Identity Diffusion

In this episode, Dr. David Puder and Mark Ruffalo dive into the history and theory of identity diffusion, from Kernberg’s structural model and Gunderson’s work on BPD to Akhtar’s clinical descriptions. We explore how identity diffusion shows up in patients’ lived experiences—feelings of emptiness, fractured self-image, lack of authenticity—and what these struggles mean for psychotherapy. You’ll also hear practical insights into treatment, including empathetic confrontation, fostering continuity of self, and amplifying moments of authenticity. Whether you’re a clinician, student, or simply curious about the complexities of identity, this conversation sheds light on one of the most important yet misunderstood dimensions of mental health.   By listening to this episode, you can earn 1.75 Psychiatry CME Credits. Link to blog.

In this episode, we explore the latest 2025 research on cannabis and mental health. Our discussion covers how cannabis use impacts depression, anxiety, PTSD, sleep, cognitive function, and cannabis use disorder (CUD). While many patients report short-term relief from symptoms, studies reveal complex risks, including increased odds of mood disorders, suicidality, impaired cognition, and withdrawal challenges. We also examine the evidence behind medical marijuana for PTSD and anxiety, the role of CBD and terpenes, and the long-term effects of cannabis on brain development, academic performance, and overall health. Whether you are a clinician, researcher, or someone curious about cannabis and psychiatry, this update will help you better understand the science, myths, and clinical realities of cannabis use. By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Parenting brings love, joy and plenty of emotional challenges. In this episode, clinical psychologist Dr. Alissa Jerud explores how parents can better understand and regulate their emotions instead of getting stuck in cycles of frustration, anxiety, or control. Drawing on exposure therapy, DBT skills, and her Emotion-Savvy Parenting approach, Dr. Jerud introduces practical tools: the ART framework (Accept, Regulate, Tolerate) to help parents stay grounded during emotional storms. Whether it’s managing anxiety, tolerating distress, or responding more calmly to your kids, this conversation is full of evidence-based strategies for building resilience, deepening connection, and showing up as the parent you want to be. Connect with Alissa Jerud on her Instagram or LinkedIn Check out her new book Emotion-Savvy Parenting.  Announcement: for interest in psychotherapy cohort, go to www.psychiatrypodcast.com/cohort By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube   

In this episode, I engage in a shared-interest conversation with Dr. David Mintz, a psychiatrist with over 30 years of experience at the Austen Riggs Center, about his book Psychodynamic Psychopharmacology: Caring for the Treatment-Resistant Patient. Mintz explores the integration of psychodynamic principles into medication prescribing, emphasizing that psychiatric treatments are not purely biomedical but profoundly shaped by meaning, symbolism, attachment and interpersonal dynamics. Drawing from his work with treatment-resistant patients, often those with histories of early adversity, the discussion distills how psychodynamics influence medication efficacy, adherence, and overall recovery. By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Catatonia in children and teens is underdiagnosed, frequently misunderstood, and potentially fatal if left untreated. In this episode, Dr. David Puder and Dr. Annabel Kuhn interview Dr. Joshua Ryan Smith—child and adolescent psychiatrist and division director at Vanderbilt University—to explore the essential clinical skills and medical knowledge needed to identify and treat pediatric catatonia. You’ll learn how to differentiate catatonia from other neuropsychiatric conditions in both neurodivergent and neurotypical children, how to apply tools like the Bush-Francis and Pediatric Catatonia Rating Scales. This episode also unpacks common misdiagnoses in cases involving autism spectrum disorder, schizophrenia, and autoimmune or metabolic conditions. Finally, it offers practical, evidence-based guidance for both inpatient stabilization and outpatient follow-up care. Whether you’re a psychiatrist, pediatrician, therapist, or student, this episode offers life-saving insights into one of the most overlooked syndromes in child psychiatry. By listening to this episode, you can earn 1.0 Psychiatry CME Credits. Link to blog. Link to YouTube video.

In this episode, Dr. David Puder is joined by psychiatrist Dr. Eric Bender to explore the psychological depth of the Emmy Award-winning show, The Bear (FX). Through a psychodynamic lens, they examine Carmy’s character—his trauma, complex PTSD, obsessive-compulsive personality traits, and avoidant attachment style. They also break down the borderline dynamics in his family, especially his mother’s primitive defenses, identity diffusion, and projective identification. The discussion covers dissociation, personality styles, sibling roles, and emotional neglect, drawing connections to clinical work and real-life therapy. This episode gives both clinicians and fans of the show a nuanced understanding of how early attachment, trauma, and family dynamics shape adult behavior. Whether you're a therapist, student, or simply a fan of the show, you'll gain insight into how The Bear reflects complex inner worlds. Link to blog. Link to YouTube video.

Dr. David Puder and psychologist Dr. Jonathan Shedler explore depressive personality style—how it differs from clinical depression and why it often goes unrecognized. Through a detailed role play, they demonstrate how self-criticism, unconscious guilt, emotional deprivation, and suppressed anger emerge in therapy. They discuss: How depressive personalities form in childhood The role of introjection, self-blame, and gentle idealization Why therapists may miss key dynamics if therapy feels “too good” How to help patients access their real needs and frustrations This episode is ideal for clinicians and anyone interested in deep psychodynamic work. Shedler draws from the work of Nancy McWilliams and Otto Kernberg while offering his own insights on personality, countertransference, and therapeutic technique.   Link to blog. Link to YouTube video. By listening to this episode, you can earn 2 Psychiatry CME Credits.

Dive deep into the connection between cannabis (THC) and psychosis in this enlightening episode with Dr. David Puder. Explore cutting-edge research on how cannabis impacts neurodevelopment, particularly during adolescence, and discover genetic and environmental factors that can amplify psychosis risk. This episode provides valuable insights into recognizing cannabis-induced psychotic symptoms, understanding the importance of early intervention, and implementing effective strategies for treatment and prevention. Essential listening for mental health professionals, educators, parents, and anyone interested in the nuanced relationship between cannabis use and mental health.   By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video.

In this episode, Dr. Otto Kernberg, a pioneer of Transference-Focused Psychotherapy (TFP), discusses personality disorders through a psychoanalytic lens. Explore key insights into Borderline Personality Disorder (BPD), identity diffusion, primitive defense mechanisms such as splitting and projective identification, and the complexities of narcissistic, paranoid, schizoid, and histrionic personalities. Dr. Kernberg also shares reflections on sexuality, aggression, reflective functioning, and why therapists choose to help others. By listening to this episode, you can earn 1.5 Psychiatry CME Credits. Link to blog. Link to YouTube video.

In this episode of Psychiatry & Psychotherapy, Dr. David Puder hosts a deep dive with experts Nicholas Fabiano, MD, Brandon Luu, MD, Joshua Mangunsong, MS3, and Liam Browning, MS4 into the exciting potential of creatine supplementation for mental health and cognitive enhancement. They explore cutting-edge research on how creatine can improve mood disorders, including depression and anxiety, enhance cognitive functions such as memory, attention, and reasoning, and support brain metabolism through its role in ATP regeneration. The episode also reviews clinical trials demonstrating creatine’s effectiveness in psychiatric disorders, optimal dosing strategies, and its safety profile. Listen to learn how creatine may revolutionize treatment options in psychiatry. By listening to this episode, you can earn 1.5 Psychiatry CME Credits. Link to blog. Link to YouTube video.