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Metacognitive Interpersonal Therapy for Personality Disorders: The Case of a Man with Obsessive–Compulsive Personality Disorder and Avoidant Personality Disorder


Personality disorders have a deleterious impact on individual quality of life, and are associated with a significant social burden. Despite a broad range of presentations across the various personality disorders, clinical research has shown a strong bias toward borderline personality disorder. In contrast to the emotional dysregulation of borderline personality disorder, a number of personality disorders are characterised by emotional inhibition and alexithymia. Research increasingly suggests that these deficits in emotional regulation may be symptomatic of problems with metacognition—the ability to identify, understand, and influence mental states. Research and specific treatment approaches are needed which target personality dysfunction characterised by emotional inhibition, rather than dysregulation. Emerging evidence suggests that metacognitive interpersonal therapy may be an effective treatment approach for personality disorders characterised by emotional inhibition. The current case study provides an in-depth examination of the application of metacognitive interpersonal therapy for a man diagnosed with comorbid avoidant personality disorder, and obsessive compulsive personality disorder. The patient described a history of bullying and unmet needs throughout his childhood, resulting in maladaptive interpersonal schemas and metacognitive deficits. Treatment focused on building the patient’s ability to identify and understand his mental states, and targeted schema-driven behaviour. The patient reported experiencing the therapy as helpful, and stated that it contributed to a marked improvement in his quality of life. Results indicate that a 1 year intervention was successful in achieving diagnostic recovery and symptom reduction, supporting metacognitive interpersonal therapy as an effective intervention.

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Correspondence to Keely Gordon-King.

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Dr. Gordon-King, Dr. Schweitzer and Dr. Dimaggio declares that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Gordon-King, K., Schweitzer, R.D. & Dimaggio, G. Metacognitive Interpersonal Therapy for Personality Disorders: The Case of a Man with Obsessive–Compulsive Personality Disorder and Avoidant Personality Disorder. J Contemp Psychother 49, 39–47 (2019).

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  • Avoidant personality disorder
  • Obsessive–compulsive personality disorder
  • Treatment
  • Intervention
  • Metacognitive interpersonal therapy