Evolutionary Systems Therapy Archives

November 12, 2024November 12, 2024

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).

October 2, 2024October 2, 2024

Two new studies registered

Evolutionary Systems Therapy, Evolution and Personality Lab

Two new studies registered at our lab! The main goal of Evolution & Personality Lab is to investigare personality and its pathology through the lens of evolutionary psychology and psychopathology. Consistently with this goal and ongoing studies, we registered two research protocols.

The first study is aimed to validate cross-culturally the evolutionarily informed conceptualization model we have worked on in the last few years. The protocol has been registered on ClinicalTrials.gov and comprises three studies involving teams from USA, Italy, Spain, Poland, China: (i) to explore the inter-rater reliability of the model in therapists; (ii) to explore the acceptability by therapists and patients; (iii) to explore the cross-cultural and cross-theoretical validity of training and application of the model. We hope this project will confirm that our model can be used within different cultural contexts and by clinicians with different therapeutic backgrounds.

The second study is aimed to explore the clinical utility of the three interpersonal styles and dynamics we have tested in a previous trial. In a recently concluded study we found that patients with personality pathology may show three prominent interpersonal styles that would correspond to the three main spectra of psychopathology: perfectionistic style and internalizing spectrum; antagonistic style and externalizing spectrum; schizotypal style and reality impairing/psychosis spectrum. The methodology used was potentially biased (patients were forced to chose only one style through a dummy variable). In this new study (registered on OSF) we used de-sitgmatizing labels for the three styles and offer a continuous Likert-type scale.

These two new studies registered on ClinicalTrials and OSF will better describe the clinical utility of our protocol for conceptualizing and treating personality pathology: namely, Evolutionary Systems Therapy. This protocol may be hopefully useful not only as and independent treatment. We are not that interested in proving what we do is good! It would be more important to show how an evolutionarily informed conceptualization may support different kinds of treatments (we are involving colleagues from a variety of background: psychodynamic, integrative, humanistic, cognitive, etc.) and may be reliable in spite of the different cultural background and interpersonal style of the patient.

September 25, 2024September 25, 2024

Interpersonal dynamics and styles in personality pathology

We have finally presented our work on interpersonal dynamics and styles in personality pathology. During a symposium a was chairing on this topic at the 7° Congress of the European Society of Personality Disorders I summarized our pre-registered trial on the feasibility of our Evolutionary Systems Therapy for personality pathology at large.

This study is part of the activities of our Evolution and Personality Lab and showed promising results. The paper about interpersonal dynamics and styles in personality pathology is under submission….so figers crossed!

The objective of this study was to evaluate the feasibility and rationale of a six-month Evolutionary Systems Therapy for personality pathology. In doing so, we employed a conceptualization that is supposed to be consistent with dimensional models of personality disorders and evolutionary psychopathology. Twenty-one patients were recruited and stratified into three homogeneous subgroups in accordance with spectra of psychopathology (internalizing, externalizing, schizotypy). An evolutionarily informed conceptualization was shared with patients based on three interpersonal styles that we consider to be prominent in the three spectra. Feasibility indicators were evaluated monthly, while changes in clinical measures were assessed by three procedures: ecological momentary assessment, monthly self-report measures, pre-post self-reports and interviews.

Eighteen out of 21 patients remitted from diagnosis, all indicators suggested a high feasibility. Individually, all patients showed reliable changes in measures of symptomatology and personality pathology. A repeated-measures ANOVA reported large effect sizes (η² ranging between .892 to .979) for the whole sample. Ecological momentary assessment suggests that the three interpersonal styles are prominent in the corresponding spectra both before and after the treatment. This study supports the need for a confirmatory randomized controlled trial on the clinical utility of Evolutionary Systems Therapy. Despite the limited sample size, the findings are consistent with the importance of a dimensional approach to psychopathology and of an evolutionarily informed conceptualization of personality disorders.

July 19, 2024July 19, 2024

New advancements in Evolutionary Systems Therapy

We are collecting new advancements in Evolutionary Systems Therapy. This is a new form of psychotherapy that integrates evolutionary psychopathology, compassion focused therapy and metacognitively oriented treatments.

To date, Evolutionary Systems Therapy (EST) has shown promising results in the treatment of personality disorders with traits primarily related to psychoticism and detachment: one randomized controlled trial (RCT) suggested that EST without medication is at least as effective as CBT with medication for patients diagnosed with schizotypal personality disorder (Cheli et al, 2023); some case series have shown the feasibility of EST for paranoid and schizoid personality disorders and for autistic traits (Cheli et al., 2024; Cheli, Chiarello & Cavalletti, 2023; Cheli & Cavalletti, 2023); moreover, we suggest how it can work with adolescents with schizotypal traits (Cheli et al., 2023).

Now we are working on new advancements in Evolutionary Systems Therapy. First, a new RCT is closed to end and – fingers crossed – it should confirm and extend previous findings. Second, an open trial currently underway is investigating the clinical utility of EST for all personality disorders. Third, a single case on comorbid eating and personality disorder, plus a 5 case series on obsessive compulsive personality disorder have been submitted. The single case is accessible as preprint. It investigates the role of self-recriminatory dialogue in a young female diagnosed with anorexia nervosa, borderline and obsessive-compulsive personality disorder.