Self-Knowledge in Personality Disorders: An Emotion-Focused Perspective

Abstract

Emotional knowledge about one's own and others' emotional experience are central features of mental health and may be characteristic of therapeutic processes leading to good outcome. Clients with personality disorders (PDs) often lack in their ability to access and accept emotional experiences, or to reflect on emotion and use it in adaptive ways. The present theoretical and clinical review discusses self-knowledge, and lack thereof, in personality disorders, from an emotion-focused perspective. A first section differentiates between two fundamental types of meaning construction processing. The second section describes, from an integrative therapy perspective, how self-knowledge may be facilitated in psychotherapy by the client-therapist interaction. A subsequent section discusses lack of awareness of one's own emotions in the construction of meaning associated with PDs. The final section describes initial studies that demonstrate change occurring in constructing emotional self-knowledge as a correlate of treatment. The concepts of the review are illustrated throughout with three clinical cases of PD.

Internal Processing in Patients With Pathological Narcissism or Narcissistic Personality Disorder: Implications for Alliance Building and Therapeutic Strategies

“…At other times, they can demonstrate a remarkable capacity for identifying and relating to others' states and intentions, but they may use this primarily for self-enhancing or avoiding purposes, without reflecting on or understanding the underlying motives. Nevertheless, a compromised or even a lack of emotional self-knowledge (Kramer & Pascale-Leone, 2018)-an awareness and understanding of one's own emotions and feelings, and their expressions and meanings in interpersonal and social contexts-is predominant in patients with PN and NPD.…”

“…Compromised capacity to symbolize leads to a "concrete" mode of mental functioning with diminished reflective and mentalizing ability. It leads to compromised awareness and understanding of own emotions and feelings (Kramer & Pascale-Leone, 2018). When facing sudden, unexpected, and challenging life circumstances, this can also escalate sudden acute suicidality, with risk for lethal actions (Ronningstam, Weinberg, Goldblatt, Schechter, & Herbstman, 2018).…”

Mechanisms of change in brief treatments for borderline personality disorder: a protocol of a randomized controlled trial

“…The relevance of this dynamic conception of emotion processing to BPD was supported in terms of change in anger processing [48] and in terms of change in undifferentiated global distress [27]. It was shown to also be of relevance in narcissistic and histrionic PDs [49,50].…”

Change in Emotional and Theory of Mind Processing in Borderline Personality Disorder

“…These structures are known for the treatment of reflective self-awareness and the development of consciousness. Self-awareness may have several sources (i.e, cognitive, affective, sensorial), however, the design of the present study may suggest that patients most likely use an emotional self-awareness, integrating afferent information from the bodily felt sense related to the reaction to the self-critical words, towards an emergent representation directly from affective information (Kramer & Pascual-Leone, 2018).…”