Featured Papers
Ruffalo, M. L., & Kreisman, J. J. (2026). Toward a double bind theory of borderline personality disorder. Bulletin of the Menninger Clinic, 90(2), 168–185. https://doi.org/10.1521/bumc.2026.90.2.168
This paper with Jerold Kreisman, M.D., proposes that borderline personality disorder is fundamentally a disorder of paradox, characterized by contradictory needs and fears that create recurrent double binds, particularly in the pursuit and avoidance of intimacy.
Ruffalo, M. L., & Pies, R. W. (2026). The need for a validity-based diagnostic hierarchy in DSM-6. Psychiatric Services. Advance online publication. https://doi.org/10.1176/appi.ps.20260333
This paper with Ronald Pies, M.D., argues that DSM-6 should adopt a validity-based diagnostic hierarchy that prioritizes well-established psychiatric syndromes over less validated diagnoses, reduces artificial comorbidity, and restores scientific rigor to psychiatric classification.
Ruffalo, M. L. (2026). Etiologically speculative versus etiologically neutral psychoanalysis. Journal of Contemporary Psychotherapy. Advance online publication. https://doi.org/10.1007/s10879-026-09761-6
This paper distinguishes between etiologically speculative and etiologically neutral approaches to psychoanalysis, arguing that compelling clinical narratives do not establish causation and that psychoanalysis can retain scientific credibility by clearly distinguishing meaning, mechanism, and cause.
Selected Publications
Ruffalo, M. L., & Reidbord, S. P. (in press). Beyond major depressive disorder: Why DSM-6 should recognize a non-melancholic depressive disorder [Letter to the editor]. American Journal of Psychiatry.
Henderson, A., & Ruffalo, M. L. (in press). Two conceptual models of severity in cluster B personality disorders. The Psychoanalytic Review.
Ruffalo, M. L. (in press). Fundamental problems in borderline personality disorder. The Psychoanalytic Review.
Ruffalo, M. L. (2026). 'But the patient doesn't seem borderline': Some observations on a common diagnostic error. BJPsych Bulletin. Advance online publication. https://doi.org/10.1192/bjb.2026.10313
Ruffalo, M. L., & Ruffalo, T. M. (2026). Using psychotherapy for the prevention of relapse in schizophrenia. Psychiatric Times, 43(9), 9–10.
Ruffalo, M. L., & Ray, A. M. (2026). Distinguishing mood temperaments from personality disorders: Diagnostic and clinical implications. Psychodynamic Psychiatry, 54(3), 381–388. https://doi.org/10.1521/pdps.2026.54.3.381
Ghaemi, S. N., & Ruffalo, M. L. (2026, September 9). The postmodern worldview and contemporary psychiatry. Psychiatric Times. https://www.psychiatrictimes.com/view/the-postmodern-worldview-and-contemporary-psychiatry
Newhill, C. E., & Ruffalo, M. L. (2026). Trauma, diagnosis, and borderline personality disorder: The need for conceptual clarity. Social Work, 71(4), 357–364. https://doi.org/10.1093/sw/swag037
Ruffalo, M. L., & D'Agostino, A. (2026). Why is it still so difficult to acknowledge the reality of borderline personality disorder? Harvard Review of Psychiatry, 34(4), 248–255. https://doi.org/10.1097/HRP.0000000000000465
Ruffalo, M. L. (2026). Psychiatric diagnosis in psychoanalysis: Integrating nosology and psychology. Psychoanalytic Psychotherapy, 40(3), 207–220. https://doi.org/10.1080/02668734.2026.2664850
Radoi, V., & Ruffalo, M. L. (2026). Preserving borderline personality disorder within dimensionalized personality disorder assessment: A clinical sequencing model. Irish Journal of Psychological Medicine. Advance online publication. https://doi.org/10.1017/ipm.2026.10210
Huda, A. S., Ruffalo, M. L., & Aftab, A. (2026). Psychological factors domain is a necessity for the future DSM [Letter to the editor]. American Journal of Psychiatry. Advance online publication. https://doi.org/10.1176/appi.ajp.20260126
Ruffalo, M. L. (2026). Description, understanding, and diagnosis in psychiatry. Philosophy, Psychiatry, & Psychology. Advance online publication. https://doi.org/10.1353/ppp.0.a993659
Ruffalo, M. L. (2026). Riflessioni sul terzo analitico: Postmodernismo, psicoanalisi e psicopatologia [Some reflections on the analytic third: Postmodernism, psychoanalysis, and psychopathology]. Psicoterapia e Scienze Umane, 60(1), 108–118. https://doi.org/10.3280/PU2026-001008
Ruffalo, M. L., Ray, A. M., Rasol, A., & Staal, C. (2026). Psychosis in borderline personality disorder: A neglected clinical phenomenon. The Psychoanalytic Review, 113(1), 23–37. https://doi.org/10.1521/prev.2026.113.1.23
Ruffalo, M. L. (2026). Psychiatric diagnosis in clinical social work. Social Work, 71(2), 191–193. https://doi.org/10.1093/sw/swag012
Ruffalo, M. L. (2026). The validity of borderline personality disorder: Robins and Guze applied. BJPsych Bulletin, 50(5), 432–434. https://doi.org/10.1192/bjb.2025.10206
Rucker, J., & Ruffalo, M. (2026). Relationships between language use, working alliance, and personality pathology in an inpatient psychiatric sample. Journal of Contemporary Psychotherapy, 56, 107–113. https://doi.org/10.1007/s10879-025-09694-6
Hale, M., & Ruffalo, M. L. (2025). From stimulation to interpretation: Psychodynamic aspects of transcranial magnetic stimulation. Psychodynamic Psychiatry, 53(4), 477–483. https://doi.org/10.1521/pdps.2025.53.4.477
Ruffalo, M. L., Rasol, A., & Ray, A. M. (2025). Fifty years of borderline personality disorder: A history of the syndrome. Psychodynamic Psychiatry, 53(4), 525–547. https://doi.org/10.1521/pdps.2025.53.4.525
Ruffalo, M. L. (2025). Moving beyond the biopsychosocial model in clinical social work. Clinical Social Work Journal. Advance online publication. https://doi.org/10.1007/s10615-025-01019-3
Ruffalo, M. L. (2025). Some observations on paleologic thinking in borderline personality disorder. Psychodynamic Psychiatry, 53(3), 294–300. https://doi.org/10.1521/pdps.2025.53.3.294
Le, T., & Ruffalo, M. L. (2025). The psychotherapy of delusional disorder: Theoretical models and therapeutic technique. American Journal of Psychotherapy, 78(4), 251–255. https://doi.org/10.1176/appi.psychotherapy.20240061
Ruffalo, M. L. (2025). On the borderline syndrome and its relationship to schizophrenia. Psychodynamic Psychiatry, 53(2), 162–167. https://doi.org/10.1521/pdps.2025.53.2.162
Pies, R. W., & Ruffalo, M. L. (2025, April 10). Use of the PRiSM diagnostic instrument in clinical practice. Psychiatric Times. https://www.psychiatrictimes.com/view/use-of-the-prism-diagnostic-instrument-in-clinical-practice
Ruffalo, M. L. (2025). Communication paradoxes in borderline personality disorder. Psychodynamic Psychiatry, 53(1), 27–32. https://doi.org/10.1521/pdps.2025.53.1.27
Ruffalo, M. L. (2025). Heads I win, tails you lose: Interpersonal aspects of borderline personality disorder. Bulletin of the Menninger Clinic, 89(1), 52–69. https://doi.org/10.1521/bumc.2025.89.1.52
Aftab, A., Banicki, K., Ruffalo, M. L., & Frances, A. (2024). Psychiatric diagnosis: A clinical guide to navigating diagnostic pluralism. The Journal of Nervous and Mental Disease, 212(8), 445–454. https://doi.org/10.1097/NMD.0000000000001791
MacDougald, Q., & Ruffalo, M. L. (2024, June 10). History of psychiatry: Its relevance in training and beyond. Psychiatric Times. https://www.psychiatrictimes.com/view/history-of-psychiatry-its-relevance-in-training-and-beyond
Ruffalo, M. L., Kottapalli, M., & Anbukkarasu, P. (2023). Empathy in the care of individuals with schizophrenia: A vital element of treatment. American Journal of Psychotherapy, 77(1), 30–34. https://doi.org/10.1176/appi.psychotherapy.20230022
Ruffalo, M. L. (2023). The psychotherapy of schizophrenia: A review of the evidence for psychodynamic and nonpsychodynamic treatments. Psychiatry and Clinical Psychopharmacology, 33(3), 222–228. doi:10.5152/pcp.2023.23627
Ruffalo, M. L. (2022). Remembering Silvano Arieti 40 years later. American Journal of Psychotherapy, 75(3), 103–107. https://doi.org/10.1176/appi.psychotherapy.20210039
Furiato, A. J., & Ruffalo, M. L. (2021). Schizophrenia in the emergency department: Psychologically and psychodynamically informed practices. Psychiatric Times, 38(11), 42–43.
Ruffalo, M. L. (2019). Understanding schizophrenia: Toward a unified biological and psychodynamic approach. Psychoanalytic Social Work, 26(2), 185–200. doi:10.1080/15228878.2019.1616570
Ruffalo, M. L., & Pies, R. W. (2018, August 19). The reality of mental illness: Responding to the criticisms of antipsychiatry. Psychology Today. https://www.psychologytoday.com/us/blog/freud-fluoxetine/201808/the-reality-mental-illness
Frances, A. J., & Ruffalo, M. L. (2018). Mental illness, civil liberty, and common sense. Psychiatric Times, 35(7), 14A–14C.
Ruffalo, M. L. (2017). A brief history of lithium treatment in psychiatry. The Primary Care Companion for CNS Disorders, 19(5), ii. doi:10.4088/PCC.17br02140
Ruffalo, M. L. (2013, Fall). Self-responsibility and contractual psychoanalysis. Newsletter of the American Association for Psychoanalysis in Clinical Social Work, 17–18.
Henderson, A., & Ruffalo, M. L. (in press). Two conceptual models of severity in cluster B personality disorders. The Psychoanalytic Review.
Ruffalo, M. L. (in press). Fundamental problems in borderline personality disorder. The Psychoanalytic Review.
Ruffalo, M. L. (2026). 'But the patient doesn't seem borderline': Some observations on a common diagnostic error. BJPsych Bulletin. Advance online publication. https://doi.org/10.1192/bjb.2026.10313
Ruffalo, M. L., & Ruffalo, T. M. (2026). Using psychotherapy for the prevention of relapse in schizophrenia. Psychiatric Times, 43(9), 9–10.
Ruffalo, M. L., & Ray, A. M. (2026). Distinguishing mood temperaments from personality disorders: Diagnostic and clinical implications. Psychodynamic Psychiatry, 54(3), 381–388. https://doi.org/10.1521/pdps.2026.54.3.381
Ghaemi, S. N., & Ruffalo, M. L. (2026, September 9). The postmodern worldview and contemporary psychiatry. Psychiatric Times. https://www.psychiatrictimes.com/view/the-postmodern-worldview-and-contemporary-psychiatry
Newhill, C. E., & Ruffalo, M. L. (2026). Trauma, diagnosis, and borderline personality disorder: The need for conceptual clarity. Social Work, 71(4), 357–364. https://doi.org/10.1093/sw/swag037
Ruffalo, M. L., & D'Agostino, A. (2026). Why is it still so difficult to acknowledge the reality of borderline personality disorder? Harvard Review of Psychiatry, 34(4), 248–255. https://doi.org/10.1097/HRP.0000000000000465
Ruffalo, M. L. (2026). Psychiatric diagnosis in psychoanalysis: Integrating nosology and psychology. Psychoanalytic Psychotherapy, 40(3), 207–220. https://doi.org/10.1080/02668734.2026.2664850
Radoi, V., & Ruffalo, M. L. (2026). Preserving borderline personality disorder within dimensionalized personality disorder assessment: A clinical sequencing model. Irish Journal of Psychological Medicine. Advance online publication. https://doi.org/10.1017/ipm.2026.10210
Huda, A. S., Ruffalo, M. L., & Aftab, A. (2026). Psychological factors domain is a necessity for the future DSM [Letter to the editor]. American Journal of Psychiatry. Advance online publication. https://doi.org/10.1176/appi.ajp.20260126
Ruffalo, M. L. (2026). Description, understanding, and diagnosis in psychiatry. Philosophy, Psychiatry, & Psychology. Advance online publication. https://doi.org/10.1353/ppp.0.a993659
Ruffalo, M. L. (2026). Riflessioni sul terzo analitico: Postmodernismo, psicoanalisi e psicopatologia [Some reflections on the analytic third: Postmodernism, psychoanalysis, and psychopathology]. Psicoterapia e Scienze Umane, 60(1), 108–118. https://doi.org/10.3280/PU2026-001008
Ruffalo, M. L., Ray, A. M., Rasol, A., & Staal, C. (2026). Psychosis in borderline personality disorder: A neglected clinical phenomenon. The Psychoanalytic Review, 113(1), 23–37. https://doi.org/10.1521/prev.2026.113.1.23
Ruffalo, M. L. (2026). Psychiatric diagnosis in clinical social work. Social Work, 71(2), 191–193. https://doi.org/10.1093/sw/swag012
Ruffalo, M. L. (2026). The validity of borderline personality disorder: Robins and Guze applied. BJPsych Bulletin, 50(5), 432–434. https://doi.org/10.1192/bjb.2025.10206
Rucker, J., & Ruffalo, M. (2026). Relationships between language use, working alliance, and personality pathology in an inpatient psychiatric sample. Journal of Contemporary Psychotherapy, 56, 107–113. https://doi.org/10.1007/s10879-025-09694-6
Hale, M., & Ruffalo, M. L. (2025). From stimulation to interpretation: Psychodynamic aspects of transcranial magnetic stimulation. Psychodynamic Psychiatry, 53(4), 477–483. https://doi.org/10.1521/pdps.2025.53.4.477
Ruffalo, M. L., Rasol, A., & Ray, A. M. (2025). Fifty years of borderline personality disorder: A history of the syndrome. Psychodynamic Psychiatry, 53(4), 525–547. https://doi.org/10.1521/pdps.2025.53.4.525
Ruffalo, M. L. (2025). Moving beyond the biopsychosocial model in clinical social work. Clinical Social Work Journal. Advance online publication. https://doi.org/10.1007/s10615-025-01019-3
Ruffalo, M. L. (2025). Some observations on paleologic thinking in borderline personality disorder. Psychodynamic Psychiatry, 53(3), 294–300. https://doi.org/10.1521/pdps.2025.53.3.294
Le, T., & Ruffalo, M. L. (2025). The psychotherapy of delusional disorder: Theoretical models and therapeutic technique. American Journal of Psychotherapy, 78(4), 251–255. https://doi.org/10.1176/appi.psychotherapy.20240061
Ruffalo, M. L. (2025). On the borderline syndrome and its relationship to schizophrenia. Psychodynamic Psychiatry, 53(2), 162–167. https://doi.org/10.1521/pdps.2025.53.2.162
Pies, R. W., & Ruffalo, M. L. (2025, April 10). Use of the PRiSM diagnostic instrument in clinical practice. Psychiatric Times. https://www.psychiatrictimes.com/view/use-of-the-prism-diagnostic-instrument-in-clinical-practice
Ruffalo, M. L. (2025). Communication paradoxes in borderline personality disorder. Psychodynamic Psychiatry, 53(1), 27–32. https://doi.org/10.1521/pdps.2025.53.1.27
Ruffalo, M. L. (2025). Heads I win, tails you lose: Interpersonal aspects of borderline personality disorder. Bulletin of the Menninger Clinic, 89(1), 52–69. https://doi.org/10.1521/bumc.2025.89.1.52
Aftab, A., Banicki, K., Ruffalo, M. L., & Frances, A. (2024). Psychiatric diagnosis: A clinical guide to navigating diagnostic pluralism. The Journal of Nervous and Mental Disease, 212(8), 445–454. https://doi.org/10.1097/NMD.0000000000001791
MacDougald, Q., & Ruffalo, M. L. (2024, June 10). History of psychiatry: Its relevance in training and beyond. Psychiatric Times. https://www.psychiatrictimes.com/view/history-of-psychiatry-its-relevance-in-training-and-beyond
Ruffalo, M. L., Kottapalli, M., & Anbukkarasu, P. (2023). Empathy in the care of individuals with schizophrenia: A vital element of treatment. American Journal of Psychotherapy, 77(1), 30–34. https://doi.org/10.1176/appi.psychotherapy.20230022
Ruffalo, M. L. (2023). The psychotherapy of schizophrenia: A review of the evidence for psychodynamic and nonpsychodynamic treatments. Psychiatry and Clinical Psychopharmacology, 33(3), 222–228. doi:10.5152/pcp.2023.23627
Ruffalo, M. L. (2022). Remembering Silvano Arieti 40 years later. American Journal of Psychotherapy, 75(3), 103–107. https://doi.org/10.1176/appi.psychotherapy.20210039
Furiato, A. J., & Ruffalo, M. L. (2021). Schizophrenia in the emergency department: Psychologically and psychodynamically informed practices. Psychiatric Times, 38(11), 42–43.
Ruffalo, M. L. (2019). Understanding schizophrenia: Toward a unified biological and psychodynamic approach. Psychoanalytic Social Work, 26(2), 185–200. doi:10.1080/15228878.2019.1616570
Ruffalo, M. L., & Pies, R. W. (2018, August 19). The reality of mental illness: Responding to the criticisms of antipsychiatry. Psychology Today. https://www.psychologytoday.com/us/blog/freud-fluoxetine/201808/the-reality-mental-illness
Frances, A. J., & Ruffalo, M. L. (2018). Mental illness, civil liberty, and common sense. Psychiatric Times, 35(7), 14A–14C.
Ruffalo, M. L. (2017). A brief history of lithium treatment in psychiatry. The Primary Care Companion for CNS Disorders, 19(5), ii. doi:10.4088/PCC.17br02140
Ruffalo, M. L. (2013, Fall). Self-responsibility and contractual psychoanalysis. Newsletter of the American Association for Psychoanalysis in Clinical Social Work, 17–18.