Handbook of Mentalizing in Mental Health Practice

The 11th revision of the World Health Organization (WHO) International Classification of Diseases (ICD-11) includes a fundamentally new approach to Personality Disorders (PD). ICD-11 is expected to be implemented first in European countries before other WHO member states. The present paper provides an overview of this new ICD-11 model including PD severity classification, trait domain specifiers, and the additional borderline pattern specifier. We discuss the perceived challenges and opportunities of using the ICD-11 approach with particular focus on its continuity and discontinuity with familiar PD categories such as avoidant PD and narcissistic PD. The advent of the ICD-11 PD classification involves major changes for health care workers, researchers, administrators, and service providers as well as patients and families involved. The anticipated challenges and opportunities are put forward in terms of specific unanswered questions. It is our hope that these questions will stimulate further research and discussion among researchers and clinicians in the coming years. 

https://bpded.biomedcentral.com/track/pdf/10.1186/s40479-022-00182-0

The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities

Misophonia is a chronic condition in which specific sounds cause intense negative emotions and autonomic arousal. Misophonia is considered a psychological disorder without any relationship with specific alterations of hearing receptors and independent from physical characteristics of the sound. Moreover if misophonia can be defined as a specific psychiatric disorder or a correlate of other conditions is still under debate. The patients were two women and one man. In this case series we first identified the presence of triggers sounds inducing misophonia as reported during the psychotherapy sessions. At a qualitative level all the three patients perceived that the others were intentionally acting with the purpose of underline their maladaptive interpersonal schemas. All the patients were evaluated with the use of questionnaires. Regarding personality disorders (PD) all three patients suffered from at least one PD. As regard depression, one had moderate depression and one had severe depression. Two patients had moderate/severe anxiety. All the three patients can be considered as highly problematic in the interpersonal domain. Our findings have clinical implications for the treatment of misophonia because it seems to be sustained by underlying PD or maladaptive interpersonal schemas. The qualitative analysis of these cases has highlighted how patients with misophonia tended to ascribe intentionality to the people who emit the sounds that trigger their negative emotional reactions. Further studies are necessary to evaluate which kind of interpersonal patterns occur in these patients.

/pdf/misophonia-maladaptive-schemas-and-personality-disorders-a-4f327a26q9.pdf

Misophonia, Maladaptive Schemas and Personality Disorders: A Report of Three Cases

Background and objectives Avoidant Personality Disorder (AvPD) is considered a mild to moderate personality disorder. However, few studies have focused on the heterogeneity of AvPD in terms of symptoms and severity. In the current study we set out to replicate and extend earlier findings showing that there is variation among patients with AvPD in terms of alexithymia and, further, that this variation is especially associated with specific facets of personality functioning and is not explained by measures of depression, symptom severity, or co-occurring personality disorder traits. Method We used intake data from a sample of AvPD patients (n = 56) who had been treated in similar outpatient services. Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20). Patients filled out questionnaires that were analysed using linear regression models. Results and conclusions Using well-established cut-off points for low, intermediate and high levels of alexithymia we found an almost equal distribution of alexithymia groups in our sample. Alexithymia was associated with higher personality dysfunction on twelve out of sixteen facets of personality functioning. For eight of these personality facets the alexithymia total score explained significant variance even after controlling for self-reported depression, symptom severity and clinician ratings of personality disorder. Results suggest that AvPD is heterogeneous and that alexithymia may be important as an indicator of severity of specific personality dysfunction.

Level of alexithymia as a measure of personality dysfunction in avoidant personality disorder.

Avoidant personality disorder (AVPD) is amongst the most severe personality disorders (PDs) and associated with a marked reduction in social functioning. However, AVPD research is sparse and little...

Mentalization-Based Group Therapy for Adolescents with Avoidant Personality Disorder: Adaptations and Findings from a Practice-Based Pilot Evaluation

Avoidant personality disorder (AvPD) is a common and heterogeneous disorder In spite of this, few studies have focused on treatment, and treatment guidelines have not been developed In Scandinavian countries many patients with low levels of AvPD are treated sufficiently in private practices or in briefer psychiatric treatments, often for anxiety or depression However, patients with higher levels of personality dysfunction are often not helped sufficiently by such treatments In this paper we describe a longer and more intense treatment for severe AvPD based on a combination of Mentalization-Based Group Psychotherapy and Metacognitive Interpersonal Individual Therapy This treatment has been piloted in Norway and Denmark, and we provide a case example of a successful treatment of a patient, “Julie” treated at Stolpegaard Psychotherapy Centre in Denmark Based on our review of the literature and experiences from the pilot studies, we also provide some observations and general guidelines about important aspects of treatment of severe AvPD

Ingeborg Ullveit-Moe Eikenaes

Papers

Specialized Treatment for Patients with Severe Avoidant Personality Disorder: Experiences from Scandinavia

Level of alexithymia as a measure of personality dysfunction in avoidant personality disorder.