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Personality Disorders (PDs) are hypothesized to involve a decrement in the capacity to understand one's own thoughts and feelings. Patients may not, for example, recognize their own emotions or put together integrated representations of self with other. Some researchers have suggested that this deficit varies between the different PDs. However, empirical evidence that might confirm or disconfirm this hypothesis is scarce. The goal of the present research is to evaluate the metacognitive capacity in four participants, two with Narcissistic Personality Disorder and two with Avoidant Personality Disorder. Using the Metacognition Assessment Scale to analyse the transcripts of their first year of psychotherapy, we have found that three of the four participants displayed difficulties in recognizing their inner states and in linking them to the environmental and psychological causes behind them. There was, additionally, a milder deficit in the ability to integrate multiple images of self with other. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Disorders in the ability to understand mental states (metacognition) have an important role in psychopathology. Some clinicians talk of a generalised impairment of metacognition and others of malfunctioning of specific aspects. We compare two contrasting hypotheses. We call the first one ‘fast running’ hypothesis according to which metacognition is a single function, like speed in running. The second one is the ‘tennis playing’ hypothesis according to which metacognition is composed, like the ability to play tennis, of various, relatively independent skills, which can get impaired selectively. We reviewed the main theories and researches on metacognition and, therefore, we outlined a research programme based on them, describing the contribution made by the research on the psychotherapeutic process to this programme. [ABSTRACT FROM AUTHOR]

If we want to explain the links between the various and heterogeneous elements—symptoms, dysfunctional forms of behavior and poor social functioning—making up personality disorders, we need model a self pathology that portrays dysfunctions, the links among them, and how their interactions maintain disorders over time. In our view, the most likely elements of self pathology are: a. problematic contents (thoughts and emotions)—experienced subjectively as states of mind and organized in the form of narratives; b. shortfalls in the ability, termed meta-cognition, to reflect on mental states, both of oneself and of others; c. pathogenic interpersonal schemas; and d. maladaptive decision-making processes. These elements get altered in the various personality disorders and interact to form typical pathological organizations. This article seeks to describe a model of self pathology in personality disorders and discuss its current scientific status based on a literature review that spans several disciplines. The model is illustrated with an example of how the pathogenic elements can interact to form personality disorder. Lastly, the limitations and advantages of the model are discussed. [ABSTRACT FROM AUTHOR]

Many authors consider that patients suffering from Borderline Personality Disorder (BPD) are hampered in their ability to metarepresent, which is the correct ascribing of states of mind to oneself and to others and the reflecting thereon. Although the ability to mentalize is generally described as being uniform, various authors pinpoint problems which appear to be of a diverse psychological nature. Some describe difficulties in identifying emotions or a shortfall in their regulation, others identify a lack of integration between representations of self and those of others, and yet others focus on the failure to distinguish between fantasy and reality. In the present research all sessions during the first year of therapy of four patients suffering from BPD were tape-recorded and transcribed, and then analyzed using the Metacognition Assessment Scale (MAS), which is designed for the evaluation of the ability to metarepresent in clinical reports. The results support the hypothesis that there is a metarepresentation impairment in BPD but that it is more selective than was thought until now. In particular, such patients maintain their ability to identify internal states, whereas they are impaired in the integration of representations of self and others and in the differentiation between fantasy and reality. [ABSTRACT FROM AUTHOR]

It is possible to portray patients suffering from personality disorders using Horowitz's States of Mind Theory, according to which each disorder features its own particular set of forms of subjective experience (states of mind) and the shifting from one state to another is done under compulsion. If we want to define personality disorders correctly we need to define the rules causing inter-state shifts and, as a result, creating personality organization. The prime candidates to acting as these rules constraining the shifts are interpersonal patterns and shortfalls in the ability to metarepresent internal experience and others' psychological worlds. We shall illustrate these hypotheses with some session transcript extracts involving patients suffering from personality disorders. In the transcripts we have pinpointed the initial state of mind, the cause of the shift and the state of mind the patient has moved into. The discussion of the theory that personality disorders are organizations of states of mind in which the inter-state shifts are constrained will be on the basis of some clinical examples. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: Impairment in the ability to recognize and make sense of emotions has been hypothesized to be present in a sub-sample of people suffering from personality disorder (PD). In particular it is possible that difficulty recognizing and expressing feelings, or alexithymia, is related to many of the symptoms and problems in making sense of social interactions which are hallmarks of PD. In this study we measured levels of alexithymia with the Toronto Alexithymia Scale-20 and explored its correlations with the overall presence of PD and different PD diagnoses, symptoms, and interpersonal difficulties. Results were largely consistent with the hypothesis. Higher levels of alexithymia were related to high levels of global psychopathology and with dysfunctional representation of interpersonal relations. A sub-sample of patients, mostly suffering from avoidant, dependent, passive–aggressive and depressive PD, had alexithymic features and, in particular reported difficulties describing their feelings to others. A patient with cluster B PD featured no alexithymia. Implications of this study for future research and treatment are discussed. [Copyright &y& Elsevier]