Psychopathological investigation of the personality of “psychic mediums”: Clinical evidence

Introduction and background

In popular culture, the medium is an individual with seemingly controversial psychic abilities in that he or she seems to be able to communicate telepathically and physically with the various spirit entities present on the astral plane, i.e., a plane parallel to the physical plane that can interact with it. Occult mystical tradition reports that such abilities are innate in every human being but only certain people can release their psychic energy flow to concretely achieve the state of connection with the plane where these “entities” are present.

In the literature, such assumptions rise to mere speculation, the result of superstitions and personal beliefs of certain individuals who, using their skills of mental manipulation and credibility, manage to make people believe what they want, especially if the victims are prone to religious beliefs and easy gullibility. Several scientific researchers, however, have tried to prove the inconsistency of the paranormal phenomenon, citing mental disorders, epileptic forms, and electromagnetic field alterations as possible causes; yet, in some cases, these deep-rooted beliefs have faltered.

Such is the case with Moreira-Almeida’s Brazilian research [1], conducted on 115 mediums and their mental health status, to demonstrate a greater psychopathological component than the average population: however, this bias seems to be disproved, having found that the sample subjected to the study presents a high socio-educational level, a low probability of mental problems and a good integration in society compared to the rest of the population.

Attention then shifted to the trance state that the medium experiences during contact with the alleged spirit entity, i.e., that mental condition typical of dissociation, when a lack of integration between consciousness and other cognitive processes (memory, emotions, ...) originates: again, according to Peres’ research. Peres [2], focusing, however, on the moment related to psychography (automatic writing under trance), using a sample of 10 subjects (5 experts and 5 trainees), interesting peculiarities were found with the use of SPECT (single photon emission tomography). In particular, the mediums had 15 to 47 years of experience in automatic writing, performing up to 18 psychographies per month. All were right-handed, in good health, and did not normally use psychotropic drugs. None had problems entering a trance state to perform a psychography task, while they were in a regular state of consciousness during the control task (without psychography). Experienced mediums had low levels of activity in the left hippocampus, right superior temporal gyrus and frontal lobe regions of the brain compared with the control condition (i.e., without trance). In contrast, for the learner mediums, the results were virtually the opposite, especially higher levels of activity in the same frontal regions compared to the control condition, and even more pronounced was the difference compared to the experienced mediums. The frontal lobes are those regions of the brain associated with high cognitive functions, such as reasoning, planning, language generation, and problem-solving. It seems that more experienced mediums reduce their “rational” concentration, has a quirky consciousness, and are less integrated during psychography. In contrast, the less experienced perform the test with more difficulty, activating the more “cognitive” regions of the brain. An additional, more curious aspect is that the better mediums produce more complex and elaborate writing texts than the control condition (without trance) and the less skilled. Typically this would imply increased activity in the temporal and frontal lobes, an increased activity that did not occur. Indeed, while we would expect less regular, more chaotic, and confusing writing precisely because of low frontal cortical activity, nevertheless the mediums were able to write better than when not in trance. A possible explanation then for this phenomenon is, according to the researchers, the fact that the trance state acts in much the same way as alcoholic and narcotic substances, disinhibiting precisely those areas that drive psychographic writing, increasing the complexity of the paper. However, this research suffers from 2 major criticisms: a) the sample examined is too small and is all from the same geographical region; b) the correlation with possible mental contact of a supposedly paranormal nature has not been explained.

A third research paper, by Richeport [3], focused instead on the hypothesis of a possible multiple personality disorder underlying the mediumistic experience. This assumption, drawing interesting parallels with historical, clinical, and anthropological perspectives, then dwelled on the Eriksonian view, where multiplicity might not be strictly related to a psychopathological fact in the strict sense: in essence, seeing them as resources and not as afflictions to be treated, other personalities would be nothing but normal manifestations of “other selves”. Fascinating thesis, though not confirmed in light of the scientific rigor that research should have.

In the wake of the last theses, namely dissociation in a general sense, another research, conducted by Wahbeh and Radin [4], however, showed that people who report mediumship experiences have higher dissociation symptom scores than non-medians, but still below the thresholds for pathological dissociation.

The results, on the other hand, obtained from the research conducted by Beischel and Schwartz [5] did indeed bring out something very interesting: it appears that some mediums can receive accurate information about deceased individuals, but not according to the classical pattern of telepathy, so much as survival of consciousness (continuous existence, separate from the body, of an individual’s consciousness or personality after physical death) and super-ESP (the so-called retrieval of information via a psychic channel or quantum field). Thus, a detailed study of the electromagnetic interaction of such individuals with their surroundings is urgently needed.

Research partially carried out by Persinger [6] but not fully completed: a total of 621 reports (with experience for about 70 years) of paranormal experiences concerning death were differentiated according to the traditional labels: telepathic, precognitive, and postmortem phenomena. The 232 telepathic experiences occurred during 24-hour periods when global geomagnetic activity was significantly less (quieter) than in the days before or after the experiences; this relationship was not shown by the 186 precognitive or 203 postmortem cases. Although content analysis suggests that nocturnal psi experiences and temporal lobe epilepsy may share a similar mechanism, different classes of subjective psi experiences may not be affected by the same stimuli.

Finally, Claus [7] concluded that the phenomenon of the spirit has its existential dignity: in particular, he argued that the phenomenon of spirit possession is considered concerning the broad cultural context in which it is found to exist, in a region of southern India. The author critically critiques various attempts to explain spirit possession as an exclusively psychological or sociological event; instead, he turns to mediumship cults, oral traditions, and social ideology for an ethnographic interpretation.

In the literature, there are many possible explanations [8-13]:

a) According to Alexander’s studies, it is unclear whether ESP phenomena are attributable to the right (predominance) or left hemisphere, or depend on factors related to multiple areas present in both hemispheres.

b) Persinger demonstrated through dozens of researches, between the 1950s and 1960s, that there was a direct connection between hallucinations and the temporal lobes (on the left is the sense of self, while on the right is the other external self, precisely the entity), just as there was between mystical and religious experience and the limbic system. Ramachandran then concluded that the temporal lobes were the seat of religious experience (the right temporal lobe in particular, for Morse); of a different opinion were Newberg and D’Aquili who pointed to the parietal and frontal lobes, while Joseph valued the importance of the amygdala as a transmitter of God.

c) On the ESP-related contributions of Joire (1892), Rhine (1884, 1930), Persinger (1950-1960), Mitchell (1971), Honorton (1974), Schmeidler (1988), and Bem (2011), and the incredible insight of several researchers that perhaps the answer to psi phenomena can be found in junk DNA, there is no scientific research geared toward the existential hypothesis of the spirit phenomenon, studied, however, through field data related to temperatures and electromagnetism, or even brain scanning during the episode of telepathic connection with the entity. It seems strange that no scientific research has been concretely oriented toward the hypothesis of hallucinations determined by electromagnetic alterations, except for Persinger’s studies on sacred places and the recent Blanke on the feeling of presence (FoP), demonstrating the involvement of 3 brain regions: the temporoparietal cortex, the insular or insula cortex, and the frontoparietal cortex. The data obtained help to understand how such illusory experiences are mediated by altered perceptions regarding the origin and identity of sensory and motor signals (in particular, those of a tactile, proprioceptive, and motor nature) of one’s body. These findings provide a framework of probable neural mechanisms for the experience of FoP, for the generation of the experience of “self” and “others,” and constitute an advance in understanding the brain mechanisms that induce hallucination phenomena in schizophrenic patients. Precisely on the latter point, interesting research, such as that of Figner, has shown instead how low-level electromagnetic fields can alter self-control and the sense of morality, while other research has shown how such fields can negatively interfere with the physiological functions of the body, from the immune system to the circadian system, regulated by melatonin, produced by the epiphysis or pineal gland (third eye for Western and Eastern esoteric traditions), often referred to by occultists and esotericists as the seat of the soul, although to date there is no scientific evidence for such claims.

The literature, therefore, places more emphasis on the denialist hypothesis, claiming the inconsistency of the mediumistic phenomenon [14,15], albeit with some exceptions [16,17], seeking explanations in clinical hypotheses or mechanisms not yet perfectly known and explained but not paranormal [5,18-22], although the studies that delved into the psychopathological issue were limited to assessing the possible presence of one or more morbid conditions, without ever delving into the personality framework from both a structural and a functional point of view.

Objective

The main research objective, based on the findings in the literature, is to identify the exact psychological picture of the participants in the selected population sample, to try to answer the following profiles:

1. Ontological, i.e., whether the reality under scrutiny exists objectively (and thus whether or not the individual presents a pathological personality profile);
2. Epistemological, that is, whether the reality under examination is knowable (and whether it is possible to identify both the structural and functional profile of one’s personality framework);
3. Methodological, that is, whether the reality under examination is measurable (using suitable psychometric instruments to identify individual characteristics);
4. Axiological, i.e., whether the reality under investigation is worthy of study (and thus whether any psychopathological correlation found can influence the quality and goodness of the perception reported by the subject).

Materials and methods

I searched in Pubmed until November 20, 2022, for reviews, meta-analyses, clinical trials, and randomized controlled trials, using the keywords “medium”, “seer”, “mediumship” and “paranormal”, content on the abstract and title, have been selected 22 useful results. Simple reviews, opinion contributions, or systematic reviews were included because there are no published clinical trials. No limit was placed on the year of publication, covering the time window from 1979 to the present period Figure 1.

Table 1: Prisma model.

The methods used are two: 1) Clinical interview, based on narrative-anamnestic and documentary evidence and the basis of the Perrotta Human Emotions Model (PHEM) [23] concerning their emotional and perceptual-reactive experience; 2) Administration of the battery of psychometric tests published in international scientific journals by the author of this work [24-29]: a) Perrotta Integrative Clinical Interviews (PICI-2), to investigate functional and dysfunctional personality traits; b) Perrotta Individual Sexual Matrix Questionnaire (PSM-Q), to investigate individual sexual matrix; c) Perrotta Affective Dependence Questionnaire (PAD-Q), to investigate affective and relational dependence profiles; d) Perrotta Human Defense Mechanisms Questionnaire (PDM-Q), to investigate ego defense mechanisms.

The phases of the research were divided as follows:

1. Selection of the population sample, according to the parameters indicated in the following paragraph.
2. Clinical interview, with each population group.
3. Administration of the psychometric tests.
4. Data processing following administration.
5. Comparison of data obtained.

Setting and participants

The requirements decided for the selection of the sample population are:

1. Age between 21 years and 80 years, m/f defined, heterosexual orientation, of healthy and robust constitution, and in the absence of pathological symptoms: this choice is oriented to exclude underage subjects because they were not identified during the research of the sample population and subjects of excessively old age to avoid possible implications with neurodegenerative and/or neurovascular medical conditions.
2. Status statement of one’s mediumistic ability, demonstrable through professional or scholarly activity, and research with public and private entities, for at least 2 years.
3. Absence of psychopathological diagnoses or known neurological and neurodegenerative disorders at the time of participation in this study.

The selected setting, taking into account the protracted pandemic period (already in progress since the beginning of the present research), is the online platform via Skype and Video call Whatsapp, both for the clinical interview and for the administration. The present research work was carried out from March 2019 to November 2022. All participants were guaranteed anonymity and the ethical requirements of the Declaration of Helsinki are met. Since the research is not financed by anyone, it is free of conflicts of interest. The selected population clinical sample (Clinical group, CG), which meets the requirements, is 140 participants, divided into six groups Table 1:

A second group (Control Group, CG) was then selected, consisting of the same numerosity and selected based on the following inclusion criteria, then again divided into six groups by age groups identical to the CG: 1) Age between 21 years and 80 years, m/f defined, heterosexual orientation, of the healthy constitution and in the absence of pathological symptoms. 2) Declaration of atheism of one’s religious faith and absence of belief in the psychic faculties of mediums. 3) Absence of psychopathological diagnoses or known neurological and neurodegenerative disorders at the time of participation in this study Table 2.

Results

After the selection of the chosen population sample (first stage), we proceeded with the clinical interviews (second stage), from which the first significant data emerged:

1. Considering the total population sample (140/140), one immediately notices in the CG the substantial parity of distribution between the overall female (76/112) versus male (64/112) sample populousness, albeit with a slight majority for the female population. For the sake of organizational simplicity, the different mediumistic nuances were flattened by categorizing the clinical group (avoiding distinguishing between different mediumistic faculties and focusing only on the ability to communicate with spirit entities through thought means or physical means such as writing). Preliminary results from the interviews and the medical history form would suggest that the phenomenon of mediumistic communication has a total prevalence in the population believing in the existence of paranormal phenomena per se, even in the absence of objective and/or scientific evidence, and this is a phenomenon almost completely related (136/140, 97.1%) to individuals who have a low to middle cultural level or are not fully educated.
2. Other data of relevance also emerged during the first clinical interview: a) all of the proposed narratives had fantastic and phantasmal elements, unsupported by evidentiary evidence such as descriptive testimonies, photo-video-audio material, and peculiar physical signs, except in 14/140 (10%) cases where the material produced (audio-video and material) presents anomalies that deserve further investigation elsewhere and with specialized technical instrumentation; b) at the clinical interviews, 81/140 (57. 9%) of the sample presented markedly psychotic features (mainly paranoid, delusional, dissociative, and schizophrenic), but denied ever having received a psychiatric diagnosis, having ever taken psychotropic drugs, or having undergone psychotherapy.
3. Using, during the interview, the strategic language and the Perrotta Human Emotions Model (PHEM) [23], it emerged that the totality of the selected population sample presents a full distress orientation, facilitating feelings such as guilt, shame, anger, fear, and disappointment, in the presence of past (childhood) and current (interpersonal and work) family traumas. In fact, without the administration of questionnaires, it is evident that the impairment of perception in the plane of reality involves per se the manifestation of paranormal episodes described by patients, in the presence of a probable personality disorder to be identified with the help of psychodiagnostic tools.

The third phase of the research focused on the administration of the battery of questionnaires, to the two study groups, from which the following results emerged for the “clinical group” (CG): [24-29]

Administration of the Perrotta Integrative Clinical Interviews (PICI-2): Regarding the analysis of dysfunctional traits (PICI-2TA), the primary (structure) disorder that emerged with at least 5 traits [30-33] was delusional disorder (64/140, 45.7%), dissociative disorder (44/140, 31.4%), narcissistic overt-type disorder (26/140, 18.6%), and disorder (6/140, 4.3%). Secondary (function) disorders include borderline disorder (48/140, 34.3%), bipolar disorder (29/140, 20.7%), paranoid disorder (23/140, 16.4%), obsessive disorder (22/140, 15.7%), narcissistic covert type disorder (11/140, 7.9%), and psychopathic disorder (7/140, 5%). A separate category that deserves specific mention is schizophrenic disorder, which was first diagnosed in 2/140 (1.4%) of the population sample (1 woman and 1 man, both in the age range 21-30 years) after administration of the PICI-2, confirmed by the psychiatric examination offered later. In 131/140 (93.6%), the following disorders emerged as comorbidities: anxiety [34-38] and mood disorders [39-42], ADHD (in the subpopulation under 40 years old) [43-45], body dysmorphism [46-49], sleep disorders [50-52], eating disorders [53-55], and behavioral addictions (especially technology, internet addiction, and paraphiliac disorders) [56-64]; concrete risk of suicide [65-68] then emerged in 8/140 cases (5.7%), while presumed risk or demand for attention emerged in 21/140 (15%). In the analysis of functional traits (PICI-2FT), on the other hand, it was found that the most impaired classes, because they tended to be dysfunctional (with values of 0 or 4), were those referring to self-control, sensitivity, action, Ego-Id comparison, emotionality, ego stability, safety, and relational functionality, again confirming the marked dysfunctional tendency of the clinical population.

Administration of the Perrotta Individual Sexual Matrix Questionnaire (PSM-Q): The PSM questionnaires demonstrated that almost 2/3 of the participants (77/140, 55%) show a dysfunctional tendency towards sexual behavior and a marked tendency to chronicle feelings of shame in avoidance behavior or hyposexuality/hypersexuality. Furthermore, 100% (140/140) of the sample of the population interviewed reported having suffered significant or serious psychological or physical abuse at a young age, intra-parental relational imbalances, or in any case a sexual upbringing that was not open and lacking in free communication.

Administration of the Perrotta Affective Dependence Questionnaire (PAD-Q): According to the PDM-Q, 22.1% (31/140) are affected by affective dependency, with greater emphasis on types I (neurotic), VI (covert narcissist), V (borderline), and VII (psychotic), in this descending order.

Administration of the Perrotta Human Defense Mechanisms Questionnaire (PDM-Q): The PDM-Q reveals the widespread psychopathological tendency of the functional framework of the Ego, in the totality of the population sample (140/140) for the mechanisms of isolation, denial, regression, reactive formation, denial, projection, removal, withdrawal, instinct, repression, and idealization.

The second part of the third phase of the research focused on administering the battery of questionnaires to the “control group” (Cg) only, from which the following results emerged: [24-29]

1. Administration of the Perrotta Integrative Clinical Interviews (PICI-2): As for the analysis of dysfunctional traits (PICI-2TA), there were 41/140 (29.3%) subjects with at least 5 traits, with profiles equally distributed among neurotic, borderline, and psychotic (with greater tendency according to this order). The same should be said for the analysis of functional traits (PICI-2FT), in which the classes of distribution on the 18 channels emerged equally.
2. Administration of the Perrotta Individual Sexual Matrix Questionnaire (PSM-Q): 36/140 (25.7%) show a dysfunctional tendency to sexual behavior and a marked tendency to chronicle feelings of shame into avoidance behaviors or hyposexuality/hypersexuality. In addition, 61/140 (43.6%) of the sample population surveyed reported having experienced significant or severe psychological or physical abuse at a young age, intra-parental relational imbalances, or otherwise a sexual upbringing that was not open and lacked free communication.
3. Administration of the Perrotta Affective Dependence Questionnaire (PAD-Q): 7/140 (5%) are affected by affective dependency, with trends evenly distributed among the seven categories, with a majority pattern prevalence for the neurotic and border classes.
4. Administration of the Perrotta Human Defense Mechanisms Questionnaire (PDM-Q): The PDM-Q reveals the widespread psychopathological tendency of the functional framework of the Ego, in the totality of the population sample (76/140, 54.3%) with trends evenly distributed among the seven categories, with a majority pattern prevalence for the neurotic and border classes.

Discussions and limits

The research results show the following:

1. There is, in the CG, a substantial parity of distribution between the overall female versus male sample populousness, albeit with a slight majority for the female population, with a total prevalence in the population of the existential belief of paranormal phenomena per se, even in the absence of objective and/or scientific evidence, and this is a phenomenon almost entirely related to subjects who have a low to medium cultural level or are not fully educated. A possible limitation is determined by the fact that neither population group declared or produced documentation about the existence of a past or ongoing epileptic form, and therefore they were included in the population samples based on a statement that could not be disproved.
2. The entirety of the CG population sample appears to be pathological, with at least 5 dysfunctional traits, and a corollary of secondary traits reinforcing the primary condition and related conditions, such as sleep disturbances and suicidal risk. The preference for administering the PICI-2 over other widely validated and used psychometric tests, such as the MMPI-2, was motivated by reasons of expediency: in fact, previous research has demonstrated the effectiveness and efficiency, sometimes better indicated, of the PICI-2 over the MMPI-2, in terms of performance and completeness of diagnosis. However, this can be considered formally a limitation, albeit not substantively. The pathological differential, compared with the PICI-2, between the CG and the Cg is +70.7%.
3. On individual sexual matrix questionnaires, slightly more than 1/4 of the CG show a dysfunctional tendency to sexual behavior and a marked tendency to chronicle feelings of shame into avoidance behaviors or hyposexuality/hypersexuality, while slightly less than half of the sample population surveyed report significant or severe psychological or physical abuse at a young age, or intra-parental relational imbalances, or otherwise a sexual upbringing that is not open and lacks free communication. The pathological differential of PSM-Q between CG and Cg, taking the average of the two differential values, is + 42.8%.
4. Just over one-fifth of the total CG population sample has affective dependence, while the pathological differential for PAD-Q between CG and Cg is + 17%.
5. The entirety of the total CG population sample exhibits a pathological tendency of ego defense mechanisms, and therefore the pathological differential for PDM-Q is + 45.7%.

The research results show significant differences between the two groups (CG/Cg), assigning a summed value of traits for each participant and relating the statistics to the personality profile determined by the PICI-2 findings; here the data summarized in the Tables 3,4.

Conclusion

In conclusion, this research confirms the psychopathological nature of the personality profiles of the mediums who are part of the selected clinical population sample, although these results do not prove the fraudulent nature of the mediumistic activity carried out by the mediums, and therefore what has been obtained should be read in a more general key, subjecting mediums in mediumistic activity to technical instrumentation (electroencephalogram, functional magnetic resonance imaging, signal potential, and audio-video) to verify their outcomes. From the psychological point of view, the results obtained demonstrate the fallible subjective interpretation of reality [69,70] and the undoubted need for psychotherapeutic intervention (preferably cognitive-behavioral and/or strategic) of the subjects belonging to the selected population sample [71-75], including pharmacological, depending on the symptoms manifested and the severity of the morbid condition.

1. Moreira-Almeida A, Neto FL, Cardeña E. Comparison of brazilian spiritist mediumship and dissociative identity disorder. J Nerv Ment Dis. 2008 May;196(5):420-4. doi: 10.1097/NMD.0b013e31816ff3a1. PMID: 18477886.
2. Peres JF, Moreira-Almeida A, Caixeta L, Leao F, Newberg A. Neuroimaging during trance state: a contribution to the study of dissociation. PLoS One. 2012;7(11):e49360. doi: 10.1371/journal.pone.0049360. Epub 2012 Nov 16. PMID: 23166648; PMCID: PMC3500298.
3. Richeport MM. The interface between multiple personality, spirit mediumship, and hypnosis. Am J Clin Hypn. 1992 Jan;34(3):168-77. doi: 10.1080/00029157.1992.10402841. PMID: 1543146.
4. Wahbeh H, Radin D. People reporting experiences of mediumship have higher dissociation symptom scores than non-mediums, but below thresholds for pathological dissociation. F1000Res. 2017 Aug 10;6:1416. doi: 10.12688/f1000research.12019.3. PMID: 29416850; PMCID: PMC5782403.
5. Beischel J, Schwartz GE. Anomalous information reception by research mediums demonstrated using a novel triple-blind protocol. Explore (NY). 2007 Jan-Feb;3(1):23-7. doi: 10.1016/j.explore.2006.10.004. PMID: 17234565.
6. Persinger MA. Geophysical variables and behavior: LXXI. Differential contribution of geomagnetic activity to paranormal experiences concerning death and crisis: an alternative to the ESP hypothesis. Percept Mot Skills. 1993 Apr;76(2):555-62. doi: 10.2466/pms.1993.76.2.555. PMID: 8483667.
7. Claus PJ. Spirit possession and spirit mediumship from the perspective of Tulu oral traditions. Cult Med Psychiatry. 1979 Mar;3(1):29-52. doi: 10.1007/BF00114691. PMID: 498800.
8. Williams BJ. Extrasensory Perception and the Brain Hemispheres: Where Does the Issue Stand Now? NeuroQuantology. 2012; 10(3). doi: 10.14704/nq.2012.10.2.600.
9. Blanke O, Pozeg P, Hara M, Heydrich L, Serino A, Yamamoto A, Higuchi T, Salomon R, Seeck M, Landis T, Arzy S, Herbelin B, Bleuler H, Rognini G. Neurological and robot-controlled induction of an apparition. Curr Biol. 2014 Nov 17;24(22):2681-6. doi: 10.1016/j.cub.2014.09.049. Epub 2014 Nov 6. PMID: 25447995.
10. Kaszuba-Zwoińska J, Gremba J, Gałdzińska-Calik B, Wójcik-Piotrowicz K, Thor PJ. Electromagnetic field induced biological effects in humans. Przegl Lek. 2015;72(11):636-41. PMID: 27012122.
11. Perrotta G. The Pineal Gland: anatomical, clinical and neurobiochemical profiles, between hypotheses of the past, certainties of the present and future perspectives. J Neurol Psychol. 2019; 7(1):5.
12. Perrotta G. The neural correlates in the presumed extrasensory faculties of the medium and in the perception of the sacred. J Neurol Psychol. 2019; 7(1):07.
13. Lewczuk B, Redlarski G, Zak A, Ziółkowska N, Przybylska-Gornowicz B, Krawczuk M. Influence of electric, magnetic, and electromagnetic fields on the circadian system: current stage of knowledge. Biomed Res Int. 2014;2014:169459. doi: 10.1155/2014/169459. Epub 2014 Jul 22. PMID: 25136557; PMCID: PMC4130204.
14. O'keeffe C, Wiseman R. Testing alleged mediumship: methods and results. Br J Psychol. 2005 May;96(Pt 2):165-79. doi: 10.1348/000712605X36361. PMID: 15969829.
15. Freire ES, Rocha AC, Tasca VS, Marnet MM, Moreira-Almeida A. Testing alleged mediumistic writing: An experimental controlled study. Explore (NY). 2022 Jan-Feb;18(1):82-87. doi: 10.1016/j.explore.2020.08.017. Epub 2020 Sep 1. PMID: 32917531.
16. Gomide M, Wainstock BC, Silva J, Mendes CG, Moreira-Almeida A. Controlled semi-naturalistic protocol to investigate anomalous information reception in mediumship: Description and preliminary findings. Explore (NY). 2022 Sep-Oct;18(5):539-544. doi: 10.1016/j.explore.2021.08.011. Epub 2021 Sep 23. PMID: 34602351.
17. Paraná D, Rocha AC, Freire ES, Lotufo Neto F, Moreira-Almeida A. An Empirical Investigation of Alleged Mediumistic Writing: A Case Study of Chico Xavier's Letters. J Nerv Ment Dis. 2019 Jun;207(6):497-504. doi: 10.1097/NMD.0000000000000999. PMID: 31158111.
18. Bonilla E. Conexión mente-cuerpo, fenómenos parapsicológicos y curación espiritual. Revisión [Mind-body connection, parapsychological phenomena and spiritual healing. A review]. Invest Clin. 2010 Jun;51(2):209-38. Spanish. PMID: 20928979.
19. Escolà-Gascón Á. Forced-choice experiment on Anomalous Information Reception and correlations with states of consciousness using the Multivariable Multiaxial Suggestibility Inventory-2 (MMSI-2). Explore (NY). 2022 Mar-Apr;18(2):170-178. doi: 10.1016/j.explore.2020.11.009. Epub 2020 Nov 24. PMID: 33288468.
20. Escolà-Gascón Á. Researching unexplained phenomena: empirical-statistical validity and reliability of the Multivariable Multiaxial Suggestibility Inventory-2 (MMSI-2). Heliyon. 2020 Jul 7;6(7):e04291. doi: 10.1016/j.heliyon.2020.e04291. PMID: 32671247; PMCID: PMC7347654.
21. Moreira-Almeida A. Implications of spiritual experiences to the understanding of mind-brain relationship. Asian J Psychiatr. 2013 Dec;6(6):585-9. doi: 10.1016/j.ajp.2013.01.006. Epub 2013 Feb 19. PMID: 24309878.
22. Sarraf M, Woodley Of Menie MA, Tressoldi P. Anomalous information reception by mediums: A meta-analysis of the scientific evidence. Explore (NY). 2021 Sep-Oct;17(5):396-402. doi: 10.1016/j.explore.2020.04.002. Epub 2020 Jul 3. PMID: 32660815.
23. Perrotta G. The Human Emotions and the Perrotta Human Emotions Model (PHEM): The new theoretical model. Historical, neurobiological and clinical profiles. Arch Depress Anxiety. 2021; 7(2): 020-027. doi: 10.17352/2455-5460.000062.
24. Perrotta G. The structural and functional concepts of personality: The new Integrative Psychodynamic Model (IPM), the new Psychodiagnostic Investigation Model (PIM) and the two clinical interviews for the analysis of personality disorders (Perrotta Integrative Clinical Interview or PICI) for adults and teenagers (1TA version) and children (1C version), Psychiatry Peertechz, E-book. 2020. doi: 10.17352/ebook10118.
25. Perrotta G. Perrotta Integrative Clinical Interviews (PICI-2): innovations to the first model, the study on the new modality of personological investigation, trait diagnosis and state diagnosis, and the analysis of functional and dysfunctional personality traits. An integrated study of the dynamic, behavioural, cognitive and constructivist models in psychopathological diagnosis. Ann Psychiatry Treatm. 5(1): 067-083. 2021. doi: 10.17352/apt.000033.
26. Perrotta G. Perrotta Individual Sexual Matrix Questionnaire (PSM-1). The new clinical questionnaire to investigate the main areas of the individual sexual matrix. Int J Sex Reprod Health Care. 2021; 4(1): 013-021. doi: 10.17352/ ijsrhc.000020.
27. Perrotta G. Perrotta Individual Sexual Matrix Questionnaire (PSM-Q): Technical updates and clinical research. Int J Sex Reprod Health Care. 2021; 4(1): 062-066. doi: 10.17352/ijsrhc.000025.
28. Perrotta G. Perrotta Affective Dependence Questionnaire (PAD-Q): Clinical framing of the affective-sentimental relational maladaptive model. Ann Psychiatry Treatm. 2021; 5(1): 062-066. doi: 10.17352/apt.000032.
29. Perrotta G. Perrotta Human Defense Mechanisms Questionnaire (PDM-Q): The new psychodiagnostic tool to identify human psychological defense mechanisms and their clinical implications. Arch Depress Anxiety. 2021; 7(2): 029-033. doi: 10.17352/2455-5460.000063.
30. Perrotta G. Borderline Personality Disorder: definition, differential diagnosis, clinical contexts and therapeutic approaches. Ann Psychiatry Treatm. 2020; 4(1): 043-056, DOI: 10.17352/apt.000020.
31. Perrotta G. Narcissism and psychopathological profiles: definitions, clinical contexts, neurobiological aspects and clinical treatments. J Clin Cases Rep. 2020; 4(85): 12-25, DOI: 10.46619/joccr.2021.S5-1003.
32. Perrotta G. Histrionic personality disorder: Definition, clinical profiles, differential diagnosis and therapeutic framework. Arch Community Med Public Health. 2021; 7(1): 001-005, DOI: 10.17352/2455-5479.000123.
33. Perrotta G. Psychotic spectrum disorders: definitions, classifications, neural correlates and clinical profiles. Ann Psychiatry Treatm. 2020; 4(1): 070-084, DOI: 10.17352/apt.000023.
34. Perrotta G. Anxiety disorders: definitions, contexts, neural correlates and strategic therapy. J Neurol Neurosci. 2019; 6(1):046.
35. Perrotta G. Maladaptive stress: Theoretical, neurobiological and clinical profiles. Arch Depress Anxiety. 2021; 7(1): 001-007, DOI: 10.17352/2455-5460. 000057.
36. Szuhany KL, Simon NM. Anxiety Disorders: A Review. JAMA. 2022 Dec 27;328(24):2431-2445. doi: 10.1001/jama.2022.22744. PMID: 36573969.
37. Volz HP, Saliger J, Kasper S, Möller HJ, Seifritz E. Subsyndromal generalised anxiety disorder: operationalisation and epidemiology - a systematic literature survey. Int J Psychiatry Clin Pract. 2022 Sep;26(3):277-286. doi: 10.1080/13651501.2021.1941120. Epub 2021 Jul 27. PMID: 34314295.
38. Davies MR, Glen K, Mundy J, Ter Kuile AR, Adey BN, Armour C, Assary E, Coleman JRI, Goldsmith KA, Hirsch CR, Hotopf M, Hübel C, Jones IR, Kalsi G, Krebs G, McIntosh AM, Morneau-Vaillancourt G, Peel AJ, Purves KL, Lee SH, Skelton M, Smith DJ, Veale D, Walters JTR, Young KS, Zvrskovec J, Breen G, Eley TC. Factors associated with anxiety disorder comorbidity. J Affect Disord. 2023 Feb 15;323:280-291. doi: 10.1016/j.jad.2022.11.051. Epub 2022 Nov 26. PMID: 36442657.
39. Perrotta G. Depressive disorders: Definitions, contexts, differential diagnosis, neural correlates and clinical strategies. Arch Depress Anxiety, 2019; 5(2):009-033, DOI: 10.17352/2455-5460.000038.
40. Perrotta G. Bipolar disorder: definition, differential diagnosis, clinical contexts and therapeutic approaches. J. Neuroscience and Neurological Surgery. 2019; 5(1), DOI: 10.31579/2578-8868/097.
41. Couillard Larocque M, Fortin-Vidah G, Angers M, Garceau L, Gros L, Fournel I, Provencher MD. Anxiety in bipolar disorder: A review of publication trends. J Affect Disord. 2023 Jan 1;320:340-347. doi: 10.1016/j.jad.2022.09.057. Epub 2022 Sep 27. PMID: 36174785.
42. Wartchow KM, Cordeiro RC, Scaini G. Advances in the pathophysiology of bipolar disorder. Curr Opin Psychiatry. 2023 Jan 1;36(1):20-27. doi: 10.1097/YCO.0000000000000836. Epub 2022 Nov 15. PMID: 36449729.
43. Perrotta G. Attention Deficit Hyperactivity Disorder: definition, contexts, neural correlates and clinical strategies. J Addi Adol Beh. 2019; 2(1). DOI: 10.31579-007/2688-7517/08.
44. Cortese S, Coghill D. Twenty years of research on attention-deficit/hyperactivity disorder (ADHD): looking back, looking forward. Evid Based Ment Health. 2018 Nov;21(4):173-176. doi: 10.1136/ebmental-2018-300050. Epub 2018 Oct 9. PMID: 30301823.
45. Rohner H, Gaspar N, Philipsen A, Schulze M. Prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among Substance Use Disorder (SUD) Populations: Meta-Analysis. Int J Environ Res Public Health. 2023 Jan 10;20(2):1275. doi: 10.3390/ijerph20021275. PMID: 36674031; PMCID: PMC9859173.
46. Perrotta G. Obsessive-Compulsive Disorder: definition, contexts, neural correlates and clinical strategies. Journal of Neurology. 2019; 1.4: 08-16.
47. Perrotta G. The concept of altered perception in “body dysmorphic disorder”: The subtle border between the abuse of selfies in social networks and cosmetic surgery, between socially accepted dysfunctionality and the pathological condition. J Neurol Neurol Sci Disord. 2020; 6(1): 001-007. DOI: 10.17352/jnnsd.000036.
48. Jassi A, Krebs G. Body Dysmorphic Disorder. Psychiatr Clin North Am. 2023 Mar;46(1):197-209. doi: 10.1016/j.psc.2022.10.005. Epub 2022 Dec 26. PMID: 36740353.
49. Rossell S. Understanding and treating body dysmorphic disorder. Psychiatry Res. 2023 Jan;319:114980. doi: 10.1016/j.psychres.2022.114980. Epub 2022 Nov 21. PMID: 36470162.
50. Perrotta G. Sleep-wake disorders: Definition, contexts and neural correlations. J Neurol Psychol. 2019; 7(1):09.
51. Raciti L, Raciti G, Militi D, Tonin P, Quartarone A, Calabrò RS. Sleep in Disorders of Consciousness: A Brief Overview on a Still under Investigated Issue. Brain Sci. 2023 Feb 7;13(2):275. doi: 10.3390/brainsci13020275. PMID: 36831818; PMCID: PMC9954700.
52. Zhou L, Kong J, Li X, Ren Q. Sex differences in the effects of sleep disorders on cognitive dysfunction. Neurosci Biobehav Rev. 2023 Mar;146:105067. doi: 10.1016/j.neubiorev.2023.105067. Epub 2023 Jan 27. PMID: 36716906.
53. Perrotta G. Neural correlates in eating disorders: Definition, contexts and clinical strategies. J Pub Health Catalog. 2019; 2(2):137-148.
54. Barakat S, McLean SA, Bryant E, Le A, Marks P; National Eating Disorder Research Consortium; Touyz S, Maguire S. Risk factors for eating disorders: findings from a rapid review. J Eat Disord. 2023 Jan 17;11(1):8. doi: 10.1186/s40337-022-00717-4. PMID: 36650572; PMCID: PMC9847054.
55. St-Pierre MJ, Therriault PY, Faghihi U, Monthuy-Blanc J. Eating disorders: When food "Eats" time. Appetite. 2023 Mar 5;185:106509. doi: 10.1016/j.appet.2023.106509. Epub ahead of print. PMID: 36871602.
56. Perrotta G. Behavioral addiction disorder: definition, classifications, clinical contexts, neural correlates and clinical strategies. J Addi Adol Beh. 2019; 2(1), DOI: 10.31579/ JARAB.19/007.
57. Perrotta G, Fabiano G. Behavioural disorders in children and adolescents: Definition, clinical contexts, neurobiological profiles and clinical treatments. Open J Pediatr Child Health. 2021; 6(1): 005-015. DOI: 10.17352/ ojpch.000030.
58. Perrotta G. Paraphilic disorder: definition, contexts and clinical strategies. Neuro Research. 2019; 1(1): 4, DOI: 10.35702/nrj.10004.
59. Perrotta G. Pedophilia: definition, classifications, criminological and neurobiological profiles and clinical treatments. A complete review. Open J Pediatr Child Health. 2020; 5(1): 019-026, DOI: 10.17352/ojpch.000026.
60. Perrotta G. Dysfunctional sexual behaviours: definition, clinical contexts, neurobiological profiles and treatments. Int J Sex Reprod Health Care. 2020; 3(1): 061-069, DOI: 10.17352/ijsrhc.000015.
61. Perrotta G. Sexual fantasies: the boundary between physiology and psychopathology. Int J Sex Reprod Health Care. 2021; 4(1): 042-052, DOI: 10.17352/ijsrhc000023.
62. Forte G, Favieri F, Casagrande M, Tambelli R. Personality and Behavioral Inhibition/Activation Systems in Behavioral Addiction: Analysis of Binge-Watching. Int J Environ Res Public Health. 2023 Jan 16;20(2):1622. doi: 10.3390/ijerph20021622. PMID: 36674381; PMCID: PMC9863166.
63. Evli M, Şimşek N, Işıkgöz M, Öztürk Hİ. Internet addiction, insomnia, and violence tendency in adolescents. Int J Soc Psychiatry. 2023 Mar;69(2):351-361. doi: 10.1177/00207640221090964. Epub 2022 Apr 26. PMID: 35470724.
64. Levine SB. What is sexual addiction? J Sex Marital Ther. 2010;36(3):261-75. doi: 10.1080/00926231003719681. PMID: 20432125.
65. Perrotta G. Suicidal risk: definition, contexts, differential diagnosis, neural correlates and clinical strategies. J. Neuroscience and Neurological Surgery. 2020; 6(2)-114. DOI: 10.31579/2688-7517/114.
66. de la Torre-Luque A, Pemau A, Ayad-Ahmed W, Borges G, Fernandez-Sevillano J, Garrido-Torres N, Garrido-Sanchez L, Garriga M, Gonzalez-Ortega I, Gonzalez-Pinto A, Grande I, Guinovart M, Hernandez-Calle D, Jimenez-Treviño L, Lopez-Sola C, Mediavilla R, Perez-Aranda A, Ruiz-Veguilla M, Seijo-Zazo E, Toll A, Perez-Sola V, Ayuso-Mateos JL; SURVIVE Consortium. Risk of suicide attempt repetition after an index attempt: A systematic review and meta-analysis. Gen Hosp Psychiatry. 2023 Mar-Apr;81:51-56. doi: 10.1016/j.genhosppsych.2023.01.007. Epub 2023 Jan 23. PMID: 36805332.
67. Kim H, Ryu S, Jeon HJ, Roh S. Lifestyle factors and suicide risk: A nationwide population-based study. J Affect Disord. 2023 May 1;328:215-221. doi: 10.1016/j.jad.2023.02.044. Epub 2023 Feb 19. PMID: 36806600.
68. Alejos M, Vázquez-Bourgon J, Santurtún M, Riancho J, Santurtún A. Do patients diagnosed with a neurological disease present increased risk of suicide? Neurologia (Engl Ed). 2023 Jan-Feb;38(1):41-46. doi: 10.1016/j.nrleng.2020.03.005. Epub 2022 Sep 24. PMID: 36167285.
69. Perrotta G. The reality plan and the subjective construction of one's perception: the strategic theoretical model among sensations, perceptions, defence mechanisms, needs, personal constructs, beliefs system, social influences and systematic errors. J Clinical Research and Reports. 2019; 1(1). DOI: 10.31579/JCRR/2019/001.
70. Perrotta G. The state of consciousness: from perceptual alterations to dissociative forms. Defining, neurobiological and clinical profiles, J Neuro Neurol Sci Disord. 2021; 7(1): 006-018. DOI: 10.17352/jnnsd.000042.
71. Cordioli AV, Knapp P. A terapia cognitivo-comportamental no tratamento dos transtornos mentais [Cognitive-behavioral therapy in the treatment of mental disorders]. Braz J Psychiatry. 2008 Oct;30 Suppl 2:s51-3. Portuguese. doi: 10.1590/s1516-44462008000600001. PMID: 19039444.
72. Hodgins DC, Peden N. Tratamento cognitivo e comportamental para transtornos do controle de impulsos [Cognitive-behavioral treatment for impulse control disorders]. Braz J Psychiatry. 2008 May;30 Suppl 1:S31-40. Portuguese. doi: 10.1590/s1516-44462006005000055. Epub 2007 Aug 3. PMID: 17713695.
73. Perrotta G. The strategic clinical model in psychotherapy: theoretical and practical profiles. J Addi Adol Beh. 2020; 3(1). DOI: 10.31579-007/2688-7517/016.
74. Perrotta G. Accepting "change" in psychotherapy: from consciousness to awareness. J Addiction Research and Adolescent Behaviour. 2020; 3(1). DOI: 10.31579/2688-7517/018.
75. Perrotta G. Strategic psychotherapy and the "decagonal model" in clinical practice. Ann Psychiatry Treatm. 2021; 5(1): 028-035. DOI: 10.17352/apt.000028.