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A new case report describes a 37-year-old woman with severe personality disorders and ADHD who improved markedly over a year of specialized psychotherapy, during which she also took psychedelic drugs on her own. 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 report, published in Psychiatry Research Case Reports, raises the question of whether psychedelics might aid psychotherapy for personality disorders, a possibility the authors say needs testing in further pilot studies.
Personality disorders are deeply ingrained patterns of thinking, feeling, and behaving that deviate from cultural expectations and cause severe distress or difficulty in daily life. People with these conditions often struggle with a distorted sense of self, extreme emotional swings, and turbulent relationships. Narcissistic personality disorder involves a fragile sense of self-esteem regulated through grandiosity or extreme vulnerability to criticism, while borderline personality disorder is marked by intense fears of abandonment, impulsive actions, and sudden shifts in mood.
Paranoid personality disorder involves pervasive, unwarranted distrust and suspicion of others, while antisocial personality disorder involves a persistent disregard for the rights of others. Talk therapy remains the primary treatment for these conditions because no medications have been specifically approved to resolve core personality pathology.
In recent years, psychiatrists and psychologists have begun exploring whether psychedelic substances like psilocybin and MDMA might help treat stubborn mental health conditions. This involves either macrodosing, where a patient takes a large dose to induce an intense, mind-altering experience, or microdosing, which entails taking tiny, repeated doses that do not cause hallucinations.
The authors of a 2020 review made the case for researching psychedelics as part of treatment for borderline personality disorder, noting that the drugs may influence some of the same targets as existing therapies, including emotional control, self-compassion, and social functioning. Similarly, a study of clinicians noted trauma-related parallels between PTSD and borderline personality disorder, suggesting that the goals of MDMA-assisted therapy align closely with those of dialectical behavior therapy, a skills-based therapy developed for borderline personality disorder.
Actual clinical data on using psychedelics for personality disorders has remained minimal. Before the new study, the only previously published case of its kind, to the authors’ knowledge, was a 2020 case report describing a 39-year-old woman with treatment-resistant depression and a complex personality disorder who received escalating weekly doses of LSD in a hospital setting. That patient experienced rapid reductions in emotional instability, depressed mood, and suicidal thoughts for about a week after each dose, even without experiencing acute hallucinogenic trips or receiving specialized talk therapy.
To expand on this small body of evidence, Martin Blay of the ADDIPSY Outpatient Addictology and Psychiatry Center in Lyon and Université Paris-Saclay, alongside his colleagues Inès Benmakhlouf and Mario Speranza, documented the trajectory of a patient who combined structured psychotherapy with her own independent psychedelic regimen.
The descriptive case report focuses on a 37-year-old woman, referred to as Mrs. P, who sought treatment at an outpatient center for severe personality pathology, ADHD, and cannabis use disorder. Mrs. P reported a history of severe physical and emotional abuse from her parents during childhood, as well as an attempted rape in 2016, and she was entirely estranged from her family. Her family medical history included two cases of schizophrenia in her grandmother and sister, bipolar disorder in her mother, and alcohol use and depressive disorders among other relatives. Her own psychiatric care began in 2009 after a suicide attempt, resulting in an initial diagnosis of bipolar disorder and over a decade of unsuccessful medication and psychoanalytic therapy.
In late 2021, specialists revised her diagnosis to mixed personality disorder and ADHD, and she completed a year of dialectical behavior therapy without improvement before arriving at the authors’ clinic. At her initial intake, she was highly agitated, spoke rapidly, and reported severe emotional outbursts, frequent conflicts with her partner, suicidal behaviors, and deep mistrust and contempt toward others. The clinicians administered a battery of standardized interviews and questionnaires before treatment began and again after one year. At baseline, using the Structured Clinical Interview for DSM-IV Personality Disorders, she met the diagnostic thresholds for borderline, antisocial, narcissistic, and paranoid personality disorders.
The treatment team proposed a weekly individual therapy program alongside a prescription for methylphenidate to manage her hyperactivity. The psychotherapy was based on Good Psychiatric Management, a structured approach that helps patients understand how their symptoms relate to interpersonal sensitivity and daily stressors. She also joined a six-week psychoeducation group for narcissistic personality disorder, an intervention previously developed and outlined in a 2024 proposal by all three of the study’s authors and their colleagues. Mrs. P initially refused all psychiatric medication, accepted the psychotherapy, and informed her clinicians during the first sessions that she had begun buying psychedelics online to self-administer alongside her therapy.
Because of her family history of schizophrenia, the clinicians had serious safety concerns about her psychedelic use, as these substances can trigger psychotic episodes in vulnerable people. However, Mrs. P insisted she would take the substances regardless of their advice. To preserve the fragile therapeutic relationship and monitor her for any emerging signs of psychosis, the team agreed to proceed with the psychotherapy while discussing her experiences openly during sessions. Each weekly therapy session reviewed her recent emotional outbursts, practiced mentalizing (the ability to understand her own and others’ mental states and motives), linked her current reactions to past traumas, and set practical goals for emotional regulation.
Over the course of her treatment, Mrs. P logged her psychedelic intakes, tracking the dates, doses, substances, and personal insights gained, while abstaining from cannabis and other drugs during the year. In most microdosing cycles she took a dose every two to three days, using small amounts of psilocybin truffles, an LSD analog called 1cP-LSD, or a mescaline analog called methallylescaline. Her 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, about five times her usual dose, resulting in an overly intense experience accompanied by temporary side effects including a rapid heart rate, anxiety, and impaired physical coordination, though she did not seek medical care.
After one year of this combined regimen, psychometric testing showed substantial reductions across multiple symptoms. On the structured diagnostic interview, her narcissistic criteria fell from five to none and her paranoid criteria from four to one, so she no longer qualified for either diagnosis. Her borderline criteria fell from eight to five and her antisocial criteria from six to four, still enough for both diagnoses. Her scores for avoidant and obsessive-compulsive personality disorder criteria remained unchanged at one and three.
Symptom severity scales echoed these diagnostic shifts. Her borderline symptom severity dropped by 72.2 percent on the self-reported Borderline Symptom List (from 3.13 to 0.869 on a 4-point scale) and by 68.8 percent on the clinician-administered Zanarini Rating Scale (from 16 to 5 on a 36-point scale), shifting her borderline symptoms from high or moderate down to moderate or mild. Measures of pathological obsessive-compulsive traits and covert narcissism also declined by about 20 to 32 percent. Her scores on a brief pathological narcissism inventory, which were already within the normal range at baseline, showed a modest reduction in vulnerable narcissism and almost none in grandiose narcissism.
Measures of emotional and social functioning also improved over the year. Her difficulties with emotion regulation decreased by 29.1 percent (from 127 to 90), and her impulsivity score dropped by nearly 12 percent. Her score on the Toronto Alexithymia Scale (which measures alexithymia, the difficulty recognizing and describing one’s own emotions) dropped by 28.3 percent, moving her out of the possible-alexithymia range. Her social functioning frequency rose by 24.1 percent and her social satisfaction increased by 85.7 percent (from 21 to 39 out of 40), though her overall functional impairment on the Sheehan Disability Scale changed little, moving from 27 to 25 out of 30.
Clinically, Mrs. P stopped having suicidal crises and began viewing her intense mistrust of others as an outdated defense mechanism rooted in childhood trauma rather than an objective reality. Her ADHD hyperactivity remained pronounced, and she had to rely on daily organizational strategies to avoid exhaustion after briefly trying and stopping stimulant medication. The authors hypothesize that the psychedelic intakes facilitated her progress in therapy, noting that her major interpersonal breakthroughs in sessions closely followed her macrodosing experiences, though they emphasize that this idea remains highly speculative and should be considered with the utmost caution.
In her own written perspective, Mrs. P recalled her mindset before treatment: “I was like an injured wild animal, like ‘me against the whole world.'” She credited the psychedelics with shifting her out of emotional dissociation and helping her replace shame and guilt with self-compassion, while crediting the non-judgmental psychotherapy with helping her integrate those lessons and trust other people.
Aspects of Mrs. P’s progress align with several earlier studies on psychoactive substances, though those studies used different designs and populations. Her reductions in narcissistic traits parallel a 2020 survey of the general population, which examined self-reported traits rather than clinical personality disorder symptoms in a psychotherapy patient, and found that awe-inspiring psychedelic experiences were associated with lower maladaptive narcissism. Her reductions in borderline symptoms also align with a clinical study of depressed patients with borderline personality disorder that observed symptom improvements following intravenous ketamine infusions rather than classic psychedelics.
Additionally, a 2024 prospective survey of adults microdosing for ADHD found that microdosing was associated with reductions in ADHD symptoms and one aspect of emotion regulation over four weeks compared to conventional medication. That survey relied on online self-reports rather than a clinical case combining micro- and macrodosing with talk therapy. While Mrs. P similarly showed improvements in emotion regulation and impulsivity, her core hyperactive ADHD symptoms persisted throughout the year.
At the same time, this single positive outcome stands in tension with broader safety data regarding personality disorders and psychedelic use. In a 2024 observational study that tracked general drops in mental wellbeing across mostly unsupervised and recreational psychedelic use rather than structured, specialized psychotherapy, 16 percent of all participants reported worse mental health afterward, and people with a history of personality disorders accounted for a disproportionate 31 percent of those negative outcomes.
The case report’s authors cite this research as showing roughly a fourfold higher risk of worsening mental health among people with personality disorders. Although the authors acknowledge that no such worsening occurred in Mrs. P’s case, they also point to a phase 2 trial of psilocybin for treatment-resistant depression in which all three participants who showed suicidal behavior after receiving the highest dose had a history of suicide attempts or self-injury, a pattern the authors suggest may indicate underlying personality disorders.
There are several other caveats to keep in mind when interpreting this case report. Because Mrs. P chose the timing, substances, and doses on her own without supervised drug sessions, her care cannot be classified as standard psychedelic-assisted psychotherapy, and it is impossible to separate the effects of the drugs from the effects of the talk therapy. As the authors note, Mrs. P might have achieved these same improvements through the specialized psychotherapy and strong therapeutic alliance alone.
Other factors could explain her progress. People who enter treatment in crisis often improve from that low point regardless of the intervention, and stopping cannabis use (one of the reasons she was referred for care) may by itself ease mood swings, impulsivity, and the kind of suspiciousness reflected in her drop from four paranoid criteria to one. Her enthusiasm for psychedelics could have shaped her questionnaire answers, and the acknowledgments thank her for helping write the paper. In addition, case reports tend to be written up when outcomes are good, whereas patients in similar situations who got worse would be unlikely to produce a paper like this.
Questions also surround the drugs she took and the timeline of her use. The substances she bought online were never tested, so their actual content and doses cannot be verified. The paper’s dates also conflict: the text says her therapy began at the end of 2023, yet her psychedelic log starts in September 2022 and includes overlapping cycles and out-of-order entries. That makes it unclear whether she started psychedelics before therapy or how much of her use fell between the two assessments.
The authors further note that Mrs. P’s case does not reflect typical psychiatric patients, who frequently take daily prescription medications. Aside from her brief trial of methylphenidate, she took no psychiatric medications while using psychedelics. Combining psychedelics with some psychiatric drugs can trigger severe medical emergencies, such as seizures when mixed with lithium or dangerous spikes in blood pressure when combined with monoamine oxidase inhibitors, an uncommon class of antidepressants.
The researchers suggest that further pilot studies are needed to test whether combining psychedelics with psychotherapy could be safe and useful for patients with 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.