Roberto Pedone

Metacognitive dysfunctions in personality disorders: correlations with disorder severity and personality styles.

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.

States of minds in narcissistic personality disorder: Three psychotherapies analyzed using the grid of problematic states

Abstract The subjective experience of patients suffering from narcissistic personality disorder (NPD) has been studied using various methods. However, there has not been an analysis of psychotherapy session transcripts. It is much more likely that the facets of experience surface in this context than during a single interview or in a self-administered questionnaire. Using the Grid of Problematic States, designed to assess contents emerging in patients’ transcripts, the authors analyzed the first 18 psychotherapy sessions with three female patients suffering from NPD and treated by therapists of the cognitive–constructivist school specializing in personality disorders. The three patients’ dominant states of mind were characterized by anger, feeling excluded from groups, feelings of being harmed, and distrust toward others. The authors discuss the results and their implications for future research and for the definition of NPD in future editions of the Diagnostic and Statistical Manual of Mental Disorders.

An intensive case analysis of client metacognition in a good-outcome psychotherapy: Lisa's case

Abstract The authors analyzed the successful case of Lisa, a client with major depression, using the Metacognitive Assessment Scale (MAS). Consistently with the literature on depression, the authors hypothesize that Lisas ability to reflect on mental states—here metacognition—is marginally affected. The authors found that Lisa was better at describing her own mind rather than understanding the mind of the others. Furthermore, the most severe impairment was in using metacognition to cope with mental state source of distress and to enact strategies to solve interpersonal problems. During the therapy such difficulties improved progressively. Limitations and implications of these findings are discussed.

Differences Between Axes Depend on Where You Set the Bar: Associations Among Symptoms, Interpersonal Relationship and Alexithymia With Number of Personality Disorder Criteria

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.

Personality Disorders and Mindreading: Specific Impairments in Patients With Borderline Personality Disorder Compared to Other PDs.

Abstract The capacity of understanding mental states is a complex function which involves several components. Single components can be selectively impaired in specific clinical populations. It has been suggested that impairments in mindreading are central for borderline personality disorder (BPD). However, empirical findings are inconsistent, and it is debatable whether BPD presents a specific profile of mindreading impairments. The aim of this study is to compare BPD and other PDs in mindreading. Seventy-two patients with BPD and 125 patients with other PD diagnoses were assessed using the Metacognition Assessment Interview. BPD showed difficulties in two mindreading functions, differentiation and integration, even when the severity of psychopathology was controlled. These results suggest a specific mindreading impairment in BPD and a strong relationship between these impairments and the severity of psychopathology.

How states of mind change in psychotherapy: An intensive case analysis of Lisa's case using the Grid of Problematic States

Abstract This study uses the Grid of Problematic States (GPS) to examine Lisas case, one of the most successful in the York Psychotherapy Depression Project. This study tried to assess whether the contents of mental experience form stable clusters consistent with a diagnosis of depression. It was possible with the GPS to pinpoint problematic states typical of depression and trace the transitional states occurring in Lisa between two different mental states: depressive and well-being. The GPS analysis suggested that the treatment successfully managed to deal with symptoms and to change the patients thought themes and emotions. At the end of treatment, Lisa was less sad and displayed some anger, and a state of being nurtured emerged.

Mindreading Dysfunction in Avoidant Personality Disorder Compared With Other Personality Disorders.

Abstract The ability to reflect on ones 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.

Expanding the validity of the Malignant Self-Regard construct in an Italian general population sample

Malignant self-regard (MSR) was proposed as a particular type of self-structure that may account for similarities among a set of clinically relevant Personality Disorders (PDs) such as masochistic/self-defeating and depressive PDs that yet have failed to be adequately represented in the diagnostic manuals. The investigation on the MSR may provide a better framework upon which to understand the nature of these personality types and their discrimination from related constructs. The present study examines the psychometric properties of the Italian adaptation of the Malignant Self-Regard Questionnaire (MSRQ). Reliability and validity indicators are determined in a large sample of adults from general population (n = 2574). The measure was found to be reliable and valid, given its correlations with measures of depressive personality, negative affectivity, self-defeating, and vulnerably narcissistic personalities. MSR also can be meaningfully differentiated from a nomological network of related constructs, including sadness rumination, depression, neuroticism, extraversion, and grandiose narcissism. These findings suggest that MSR may be a personality component which includes a negativistic self-representation, vulnerability and hypersensitivity to judgment, sometimes compensated by perfectionistic tendencies. As a whole, results seem to support the reliability and the validity of the Italian adaptation of the MSRQ as a measure of the MSR.

Symptom severity and mindreading in narcissistic personality disorder

Background Grandiose narcissism has been associated with poor ability to understand one’s own mental states and the mental states of others. In particular, two manifestations of Narcissistic Personality Disorder (NPD) can be explained by poor mindreading abilities: absence of symptomatic subjective distress and lack of empathy. Methods We conducted two studies to investigate the relationships between mindreading capacity, symptomatic subjective distress and narcissistic personality. In the first study (N = 246), we compared mindreading capacities and symptomatic distress in three outpatient samples: narcissistic patients (NPD); patients with other Personality Disorders (PD); patients without PD. In the second study (N = 1357), we explored the relationships between symptomatic distress, mindreading and specific NPD criteria. Results In the first study, the NPD patients showed poorer mindreading than the patients without PD and comparable to patients with other PDs. Symptomatic subjective distress in the narcissistic group was less severe than in the other PDs group and comparable to the group without PDs. However, no relationship emerged between mindreading and symptomatic subjective distress. In the second study, taking the clinical sample as a whole, symptomatic distress appeared negatively linked to grandiosity traits, while mindreading scores were negatively linked to empathy. Conclusions NPD showed specific mindreading impairments. However, mindreading capacity did not appear to be directly connected with subjective distress, but did appear to be connected with specific aspects of narcissistic pathology.

Definizione e selezione di un gruppo di controllo non clinico per la valutazione degli outcome in soggetti trattati in gruppi di Skills Trainingcondotti secondo la Dialectical Behaviour Therapy (DBT)

I gruppi di skills training condotti secondo la DBT rappresentano un mediatore cruciale del cambiamento. Lo skills training e necessario quando mancano abilita emotive, cognitive, comportamentali integrate per risolvere problemi personali e raggiungere gli obiettivi desiderati. Questo lavoro ha lo scopo di selezionare un gruppo di controllo non clinico confrontabile con i gruppi in trattamento DBT-Skills per valutarne gli esiti. La possibilita di disporre di valori di baseline di soggetti non clinici relativamente alle capacita di regolazione emotiva, abilita sociali e sintomatologia, consente la valutazione statistica degli outcome dei soggetti in trattamento non solo rispetto al miglioramento fra le diverse fasi del training, ma anche in relazione alla potenziale generalizzabilita del risultato alla popolazione normale di riferimento. Sulla base delle caratteristiche sociodemografiche di pazienti inclusi nella DBT e stato selezionato un gruppo di controllo di 100 soggetti non clinici, appaiato per eta, genere, stato civile e titolo di studio equivalenti al campione clinico. Al campione di controllo e stata somministrata la stessa batteria di test utilizzata per la valutazione del gruppo in trattamento. Sono state misurate: efficacia percepita nella regolazione emotiva (APEP/APEN), caratteristiche temperamentali (TCI-R), sintomatologia e disagio psichico (SCL-90R), abilita interpersonali (IIP), alessitimia (TAS-20). I risultati sono stati confrontati con i punteggi ottenuti sia nella valutazione iniziale che a 6 mesi dal trattamento (un intero ciclo di Skills Training DBT) nei soggetti con disturbo borderline di personalita (reperiti presso il Terzocentro di Psicoterapia Cognitiva di Roma). I soggetti in trattamento DBT presentano, dopo un ciclo completo di Skills Training capacita di regolazione emotiva e problem-solving equivalenti a quelle mostrate dai soggetti non clinici.