Thinking about reflection: an investigation of metacognition in individuals with borderline personality disorder and psychosis

Abstract

Introduction – Previous research suggests that individuals who experience complex mental health problems have difficulties in thinking about their own and others’ mental processes and using this information to solve problems, or metacognition. This exploratory study investigated metacognition in individuals with a diagnosis of borderline personality disorder or psychosis. Measures of attachment, symptom experience and interpersonal problems were taken to explore possible correlations with metacognition. Methods – Metacognition was measured through semi-structured interview rated using the Metacognitive Assessment Scale (MAS) which categorised metacognition into subscales: understanding own mind (UM), understanding others’ mind (UOM) and mastery (M). Results – Mann-Whitney analysis revealed both groups demonstrated metacognitive difficulties and no differences in metacognition were observed between groups. Friedman’s ANOVA and post hoc Wilcoxon Signed Rank tests found statistically significant differences between MAS subscales, UM was better than UOM which was more developed than M. Nonparametric correlational analysis revealed poorer metacognition was associated with greater positive symptoms and attachment anxiety and greater metacognitive skills were associated with attachment avoidance. Discussion – Metacognition was impaired in both groups suggesting it is a transdiagnostic construct and the pattern of metacognitive impairment suggests metacognition is organised hierarchically. These finding are discussed in the context of relevant theory, limitations highlighted and clinical implications proposed