Contrasting metacognitive, social cognitive and alexithymia profiles in adults with borderline personality disorder, schizophrenia and substance use disorder.

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.

Cluster B and C personality traits, symptom correlates, and treatment utilization in postacute schizophrenia.

Unusually high levels of Cluster B and C personality traits have been observed in schizophrenia. While these have been linked to poorer function, less clear is the association of these personality traits with symptoms and service utilization. To examine this issue, 46 participants with schizophrenia or schizoaffective disorder were administered the Millon Clinical Multiaxial Inventory, Third Edition, and the Positive and Negative Syndrome Scale, and an inventory was taken of medical and psychiatric service utilization. Two sets of multiple regression analyses using Cluster B and C traits to predict treatment utilization and symptoms revealed that emotional discomfort symptoms were significantly related to level of borderline traits. Higher levels of positive symptoms were linked with more avoidant traits and fewer dependent traits. Higher levels of negative symptoms were linked with greater avoidant traits. Service utilization was predicted by borderline, antisocial, and avoidant traits. Implications for rehabilitation and treatment are discussed.

Personal narratives in schizophrenia: increases in coherence following 5 months of vocational rehabilitation.

Many researchers have hoped vocational rehabilitation might help people with schizophrenia not only to work but also to develop more coherent narratives of their abilities and the boundaries imposed by their condition. This study compared narrative accounts of persons with schizophrenia spectrum disorders (n = 16) generated using the Indiana Psychiatric Illness Interview prior to and 5 months following entry into a vocational rehabilitation program. Results revealed participants with more intact levels of neurocognitive function as assessed with the Wisconsin Card Sorting Test demonstrated significant gains in narrative coherence relative to those with greater levels of deficit (F(1,14) = 6.3, p = .02).

Narrative qualities in schizophrenia: associations with impairments in neurocognition and negative symptoms.

Schizophrenia spectrum disorders often involve a profound diminishment in people's ability to coherently narrate their lives. Unknown is whether narrative difficulties of persons with schizophrenia differ from those with other disabilities, and how they relate to clinical or neurocognitive aspects of schizophrenia. To address both issues, personal narratives were obtained for 25 participants with schizophrenia spectrum disorders and a comparison group of eight legally blind participants and four with major depressive disorders. Flexibility of abstract thought and positive, negative, and emotional discomfort symptoms were assessed among the schizophrenia group. ANCOVA comparing scores on our scale to assess narrative development, controlling for age, found the schizophrenia group narratives significantly more impoverished than the comparison group on multiple dimensions, including self-worth and agency. Neurocognitive impairment and negative symptoms were significant predictors of impoverishment in the schizophrenia group. Results may highlight deficits that could be addressed in psychotherapy or rehabilitation to promote recovery.

Heightened interpersonal dependency in schizophrenia: associations with graver impairment in neurocognition but not with negative or positive symptoms.

This study sought to clarify how dependency traits may be related to neurocognition and clinical symptoms of schizophrenia. Participants were 35 persons diagnosed with a schizophrenia-spectrum disorder who were recruited from a comprehensive day hospital at a VA Medical Center. Neurocognition, symptoms and level of interpersonal dependency were measured. Multiple regression analyses demonstrated that greater neurocognitive deficits predicted greater dependency needs. No relationship was found between symptoms and the level of dependency needs.

Neurocognitive deficits and history of childhood abuse in schizophrenia spectrum disorders: associations with Cluster B personality traits.

Cluster B personality traits have been detected in persons with schizophrenia, at a rate exceeding that of the general population. Unclear, however, is how to account for such high rates of Cluster B traits. Accordingly, this study explored the hypothesis that the presence of these traits may be linked to impairments in neurocognition, and childhood abuse history. To test this, we simultaneously obtained an assessment of Cluster B traits using the Millon Clinical Multiaxial Inventory III, along with measures of attention, verbal memory, affect recognition, executive function and childhood abuse history among 37 persons with schizophrenia spectrum disorders in a post acute phases of illness. Pearson correlation coefficients revealed that higher levels of histrionic and narcissistic traits were related to poorer neurocognition while higher levels of narcissistic traits were negatively correlated with childhood physical abuse. Higher levels of borderline traits were uniquely related to the report of childhood sexual abuse while higher levels of antisocial traits were related to higher levels of childhood physical abuse. Theoretical and clinical implications are discussed.

Narrative incoherence in schizophrenia: the absent agent-protagonist and the collapse of internal dialogue.

It is widely known that people with schizophrenia have difficulty telling a coherent story of their lives and that this is linked to impoverished function. But what specifically has gone wrong in the narratives in schizophrenia? Is it the case that some elements of narrative remain intact in schizophrenia while others are uniquely affected? To address these questions, we qualitatively analyze the personal narratives of three persons with schizophrenia, which have emerged in psychotherapy. Based on this analysis we suggest that narratives in schizophrenia uniquely fail to situate agency within the narrator resulting in a story that is missing an agent-protagonist. While the narratives we present contain coherent accounts of how others are connected to one another, they fail to evolve into a story about the self as an agent that others could associate with the narrator. We speculate that this may reflect neuro-cognitively based difficulties maintaining the internal dialogue that propels agency as well as fears that any emergent subjectivity may be appropriated or objectified by others. Implications for psychotherapy are discussed.