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. Copyright © 2007 John Wiley & Sons, Ltd.