Psychedelics and personality disorders: the potential risks

Interest in psychedelics is increasing among both researchers and the wider public. These potent substances can change perception, mood and a range of mental processes. They also hold potential as treatments for numerous mental health conditions.

For psychedelics to be used safely and effectively, however, it is essential to understand how they interact with different mental health conditions. This is particularly important in relation to personality disorders.

A personality disorder is a mental health condition characterised by inflexible and unhealthy patterns of thought, functioning and behaviour that can have a substantial impact on someone’s life. Examining how these conditions interact with psychedelics is vital. Psychedelics can profoundly affect mental states, potentially easing or aggravating symptoms in ways that are specific to these disorders.

In a recent study, researchers at Imperial College London examined the complicated link between psychedelics and mental health, drawing attention to possible risks for people with personality disorders.

The researchers gathered self-reported information from 807 people who had used psychedelics in settings ranging from recreational to therapeutic. Participants’ mental wellbeing was assessed before and after psychedelic use with the Warwick-Edinburgh mental wellbeing scale.

A decline in mental health was regarded as meaningful when a person’s happiness and wellbeing dropped by more than would usually be seen among most people in the study.

Psychedelics and personality disorders: differing responses

The researchers focused in particular on participants who reported negative experiences while using psychedelics. Overall, only 16% of participants described a negative response. Yet people with a history of personality disorders accounted for a sizeable share of these negative experiences (31%).

Different personality disorders may produce different reactions to psychedelics. For example, people with histrionic personality disorder - characterised by excessive attention-seeking and emotional overreaction - or borderline personality disorder - involving emotional instability, intense relationships and fear of abandonment - may feel more unwell or less stable.

Those with schizotypal personality disorder, which can involve social anxiety, unusual beliefs and eccentric behaviour, may become more paranoid.

People with narcissistic personality disorder, marked by an exaggerated sense of self-importance, limited empathy and a need for admiration, may find the self-reflective effects of psychedelics difficult. They often struggle to cope with criticism.

Limitations of the psychedelic study

The study has several important limitations. It depended on self-reported data, involved a small participant group and had a 56% dropout rate. Each of these issues could have distorted the findings.

Further limitations include the absence of a control group - people receiving a placebo or standard treatment - against which to compare the results. The types and doses of psychedelics used also varied.

The way participants were selected may likewise have introduced bias. In addition, grouping distinct personality disorders together could obscure the particular risks linked to each condition.

Given these substantial limitations, the findings should be treated with caution. Nevertheless, the study acknowledges the possible mental health benefits of psychedelics and underlines the importance of careful screening for personality disorders.

Safer psychedelic therapy

A personalised approach is necessary if psychedelics are to be used safely and effectively, especially for people who may be vulnerable. This reinforces the need to refine psychedelic therapy so that it is safe and effective for everyone.

As psychedelic therapy continues to develop, understanding how these substances interact with mental health conditions - including personality disorders - remains essential.

More robust research methods are needed, including controlled trials comparing psychedelics with standard treatments or a placebo. Personality disorders should also be confirmed through professional assessment rather than self-reporting alone. Finally, psychedelic doses must be standardised to enable their therapeutic effects to be assessed reliably.

Pouya Movahed Rad, Researcher and Consultant, Psychiatry, Lund University

This article is republished from The Conversation under a Creative Commons licence. Read the original article.