Poor metacognition in Narcissistic and Avoidant Personality Disorders: four psychotherapy patients analysed using the Metacognition Assessment Scale

Abstract

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.

The Metacognitions about Symptoms Control Scale: Development and Concurrent Validity

“…In support of this view, metacognitions have been found to be associated with a wide array of psychological and behavioural problems (for a full review, see Wells, ; Wells, 2013). Related research by Dimaggio and colleagues () and Lysaker and colleagues () has also highlighted the importance of an awareness of one's own mental state and the ability to recognize the mental states of others in personality disorder. This is of particular relevance in studying metacognition in CFS because of the high prevalence of personality disorders found in CFS (e.g., Henderson & Tannock, ).…”

Addressing metacognitive capacity for self reflection in the psychotherapy for schizophrenia: A conceptual model of the key tasks and processes

“…Regarding the potential of psychotherapy to address metacognitive deficits, a broad literature has suggested that psychotherapy can promote metacognitive capacity (sometimes referred to as mentalizing) in persons with personality disorders, depression, and anxiety (Bateman & Fonagy, 2001; Dimaggio et al , 2007; Karlsson & Kermott, 2006). With regard to schizophrenia, case studies have provided some evidence that metacognitive capacity may be addressed in individual psychotherapy and that changes in metacognition may lead to improvements in function (Buck & Lysaker, 2009; Lysaker, Buck, & Ringer, 2007; Lysaker, Davis, et al , 2005; Salvatore et al , 2009).…”

Health and Adaptation in a Multiple Self

“…We endorse here elements from dialogical self theory (Hermans, 2002;Lysaker & Lysaker, 2002), which offers a model of how parts of the self engage in a constant flow of conversation, and from metacognitive theory (Dimaggio & Lysaker, 2010;-and related concepts such as a mentalization, theory of mind, or social cognition-which offer models of how persons with significant pathology may lack the set of psychological skills needed to recognize and reason about their own minds.…”