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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.

Personality Disorders (PDs) are particularly hard to treat and treatment drop-out rates are high. Several authors have agreed that psychotherapy is more successful when it focuses on the core of personality pathology. For this reason, therapists dealing with PDs need to understand the psychopathological variables that characterize this pathology and exactly what contributes to maintaining psychopathological processes. Moreover, several authors have noted that one key problem that characterizes all PDs is an impairment in understanding mental states – here termed metacognition – which could also be responsible for therapy failures. Unfortunately, a limited number of studies have investigated the role of mentalization in the process of change during psychotherapy. In this paper, we assume that poor metacognition corresponds to a core element of the general pathology of personality, impacts a series of clinical variables, generates symptoms and interpersonal problems, and causes treatment to be slower and less effective. We explored whether changes in metacognition predicted an improvement among different psychopathological variables characterizing PDs; 193 outpatients were treated at the Third Center of Cognitive Psychotherapy in Rome, Italy, and followed a structured path tailored for the different psychopathological variables that emerged from a comprehensive psychodiagnostic assessment that considered patients’ symptoms, metacognitive abilities, interpersonal relationships, personality psychopathology, and global functioning. The measurements were repeated after a year of treatment. The results showed that changes in metacognitive abilities predicted improvements in the analyzed variables.

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.

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.