Personality Disorders (PDs) are particularly hard to treat and treatment drop-out rates are high. Several authors have agreed that psychotherapy is more successful when it focuses on the core of personality pathology. For this reason, therapists dealing with PDs need to understand the psychopathological variables that characterize this pathology and exactly what contributes to maintaining psychopathological processes. Moreover, several authors have noted that one key problem that characterizes all PDs is an impairment in understanding mental states – here termed metacognition – which could also be responsible for therapy failures. Unfortunately, a limited number of studies have investigated the role of mentalization in the process of change during psychotherapy. In this paper, we assume that poor metacognition corresponds to a core element of the general pathology of personality, impacts a series of clinical variables, generates symptoms and interpersonal problems, and causes treatment to be slower and less effective. We explored whether changes in metacognition predicted an improvement among different psychopathological variables characterizing PDs; 193 outpatients were treated at the Third Center of Cognitive Psychotherapy in Rome, Italy, and followed a structured path tailored for the different psychopathological variables that emerged from a comprehensive psychodiagnostic assessment that considered patients’ symptoms, metacognitive abilities, interpersonal relationships, personality psychopathology, and global functioning. The measurements were repeated after a year of treatment. The results showed that changes in metacognitive abilities predicted improvements in the analyzed variables.

The authors analyzed the successful case of Lisa, a client with major depression, using the Metacognitive Assessment Scale (MAS). Consistently with the literature on depression, the authors hypothesize that Lisa's ability to reflect on mental states—here metacognition—is marginally affected. The authors found that Lisa was better at describing her own mind rather than understanding the mind of the others. Furthermore, the most severe impairment was in using metacognition to cope with mental state source of distress and to enact strategies to solve interpersonal problems. During the therapy such difficulties improved progressively. Limitations and implications of these findings are discussed.

Introduction: The present study aimed to adapt the 25‐item Hikikomori Questionnaire to the Italian context (HQ‐25‐I) and to test its psychometric properties in two samples, particularly a sample of residents with psychiatric conditions (n = 117) and a sample of individuals from the community (n = 209).Methods: We tested the fit of the original three‐factor structure (Socialization, Isolation, and Emotional Support) and measurement invariance across the two groups, and the reliability, convergent, and criterion (concurrent) validity of the HQ‐25‐I.Results: The results showed that the original measurement model fitted the data well and that it was invariant across the two groups. The measure was reliable and positively correlated with some maladaptive personality trait domains (PID‐5‐BF), Depression (BDI‐II), and Hopelessness (BHS) in both groups, with higher scores observed in the clinical sample. However, low correlations were found between the HQ‐25‐I and the PID‐5‐BF Detachment and Negative Affectivity.Conclusions: The results from the study showed that the HQ‐25‐I is reliable, but further examination of its validity is warranted. Implications for theory and future research are discussed.