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Objective: Avoidant personality disorder (AvPD) is closely related to and partially overlaps with social phobia (SP). There is an ongoing debate as to whether AvPD and SP can be classified as separate and distinct disorders or whether these diagnoses rather reflect different degrees of severity of social anxiety. The hypothesis of this study is that in patients with AvPD and in those with AvPD and comorbid SP both interpersonal functioning and metacognitive abilities (the ability to understand mental states) are more severely impaired than they are in patients with SP only. We also hypothesise that the interpersonal and metacognitive functioning of these patients (both AvPD and AvPD+SP) is comparable to that of patients with other PD diagnoses., Methods: To test this hypothesis, we compared four groups (22 patients with SP, 32 patients with AvPD, 43 patients with both AvPD and SP and 50 patients with other personality disorders without SP and AvPD criteria) on metacognitive abilities, interpersonal functioning and global symptomatic distress., Results: Metacognitive ability showed significant variation among the four groups, with the lowest score observed in the AvPD group. As far as the interpersonal functioning is concerned, the lack of sociability was more severe in the AvPD group compared with the SP group. These differences were maintained even after controlling for global symptomatic distress., Conclusion: Results are in line with the alternative model of PD, proposed in the DSM-5, as dysfunction of the self and relationships. They suggest that specific impairments in critical areas of self domains and interpersonal domains of personality functioning may serve as markers distinguishing AvPD from SP., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The ability to reflect on one's own states of mind and those of others (metacognition or mindreading) is strongly implicated in personality disorders (PDs). Metacognition involves different abilities, and there is evidence that specific abilities can be selectively impaired in different PDs. The purposes of this study were to compare metacognitive competence in avoidant PD (AvPD) with that in other PDs and to investigate whether there is a specific profile for AvPD. Sixty-three patients with AvPD and 224 patients with other PDs were assessed using the Metacognitive Assessment Interview. AvPD patients showed difficulties with two metacognitive functions: monitoring and decentration, even when the severity of psychopathology was controlled for. These results support the hypothesis of specific profiles of metacognitive dysfunction in different PDs and highlight a close link between impaired monitoring and decentration functions and the inhibited and withdrawn personality style typical of AvPD.

Metacognitive impairment is crucial to explaining difficulties in life tasks of patients with personality disorders (PDs). However, several issues remain open. There is a lack of evidence that metacognitive impairments are more severe in patients with PDs. The relationship between severity of PD pathology and the extent of metacognitive impairment has not been explored, and there has not been any finding to support the linking of different PDs with specific metacognitive profiles. The authors administered the Metacognitive Assessment Interview to 198 outpatients with PDs and 108 outpatients with no PDs, differentiating overall severity from stylistic elements of personality pathology. Results showed that metacognitive impairments were more severe in the group with PDs than in the control group, and that metacognitive dysfunctions and the severity of the PD were highly associated. Positive correlations were found between specific metacognitive dysfunctions and specific personality styles. Results suggest that metacognitive impairments could be considered a common pathogenic factor for PDs.

Personality disorders are better understood as entities that vary according to severity along specific domains rather than a phenomenon separate from and unrelated to Axis I disorders. This study explores whether patients who were rated as having greater numbers of personality disorder traits reported greater levels of interpersonal problems, psychiatric symptoms, and alexithymia. The sample was composed of 506 consecutive patients assessed in a private outpatient center who were administered the SCID-II Symptom-Checklist (SCL-90-R), Inventory of Interpersonal Problems (IIP-47), and Toronto Alexithymia-Scale (TAS-.20). Based upon the number of personality disorder traits identified in the SCID, participants were classified into five groups: 0-4, 5-9, 10-14, 15-19, and 20 or more personality disorder traits met. Comparisons between groups revealed that symptom severity and levels of interpersonal problems increased between groups as the number of personality disorder traits increased. After covarying for symptom severity, there were no significant between-groups differences for levels of alexithymia. Findings are consistent with the claims that the simple Axis I-Axis II distinction is not an optimal strategy to understand personality pathology. It instead may be more fruitful to consider group differences in terms of numbers of personality disorder traits met.

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 © 2010 Elsevier Ireland Ltd. All rights reserved.)

Individuals with personality disorders (PDs) have difficulties in modulating mental states and in coping with interpersonal problems according to a mentalistic formulation of the problem. In this article we analyzed the first 16 psychotherapy sessions of 14 PD patients in order to explore whether their abilities to master distress and interpersonal problems were actually impaired and how they changed during the early therapy phase. We used the Mastery Section of the Metacognition Assessment Scale, which assesses the use of mentalistic knowledge to solve problems and promote adaptation. We explored the hypotheses that a) PD patients had problems in using their mentalistic knowledge to master distress and solve social problems; b) the impairments were partially stable and only a minimal improvement could be observed during the analyzed period; c) patients' mastery preferences differed from one another; d) at the beginning of treatment the more effective strategies were those involving minimal knowledge about mental states. Results seemed to support the hypotheses; the patients examined had significant difficulties in mastery abilities, and these difficulties persisted after 16 sessions. Moreover, the attitudes towards problem-solving were not homogenous across the patients. Lastly, we discuss implications for assessment and treatment of metacognitive disorders in psychotherapy., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: There is growing support for the idea that an impaired understanding of others' mental states is an underlying feature of personality disorder (PD). Only recently has there begun to be evidence of impairments to subjects' ability to infer and reason about others' intentions and emotions, and detach from their own perspective when doing so., Method: We analysed the transcripts from the first 16 psychotherapy sessions of 14 PD patients. Scales for understanding others' minds from the Metacognition Assessment Scale were used., Results: Patients were generally able to describe others' mental states, although, at times, they had problems. There was, on the other hand, an inability to decentre while reasoning about others, and this was common to all the patients., Conclusions: PDs indeed feature a poor decentration, which is not easily identified with the usual lab tasks. Implications for further research and treatment are discussed., Key Practitioner Message: *Patients with personality disorders have substantial difficulties in adopting others' point of view and standing back from their own, and grasping that they are not the center of other peoples' thoughts.

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.

Social sharing capacities have attracted attention from a number of fields of social cognition and have been variously defined and analyzed in numerous studies. Social sharing consists in the subjective awareness that aspects of the self's experience are held in common with other individuals. The definition of social sharing must take a variety of elements into consideration: the motivational element, the contents of the social sharing experience, the emotional responses it evokes, the behavioral outcomes, and finally, the circumstances and the skills which enable social sharing. The primary objective of this study is to explore some of the diverse forms of human social sharing and to classify them according to levels of complexity. We identify four different types of social sharing, categorized according to the nature of the content being shared and the complexity of the mindreading skills required. The second objective of this study is to consider possible applications of this graded model of social sharing experience in clinical settings. Specifically, this model may support the development of graded, focused clinical interventions for patients with personality disorders characterized by severe social withdrawal. [ABSTRACT FROM AUTHOR]

Objective: Metacognition is a multi-component psychological construct, characterized by the ability to identify and describe one's own mental states and those of others. Evidence has been found for an association between impairments in metacognitive abilities and poor social functioning, low quality of life, severity of psychopathology in Personality Disorders (PDs). However, to date, there are few psychometrically validated instruments available for assessing the different components of metacognition. A self-report questionnaire, the Metacognition Self-Assessment Scale (MSAS), has been developed to evaluate the different functions of metacognition (Monitoring, Integration, Differentiation and Decentration) as defined in the framework of Metacognitive Multi-Function Model (Semerari et al. 2003, 2007). The aim of the present study is to preliminarily investigate the psychometric properties of the MSAS in a large non-clinical sample. Method: The MSAS was administered to 6659 people randomly recruited from the general population. Exploratory and confirmatory factor analyses were carried out to examine the dimensionality of the MSAS. Results: The results of the exploratory and confirmatory factor analyses revealed a good fit for a four-factor model of metacognition and suggested that metacognition as measured by the MSAS is a multidimensional construct consisting of one general factor with several sub-components. All Monitoring and Integration items loaded on the first factor which appeared to correspond to self-directed reflective cognition, that we named Self-Reflectivity. The Differentiation and Decentration items loaded on the second factor that captures the ability to distance oneself from cognitions and evaluate them critically, we named it Critical Distance. Items related to Monitoring Others' cognitions constituted a separated factor, related to the ability to understand others' minds, we named this factor Understanding Other Minds. The results also supported the hyp othesis that metacognitive regulation (i.e. Mastery) constitutes a separate metacognitive function, relatively independent of the metacognitive knowledge-related functions. Conclusions: These preliminary results confirm that the MSAS has the premises to be validated as a reliable instrument for measuring metacognition and its components. In particular, the MSAS could represent a useful and flexible instrument for a rapid screening of metacognitive abilities in both clinical and non-clinical contexts. [ABSTRACT FROM AUTHOR]

Objective: Metacognition is a multi-component psychological construct, characterised by the ability to identify and describe one's own mental states and those of others. Evidence has been found for an association between deficits in metacognitive abilities and poor social functioning, low quality of life, psychopathology, and symptoms in Personality Disorders (PDs). However, to date, there are few psychometrically validated instruments available for assessing the different components of metacognition. A semi-structured interview, the Metacognition Assessment Interview (MAI), has been developed to evaluate different domains of metacognition. In the present study, we investigated the psychometric properties of the MAI in an outpatient clinical sample. Method: The MAI was administered to a clinical population of 306 outpatients attending a private clinical centre. Exploratory factor analysis, confirmatory factor analysis and correlation with instruments assessing alexithymia and interpersonal problems were carried out to examine the dimensionality and validity of the MAI. Result: Explorative and confirmatory factor analyses revealed a good fit for both a two-factor model and a four-factor model of metacognition. The two-factor model yielded two main dimensions, which we named: Self domain, defined as self-reflection, and Other domain, defined as critical distancing from one's own mental state and that of others. The four-factor solution is composed of four sub-domains: monitoring, integration, differentiation and decentration. Moreover, the MAI showed good convergent validity, with significant correlations with both alexithymia and interpersonal problems. Conclusions: These results confirm that the MAI is a reliable instrument for measuring metacognition and its different sub-domains. In particular, the MAI represents a useful and flexible instrument for the assessment of metacognition impairments in different psychopathologies and it can provide useful indications for the focus of psychotherapy treatment. [ABSTRACT FROM AUTHOR]

Copyright of Psychotherapy Research is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Psychotherapy Research is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

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]