Mindreading Dysfunction in Avoidant Personality Disorder Compared With Other Personality Disorders
Abstract
The ability to reflect on one's 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different PDs and highlight a close link between impaired monitoring and decentration functions and the inhibited and withdrawn personality style typical of AvPD.
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SCID-I and SCID-II had adequate inter-rater reliability for trait scores (ICC 0.84-0.99; mean 0.93) and categorical diagnoses (average κ = 0.90) in previous studies.
“In previous studies we observed that inter-rater reliability was adequate for both trait scores (a two-way mixed absolute agreement model for intra-class correlations coefficients ranged between 0.84 and 0.99; mean, 0.93) and categorical diagnoses (average κ = 0.90) [52].”
From Symptom severity and mindreading in narcissistic personality disorder. (2018) · cites this paper as [52]
Cites
Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(94)90005-1 · Cited by 5,293 · see citing works
Affect Regulation, Mentalization, and the Development of the Self
Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2018) · doi:10.4324/9780429471643 · Cited by 3,886 · see citing works
The Prevalence of Personality Disorders in a Community Sample
Torgersen, S. O., Kringlen, E., & Cramer, V. (2001) · Archives of General Psychiatry · doi:10.1001/archpsyc.58.6.590 · Cited by 1,300 · see citing works
Mentalizing in Clinical Practice
Allen, J. G., Fonagy, P., & Bateman, A. W. (2008) · doi:10.1176/appi.books.9781615370887 · Cited by 944 · see citing works
Theory of mind impairment in schizophrenia: meta-analysis
Bora, E., Yucel, M., & Pantelis, C. (2009) · Schizophrenia Research · doi:10.1016/j.schres.2008.12.020 · Cited by 797 · see citing works
Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolò, G., Procacci, M., & Alleva, G. (2003) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.362 · Cited by 605 · see citing works
Self-citationChoi-Kain, L. W., & Gunderson, J. G. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07081360 · Cited by 565 · cited 1× · see citing works
“…to integrate changingmental states into a coherent narrative, the ability to recognize other people's emotions, the ability to understand viewpoints and perspectives of other people, and so on (Antonsen et al., 2016; Choi-Kain and Gunderson, 2008; Gullestad et al., 2013; Semerari et al., 2007).”
BackgroundPersonality Assessment in DSM-5: Empirical Support for Rating Severity, Style, and Traits
Hopwood, C. J., Malone, J. C., Ansell, E. B., Sanislow, C. A., Grilo, C. M., McGlashan, T. H., Pinto, A., Markowitz, J. C., Shea, M. T., Skodol, A. E., et al. (2011) · Journal of Personality Disorders · doi:10.1521/pedi.2011.25.3.305 · Cited by 377 · see citing works
Disorders of personality introducing a DSM/ICD spectrum from normal to abnormal
Millon, T. (2011) · Wiley eBooks · doi:10.1002/9781118099254 · Cited by 258 · see citing works
Personality Disorder Types Proposed for DSM-5
Skodol, A. E., Bender, D. S., Morey, L. C., Clark, L. A., Oldham, J. M., Alarcon, R. D., Krueger, R. F., Verheul, R., Bell, C. C., & Siever, L. J. (2011) · Journal of Personality Disorders · doi:10.1521/pedi.2011.25.2.136 · Cited by 241 · see citing works
Family Study of Early-Onset Dysthymia
Klein, D. N. (1995) · Archives of General Psychiatry · doi:10.1001/archpsyc.1995.03950180073010 · Cited by 208 · see citing works
Alexithymia in personality disorders: Correlations with symptoms and interpersonal functioning
Nicolò, G., Semerari, A., Lysaker, P. H., Dimaggio, G., Conti, L., D'Angerio, S., Procacci, M., Popolo, R., & Carcione, A. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2010.07.046 · Cited by 168 · see citing works
Self-citationSemerari, A., Carcione, A., Dimaggio, G., Nicolò, G., & Procacci, M. (2007) · Psychotherapy Research · doi:10.1080/10503300500536953 · Cited by 163 · see citing works
Self-citationSemerari, A., Colle, L., Pellecchia, G., Buccione, I., Carcione, A., Dimaggio, G., Nicolò, G., Procacci, M., & Pedone, R. (2014) · Journal of Personality Disorders · doi:10.1521/pedi_2014_28_137 · Cited by 154 · see citing works
Self-citationFischer‐Kern, M., Buchheim, A., Hörz‐Sagstetter, S., Schuster, P., Doering, S., Kapusta, N. D., Taubner, S., Tmej, A., Rentrop, M., Buchheim, P., et al. (2010) · Psychoanalytic Psychology · doi:10.1037/a0020862 · Cited by 130 · see citing works
Semerari, A., Cucchi, M., Dimaggio, G., Cavadini, D., Carcione, A., Battelli, V., Nicolò, G., Pedone, R., Siccardi, T., D′Angerio, S., et al. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.07.015 · Cited by 118 · see citing works
Self-citationAlexithymia: Relationship to personality disorders
Bach, M., de Zwaan, M., Ackard, D., Nutzinger, D. O., & Mitchell, J. E. (1994) · Comprehensive Psychiatry · doi:10.1016/0010-440x(94)90197-x · Cited by 113 · see citing works
Dimaggio, G., Procacci, M., Nicolò, G., Popolo, R., Semerari, A., Carcione, A., & Lysaker, P. H. (2007) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.541 · Cited by 105 · see citing works
Self-citationIs Avoidant Personality Disorder More Than Just Social Avoidance?
Taylor, C. T., Laposa, J. M., & Alden, L. E. (2004) · Journal of Personality Disorders · doi:10.1521/pedi.18.6.571.54792 · Cited by 105 · see citing works
Metacognitive mastery dysfunctions in personality disorder psychotherapy
Carcione, A., Nicolò, G., Pedone, R., Popolo, R., Conti, L., Fiore, D., Procacci, M., Semerari, A., & Dimaggio, G. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2010.12.032 · Cited by 99 · see citing works
Self-citationInvited Essay: Identity and Borderline Personality Disorder
Jørgensen, C. R. (2010) · Journal of Personality Disorders · doi:10.1521/pedi.2010.24.3.344 · Cited by 84 · see citing works
Gullestad, F. S., Johansen, M. S., Høglend, P. A., Karterud, S., & Wilberg, T. (2012) · Psychotherapy Research · doi:10.1080/10503307.2012.684103 · Cited by 76 · see citing works
The impact of avoidant personality disorder on psychosocial impairment is substantial
Wilberg, T., Karterud, S., Pedersen, G., & Urnes, Ø. (2009) · Nordic Journal of Psychiatry · doi:10.1080/08039480902831322 · Cited by 76 · see citing works
Antonsen, B. T., Johansen, M. S., Rø, F. G., Kvarstein, E. H., & Wilberg, T. (2015) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2015.05.016 · Cited by 73 · see citing works
Personality Functioning in Patients With Avoidant Personality Disorder and Social Phobia
Eikenæs, I. U.-M., Hummelen, B., Abrahamsen, G., Andrea, H., & Wilberg, T. (2013) · Journal of Personality Disorders · doi:10.1521/pedi_2013_27_109 · Cited by 59 · see citing works
Dimaggio, G., Carcione, A., Nicolò, G., Conti, L., Fiore, D., Pedone, R., Popolo, R., Procacci, M., & Semerari, A. (2009) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.619 · Cited by 59 · see citing works
Self-citationCramer, V., Torgersen, S., & Kringlen, E. (2007) · Journal of Personality Disorders · doi:10.1521/pedi.2007.21.5.552 · Cited by 57 · see citing works
Personality Disorders and Mindreading
Semerari, A., Colle, L., Pellecchia, G., Carcione, A., Conti, L., Fiore, D., Moroni, F., Nicolò, G., Procacci, M., & Pedone, R. (2015) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000339 · Cited by 52 · see citing works
Self-citationBilotta, E., Giacomantonio, M., Leone, L., Mancini, F., & Coriale, G. (2015) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12079 · Cited by 39 · see citing works
Johansen, M. S., Normann‐Eide, E., Normann‐Eide, T., & Wilberg, T. (2013) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12076 · Cited by 39 · see citing works
Dreessen, L., Arntz, A. R., Hendriks, T., Keune, N., & van den Hout, M. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00154-5 · Cited by 33 · see citing works
Rosenthal, M. Z., Kim, K. K., Herr, N. R., Smoski, M. J., Cheavens, J. S., Lynch, T. R., & Kosson, D. S. (2011) · Personality Disorders Theory Research and Treatment · doi:10.1037/a0023672 · Cited by 18 · see citing works
Hopwood, C. J., Morey, L. C., Gunderson, J. G., Skodol, A. E., Shea, M. T., Grilo, C. M., & McGlashan, T. H. (2005) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2005.00683.x · Cited by 16 · see citing works
Normann‐Eide, E., Johansen, M. S., Normann‐Eide, T., Egeland, J., & Wilberg, T. (2015) · PLoS ONE · doi:10.1371/journal.pone.0145625 · Cited by 12 · see citing works
Yao, F. (2011) · Zhongguo xinli weisheng zazhi · Cited by 9 · see citing works
Eikenæs, I. U.-M., Egeland, J., Hummelen, B., & Wilberg, T. (2015) · PLoS ONE · doi:10.1371/journal.pone.0128737 · Cited by 5 · see citing works
Flagged first, then by citations
1 of the 37 references couldn’t be matched to a known paper.
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Avoidant personality disorder: current insights
Lampe, L. A., & Malhi, G. S. (2018) · Psychology Research and Behavior Management · doi:10.2147/prbm.s121073 · Cited by 100 · see citing works
You ≠ me: individual differences in the structure of social cognition
Shaw, D. J., Czekóová, K., Pennington, C. R., Qureshi, A., Špiláková, B., Salazar, M., Brázdil, M., & Urbánek, T. (2018) · Psychological Research · doi:10.1007/s00426-018-1107-3 · Cited by 38 · see citing works
Simonsen, S., Popolo, R., Juul, S., Frandsen, F. W., Sørensen, P., & Dimaggio, G. (2021) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001432 · Cited by 37 · see citing works
Chevalier, V., Simard, V., & Achim, J. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102694 · Cited by 36 · see citing works
Avoidant personality disorder and social phobia: Does mindreading make the difference?
Pellecchia, G., Moroni, F., Colle, L., Semerari, A., Carcione, A., Fera, T., Fiore, D., Nicolò, G., Pedone, R., & Procacci, M. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.09.011 · Cited by 36 · see citing works
Self-citationSocial anxiety disorder and avoidant personality disorder from an interpersonal perspective
Frandsen, F. W., Simonsen, S., Poulsen, S., Sørensen, P. S., & Lau, M. E. (2019) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12214 · Cited by 34 · see citing works
Metacognitively oriented psychotherapy for schizotypal personality disorder: A two‐case series
Cheli, S., Lysaker, P. H., & Dimaggio, G. (2019) · Personality and Mental Health · doi:10.1002/pmh.1447 · Cited by 34 · see citing works
Simonsen, S., Eikenæs, I. U.-M., Nørgaard, N. L., Normann‐Eide, E., Juul, S., & Wilberg, T. (2018) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-018-9395-x · Cited by 31 · see citing works
Struggling to be a person: Lived experience of avoidant personality disorder
Sørensen, K. D., Råbu, M., Wilberg, T., & Berthelsen, E. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22740 · Cited by 31 · see citing works
Symptom severity and mindreading in narcissistic personality disorder.
Bilotta, E., Carcione, A., Fera, T., Moroni, F., Nicolò, G., Pedone, R., Pellecchia, G., Semerari, A., & Colle, L. (2018) · PLOS ONE · doi:10.1371/journal.pone.0201216 · Cited by 29 · see citing works
Self-citationAssessing mentalization in psychotherapy: first validation of the Mentalization Imbalances Scale
Gagliardini, G., Gullo, S., Caverzasi, E., Boldrini, A., Blasi, S., & Colli, A. (2018) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2018.339 · Cited by 27 · see citing works
Level of alexithymia as a measure of personality dysfunction in avoidant personality disorder
Simonsen, S., Eikenæs, I. U.-M., Bach, B., Kvarstein, E. H., Gondan, M., Møeller, S. B., & Wilberg, T. (2020) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2020.1841290 · Cited by 26 · see citing works
Metacognitive interpersonal therapy in group: a feasibility study
Popolo, R., MacBeth, A. M., Brunello, S., Canfora, F., Ozdemir, E., Rebecchi, D., Toselli, C., Venturelli, G., Salvatore, G., & Dimaggio, G. (2018) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2018.338 · Cited by 25 · see citing works
Kvarstein, E. H., Antonsen, B. T., Klungsøyr, O., Pedersen, G., & Wilberg, T. (2021) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000471 · Cited by 22 · see citing works
Combined group and individual therapy for patients with avoidant personality disorder—A pilot study
Wilberg, T., Pedersen, G., Bremer, K., Johansen, M. S., & Kvarstein, E. H. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1181686 · Cited by 19 · see citing works
Gagliardini, G., Gullo, S., Teti, A., & Colli, A. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23430 · Cited by 16 · see citing works
Johansen, M. S., Karterud, S., Normann‐Eide, E., Rø, F. G., Kvarstein, E. H., & Wilberg, T. (2018) · Psychoanalytic Psychology · doi:10.1037/pap0000169 · Cited by 16 · see citing works
Colle, L., Pellecchia, G., Moroni, F., Carcione, A., Nicolò, G., Semerari, A., & Procacci, M. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00263 · Cited by 15 · see citing works
Self-citationKvarstein, E. H., Zahl, K., Stänicke, L. I., Pettersen, M. S., Baltzersen, Å.-L., Johansen, M. S., Eikenæs, I. U.-M., Arnevik, E. A., Hummelen, B., Wilberg, T., et al. (2021) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2021.1934110 · Cited by 13 · see citing works
Ohse, L., Zimmermann, J., Kerber, A., Kampe, L., Mohr, J., Schierz, R., Rentrop, M., Dziobek, I., & Hörz‐Sagstetter, S. (2023) · Psychopathology · doi:10.1159/000533861 · Cited by 13 · see citing works
Lived Experience of Treatment for Avoidant Personality Disorder: Searching for Courage to Be
Sørensen, K. D., Wilberg, T., Berthelsen, E., & Råbu, M. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02879 · Cited by 12 · see citing works
Sayar, H., Wilberg, T., Eikenæs, I. U.-M., Ekberg, A., Leitemo, K., Morken, K. T. E., Oftedal, E., Omvik, S., Ulvestad, D. A., Pedersen, G., et al. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1558654 · Cited by 11 · see citing works
Agency in avoidant personality disorder: a narrative review
Weme, A. V., Sørensen, K. D., & Binder, P. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1248617 · Cited by 10 · see citing works
Frederiksen, C. K., Solbakken, O. A., Licht, R. W., Jørgensen, C. R., Rodrigo-Domingo, M., & Telléus, G. K. (2021) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12771 · Cited by 9 · see citing works
Inchausti, F., Prado-Abril, J., Sánchez-Reales, S., Vilagrà-Ruiz, R., & Fonseca‐Pedrero, E. (2018) · Ansiedad y Estrés · doi:10.1016/j.anyes.2018.05.002 · Cited by 8 · see citing works
Prunetti, E., Magrin, C., Zavagnin, M., Bodini, L., Bateni, M., & Dimaggio, G. (2022) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-022-09536-9 · Cited by 7 · see citing works
Pedone, R., Barbarulo, A. M., Colle, L., Semerari, A., & Grimaldi, P. (2021) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001304 · Cited by 6 · see citing works
Self-citationPedone, R., & Semerari, A. (2023) · PubMed Central · doi:10.36131/cnfioritieditore20230606 · Cited by 5 · see citing works
Self-citationCzekóová, K., Shaw, D. J., Pokorná, Z., & Brázdil, M. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.00563 · Cited by 4 · see citing works
Simonsen, S., & Bo, S. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23136 · Cited by 4 · see citing works
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Parashar, N., Kellermann, A., Arnau, R. C., & Green, B. A. (2024) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-024-10186-5 · Cited by 3 · see citing works
Is Personality Pathology Ego-Syntonic? Self- and Meta-Perception of Maladaptive Personality Traits
Sharpe, B. M., Sleep, C. E., Carter, N. T., Lynam, D. R., & Miller, J. D. (2023) · Journal of Personality Disorders · doi:10.1521/pedi.2023.37.4.383 · Cited by 3 · see citing works
Omvik, S., Kvamme, A., Aßmus, J., Kvarstein, E. H., Pedersen, G., & Zahl, K. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70149 · Cited by 2 · see citing works
Wichstrøm, L., Wilberg, T., Kvarstein, E. H., & Steinsbekk, S. (2024) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.14064 · Cited by 2 · see citing works
Theory of Mind in Social Anxiety Disorder and Avoidant Personality Disorder Comorbidity
Özdel, K., & Aghakishiyeva, T. (2023) · Nöro Psikiyatri Arşivi · doi:10.29399/npa.28368 · Cited by 2 · see citing works
Sørensen, K. D., Bremer, K., & Wilberg, T. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1412665 · Cited by 2 · see citing works
Suggerimenti di buona pratica clinica per il disturbo evitante di personalità
Mammone, I., & Dimaggio, G. (2023) · QUADERNI DI PSICOTERAPIA COGNITIVA · doi:10.3280/qpc52-2023oa16175 · Cited by 2 · see citing works
Semerari, A. (2018) · QUADERNI DI PSICOTERAPIA COGNITIVA · doi:10.3280/qpc2018-042005
Self-citationMetacognition as a General Factor of Personality Pathology
Riccardi, I., Pedone, R., & Semerari, A. (2021) · Springer eBooks · doi:10.1007/978-3-030-70455-1_3
Self-citationCognizione sociale, metacognizione e psicopatologia
Grimaldi, P. (2023) · QUADERNI DI PSICOTERAPIA COGNITIVA · doi:10.3280/qpc51-2022oa15180
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Frederiksen, C. K. (2021) · doi:10.54337/aau448604869
- Authors
- Moroni, F., Procacci, M., Pellecchia, G., Semerari, A., Nicolò, G., Carcione, A., Pedone, R., & Colle, L.
- Affiliations
- University of Campania "Luigi Vanvitelli" (IT)
- Corresponding author
- Moroni, Fabio
- Procacci, Michele
- Pellecchia, Giovanni
- Semerari, Antonio
- Nicolò, Giuseppe
- Carcione, Antonino
- Pedone, Roberto
- Colle, Livia
- Venue
- Journal of Nervous & Mental Disease
- Published
- 2016-10
- Volume
- 204
- Issue
- 10
- Pages
- 752-757
- ISSN
- 0022-3018 (ISSN-L)
- 1539-736X
- OpenAlex
- W2403041468
- Cited by
- 41
- References
- 37
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 9 · 2022: 2 · 2021: 8 · 2020: 2 · 2019: 4 · 2018: 9 · 2017: 2
- FWCI
- 6.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- avoidant personality disorder, metacognition, theory of mind, metacognitive monitoring, decentering, personality disorders
- MeSH terms
- Metacognition, Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Personality Disorders, Social Behavior, Young Adult, Theory of Mind
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