Erik Simonsen

University of Copenhagen and Psychiatry Region Zealand

Objective: To examine the concurrent validity of the Anxiety Symptom-scale against two well-being scales, the Cantril Ladder (CL) and World Health Organization Well-Being Index (WHO-5), to test the algorithm defining anxiety against these scales, and identify cut-off points for the Anxiety Symptom-scale sum score. Subjects: 14,405 adult responde...

Purpose: The purpose of this study is to describe the prevalence of anxiety disorders in a general population and the association to socioeconomic position (SEP), which has not been described in a Danish context before. Material and methods: We present data on anxiety symptoms from respondents in the rural-provincial Lolland-Falster population H...

Background Clozapine is the gold standard for treating treatment-resistant schizophrenia (TRS) although widely underutilised. Both organisational, patient- and clinician related reasons for the underutilisation have been reported, however, the clinical impact of either in real-world settings is not fully elucidated. Aim This audit aimed to evaluat...

Borderline personality disorder (BPD) is a highly studied condition. During the last 3 decades, the understanding of the disorder has substantially changed, based on thorough, accumulating research. At the same time, the interest in BPD is still not decreasing but continues to grow. This article aims to critically discuss research trends in clinica...

Disconnection from education and employment in youth termed Not in Education, Employment or Training (NEET) has global attention. Major societal economic consequences and detrimental individual consequences follow disconnection. On the one hand, mental health problems are recognized as essential factors in disconnection, and on the other hand, yout...

BACKGROUND Telemedicine (TM) has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the Covid-19 pandemic. Furthermore, TM usage is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in the scientific literature. However, there is a need for...

Background Among people with a diagnosis of borderline personality disorder (BPD) who are engaged in clinical care, prescription rates of psychotropic medications are high, despite the fact that medication use is off‐label as a treatment for BPD. Nevertheless, people with BPD often receive several psychotropic drugs at a time for sustained periods...

Current evidence suggests that individuals with borderline personality disorder (BPD) are likely to benefit from specialized, or BPD-specific, treatments. Dialectical behavior therapy (DBT) and mentalization-based treatment (MBT) are currently the most intensively researched BPD treatments. Reviewing the current research, this paper highlights sim...

Background Schizophrenia spectrum disorders typically emerge during adolescence or early adulthood. Often the symptomatology is vague initially, while a marked functional decline and social withdrawal can be seen. A group of young people with such social and functional impairments is the so-called “Not in Education, Employment or Training” (NEET),...

Introduction Major advancements in technology have led to considerations how telemedicine (TM) and other technology platforms can be meaningfully integrated in treatment for psychiatric disorders. The COVID-19 pandemic has placed a further focus on use of TM in psychiatry. Despite the widespread use of TM, little is known about its effect compared...

Therapist behaviour influences group cohesion and the outcome of group psychotherapy. The group members make first hand observations of the therapists in action, and experience the benefit or adversity from it. This study explores patients’ experiences of therapist behaviour and how it is helpful and hindering for progress in cognitive behavioural...

It is unclear whether children with autism spectrum disorders have atypical semantic fluency and lower memory for the semantics of words. Therefore, we examined semantic typicality, fluency and recall for the categories of fruits and animals in 60 children with autism aged 7–15 years (boys: 48/girls: 12) compared to 60 typically developing controls...

Background and objectives This study sought to investigate the role of personality pathology for explaining functional impairment in patients with hypochondriasis, while accounting for the influence of health anxiety severity. Methods Patients diagnosed with hypochondriasis (N = 84; 60% women) were administered interview- and self-report instrumen...

Maladaptive personality traits may link childhood trauma history to current internalizing symptoms. Scandinavian Journal of Psychology. Research supports a strong relationship between childhood maltreatment and internalizing psychopathology (e.g., anxiety and depression), and features of personality are assumed to explain some of this relationship....

The Reflective Functioning Questionnaire for Youths (RFQY) is a self-report measure of reflective functioning (RF) also referred to as mentalizing. Lower levels of RF are characteristic of a wide range of mental disorders and are especially relevant in the assessment of personality pathology. The goal of the current study is to examine the psychome...

Background: Control interventions in randomised trials provide a frame of reference for the experimental interventions and enable estimations of causality. In the case of randomised trials assessing patients with mental health disorders, many different control interventions are used, and the choice of control intervention may have considerable imp...

Cognitive behavioural therapy (CBT) is recommended as the frontline treatment for depression and anxiety disorders and has been implemented in a wide range of mental health care contexts. In Danish mental health services, group CBT is the most common psychotherapeutic treatment format. Recently, a standardized, time-restricted treatment format has...

Information regarding welfare consequences of early onset of Borderline Personality Disorder (BPD) is limited. This nationwide study aimed to estimate the educational and employment outcome and health care costs of patients with early-onset BPD compared with matched controls. All patients (< 19 years) with first diagnosis of BPD in the Danish Patie...

Background We aimed to assess the psychometric properties of the ten-item Anxiety Symptom Scale (ASS) using Rasch analysis. Data from the Lolland-Falster Health Study (LOFUS) were used including ASS data for 16,137 persons aged 18-90 years. Methods Fit to the Rasch model, ordering of response categories, dimensionality testing, test for differenti...

Background A recently updated Cochrane review supports the efficacy of psychotherapy for borderline personality disorder (BPD). Aims To evaluate the effects of standalone and add-on psychotherapeutic treatments more concisely. Method We applied the same methods as the 2020 Cochrane review, but focused on adult samples and comparisons of active tr...

Purpose: Enhancing early help-seeking is important for early intervention in psychosis. However, knowledge is limited about those help-seekers who are not initially found to have psychotic symptoms when assessed in services aiming at psychosis detection and, thus, deemed ineligible for early intervention of psychosis programs. We aimed to examine c...

Introduction Schizophrenia is a serious mental illness characterized by a range of symptoms such as distortions in reality, emotional abnormalities and deficits in cognition. Recovery from severe mental illness can be conceptualized in a number of ways. Clinical recovery has a focus on symptoms and functioning whilst personal recovery describes the...

Background To what extent psychotic symptoms in first-episode psychosis (FEP) with a history of childhood interpersonal trauma (CIT) are less responsive to antipsychotic medication is not known. In this longitudinal study, we compare symptom trajectories and remission over the first 2 years of treatment in FEP with and without CIT and examine if di...

Introduction The atypical antipsychotic clozapine has shown superior efficacy compared with other antipsychotics and is the gold standard for treating otherwise treatment resistant schizophrenia. However, multiple studies have found that clozapine is underutilised in most parts of the world. A few reviews of literature addressing barriers to clozap...

Borderline personlighedsforstyrrelse er en alvorlig psykisk lidelse, som historisk har været omgærdet med behandlingspessimisme. Artiklen opsummerer den eksisterende evidens for psykoterapeutisk behandling af borderline personlighedsforstyrrelse og konkluderer, at der er basis for moderat optimisme. Afslutningsvis peger artiklen på fremtidig forskn...

The newly added diagnosis complex posttraumatic stress disorder (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11) includes a domain of disturbances in self-organization (DSO), in addition to PTSD. The DSO construct appears to have definitional overlap with the dimensional personality pathology severity measure, pe...

Borderline (BPD) and schizotypal personality disorder (SPD) were introduced in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). However, the clinical differentiation of the 2 diagnoses (e.g., psychotic-like features) was challenging for diagnostic classification and clinical management. With the introduction of th...

Borderline personality disorder (BPD) is a serious mental health condition associated with severe symptoms of distress and poor quality of life (QoL). Research outside the field of BPD suggests that ego‐resiliency is negatively associated with psychopathology and positively associated with a range of positive life outcomes. Thus, ego‐resiliency may...

Objective: Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder diagnosed in increasing proportions of children and adolescents. The psychostimulant methylphenidate has been considered the first-line pharmacological treatment for children and adolescents with ADHD for more than 60 years. Considering recent publications...

Background: Many people with refugee backgrounds suffer from trauma-related complex social and psychological problems, and compliance with standard psychological treatment tends to be low. More culturally adaptable treatment options seem to be needed. Objective: We aimed to investigate whether the music therapy method: ‘trauma-focused music and ima...

Objective The objective of the current study was to quantitatively explore aspects of external validity, both researcher's choices (eligibility) and patient's choices (consent), of a recently conducted clinical trial. Methods A cohesive comparison between the MEDACIS trial (NCT02451293) database and a national quality and research database was con...

Background: People suffering from Borderline Personality Disorder (BPD) seem to have incoherent autobiographical narratives. Tentative evidence suggests that reduced narrative coherence of autobiographical memories is associated with insecure attachment. However, it remains unknown whether incoherent autobiographical narratives in people with BPD a...

Previous research has repeatedly demonstrated positive associations between negative affect (NA) and borderline personality disorder (BPD) symptoms in daily life, but studies have rarely addressed potential effects of positive affect (PA). Consequently, little is known about how PA in daily life covaries with symptoms of BPD. The authors assessed t...

Objective The structure of the relationship between ICD-11 Complex Post-traumatic Stress Disorder (C-PTSD) and dissociative symptoms requires more extensive research, especially with respect to the empirical support for a DSM-5 dissociative subtype of PTSD. The present study sought to examine (1) the structural validity of ICD-11 C-PTSD, (2) the as...

Introduction The heterogeneity in people with borderline personality disorder (BPD) and the range of specialised psychotherapies means that people with certain BPD characteristics might benefit more or less from different types of psychotherapy. Identifying moderating characteristics of individuals is a key to refine and tailor standard treatments...

Introduction: Borderline personality disorder (BPD) and schizotypal personality disorder (SPD) were introduced in DSM-III and retained in DSM-5 Section II. They often co-occur and some aspects of the clinical differentiation between the 2 diagnoses remain unclear (e.g., psychotic-like features and identity disturbance). Methods: The present stud...

Group cohesion refers to a sense of belonging, mutual support and identification with other group members. Group cohesion has been associated with better outcomes, lower drop-out rates, more interpersonal support and better participation in psychotherapy. Nevertheless, the role of group cohesion in CBT has not yet received much attention. The ratio...

This study examined prediction of various clinical outcomes in adolescents with borderline personality disorder (BPD) features. Of the 112 adolescents who participated at baseline, 97 were seen at 2-year follow-up, of which 49 (50.5%) had clinically improved, defined as a decrease in BPD pathology of minimum 12 points on the Borderline Personality...

Aim No measure has formally been developed to assess the published ICD-11 model of Personality Disorder (PD) severity. We therefore set out to develop and evaluate the 14-item Personality Disorder Severity ICD-11 (PDS-ICD-11) scale. Method A representative U.S. community sample (N = 428; 50.9% women) and a New Zealand mental health sample (N = 87;...

Criminal behavior in schizophrenia has been associated with a number of risk factors including symptoms of schizophrenia, co-occurring personality disorders (PDs), substance abuse, intellectual and cognitive dysfunctions, history of violence, and a number of sociodemographic variables. However, the relative importance and predictive power of these...

Mentalization-based treatment in groups (MBT-G) has never been tested in adolescents with Borderline Personality Disorder (BPD) in a randomized controlled trial. The current study aimed to test the long-term effectiveness of MBT-G in an adolescent sample with BPD or BPD features (≥ 4 DSM-5 BPD criteria). Hundred and eleven patients with BPD (n = 10...

PurposeThe purpose was to investigate inequalities in access to care among people with possible depression.Method In this nationwide register-based cohort study of 30,593 persons, we observed the association between socioeconomic position (SEP, education/income) and mental health care use (MHCU) four months before the date of first redeemed antidep...

Objective: Information on societal cost of patients with schizotypal disorder is limited. The aim was to investigate the societal costs of schizotypal disorder before and after initial diagnosis including both patients and their spouses. Methods: A register-based cohort study of 762 patients with incident schizotypal disorder (ICD-10; F21) inclu...

Background: People suffering from Borderline Personality Disorder (BPD) appear to have incoherent autobiographical narratives. Tentative evidence suggests that reduced narrative coherence of autobiographical memories is associated with insecure attachment. However, it remains unknown whether incoherent autobiographical narratives in people with BPD...

Innovative technological solutions are increasingly being introduced into psychotherapy. Understanding service user perspectives is a key aspect in adapting this technology to treatment. This study investigated service users’ personal experience of the utility, challenges, and rewards of using an mHealth solution in cognitive behavioral therapy for...

Objectives: To review the effectiveness of psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features. Methods: We included randomized clinical trials on psychological therapies for adolescents with BPD and BPD features. Data were extracted and assessed for quality according to Cochrane guidelines, and summ...

Mediational models

Background: Premature termination from treatment or dropout is prevalent among patients with borderline personality disorder (BPD). To our knowledge, no studies have examined which factors predispose dropout from therapy among adolescents with BPD. The current study examined sociodemographic, clinical and psychological predictors of dropout among a...

Aim The Lolland-Falster Health Study (LOFUS) is an ongoing prospective cohort study at Lolland-Falster, one of the most socio-economically disadvantaged areas of Denmark. The aim of this study was to examine the participation rates and socio-economic determinants of participation in LOFUS, approximately halfway through the data collection. Subject...

Evidence-based treatments for borderline personality disorder (BPD), including mentalization-based treatment (MBT), have not adequately examined changes in positive affect (PA) in the treatment of BPD. Therefore, we developed a new intervention, “mentalizing positive affect,” and evaluated its effect on PA, negative affect, BPD severity, ego-resili...

In composing multi-thematic questionnaires for the Lolland-Falster Health Study (LOFUS), we faced a range of challenges, for which we found limited guidance in the literature. LOFUS is a household-based population study covering multiple medical and social research areas and targeting the mixed rural-provincial population of 103,000 persons on the...

Introduction The heterogeneity in people with BPD and the range of specialised psychotherapies means that people with certain BPD characteristics might benefit more or less from different types of psychotherapy. Identifying moderating characteristics of individuals is a key to refine and tailor standard treatments so they match the specificities of...

Objective: Individual patient characteristics are important in trying to understand why people respond differently to group CBT. Only a few studies have explored therapists’ perceptions of within-patient attributes that may be hindering in group CBT in a mental health setting. Method: We explored the perception of individual patient characteristics...

Despite the fact that family involvement is encouraged in early interventions for borderline personality disorder (BPD), there is a limited knowledge on the experience of caring for adolescents with BPD. This is an exploratory retrospective study nested within a randomized controlled trial that compared mentalization-based treatment (MBT) in groups...

Individuals with borderline personality disorder (BPD) frequently display impairments in the identification of emotional facial expressions paralleled by a negativity bias. However, it remains unclear whether misperception of facial expressions is a key psychopathological marker of BPD. To address this question, the authors examined 43 women diagno...

Background: The evidence for manualized psycho-educative family intervention (FI) in first-episode psychosis (FEP) is well-established to reduce relapse and caregiver distress. Less is known, however, about type and duration of FI. Aim: To compare two different types of manualized family interventions for FEP: Multi-Family Groups (MFG) and Singl...

Objective: Premature termination, or dropout, is a major concern in psychotherapy in general and an issue of particular importance in treatments for borderline personality disorder (BPD). Yet few studies investigating dropout from therapy in adolescent BPD populations exist. This study investigates reasons for dropping out from group-based mentaliz...

Background Several disorder-specific psychotherapy methods have been developed for the treatment of borderline personality disorder (BPD). For this reason people with BPD are no longer regarded as untreatable. To date, dialectical behavior therapy (DBT) according to Linehan and the mentalization-based treatment (MBT) according to Fonagy have been m...

There is insufficient data regarding the excess direct and indirect costs associated with attention deficit hyperactivity disorder (ADHD). Using the Danish National Patient Registry (2002–2016), we identified 83,613 people of any age with a diagnosis of ADHD or who were using central-acting medication against ADHD (primarily methylphenidate, with a...

Background Psychosis and signs of severe mental disorders such as schizophrenia often emerge in adolescence. Much attention has been devoted to identifying the individuals experiencing psychosis at an early stage. Implementation of early detection services is widely acknowledged as effective in reducing treatment delays. However, little is known ab...

Aim: This study investigated the prevalence and factorial structure of personality disorder features in the general community measured with the self-report form of the Standardized Assessment of Personality - Abbreviated Scale (SAPAS-SR). Method: SAPAS-SR was administered to a Danish national community sample (N = 50,326; 53% women). The hierarc...

Background Over the decades, a variety of psychological interventions for borderline personality disorder (BPD) have been developed. This review updates and replaces an earlier review (Stoffers‐Winterling 2012). Objectives To assess the beneficial and harmful effects of psychological therapies for people with BPD. Search methods In March 2019, we...

This review sought to outline the common complicating and facilitating factors during treatment of depressive symptoms in patients with narcissistic pathology, including various specific treatment approaches. A systematic literature search was performed to identify literature describing the co-occurrence of depressive symptoms and narcissistic path...

Depressive symptoms are known to co-occur in patients with narcissistic personality disorder (NPD). From a psychodynamic perspective, perfectionism, shame, and aggression are regarded as prominent in depressed patients. The authors investigated the occurrence of perfectionism, shame, and aggression in patients with NPD, and whether shame is a media...

Objectives: This study investigated the frequency of traumatic experiences, prevalence rates of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD), and overlap with ICD-10 classified disorders in outpatient psychiatry. Method: Overall, 165 Danish psychiatric outpatients answered the International Trauma Questionnaire, the Life...

In general, research has primarily focused on understanding the psychopathology of borderline personality disorder (BPD), but there has been a paucity of research on processes associated with positive mental health. The present study sought to address this gap in knowledge by investigating associations between daily positive and negative emotions a...

The International Classification of Diseases-11th Edition (ICD-11) Classification of Personality Disorders provides the option of coding 5 trait domain qualifiers that contribute to the individual expression of personality dysfunction (i.e., Negative Affectivity, Detachment, Dissociality, Disinhibition, and Anankastia). Previous investigations of t...

Severe health anxiety (SHA)/hypochondriasis (HY) is often associated with personality pathology; however, studies report inconsistent results. In general populations, 12% have a personality disorder (PD). We assessed physician-referred psychiatric outpatients with SHA enrolled for a treatment study (n = 84) with the Structured Clinical Interview fo...

Background: Borderline personality disorder (BPD) typically onsets in adolescence and predicts later functional disability in adulthood. Highly structured evidence-based psychotherapeutic programs, including mentalization-based treatment (MBT), are first choice treatment. The efficacy of MBT for BPD has mainly been tested with adults, and no RCT h...