Evaluating personality pathological profiles in temporal lobe epilepsy and functional seizures according to DSM-5 alternative model for personality disorders.

The 5th version of DSM introduced an Alternative Model for Personality Disorders (AMPD), which conceptualizes personality pathology as result of impairments in personality functioning and maladaptive personality traits. As well-known, personality disorders represent a common psychiatric comorbidity in Temporal Lobe Epilepsy (TLE) and Functional Seizures (FS). This study aims to characterize personality pathology in these populations according to DSM-5 AMPD using the Level of Personality Functioning Scale-Brief Form 2.0 and Personality Inventory for DSM-5. Furthermore, association between pathological personality traits and psychopathological or clinical variables was also explored. Ninety individuals with TLE and 61 with FS, along with 66 healthy controls prospectively underwent an extensive personality assessment as well as a psychopathological and behavioral evaluation. A pathological personality profile was identified more frequently in TLE (30/90,33.3 %) and FS (18/61,29.5 %) rather than in HC (10/66,15.2 %), with increased odds in both groups (TLE = 2.71;FS = 2.53). In detail, personality trait-specified profiles were the most common in TLE (37.5 %), whereas borderline personality profiles predominated in FS (43.5 %). Across both TLE and FS populations, individuals with concomitant pathological personality profiles showed higher levels of depression (TLE:p < 0.001;FS:p < 0.001), anxiety (TLE:p < 0.001;FS:p = 0.02), alexithymia (TLE:p < 0.001;FS:p = 0.002), dissociative symptoms (TLE:p < 0.001;FS:p = 0.03), impulsivity (TLE:p = 0.002;FS:p = 0.03), and emotional dysregulation (TLE:p < 0.001;FS:p = 0.003). A non-significant trend toward a higher prevalence of pathological personality profiles was observed in TLE individuals with recurrent seizures (OR = 2.29;p = 0.07). In conclusion, dimensional personality assessment revealed a great prevalence of pathological personality profile in TLE and FS, highlighting distinct distributions and strong association with broader psychopathological burden, supporting its clinical value in routine evaluation of these populations.