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The present study was designed to test an emotion regulation framework to understand individual differences in personality disorder (PD) traits in a non-clinical sample. Specifically, we tested whether: selected dimensions of emotion dysregulation were differentially related to PD traits; and whether emotion dysregulation and impulsivity had independent associations with PD traits. A community sample of 399 individuals (mean age = 37.91; 56.6% males) completed self-report measures of PDs, emotion dysregulation and impulsivity. Emotion dysregulation facets and impulsivity had uniform bivariate associations with PD traits, but also evidenced unique associations in multiple regression analyses. Nonacceptance of emotional responses was the emotion dysregulation dimension underlying a wide array of PD. A limited repertoire of effective emotion regulation strategies was characteristic of cluster C PD, whereas emotional unawareness distinctly predicted schizoid PD. Antisocial PD traits were uniquely related to difficulties controlling impulsive behavior when upset. Finally, histrionic, narcissistic, and obsessive-compulsive PD were related to better self-reported emotion regulation. Impulsivity further explained a significant amount of variance in schizotypal, antisocial, borderline (positively), and obsessive-compulsive PD traits (negatively). If replicated in clinical samples, our findings will support the usefulness of targeting both emotional dysregulation and impulsivity in PDs psychotherapy., (Copyright © 2018. Published by Elsevier B.V.)

Background and Aims: Some individuals with Personality Disorders (PD), particularly of a non-Borderline type, present with difficulties relating to over-control of cognitions, emotion and behavior, perfectionistic traits, and impaired social interactions. The current study sought to evaluate the strength of association, and interactions of both emotional inhibition and perfectionism in PD's, after controlling for symptoms and interpersonal problems., Method: We recruited a sample of 578 treatment seeking outpatients. Diagnosis of PD was made with the SCID-II. Individual's completed measures of perfectionism (Frost-MPS), Emotional Inhibition (EIS), Depression (BDI-II), Anxiety (STAI-Y), Global symptoms (SCL-90-R), and interpersonal problems (IIP-32)., Results: Perfectionism was related to interpersonal problems, to the majority of PD symptomatology and to PD severity via number of SCID-II criteria met. Emotional inhibition was linked to symptoms and interpersonal problems as well as with avoidant, dependent, depressive and paranoid PDs; and with overall PD Severity. Inhibition and perfectionism were correlated with each other. Both variables predicted PD above and beyond other variables assessed. Mediation modeling demonstrated that the effect of emotional inhibition on PD severity was fully mediated by perfectionism and interpersonal problems., Conclusions: Psychological mechanisms of overcontrol are a maintaining factor in many PDs. Both perfectionism and emotional inhibition impact on a broad range of PDs and there is an urgent need for research into these processes, and to adapt psychological interventions to consider these factors., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Many patients with personality disorders (PD) display emotional inhibition or over-regulation (EOR); others display emotional dysregulation (ED)- heightened sensitivity to emotional stimuli with difficulty toning down arousal. To date, most treatments focus on patients with ED, particularly those with borderline disorders, though some focus on EOR. Patients with complex PD often swing from periods of EOR to ED. In this paper, we describe an adaptation of metacognitive interpersonal therapy (MIT), which has been manualized for treating PD with prominent EOR and is aimed at dealing with patients fluctuating from EOR to ED. We first describe the MIT model of personality pathology and offer a summary of the procedures used in MIT to treat patients with prominent EOR. Then, through the analysis of the case of a patient swinging between EOR and ED, we describe how to adapt these procedures to complex cases.

Individuals experiencing avoidant personality disorder (AvPD) tend to make sense of social interactions via maladaptive self‐and other attributions. They also experience difficulties in recognizing emotions. A further feature of AvPD psychopathology is the tendency to resort to maladaptive coping strategies, such as behavioral avoidance and perfectionism. Despite its impact, psychological treatments for AvPD remains poorly investigated. Herein, we describe the first five sessions of Metacognitive Interpersonal Therapy with a 28‐year‐old woman, whose treatment goal was to reduce social avoidance. We describe how this goal was achieved through a combination of working through the therapeutic relationship, alongside experiential techniques such as guided imagery, rescripting, and bodily work. Through this treatment configuration, the patient was able to increase self‐awareness of her own emotions, enabling her to realize that she was guided by rigid schemas; specifically seeing herself as inadequate and others as judgmental. Finally, implications for the treatment of AvPD are discussed. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is a severe disease, characterized by severe instabilities in identity, affect and relationships. Clinical improvement of BPD can be facilitated by psychotherapy aimed at tackling multiple specific cross-modality impairments and their patterns of interaction: impaired sense of self, maladaptive interpersonal schemas, impaired metacognition, emotion dysregulation and impulsivity. Herein, we describe the steps in the treatment of a young woman meeting the criteria for with BPD with paranoid traits, successfully treated with Metacognitive Interpersonal Therapy, a treatment based on comprehensive assessment of domains. In the initial phase, treatment focused on promoting emotion regulation, integrating opposing patient representations of the therapist, enhancing metacognition, and increasing focus on the maladaptive schema that elicited dysregulated behaviors. Later in therapy, treatment focused on supporting the patient to realize her ideas about self and others were schema-driven; and improving metacognitive capacity to understand others' minds. General implications for psychotherapy of BPD are discussed. [ABSTRACT FROM AUTHOR]

Individuals with personality disorders (PD) demonstrate poor metacognition, here defined as the capacity to use mental state knowledge for regulation of interpersonal relationships. Metacognitive interpersonal therapy (MIT) targets the symptoms of PD via a series of formalized procedures. Its goal is to help individuals improve their metacognitive capacity through developing and enacting more adaptive social behaviors. MIT has been manualized for the treatment of PDs featuring overcontrol, with single case studies providing initial evidence of its effectiveness. Given the need to deliver cost-effective treatments for patients with over-controlled and socially inhibited PDs, we developed MIT in groups (MIT-G), a short-term manualized group treatment with both psychoeducational and experiential aspects (Popolo et al. in Psychol Psychother: Theory Res Pract, 2018. 10.1111/papt.12182). Here we present the case of a young man presenting with Narcissistic PD (vulnerable type) featuring marked avoidant and obsessive-compulsive traits, social inhibition and emotional overcontrol. We describe the therapeutic process and how role-playing significant episodes helped him to improve metacognition, leading to the adoption of more effective social problem solving strategies. Outcomes were positive in terms of increased quality of social relationships, decreased symptoms, better emotion regulation and improved well-being. We conclude by considering how these processes may improve treatment delivery for these types of PD presentations. [ABSTRACT FROM AUTHOR]

Many patients with substance abuse problems present with co-occurrent cluster C personality disorders. Focusing on both disorders disrupts the maintenance mechanisms and the vicious cycle between the 2 conditions; however, treatment teams often neglect this issue. In this work, we describe the features of metacognitive interpersonal therapy as applied to a man with avoidant and depressive personality disorders and heroin, cocaine, and alcohol abuse. Psychotherapy proceeded through the following steps: (a) conducting drug therapy to deal with symptoms of abstinence from heroin; (b) forming a therapeutic bond to overcome the patient's severe emotional withdrawal; (c) fostering basic metacognitive capacities such as awareness of emotions and their triggers; (d) sharing formulations of maladaptive interpersonal schemas and descriptions of the associated states of mind; (e) conveying an understanding of the link between interpersonal events (recent ones and traumatic memories) and substance abuse; (f) facilitating the acquisition of critical distance from maladaptive schemas; and (g) promoting the use of adaptive coping skills instead of resorting to substance abuse. Implications for generalizing these procedures to the treatment of other patients with co-occurrent personality disorders and substance abuse are described. [ABSTRACT FROM AUTHOR]

ABSTRACT Treating patients with personality disorders (PD) with significant over-regulation of affects, poor metacognition and a restricted interpersonal schema repertoire requires specialized procedures. We present here the case of a man in his 30s suffering from Avoidant PD and overall 21 PD criteria met, with co-occurring axis I disorders. Metacognitive Interpersonal Therapy was used, and after 1 year of therapy, outcome was good, although therapy is still continuing. First, a more nuanced understanding of mental states and then attempts at change began, which led to a modification of the patient's negative self-image and a reduction of social avoidance. The possible relevance and generalization of formalized procedures, applied with a careful case formulation, is discussed to successfully treat persons with this type of complex PD. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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. Copyright © 2009 John Wiley & Sons, Ltd. 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. [ABSTRACT FROM AUTHOR]

There is a need to better understand the antecedent of aggressive behaviors in order to tailor treatments and reduce the associated damage to the others and the self. Possible mechanisms underlying aggression are poor emotional awareness and emotion dysregulation, as well as impulsivity. Here, we examined the relationships among alexithymia, emotion dysregulation, impulsivity and aggression, comparing a mixed psychiatric sample ( N =257) and a community sample ( N =617). The clinical sample reported greater levels of alexithymia, emotion dysregulation, trait impulsivity and aggression, than the community sample. Furthermore, in the community sample, emotion dysregulation and impulsivity mediated the relationship (i.e., accounted for the shared variance) between alexithymia and aggression. In the clinical sample, only emotion dysregulation explained the alexithymia-aggression link. In particular, specific dimensions of the emotion dysregulation (i.e., Negative Urgency) and impulsivity constructs (i.e., cognitive and motor impulsivity) played a unique role in explaining these associations. Finally, controlling for depressive symptoms reduced some of the findings involving impulsivity to nonsignificant results. Overall, our findings add to the extant literature attesting to the relevance of alexithymia and emotion dysregulation for understanding aggression, and providing concrete recommendation for the treatment and prevention of aggressive tendencies. [ABSTRACT FROM AUTHOR]

The recalcitrance of negative symptoms in the face of pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. Accordingly, this study investigated whether deficits in metacognition, or the ability to form integrated ideas about oneself, others, and the world, prospectively predicted levels of negative symptoms independent of deficits in neurocognition, affect recognition and defeatist beliefs. Participants were 53 adults with a schizophrenia spectrum disorder. Prior to entry into a rehabilitation program, all participants completed concurrent assessments of metacognition with the Metacognitive Assessment Scale-Abbreviated, negative symptoms with the Positive and Negative Syndrome Scale, neurocognition with the MATRICS battery, affect recognition with the Bell Lysaker Emotion Recognition Task, and one form of defeatist beliefs with the Recovery Assessment Scale. Negative symptoms were then reassessed one week, 9weeks, and 17weeks after entry into the program. A mixed effects regression model revealed that after controlling for baseline negative symptoms, a general index of neurocognition, defeatist beliefs and capacity for affect recognition, lower levels of metacognition predicted higher levels of negative symptoms across all subsequent time points. Poorer metacognition was able to predict later levels of elevated negative symptoms even after controlling for initial levels of negative symptoms. Results may suggest that metacognitive deficits are a risk factor for elevated levels of negative symptoms in the future. Clinical implications are also discussed. [ABSTRACT FROM AUTHOR]

Abstract: 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 &y& Elsevier]