A 37-year-old woman with diagnoses of borderline, antisocial, narcissistic and paranoid personality disorders no longer met the criteria for two of them after a year of specialized psychotherapy, according to a case report in Psychiatry Research Case Reports. During treatment, she also took psychedelic substances on her own, despite her clinicians’ safety concerns.
The report describes substantial reductions in her narcissistic and paranoid symptoms, as well as improvements in borderline symptoms, emotional regulation and social satisfaction. She stopped experiencing suicidal crises and came to view her mistrust of others as a response rooted in childhood trauma. Her ADHD-related hyperactivity, however, remained pronounced.
The patient, identified as Mrs. P, received weekly therapy based on Good Psychiatric Management, alongside a psychoeducation group for narcissistic personality disorder. She initially declined psychiatric medication and told the clinicians that she had begun buying psychedelics online. Because her family history included schizophrenia, the team was concerned about the possibility of psychosis. They continued therapy while discussing her drug use and monitoring for warning signs.
Mrs. P recorded her use of substances including psilocybin truffles, an LSD analog, a mescaline analog and MDMA. Her regimen included both small repeated doses and larger sessions. During one session, a weighing error led her to take 600 milligrams of MDMA, around five times her usual dose. She experienced a rapid heartbeat, anxiety and impaired coordination, but did not seek medical care.
At the end of the year, an assessment found that her narcissistic criteria had fallen from five to none, and her paranoid criteria from four to one. She no longer met the diagnostic threshold for either disorder. Her borderline criteria decreased from eight to five and antisocial criteria from six to four, but she still met the criteria for both.
The authors suggest the psychedelic experiences may have helped her make progress in therapy, noting that some major interpersonal breakthroughs followed larger doses. Mrs. P said the substances helped her move away from emotional dissociation and toward self-compassion, while she credited the non-judgmental therapy with helping her integrate those experiences and trust others.
However, the case cannot establish that psychedelics caused the improvements. Mrs. P chose the substances, timing and doses herself, and the drugs were not tested to confirm their contents. The report also cannot separate any effects of psychedelics from those of psychotherapy, the therapeutic relationship, or her decision to stop using cannabis. The authors note that specialized therapy alone may have produced similar progress.
The case is also unusual: Mrs. P took no psychiatric medication during most of the period described. The authors warn that combining psychedelics with some psychiatric drugs can cause serious medical emergencies. They also cite safety research in which people with a history of personality disorders were disproportionately represented among those reporting worse mental health after psychedelic use.
The researchers conclude that further pilot studies are needed to assess whether psychedelics could be used safely alongside psychotherapy for personality disorders. They emphasize that this single case is preliminary evidence, not proof that the drugs are an effective treatment.
Sources: PsyPost.