Attachment--and loss.

The cultural origins of human cognition

Borderline Conditions and Pathological Narcissism

We review the literature on pathological narcissism and narcissistic personality disorder (NPD) and describe a significant criterion problem related to four inconsistencies in phenotypic descriptions and taxonomic models across clinical theory, research, and practice; psychiatric diagnosis; and social/personality psychology. This impedes scientific synthesis, weakens narcissism's nomological net, and contributes to a discrepancy between low prevalence rates of NPD and higher rates of practitioner-diagnosed pathological narcissism, along with an enormous clinical literature on narcissistic disturbances. Criterion issues must be resolved, including clarification of the nature of normal and pathological narcissism, incorporation of the two broad phenotypic themes of narcissistic grandiosity and narcissistic vulnerability into revised diagnostic criteria and assessment instruments, elimination of references to overt and covert narcissism that reify these modes of expression as distinct narcissistic types, and...

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Pathological Narcissism and Narcissistic Personality Disorder

Objective Impairments in laboratory tasks of metacognition appear to be associated with symptoms, functioning, and neurocognition in schizophrenia We sought to replicate these results in a study of metacognition within personal narratives of self and illness Method Narratives of 61 men with schizophrenia were rated using the Metacognition Assessment Scale and correlated with concurrent assessment of symptoms, quality of life, neurocognition and insight Results Controlling for age and education, understanding of one's own mind was linked with better neurocognition across multiple domains, and lesser emotional withdrawal Greater understanding of other's mind was linked with better verbal memory and less emotional withdrawal Greater metacognition in the context of purposeful problem solving was associated with better verbal memory, insight and social function, and less emotional withdrawal and paranoia Conclusion Deficits in metacognition within the narratives of persons with schizophrenia are linked with symptoms, quality of life, neurocognition and poorer awareness of illness

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Metacognition amidst narratives of self and illness in schizophrenia: associations with neurocognition, symptoms, insight and quality of life.

In this article the authors present a method and a scale for the evaluation of the metacognitive profiles of psychotherapy patients. There will be a description of the metacognitive function and of the alterations that occur to it during treatment. Various hypotheses will then be considered: (1) that the metacognitive function has a modular structure; (2) that for each type of psychopathological condition there is a different metacognitive deficit profile; (3) that to be successful psychotherapy needs to involve an improvement in any deficient metacognitive sub-function. There will then be a presentation of the Metacognition Assessment Scale (MAS) for the assessment of metacognitive deficits during psychotherapy. We shall then describe the first results we have on the application of the scale. Finally there will be an analysis of two patients suffering from Personality Disorders and a demonstration of what metacognitive deficit profile each one has and how it is modified over the course of psychotherapy treatment. The article ends with a discussion of the hypotheses made at the start in the light of the results that have emerged. Copyright © 2003 John Wiley & Sons, Ltd.

How to evaluate metacognitive functioning in psychotherapy? The metacognition assessment scale and its applications

Metacognition and schizophrenia: the capacity for self-reflectivity as a predictor for prospective assessments of work performance over six months.

Disorders in the ability to understand mental states (metacognition) have an important role in psychopathology. Some clinicians talk of a generalised impairment of metacognition and others of malfunctioning of specific aspects. We compare two contrasting hypotheses. We call the first one ‘fast running’ hypothesis according to which metacognition is a single function, like speed in running. The second one is the ‘tennis playing’ hypothesis according to which metacognition is composed, like the ability to play tennis, of various, relatively independent skills, which can get impaired selectively. We reviewed the main theories and researches on metacognition and, therefore, we outlined a research programme based on them, describing the contribution made by the research on the psychotherapeutic process to this programme.

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Understanding minds: Different functions and different disorders? The contribution of psychotherapy research

Deficits in metacognitive capacity, or the abilities to think about thinking, are thought to be a key barrier to functioning in schizophrenia. Although metacognitive function may be linked to executive function, it is unclear how the different domains of each phenomenon are related to one another. Accordingly, we assessed 4 domains of metacognition on the basis of a self-generated narrative using the Metacognition Assessment Scale. These were correlated with subtests of the Delis Kaplan Executive Function System which assessed 2 domains of executive function: mental flexibility and inhibition. Participants were 49 men with schizophrenia spectrum disorders in a postacute phase of illness. Spearman Rho correlations revealed awareness of one's thoughts and feelings were more closely linked to performance on tests which required mental flexibility while recognizing others' needs, and independent relationships were more closely linked to performance on tasks which required inhibitory control. Results suggest different domains of metacognition may be influenced by and influence different neurocognitive processes.

Metacognition in schizophrenia: associations with multiple assessments of executive function.

Dimaggio, Semerari, Carcione, Nicolo, Procacci, The Perpetuation of Personality Disorders: A Model. Semerari, Dimaggio, Carcione, Conti, Nicolo, General Treatment Principles. Semerari, Fiore, Borderline Personality Disorder: Model and Treatment. Dimaggio, Fiore, Salvatore, Narcissistic Personality Disorder: Model and Treatment. Carcione, Conti, Dependent Personality Disorder: Model and Treatment. Procacci, Popolo, Petrilli, Dimaggio, Avoidant Personality Disorder: Model and Treatment. Nicolo, Nobile, Paranoid Personality Disorder: Model and Treatment. Dimaggio, Semerari, Carcione, Nicolo, Procacci, Conclusions.

Michele Procacci

Papers

How to evaluate metacognitive functioning in psychotherapy? The metacognition assessment scale and its applications

Metacognition and schizophrenia: the capacity for self-reflectivity as a predictor for prospective assessments of work performance over six months.

Understanding minds: Different functions and different disorders? The contribution of psychotherapy research

Metacognition in schizophrenia: associations with multiple assessments of executive function.

Psychotherapy of Personality Disorders: Metacognition, States of Mind and Interpersonal Cycles