline. Eight macrodosing sessions involved larger amounts of psilocybin truffles, one dose of Amanita muscaria mushrooms, or MDMA, typically 100 to 130 milligrams. In one session a weighing error led her to take 600 milligrams of MDMA, roughly five times her usual dose, producing an intensely experiences with side effects such as rapid heart rate, anxiety and impaired coordination, though she did not require medical care.
After a year of this combined regimen, structured interviews and psychometric tests showed notable reductions in multiple symptoms. Narcissistic criteria fell from five to none, and paranoid criteria from four to one, meaning she no longer qualified for narcissistic or paranoid personality disorders. Borderline criteria decreased from eight to five and antisocial criteria from six to four, leaving them still meeting those diagnoses. Avoidant and obsessive‑compulsive personality disorder criteria remained modestly unchanged at one and three respectively.
Symptom severity aligned with these diagnostic shifts: the Borderline Symptom List fell 72.2 percent (from 3.13 to 0.869 on a 4‑point scale) and the clinician‑administered Zanarini Rating Scale dropped 68.8 percent (from 16 to 5 on a 36‑point scale), moving her borderline symptoms from high or moderate to moderate or mild. Pathological obsessive‑compulsive traits and covert narcissism also declined by about 20 to 32 percent. Scores on a brief pathological narcissism inventory were already normal at baseline and showed a modest fall in vulnerable narcissism with little change in grandiose narcissism.
Emotional and social functioning improved as well. Difficulties with emotion regulation decreased by 29.1 percent (from 127 to 90), and impulsivity fell by nearly 12 percent. The Toronto Alexithymia Scale score dropped by 28.3 percent, moving her out of the possible‑alexithymia range. Social functioning frequency rose by 24.1 percent and social satisfaction increased by 85.7 percent, though overall functional impairment on the Sheehan Disability Scale changed little.
Clinically, Mrs. P ceased suicidal crises and began reframing her intense mistrust of others as an outdated defence rooted in childhood trauma rather than a veritable external threat. Her ADHD hyperactivity remained prominent, and she relied on daily organisational strategies to avoid exhaustion after briefly trying stimulant medication. The authors hypothesise that psychedelic intakes facilitated progress in therapy, noting that major interpersonal breakthroughs in sessions tended to follow macrodosing experiences, though they emphasise this remains highly speculative and should be treated with caution.
Mrs. P described her pre‑treatment mindset as “like an injured wild animal, like ‘me against the whole world’.” She credited psychedelics with pulling her out of emotional dissociation and helping her replace shame and guilt with self‑compassion, while non‑judgemental psychotherapy aided in integrating those lessons and rebuilding trust in others.
Her progress aligns with several earlier studies of psychoactive substances, though those studies used different designs and populations. The reductions in narcissistic traits echo a 2020 general population survey that linked awe‑inspiring psychedelic experiences with lower maladaptive narcissism, while her borderline improvements echo a clinical study of depressed patients with borderline personality disorder following intravenous ketamine infusions rather than classic psychedelics.
A 2024 prospective survey of adults microdosing for ADHD found associations with reduced ADHD symptoms and improvements in emotion regulation over four weeks compared with conventional medication, though that study relied on online self‑reports rather than a clinical case combining micro‑ and macrodosing with talk therapy. Mrs. P likewise showed gains in emotion regulation and impulsivity, but her core hyperactive ADHD symptoms persisted over the year.
Nonetheless, the single positive outcome is at odds with broader safety data about personality disorders and psychedelics. A 2024 observational study tracking mostly unsupervised, recreational psychedelic use reported that 16 percent of participants experienced worsened mental health, with individuals having a history of personality disorders accounting for about 31 percent of those negative outcomes. The authors cite this as suggesting roughly a fourfold higher risk of worsening mental health among people with personality disorders, even though Mrs. P did not experience such deterioration.
The case report’s authors acknowledge that the findings cannot establish a standard therapy, noting that Mrs. P’s care involved self‑selected timing, substances and doses outside supervised sessions. It is impossible to separate the effects of drugs from those of the talk therapy, and Mrs. P might have achieved similar improvements through the structured psychotherapy and the strong therapeutic alliance alone.
Other factors could explain the progress. Crisis‑driven treatment often yields improvement regardless of the intervention, and stopping cannabis use could itself ease mood swings, impulsivity and suspiciousness. Her enthusiasm for psychedelics may have shaped her questionnaire responses, and the acknowledgments note she helped write the paper. Case reports tend to be published when outcomes are good, which may bias the literature toward positive results.
Questions also surround the substances used and the timeline of use. The online purchases were not tested, so actual content and doses cannot be verified. The paper’s dates appear inconsistent: therapy began at the end of 2023, yet the psychedelic log starts in September 2022 with overlapping cycles and entries out of order, making it unclear whether psychedelic use preceded therapy or how much occurred between assessments.
The authors stress that Mrs. P’s case does not reflect typical psychiatric patients, who frequently take daily prescription medications. Apart from a brief trial of methylphenidate, she took no psychiatric drugs while using psychedelics, and combining psychedelics with certain psychiatric medications can provoke severe medical emergencies. The researchers therefore call for further pilot studies to test whether combining psychedelics with psychotherapy could be safe and beneficial for personality disorders.
The study, “Could psychedelics be useful in the treatment of patients with personality disorder? A case report of psychotherapy with concomitant use of psychedelics,” was authored by Martin Blay, Inès Benmakhlouf and Mario Speranza.
