Toward a model of self pathology underlying personality disorders: narratives, metarepresentation, interpersonal cycles and decision-making processes

If we want to explain the links between the various and heterogeneous elements—symptoms, dysfunctional forms of behavior and poor social functioning—making up personality disorders, we need model a self pathology that portrays dysfunctions, the links among them, and how their interactions maintain disorders over time. In our view, the most likely elements of self pathology are: a. problematic contents (thoughts and emotions)—experienced subjectively as states of mind and organized in the form of narratives; b. shortfalls in the ability, termed metacognition, to reflect on mental states, both of oneself and of others; c. pathogenic interpersonal schemas; and d. maladaptive decisionmaking processes. These elements get altered in the various personality disorders and interact to form typical pathological organizations. This article seeks to describe a model of self pathology in personality disorders and discuss its current scientific status based on a literature review that spans several disciplines. The model is illustrated with an example of how the pathogenic elements can interact to form personality disorder. Lastly, the limitations and advantages of the model are discussed