This work aims to shed light on the differential diagnosis of complex post-traumatic stress disorder (cPTSD), post-traumatic stress disorder (PTSD), and borderline personality disorder (BPD) within the context of intimate partner violence (IPV), which represents a highly innovative field of clinical research. To this end, a critical review of the literature was conducted to identify and compare the clinical patterns and symptomatic overlaps among cPTSD, PTSD, and BPD, with an emphasis on their manifestation in both IPV victims and offenders. The results show that despite some symptomatic similarities, cPTSD, PTSD, and BPD have distinct clinical patterns of interpersonal violence. Specifically, disturbances in self-organization (DSO) are more commonly found in offenders, while the diagnosis of cPTSD seems more aligned with the psychological functioning of victims. In addition, cPTSD and specific characteristics of BPD, such as fear of rejection and instability of identity, constitute risk factors for IPV victimization. cPTSD is shown as a predisposing factor not only for IPV victims but also for offenders, while PTSD emerges as a consequential factor. The specific pathways linking PTSD, cPTSD, and BPD with IPV have significant implications for clinical practice. Further research is needed to understand these profiles and the mechanisms linking trauma-related features to IPV, which is crucial for implementing effective violence prevention programs.

Background: Patients with Complex Trauma (CT) may have an impaired ability to trust others and build intimate relationships due to non-integrated representations of self and others. This sometimes leads to an oscillation between needing and fearing intimacy in their adult relationships. This dynamic can occur in the therapeutic relationship, undermining the effectiveness of therapy and affecting the mental health of both the patient and the therapist. To date, no study has analyzed interpersonal patient–therapist dynamics in cases of CT. The present case aims to fill this gap by exploring relational cycles between the therapist and the patient during the therapeutic process in terms of goals and self–other beliefs. Methods: The methodology consisted of a shared and integrated reconstruction by the patient and therapist, both with clinical expertise in psychology, of the impasse in their therapeutic relationship. The reading was done through the lens of the cognitive model of Pathological Affective Dependence, a theory of traumatic relationships, by describing the primary interpersonal cycles occurring in the therapeutic relationship (altruistic, deontological, and vulnerable). Results: The condition of CT leads to several alliance breakdowns and specific interpersonal cycles, leading to new healing meanings for the patient and the relationship itself. Limitations: The study’s main limitation is that it consists of a qualitative analysis of the therapeutic relationship without data that can quantify the clinically observed changes. Conclusions: This case report demonstrates how CT, PAD and the fear of intimacy can be risk factors for the therapeutic alliance and how the therapeutic relationship constitutes a fundamental tool for intervention effectiveness in patients who experience unmet primary needs.

This work aims to shed light on the differential diagnosis of Complex Post-Traumatic Stress Disorder (cPTSD), Post-Traumatic Stress Disorder (PTSD), and Borderline Personality Disorder (BPD) within the context of Intimate Partner Violence (IPV), which represents an extremely inno-vative field of clinical research. To this end, a critical review of the literature was conducted to identify and compare the clinical patterns and symptomatic overlaps among cPTSD, PTSD, and BPD, with an emphasis on their manifestation in both victims and offenders. The results show that despite some symptomatic similarities, cPTSD, PTSD and BPD have distinct clinical patterns in IPV. Disturbances in Self-Organization (DSO), are more commonly in offenders, while the di-agnosis of cPTSD is more aligned with the victims. In addition, cPTSD and characteristics of BPD, such as fear of rejection and instability of identity, constitute risk factors for IPV victimiza-tion. cPTSD is a predisposing factor not only for victims but also for offenders, while PTSD emerges as a consequential factor. The specific pathways linking PTSD, cPTSD, and BPD with IPV have significant implications for clinical practice. Further research is needed to understand these profiles and the mechanisms linking trauma-related features to IPV, which is crucial for imple-menting effective violence prevention programs.

Specific relational risk conditions may increase vulnerability to dysfunctional, coercive, or unsafe intimate relationships in adulthood. Pathological Affective Dependence (PAD) and Fear of Intimacy (FoI) represent two clinically relevant relational conditions associated with difficulties in adult intimacy. PAD is characterized by the perceived need to preserve the relational bond at all costs, even when the relationship is harmful or highly costly. FoI is characterized by avoidance of emotional closeness and defensive distancing from intimacy. Although recent research has linked these patterns to relational dysfunction and intimate partner violence risk, little is known about the attachment profiles, early relational experiences, and affective–cognitive mechanisms that differentiate PAD and FoI. The present study addressed this gap by examining, for the first time, PAD and FoI within a shared framework of attachment, recalled parental styles, and self‐ versus other‐focused threat processes. Specifically, we aimed to (a) characterize adult attachment profiles and early relational experiences associated with PAD and FoI and (b) test whether shame and paranoia function as distinct mechanisms indexing negative views of the self versus others. A community sample of 245 adults ( M = 31.9) completed measures of PAD, FoI, adult attachment, recalled parental styles (indifference, overcontrol, abuse), external shame, and paranoid ideation. PAD was uniquely associated with fearful attachment, whereas FoI was positively related to dismissing and negatively to secure attachment. Parental overcontrol and indifference predicted both outcomes; paternal overcontrol was especially relevant for PAD, and parental indifference for FoI. Mediation analyses supported distinct pathways: overcontrol was associated with higher shame, which in turn was associated with higher PAD, whereas indifference was associated with higher paranoia, which in turn was associated with higher FoI. Findings clarify PAD and FoI as distinct but related relational risk configurations and suggest tailored intervention targets to promote healthier intimacy and affect regulation.

This study evaluated the feasibility and preliminary effects of in‐person Imagery Rescripting for Pathological Affective Dependence (ImRs‐PAD), a trauma‐focused and mechanism‐based intervention for survivors of intimate partner violence (IPV). ImRs‐PAD targets trauma‐related relational dynamics—specifically Pathological Affective Dependence (PAD)—together with the related relational processes that may contribute to difficulties disengaging from abusive relationships. PAD is conceptualized as a relational constraint rooted in trauma, rather than individual pathology or responsibility. This study employed an exploratory single‐arm repeated‐measures proof‐of‐concept design conducted in Italy. Eighteen adult women survivors of IPV received a 13‐session ImRs‐PAD intervention, delivered within anti‐violence services by supervised psychotherapy trainees. Primary outcomes included state and trait levels of PAD, relational commitment and intention to return to the abusive relationship, which were conceived as different, although potentially overlapping self‐report indicators of relational entrapment. Secondary outcomes assessed complex trauma symptoms, psychological well‐being and resilience. Participants were assessed at baseline/pre‐treatment, mid‐treatment, post‐treatment and 1‐month follow‐up. Significant reductions were observed in PAD, relational commitment and intention to return over the course of the intervention. Improvements were also noted in trauma‐related symptoms, psychological well‐being and resilience from baseline to post‐treatment. At 1‐month follow‐up, changes in the primary relational outcomes and resilience were largely maintained, whereas trauma‐related symptoms showed slight attenuation but remained significantly improved relative to baseline. ImRs‐PAD appears to be a feasible and promising intervention in real‐world anti‐violence centre settings, specifically targeting unmet relational needs implicated in IPV‐related entrapment. Changes in the primary relational outcomes were more consistently maintained at follow‐up than improvements in trauma‐related symptoms after treatment termination, suggesting the potential importance of integrating such interventions within broader systems of psychosocial support. Trial Registration: ClinicalTrials.gov identifier: NCT06670326