1
|
Wilberg T, Pedersen G, Bremer K, Johansen MS, Kvarstein EH. Combined group and individual therapy for patients with avoidant personality disorder-A pilot study. Front Psychiatry 2023; 14:1181686. [PMID: 37215654 PMCID: PMC10192633 DOI: 10.3389/fpsyt.2023.1181686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Objective Avoidant personality disorder (AvPD) is a common disorder within mental health services, associated with significant psychosocial impairment. The disorder has been neglected in research. There are currently no evidence-based treatments for AvPD, and there is a need for treatment studies focusing particularly on this form of personality pathology. The present study was a pilot study of combined group and individual therapy for patients with AvPD, based on mentalization-based and metacognitive interpersonal therapy. The aim was to investigate the feasibility of the treatment program and the course of symptoms and personality functioning during treatment and 1-year follow-up. Methods The study included 28 patients. Clinical evaluation at baseline comprised structured diagnostic interviews and patients' self-report of symptoms, psychosocial function, interpersonal problems, personality functioning, alexithymia, self-esteem, attachment style, therapeutic alliance, and client satisfaction. Patients' self-report were repeated at the end of treatment and 1-year follow-up. Results The drop-out rate was 14%. Average treatment length among the 22 treatment completers was 17 months. Mean levels of therapeutic alliance and client satisfaction were satisfactory. Effect sizes were large for global symptom distress, depression, anxiety, and psychosocial adjustment, and in the moderate range for aspects of personality functioning. Yet, the results showed a wide range of outcomes among the patients. Conclusions This pilot study shows promising results for combined group- and individual therapy for AvPD patients with moderate to severe impairment. Larger scale studies should be conducted to increase empirically based knowledge to guide development of differentiated treatments adapted to patients' various levels of AvPD severity and profiles of personality dysfunction.
Collapse
Affiliation(s)
- Theresa Wilberg
- Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Geir Pedersen
- Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- The Norwegian Centre of Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjetil Bremer
- Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Merete Selsbakk Johansen
- Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- South-Eastern Norway Regional Health Authority, Unit for Mental Health Care and Substance Abuse Treatment, Hamar, Norway
| | - Elfrida Hartveit Kvarstein
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
2
|
Langwerden RJ, van der Heijden PT, Soons PH, Derksen JJ, Vuijk R, Egger JI. An Exploratory Study of MMPI-2-RF Personality and Psychopathology Profiles of Adults with Autism Spectrum Disorder without Intellectual Disability. CLINICAL NEUROPSYCHIATRY 2022; 19:335-346. [PMID: 36340276 PMCID: PMC9597642 DOI: 10.36131/cnfioritieditore20220509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE More empirical research is needed to disentangle the phenotypes of autism spectrum disorder (ASD) and cluster C personality symptomatology (CCPD), as both show similarities in their clinical presentation. We explored personality and psychopathology dimensions as conceptualized in contemporary dimensional taxonomies (i.e., hierarchical taxonomy of psychopathology; HiTOP) in adults with ASD without intellectual disability operationalized by the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). METHOD Applying secondary analytic processes using clinical data, we cross-examined the MMPI-2-RF profiles of adults with ASD (n = 28) compared to adults with Cluster C personality disorders (CCPD; n = 28) and a control group (n = 28) by conducting nonparametric tests and assessing effect sizes. RESULTS The profiles of the ASD and CCPD groups evidenced to be similar, and both average clinical profiles diverged from the average control group profiles by elevated levels of demoralization, internalizing, and somatization symptomatology. There were small differences between the average profiles of adults with ASD and adults with CCPD. Additional research using dimensional measures of psychopathology could elucidate the dimensional phenotypes of ASD and CCPD. CONCLUSIONS Based on the results in this study, the MMPI-2-RF may not meaningfully discriminate between the two clinical presentations, with the exception of various externalizing scales.
Collapse
Affiliation(s)
- Robbert J. Langwerden
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, The Netherlands, Community-Based Research Institute, Florida International University, Miami, FL, USA,Corresponding Author Robbert J. Langwerden 11200 SW 8th Street, Miami, FL 33199, USA E-mail: robbert.langwerden@ donders.ru.nl Phone: (+1) 305 348 5388
| | - Paul T. van der Heijden
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands, Reinier van Arkel Mental Health Institute, ’s Hertogenbosch, The Netherlands
| | | | - Jan J.L. Derksen
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands, Faculty of Psychology and Educational Sciences, Department of Clinical and Life Span Psychology, Vrije Universiteit Brussel, Belgium
| | - Richard Vuijk
- Sarr Autism Rotterdam, Parnassia Psychiatric Institute, Rotterdam, The Netherlands
| | - Jos I.M. Egger
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, The Netherlands, Vincent van Gogh Centres of Excellence for Neuropsychiatry, Venray, The Netherlands, Stevig Specialized and Forensic Care for People with Intellectual Disabilities, Dichterbij, Oostrum, The Netherlands
| |
Collapse
|
3
|
Metacognition Mediates the Association Between Drug Dependence and Sleep Disturbances: Cross-Sectional Findings Among Khat-Chewing Polysubstance Users. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00924-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
|
4
|
Yousefi F, Talib MA. Predictors of personality disorders in prisoners. J Med Life 2022; 15:454-461. [PMID: 35646191 PMCID: PMC9126463 DOI: 10.25122/jml-2021-0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
Personality disorders can lead to difficult social or occupational functional processes rooted in chronic maladaptive thoughts, feelings, and behaviors. This study aimed to investigate factors of personality disorder in prisoners from the central prison of Sanandaj, Iran. We conducted a cross-sectional study, which included all prisoners in the central prison of Sanandaj, Iran. The study sample includes 343 prisoners, of which 329 were male, and 14 were female, selected by randomized multistage sampling method. Participants filled in Millon's multi-axis clinical questionnaire. The data were analyzed using Chi-square, multiple logistic regression, and bootstrap analysis. There were 183 participants without personality disorders (53.4%) and 99 participants (28.9%) with cluster B personality disorders (narcissistic, histrionic, anti-social, and borderline). Male gender (OR=0.07) and elementary education level (OR=0.18) have a significant relationship with cluster A personality disorders (paranoid, schizoid, schizotypal). Cluster B has a significant relationship only with the elementary education level (OR=0.27). Cluster C (avoidant, dependent, obsessive-compulsive personality disorder) has a significant relationship with male gender (OR=0.20), elementary education level (OR=0.30), unemployment (OR=2.64), theft crime types (OR=0.38) and disputes and assaults (OR=0.18). Based on these results, psychological and psychiatric interventions in prisoners are suggested.
Collapse
Affiliation(s)
- Fayegh Yousefi
- Department of Psychiatry, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran,Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mansor Abu Talib
- Department of Psychology, Faculty of Social Sciences & Liberal Arts, UCSI University, Kuala Lumpur, Malaysia,Corresponding Author: Mansor Abu Talib, Department of Psychology, Faculty of Social Sciences & Liberal Arts, UCSI University, Kuala Lumpur, Malaysia. E-mail:
| |
Collapse
|
5
|
Kaminskaite M, Pranckeviciene A, Bunevicius A, Janaviciute J, Jokubonis D, Plioplyte A, Lelyte I, Sinkariova L, Jokubka R. Validation of the Substance Use Risk Profile Scale in Lithuanian population. Health Qual Life Outcomes 2020; 18:276. [PMID: 32787865 PMCID: PMC7425129 DOI: 10.1186/s12955-020-01527-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/03/2020] [Indexed: 01/15/2023] Open
Abstract
Background Personality traits are related with risk of hazardous alcohol use and alcohol dependence. The Substance Use Risk Profile Scale (SURPS) measures personality traits associated with addictive substance abuse. We examined psychometric properties of the SURPS in Lithuanian population. Materials and methods Two hundred forty-seven participants (mean age 37.22 ± 0.78 years), were recruited from the local community and from an inpatient addiction treatment centre. Internal consistency, stability, factor structure, content validity, and external validity of the SURPS were examined. Hazardous alcohol use was evaluated by Alcohol Use Disorder Identification Test (AUDIT). Alcohol dependence diagnosis was established by International Classification of Diseases - 10 (ICD - 10). We also performed gender analyses for associations of personality traits with alcohol dependence and hazardous use of alcohol. Results The SURPS scale demonstrated appropriate internal validity, good temporal stability, and adequate criterion validity and construct validity. The SURPS scores of hopelessness, anxiety sensitivity and impulsivity were higher in the alcohol dependence group than in the control group for both males and females. Impulsivity and sensation seeking were associated with hazardous alcohol use and these associations were more prevalent in females. Conclusions Lithuanian translation of the SURPS scale was appropriate. The SURPS demonstrated good sensitivity for discriminating on alcohol dependence and was more sensitive for discriminating on hazardous alcohol use for females.
Collapse
Affiliation(s)
- Migle Kaminskaite
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Aiste Pranckeviciene
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Adomas Bunevicius
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Darius Jokubonis
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Republican Centre for Addictive Disorders, Kaunas, Lithuania
| | - Aistė Plioplyte
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Inesa Lelyte
- Department of Psychology, Vytautas Magnus University, Kaunas, Lithuania
| | - Liuda Sinkariova
- Department of Psychology, Vytautas Magnus University, Kaunas, Lithuania
| | - Ramunas Jokubka
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
6
|
Sørensen KD, Wilberg T, Berthelsen E, Råbu M. Lived Experience of Treatment for Avoidant Personality Disorder: Searching for Courage to Be. Front Psychol 2020; 10:2879. [PMID: 31920894 PMCID: PMC6928111 DOI: 10.3389/fpsyg.2019.02879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/04/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To inquire into the subjective experience of treatment by persons diagnosed with avoidant personality disorder. Methods: Persons with avoidant personality disorder (n = 15) were interviewed twice, using semi-structured in-depth interviews, and the responses subject to interpretative-phenomenological analysis. Persons with first-hand experience of avoidant personality disorder were included in the research process. Results: The super ordinate theme emerging from the interviews, “searching for courage to be” encompassed three main themes: “seeking trust, strength, and freedom,” “being managed,” and “discovering the possibility for change and development.” The main theme, “being managed,” included the subthemes: “getting a diagnosis,” “receiving medication,” and “attending therapy.” Conclusion: Although this may not be specific to avoidant personality disorder, the findings highlight the importance of being met inter-subjectively as a person with intentionality and agency, even when one does not feel like one. The importance of establishing an emotional bond and emergent trust for open therapeutic collaboration, learning, and becoming able to build courage to begin to approach that which one fears is emphasized.
Collapse
Affiliation(s)
- Kristine Dahl Sørensen
- Group Therapy Team, Aust-Agder County Outpatient Psychiatric Unit, Sorlandet Hospital, Arendal, Norway
| | - Theresa Wilberg
- Department for Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eivind Berthelsen
- Aust-Agder County Outpatiet Psychiatric Unit, Sorlandet Hospital, Arendal, Norway
| | - Marit Råbu
- Department of Psychology, University of Oslo, Oslo, Norway
| |
Collapse
|
7
|
Cavicchioli M, Ramella P, Movalli M, Prudenziati F, Vassena G, Simone G, Maffei C. DSM-5 Maladaptive Personality Domains among Treatment-Seeking Individuals with Alcohol Use Disorder: The Role of Disinhibition and Negative Affectivity. Subst Use Misuse 2020; 55:1746-1758. [PMID: 32410484 DOI: 10.1080/10826084.2020.1762650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Dimensional models of personality and personality disorders (PDs) have been widely investigated among individuals with alcohol use disorders (AUD). Nevertheless, DSM-5 maladaptive personality domains showed mixed associations with AUD. Furthermore, no studies have explored the role of DSM-5 maladaptive personality domains on the comorbidity between AUD and different PDs. Objective(s): This study aims at investigating whether DSM-5 maladaptive personality dimensions could differentiate individuals with AUD from normative and healthy controls (HCs) subjects. The study also investigated relationships between these personality dimensions and AUD clinical features (i.e. onset, severity of concurrent substance use disorders), as well as their role in accounting for the comorbidity between AUD and PDs. Methods: This study administered the personality inventory for DSM-5 (PID-5) to 99 treatment-seeking individuals (male 68.8%; female 31.2%; age: 48.12 (14.32)) with AUD (41 AUD only; 58 AUD with PDs), comparing the participants' levels of PID-5 domains with normative data and the data from a HC sample (N = 40; male 50%; female 50%; age: 48.12 (14.32)). Results: Disinhibition and negative affectivity were relevant maladaptive personality dimensions of AUD, even when controlling for the impact of PD diagnoses. Disinhibition and negative affectivity were associated to the onset of AUD and the severity of concurrent substance use disorders. The co-occurrence of AUD and PDs is related to other two domains, namely antagonism and detachment. Conclusions: AUD is a complex psychopathological disorder in which both externalizing and internalizing aspects determine relevant clinical features.
Collapse
Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Pietro Ramella
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Mariagrazia Movalli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Francesca Prudenziati
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Giulia Vassena
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Giulia Simone
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| |
Collapse
|
8
|
Abstract
In this article, we review associations between the Dark Triad of personality (narcissism, Machiavellianism, and psychopathy) and addictive behaviors, both substance-related and non-substance-related. We summarize evidence from personality and clinical research and integrate it with prevailing models of addiction. Specifically, we discuss addictive behavior in the light of affect regulation, which is likely more relevant in narcissism, as well as inhibitory deficits, a putative mechanism in psychopathy. These mechanisms can be related to central motives of the respective personality constructs, such as stabilization of self-esteem in narcissism and impulsive stimulation seeking in psychopathy. We conclude that different mechanisms might lead to similar observable behavior in narcissism and psychopathy at earlier stages of the addiction cycle, but psychopathic disinhibition might be particularly relevant at later stages. This underpins the importance of considering personality factors for the understanding and treatment of addiction.
Collapse
Affiliation(s)
- Emanuel Jauk
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Raoul Dieterich
- Addiction Research, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
9
|
Moritz S, Lysaker PH. Metacognition - What did James H. Flavell really say and the implications for the conceptualization and design of metacognitive interventions. Schizophr Res 2018; 201:20-26. [PMID: 29903626 DOI: 10.1016/j.schres.2018.06.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 01/17/2023]
Abstract
In the last two decades years, several interventions have been designed for people with major psychological disorders that all have "metacognitive" in their name: Metacognitive Therapy (MCT), Metacognitive Training (e.g., for people with psychosis) and Metacognitive Reflection and Insight Therapy (MERIT). Two of these interventions are primarily targeted at patients with schizophrenia. Prompted by a recent discussion about what constitutes "true" metacognitive treatment, we will first explore the original concept of metacognition as defined by James H. Flavell. Then, we will describe each approach in detail before highlighting how each intervention picks up on slightly different aspects of Flavell's original metacognitive construct. We will also discuss inherent problems with the label "metacognition."
Collapse
Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Paul H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN, USA; Indiana University School of Medicine, IN, USA
| |
Collapse
|
10
|
Specialized Treatment for Patients with Severe Avoidant Personality Disorder: Experiences from Scandinavia. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2018. [DOI: 10.1007/s10879-018-9395-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
11
|
El trastorno de personalidad por evitación: una propuesta de tratamiento especializado en la sanidad pública española. ANSIEDAD Y ESTRÉS 2018. [DOI: 10.1016/j.anyes.2018.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
12
|
Gandolphe MC, Lecluyse B, Triquet C, Brunelle E, Duparcq JP, Nandrino JL. Mind reading abilities in opiate-dependent patients: An exploratory study. Compr Psychiatry 2018; 83:46-52. [PMID: 29562165 DOI: 10.1016/j.comppsych.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/16/2018] [Accepted: 03/07/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Impairments in social cognition have been described as playing a major role in the maintenance of addictive behavior in substance abusers. This study aimed to investigate the Theory of Mind (ToM) ability of opiate-dependent (OD) patients and to explore whether TOM ability was correlated with length of substance abuse, age at onset of substance abuse and length of abstinence. METHODS OD patients (N = 29) and non-dependent individuals (NDI) (N = 29) were submitted to the Theory of Mind Assessment Scale (Th.o.m.a.s.), a semi-structured interview, and to the Versailles-Lecture Intentionnelle en Situation (V-LIS), a movie paradigm in which participants have to infer the characters' intentions. RESULTS The results confirmed a deficit in ToM ability in OD patients, with OD patients demonstrating poorer performance than NDI on both the V-LIS and the Th.o.m.a.s. The combination of perspective taking and reflecting on others' mental states was particularly difficult for OD patients. Furthermore, impairments in ToM abilities were not correlated with the age at onset of substance abuse or to the duration of substance abuse or abstinence. CONCLUSIONS The results suggest OD patients may have impaired social cognition, demonstrating deficits in even basic social interaction skills, which may constitute a risk factor for addiction. These findings underline the importance of developing interventions to improve social cognition ability during the rehabilitation of OD patients.
Collapse
Affiliation(s)
- Marie-Charlotte Gandolphe
- SCALab UMR CNRS 9193, Staff DEEP (Dynamique émotionnelle et pathologies), University of Lille, Department of Psychology, B.P. 60149, F-59653 Villeneuve d'Ascq Cedex, France; Hospital Center of Hénin-Beaumont, Centre de soin, d'Accompagnement et de Prévention en Addictologie (CSAPA), 585 Avenue des déportés, 62110 Hénin-Beaumont, France.
| | - Bérénice Lecluyse
- SCALab UMR CNRS 9193, Staff DEEP (Dynamique émotionnelle et pathologies), University of Lille, Department of Psychology, B.P. 60149, F-59653 Villeneuve d'Ascq Cedex, France
| | - Claire Triquet
- Hospital Center of Felleries Liessies, Addiction Department "L'Oasis", 21 Rue du Val Joly, 59740 Felleries, France
| | - Emmanuel Brunelle
- Hospital Center of Hénin-Beaumont, Centre de soin, d'Accompagnement et de Prévention en Addictologie (CSAPA), 585 Avenue des déportés, 62110 Hénin-Beaumont, France
| | - Jean-Paul Duparcq
- Hospital Center of Hénin-Beaumont, Centre de soin, d'Accompagnement et de Prévention en Addictologie (CSAPA), 585 Avenue des déportés, 62110 Hénin-Beaumont, France
| | - Jean-Louis Nandrino
- SCALab UMR CNRS 9193, Staff DEEP (Dynamique émotionnelle et pathologies), University of Lille, Department of Psychology, B.P. 60149, F-59653 Villeneuve d'Ascq Cedex, France
| |
Collapse
|
13
|
Abstract
Avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD), schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the "severity continuum hypothesis", in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment.
Collapse
Affiliation(s)
- Lisa Lampe
- Discipline of Psychiatry, University of Newcastle, Newcastle, NSW, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
14
|
Roncero C, de Miguel A, Fumero A, Abad AC, Martín R, Bethencourt JM, Grau-López L, Rodríguez-Cintas L, Daigre C. Anxiety and Depression in Drug-Dependent Patients with Cluster C Personality Disorders. Front Psychiatry 2018; 9:19. [PMID: 29472875 PMCID: PMC5810269 DOI: 10.3389/fpsyt.2018.00019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/18/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Comorbidity between personality disorders (PD) and substance-use disorders (SUD) is one of the most common findings in the psychiatric field. The patients with Cluster C disorders present maladjustment traits often characterized by high levels of anxiety. The main aim of this study was to find evidences about higher anxiety and depression prevalence on Cluster C than others Clusters, analyzing similarities and differences within, with other Cluster A and B PD patients and patients without PD. METHOD A total of 822 substance dependent patients (ages18-78; Mean = 38.35, SD = 10.14) completed the structured clinical interview for DSM-IV Axis I and Axis II disorders, Beck Depression Inventory, and State-Trait Anxiety Inventory. RESULTS Results supported poly-consumption in Cluster C patients, being greater alcohol consumption as well as abuse of both stimulants and depressants. Anxiety and depression did not show just one pattern for all patients with SUD-Cluster C PD. There was a relation between anxiety and depression for all the groups except for the Dependent-PD. CONCLUSION Interventions should focus on aspects like depression and anxiety more than on the substance consumed.
Collapse
Affiliation(s)
- Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain.,Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adelia de Miguel
- Sciences of Health School, Universidad of La Laguna, Tenerife, Spain
| | - Ascensión Fumero
- Sciences of Health School, Universidad of La Laguna, Tenerife, Spain
| | - Alfonso C Abad
- Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Services, Hospital Universitario Vall d'Hebron, CIBERSAM, Barcelona, Spain
| | - Rita Martín
- Sciences of Health School, Universidad of La Laguna, Tenerife, Spain
| | | | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Psychiatry Services, Hospital Universitario Vall d'Hebron, CIBERSAM, Barcelona, Spain
| | - Laia Rodríguez-Cintas
- Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Constanza Daigre
- Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Psychiatry Services, Hospital Universitario Vall d'Hebron, CIBERSAM, Barcelona, Spain
| |
Collapse
|
15
|
Metacognitive Interpersonal Therapy Improves Adherence to Antiretroviral Therapies in a Man with a Severe Personality Disorder: A Case Report. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2017. [DOI: 10.1007/s10879-017-9363-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
16
|
Dimaggio G, Popolo R, Montano A, Velotti P, Perrini F, Buonocore L, Garofalo C, D'Aguanno M, Salvatore G. Emotion dysregulation, symptoms, and interpersonal problems as independent predictors of a broad range of personality disorders in an outpatient sample. Psychol Psychother 2017; 90:586-599. [PMID: 28585718 DOI: 10.1111/papt.12126] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/20/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED Emotion dysregulation (ED) is considered a hallmark of borderline personality disorder and is prominent in other personality disorders (PDs). Its presence and contribution to personality pathology need to be explored in the whole range of PDs. In this study, we investigated the association of ED with the whole range of PD traits, symptoms, and interpersonal problems and then investigated whether ED had a unique contribution in predicting the different PDs. A sample of 478 treatment-seeking outpatients was interviewed with the SCID-II. The patients were then tested for symptoms (SCL-90-R), interpersonal problems (IIP-32), and ED (DERS). RESULTS ED correlated with the large majority of PDs and with symptoms and interpersonal problems. Regression showed how ED explained a unique part of the variance for many PDs. ED appears to be a relevant feature of pathology in many PDs; with replication, it can be considered a treatment target in this population. PRACTITIONER POINTS Emotion dysregulation is present in many personality disorders. Emotion dysregulation is not just explained by heightened symptoms and interpersonal problems in personality disorders. Emotion dysregulation could be considered a treatment target in personality disorders other than borderline.
Collapse
Affiliation(s)
| | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Rome, Italy.,Studi Cognitivi, Milan, Italy
| | | | | | | | | | - Carlo Garofalo
- Department of Developmental Psychology, Tilburg University, The Netherlands
| | - Mario D'Aguanno
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Italy
| | | |
Collapse
|
17
|
Lysaker PH, George S, Chaudoin-Patzoldt KA, Pec O, Bob P, Leonhardt BL, Vohs JL, James AV, Wickett A, Buck KD, Dimaggio G. Contrasting metacognitive, social cognitive and alexithymia profiles in adults with borderline personality disorder, schizophrenia and substance use disorder. Psychiatry Res 2017; 257:393-399. [PMID: 28826064 DOI: 10.1016/j.psychres.2017.08.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/21/2017] [Accepted: 08/01/2017] [Indexed: 01/28/2023]
Abstract
Deficits in the ability to recognize and think about mental states are broadly understood to be a root cause of dysfunction in Borderline Personality Disorder (PD). This study compared the magnitude of those deficits relative to other forms of serious mental illness or psychiatric conditions. Assessments were performed using the metacognition assessment scale-abbreviated (MAS-A), emotion recognition using the Bell Lysaker Emotion Recognition Test and alexithymia using the Toronto Alexithymia Scale among adults with schizophrenia (n = 65), Borderline PD (n = 34) and Substance Use disorder without psychosis or significant Borderline traits (n = 32). ANCOVA controlling for age revealed the Borderline PD group had significantly greater levels of metacognitive capacity on the MAS-A than the schizophrenia group and significantly lower levels of metacognitive capacity than the Substance Use group. Multiple comparisons revealed the Borderline PD group had significantly higher self-reflectivity and awareness of the other's mind than the schizophrenia group but lesser mastery and decentration on the MAS-A than substance use group, after controlling for self-report of psychopathology and overall number of PD traits. The Borderline PD and Schizophrenia group had significantly higher levels of alexithymia than the substance use group. No differences were found for emotion recognition. Results suggest metacognitive functioning is differentially affected in different mental disorders.
Collapse
Affiliation(s)
- Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Day Hospital 116H, 1481 W. 10th Street, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA.
| | - Sunita George
- School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, GH109, Indianapolis, IN 46227, USA
| | - Kelly A Chaudoin-Patzoldt
- School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, GH109, Indianapolis, IN 46227, USA
| | - Ondrej Pec
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry, First Faculty of Medicine, Charles University, Ovocný trh 3-5, 116 36 Praha 1-Staré Město, Prague, Czech Republic; Psychotherapeutic and Psychosomatic Clinic ESET, Prague, Czech Republic
| | - Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry, First Faculty of Medicine, Charles University, Ovocný trh 3-5, 116 36 Praha 1-Staré Město, Prague, Czech Republic
| | - Bethany L Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA
| | - Jenifer L Vohs
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA
| | - Alison V James
- Department of Psychology, Indiana State University, B-207 Root Hall, 200 N. Seventh Street, Terre Haute, IN 47809, USA
| | - Amanda Wickett
- Richard L. Roudebush VA Medical Center, Day Hospital 116H, 1481 W. 10th Street, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA
| | - Kelly D Buck
- Richard L. Roudebush VA Medical Center, Day Hospital 116H, 1481 W. 10th Street, Indianapolis, IN 46202, USA
| | - Giancarlo Dimaggio
- Center for Metacognitive Psychotherapy, Piazza dei Martiri di Belfiore 4, 00195 Rome, Italy
| |
Collapse
|
18
|
Gierski F, Benzerouk F, De Wever E, Duka T, Kaladjian A, Quaglino V, Naassila M. Cloninger's Temperament and Character Dimensions of Personality and Binge Drinking Among College Students. Alcohol Clin Exp Res 2017; 41:1970-1979. [PMID: 28902418 DOI: 10.1111/acer.13497] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/06/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Temperament and character dimensions of personality remain largely unexplored in young adults exhibiting binge drinking (BD) patterns. Moreover, the available studies do not consider gender differences and dismiss possible personality heterogeneity among binge drinkers. In this study, we aimed to compare temperament and character dimensions between young binge drinkers and age- and sex-matched social drinkers. We further applied cluster analysis to investigate the potential heterogeneity of personality patterns among BD college students. METHODS This study included 200 university students of 18 to 24 years of age, who were recruited via an invitation to take an alcohol use survey. These participants included 100 individuals (50 females and 50 males) with a BD pattern, and 100 participants (50 females and 50 males) with a social drinking (SD) pattern. These subjects were evaluated with regard to their use of alcohol and other substances, impulsiveness, sensation seeking, mood, and Cloninger's Temperament and Character Inventory. RESULTS Between-group comparisons revealed that both male and female binge drinkers were characterized by high levels of novelty seeking, and low levels of persistence and self-directedness. However, cluster analyses within the binge drinker group revealed 2 distinct groups that differed between males and females. These groups shared similarities with Cloninger's type I (high harm-avoidance) and II (high novelty-seeking) alcoholism typology. CONCLUSIONS The present findings support the subdivision of binge drinkers according to gender and personality dimensions. Male and female binge drinkers should not be considered a unitary group, but rather a population of individuals that encompasses at least 2 distinct personality patterns. These findings have major implications for prevention and treatment approaches.
Collapse
Affiliation(s)
- Fabien Gierski
- Cognition Health Socialization Laboratory (C2S - EA 6291), Reims Champagne-Ardenne University, Reims, France.,Department of Psychiatry, Reims University Hospital, Reims, France
| | - Farid Benzerouk
- Cognition Health Socialization Laboratory (C2S - EA 6291), Reims Champagne-Ardenne University, Reims, France.,Department of Psychiatry, Reims University Hospital, Reims, France
| | - Elodie De Wever
- CRP-CPO Laboratory (EA7273), Jules Verne Picardie University, Amiens, France
| | - Theodora Duka
- Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Arthur Kaladjian
- Cognition Health Socialization Laboratory (C2S - EA 6291), Reims Champagne-Ardenne University, Reims, France.,Department of Psychiatry, Reims University Hospital, Reims, France
| | - Véronique Quaglino
- CRP-CPO Laboratory (EA7273), Jules Verne Picardie University, Amiens, France
| | - Mickaël Naassila
- INSERM ERi24 GRAP, Research Group on Alcohol and Pharmacodependences, Jules Verne Picardie University, Amiens, France
| |
Collapse
|
19
|
Are executive functions related to emotional intelligence? A correlational study in schizophrenia and borderline personality disorder. Psychiatry Res 2016; 246:84-88. [PMID: 27669495 DOI: 10.1016/j.psychres.2016.09.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 11/22/2022]
Abstract
This research explored the relationship between executive functions (working memory and reasoning subtests of the Wechsler Adult Intelligence Scale, Trail Making and Stroop tests, fluency and planning tasks, and Wisconsin Card Sorting Test) and emotional intelligence measured by the Mayer-Salovey-Caruso Emotional Intelligence Test in patients with schizophrenia or borderline personality disorder compared to a control group. As expected, both clinical groups performed worse than the control group in executive functions and emotional intelligence, although the impairment was greater in the borderline personality disorder group. Executive functions significantly correlated with social functioning. Results are discussed in relation to the brain circuits that mediate executive functions and emotional intelligence and the findings obtained with other models of social cognition.
Collapse
|
20
|
Cluster B Personality Disorder Traits as a Predictor of Therapeutic Alliance Over Time in Residential Treatment for Substance Use Disorders. J Nerv Ment Dis 2016; 204:736-740. [PMID: 27356120 DOI: 10.1097/nmd.0000000000000553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While poor therapeutic alliance is a robust predictor of poor outcome in substance abuse treatment, less is known about the barriers to therapeutic alliances in this group. To explore this issue, this study examined whether the severity of cluster B personality disorders predicted therapeutic alliances concurrently and prospectively in a residential substance treatment program for homeless veterans. Participants were 48 adults with a substance abuse disorder. Personality disorder traits were assessed using the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Personality Disorders, whereas therapeutic alliance was assessed at baseline using the Working Alliance Inventory. Partial correlations controlling for overall symptom severity measured with the Symptom Checklist 90 and education, revealed cluster B traits at baseline predicted all 4 assessments of therapeutic alliance even after controlling for initial levels of therapeutic alliance. Results suggest that higher levels of cluster B traits are a barrier to the formation of working alliances in residential substance treatment.
Collapse
|
21
|
Möller C, Karlgren L, Sandell A, Falkenström F, Philips B. Mentalization-based therapy adherence and competence stimulates in-session mentalization in psychotherapy for borderline personality disorder with co-morbid substance dependence. Psychother Res 2016; 27:749-765. [DOI: 10.1080/10503307.2016.1158433] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Clara Möller
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Linda Karlgren
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Anton Sandell
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Fredrik Falkenström
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Center for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Björn Philips
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Center for Dependency Disorders, Stockholm County Council, Stockholm, Sweden
- Center for Psychiatry Research Stockholm, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
22
|
Abstract
This review focuses on recent research on diagnostic aspects, etiology, and treatment of avoidant personality disorder (AVPD). Current studies stress the close relation between AVPD and social anxiety disorder, the influence of genetic factors in the development of AVPD, and the relative stability of symptoms. Treatment approaches should target the pervasive patterns of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Empirical evidence for cognitive-behavior and schema therapy is promising. Few other therapeutic approaches have been developed, but until now, these have only been investigated in case studies. We conclude that AVPD qualifies as a neglected disorder and that more research specifically on avoidant personality disorder symptoms and its treatment is needed.
Collapse
|
23
|
Avoidant personality disorder as a social anxiety phenotype: risk factors, associations and treatment. Curr Opin Psychiatry 2016; 29:64-9. [PMID: 26651009 DOI: 10.1097/yco.0000000000000211] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article identifies research trends and synthesizes information from recent studies of avoidant personality disorder (AVPD). RECENT FINDINGS AVPD and social anxiety disorder (SAD) share genetic vulnerability, but may have distinct environmental risk factors that shape qualitative differences. Negative self-concept, shame proneness, and interpersonal hypersensitivity are characteristic of AVPD and may be predisposed to by heritable traits of high negative affectivity and low positive affectivity, and experiences of neglectful or emotionless parents. The interpersonal difficulties of AVPD may be associated with both anxious and avoidant attachment. Most individuals with AVPD do not also meet criteria for SAD. SUMMARY Integrative treatments incorporating cognitive behavioral strategies effective in SAD but also targeting shame aversion and avoidance may be most helpful for AVPD. Therapy adapted to both anxious attachment, associated with heightened interpersonal sensitivity and distress, and avoidant attachment, associated with experiential avoidance, may be optimal, though this is yet to be tested. Effective treatment of AVPD may enhance the outcome of comorbid conditions. More research is needed which compares three social anxiety groups (SAD alone, AVPD alone, and SAD plus AVPD) to further explore these disorders which are highly related, but which may have differences that are clinically relevant for individuals.
Collapse
|
24
|
Exploring the Relationships between Spirituality and Personality Disorder Traits among a Sample of In-Patients in Treatment for Substance Use Disorder. Int J Ment Health Addict 2015. [DOI: 10.1007/s11469-015-9596-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
25
|
Dimaggio G, Lysaker PH. Metacognition and Mentalizing in the Psychotherapy of Patients With Psychosis and Personality Disorders. J Clin Psychol 2014; 71:117-24. [DOI: 10.1002/jclp.22147] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Paul H. Lysaker
- Roudebush VA Medical Center
- Indiana University School of Medicine
| |
Collapse
|
26
|
Kongerslev M, Simonsen S, Bo S. The quest for tailored treatments: a meta-discussion of six social cognitive therapies. J Clin Psychol 2014; 71:188-98. [PMID: 25557904 DOI: 10.1002/jclp.22154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this commentary on the 6 articles comprising this In Session issue on metacognition and mentalizing in the psychotherapeutic treatment of severe mental disorders, we strive to contextualize and bring together salient issues reflected in these articles. In the foreground of our discussion is the point that the commonalities of these and related social cognitive treatments far outweigh their differences. We attempt to pinpoint some of the more specific tailored treatment elements described by the authors and relate these to empirical findings and theoretical and practical problems. Among the key issues addressed in this commentary are conceptual fallacies, therapist transparency, personality disorder and self-harm in adolescence, therapeutic alliance, and a metacognitive-informed group psychotherapy practice for patients with avoidant personality disorder or alexithymia.
Collapse
Affiliation(s)
- Mickey Kongerslev
- Psychiatric Research Unit, Region Zealand, Denmark; Psychiatric Clinic Roskilde
| | | | | |
Collapse
|