Suggerimenti di buona pratica clinica per il disturbo evitante di personalità

Titolo Rivista QUADERNI DI PSICOTERAPIA COGNITIVA
Autori/Curatori Ilario Mammone, Giancarlo Dimaggio
Anno di pubblicazione 2023 Fascicolo 2023/52 Lingua Italiano
Numero pagine 25 P. 72-96 Dimensione file 0 KB
DOI 10.3280/qpc52-2023oa16175
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Questa review si concentra sugli aspetti diagnostici e sul trattamento del Disturbo Evitante di Personalità (DE). Gli studi attuali sottolineano la stretta relazione tra DE e Disturbo d’Ansia Sociale e la relativa stabilità dei sintomi oltre che l’impatto in termini sociali ed economici.Le scarse evidenze empiriche mostrano risultati promettenti per gli interventi psicoterapici, in particolare per le terapie di orientamento cognitivo-comportamentale, anche di terza onda. Mancano a oggi studi randomizzati sufficientemente solidi, mentre stanno apparendo recentemente alcuni lavori su gruppi di pazienti con grave DE trattati grazie a una comprensione accurata della psicopatologia. Complessivamente, allo stato dell’arte, è possibile suggerire alcuni obiettivi generali di medio-lungo termine da tenere in considerazione nel trattamento di questi pazienti. Gli approcci terapeutici dovrebbero mirare ai pattern pervasivi di inibizione e ritiro sociale, ai sentimenti di inadeguatezza e all’ipersensibilità verso il giudizio negativo e il rifiuto. Sarebbe utile anche puntare al miglioramento delle funzioni riflessive e metacognitive, a interrompere i processi di rimuginio e ruminazione. Allo stato attuale sappiamo che il DE è un disturbo con importanti problemi sintomatici e sociali e sono urgentemente necessari studi randomizzati controllati per definire meglio come trattarlo con efficacia.;

Keywords:; Disturbo Evitante di Personalità; ritiro sociale; linee guida; psicoterapia

  1. Benjamin, L. (2003). Interpersonal diagnosis and treatment of personality disorders. New York: Guildford.
  2. Alden, L. (1989). Short-term structured treatment for avoidant personality disorder. Journal of Consulting and Clinical Psychology, 57(6): 756-764. DOI: 10.1037//0022-006x.57.6.756.
  3. Alden, L.E. & Capreol, M.J. (1993). Avoidant personality disorder: Interpersonal problems as predictors of treatment response. Behavior Therapy, 24(3): 357-376. DOI: 10.1016/S0005-7894(05)80211-4.
  4. Alden, L.E., Laposa, J.M., Taylor, C.T. & Ryder, A.G. (2002). Avoidant personality disorder: current status and future directions. Journal of Personality Disorders, 16(1): 1-29. DOI: 10.1521/pedi.16.1.1.22558.
  5. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.) (DSM-5). Washington, DC: American Psychiatric Publishing.
  6. Ansell, E.B., Pinto, A., Edelen, M.O., Markowitz, J.C., Sanislow, C.A., Yen, S., Zanarini, M., Skodol, A.E., Shea, M.T., Morey, L.C., Gunderson, J.G., McGlashan, T.H. & Grilo, C.M. (2011). The association of personality disorders with the prospective 7-year course of anxiety disorders. Psychological Medicine, 41(5): 1019-1028. DOI: 10.1017/S0033291710001777.
  7. Arntz, A. (1999). Do personality disorders exist? On the validity of the concept and its cognitive-behavioral formulation and treatment. Behaviour Research and Therapy, 37 Suppl 1: S97-134. DOI: 10.1016/s0005-7967(99)00052-2.
  8. Arntz, A. (2012a). Schema Therapy for Cluster C Personality Disorders (pp. 397-414). In: The Wiley-Blackwell Handbook of Schema Therapy. Hoboken: John Wiley & Sons, Ltd. DOI: 10.1002/9781119962830.ch30.
  9. Arntz, A. (2012b). Imagery Rescripting as a Therapeutic Technique: Review of Clinical Trials, Basic Studies, and Research Agenda. Journal of Experimental Psychopathology, 3(2): 189-208. DOI: 10.5127/jep.024211.
  10. Bamelis, L.L.M., Arntz, A., Wetzelaer, P., Verdoorn, R. & Evers, S.M.A.A. (2015). Economic evaluation of schema therapy and clarification-oriented psychotherapy for personality disorders: a multicenter, randomized controlled trial. The Journal of Clinical Psychiatry, 76(11): e1432-40. DOI: 10.4088/JCP.14m09412.
  11. Bamelis, L.L.M., Evers, S.M.A.A., Spinhoven, P. & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171(3): 305-322. DOI: 10.1176/appi.ajp.2013.12040518.
  12. Barber, J.P., Morse, J.Q., Krakauer, I.D., Chittams, J. & Crits-Christoph, K. (1997). Change in obsessive-compulsive and avoidant personality disorders following time-limited supportive-expressive therapy. Psychotherapy, 34(2): 133-143. DOI: 10.1037/h0087774.
  13. Bartak, A., Spreeuwenberg, M.D., Andrea, H., Holleman, L., Rijnierse, P., Rossum, B.V., Hamers, E.F.M., Meerman, A.M.M.A., Aerts, J., Busschbach, J.J.V, Verheul, R., Stijnen, T. & Emmelkamp, P.M.G. (2010). Effectiveness of different modalities of psychotherapeutic treatment for patients with cluster C personality disorders: results of a large prospective multicentre study. Psychotherapy and Psychosomatics, 79(1): 20-30. DOI: 10.1159/000254902.
  14. Baumeister, R.F. & Leary, M.R. (1995). The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117(3): 497-529.
  15. Beck, A.T., Davis, D.D. & Freeman, A. (Eds.). (2015). Cognitive therapy of personality disorders. In: Progress in behavior modification, vol. 28. New York: Guilford Press. DOI: 10.1176/ajp.149.3.402.
  16. Beckwith, H., Moran, P.F. & Reilly, J. (2014). Personality disorder prevalence in psychiatric outpatients: a systematic literature review. Personality and Mental Health, 8(2): 91-101. DOI: 10.1002/pmh.1252.
  17. Cambridge Handbook of Personality Disorders (2020). In The Cambridge Handbook of Personality Disorders. Cambridge: Cambridge University Press.
  18. Carcione, A., Nicolò, G. & Semerari, A. (2016). Curare i Casi Complessi: la terapia metacognitiva interpersonale dei disturbi di personalità. Roma-Bari: Laterza.
  19. Chan, C.C., Bach, P.A. & Bedwell, J.S. (2015). An Integrative Approach Using Third-Generation Cognitive-Behavioral Therapies for Avoidant Personality Disorder. Clinical Case Studies, 14(6): 466-481. DOI: 10.1177/1534650115575788.
  20. Clark, D.M. & Wells, A. (1995). A cognitive model of social phobia (pp. 69-93). In: Heimberg, R.G., Liebowitz, M.R., Hope, D.A. & Schneier, F.R. (eds.), Social phobia: Diagnosis, assessment, and treatment. New York: Guilford Press. psycnet.apa.org/record/1995-98887-004.
  21. Coid, J., Yang, M., Tyrer, P., Roberts, A. & Ullrich, S. (2006). Prevalence and correlates of personality disorder in Great Britain. The British Journal of Psychiatry : The Journal of Mental Science, 188: 423-431. DOI: 10.1192/bjp.188.5.423.
  22. Colle, L., Pellecchia, G., Moroni, F., Carcione, A., Nicolò, G., Semerari, A. & Procacci, M. (2017). Levels of social sharing and clinical implications for severe social withdrawal in patients with personality disorders. Frontiers in Psychiatry, 8(DEC): 263. DOI: 10.3389/fpsyt.2017.00263.
  23. Cox, B.J., Pagura, J., Stein, M.B. & Sareen, J. (2009). The relationship between generalized social phobia and avoidant personality disorder in a national mental health survey. Depression and Anxiety, 26(4): 354-362. DOI: 10.1002/da.20475.
  24. Cramer, V., Torgersen, S. & Kringlen, E. (2006). Personality disorders and quality of life. A population study. Comprehensive Psychiatry, 47(3): 178-184. DOI: 10.1016/j.comppsych.2005.06.002.
  25. Cramer, V., Torgersen, S. & Kringlen, E. (2007). Socio-demographic conditions, subjective somatic health, Axis I disorders and personality disorders in the common population: the relationship to quality of life. Journal of Personality Disorders, 21(5): 552-567. DOI: 10.1521/pedi.2007.21.5.552.
  26. Crino, R.D. & Andrews, G. (1996). Personality disorder in obsessive compulsive disorder: a controlled study. Journal of Psychiatric Research, 30(1): 29-38. DOI: 10.1016/0022-3956(95)00043-7.
  27. Dalrymple, K.L. (2012). Issues and controversies surrounding the diagnosis and treatment of social anxiety disorder. Expert Review of Neurotherapeutics, 12(8): 993-1008, quiz 1009. DOI: 10.1586/ern.12.81.
  28. Denys, D., Tenney, N., van Megen, H.J.G.M., de Geus, F. & Westenberg, H.G.M. (2004). Axis I and II comorbidity in a large sample of patients with obsessive-compulsive disorder. Journal of Affective Disorders, 80(2-3): 155-162. DOI: 10.1016/S0165-0327(03)00056-9.
  29. Dimaggio, G., D’Urzo, M., Pasinetti, M., Salvatore, G., Lysaker, P.H., Catania, D. & Popolo, R. (2015). Metacognitive interpersonal therapy for co-occurrent avoidant personality disorder and substance abuse. Journal of Clinical Psychology, 71(2): 157-166. DOI: 10.1002/jclp.22151.
  30. Dimaggio, G., MacBeth, A., Popolo, R., Salvatore, G., Perrini, F., Raouna, A., Osam, C.S., Buonocore, L., Bandiera, A. & Montano, A. (2018). The problem of overcontrol: Perfectionism, emotional inhibition, and personality disorders. Comprehensive Psychiatry, 83: 71-78. DOI: 10.1016/j.comppsych.2018.03.005.
  31. Dimaggio, G., Montano, A., Popolo, R. & Salvatore, G. (2013). Terapia Metacognitiva Interpersonale dei Disturbi di Personalità. Milano: Raffaello Cortina.
  32. Dimaggio, G., Ottavi, P., Popolo, R. & Salvatore, G. (2019). Corpo, Immaginazione e Cambiamento. Terapia Metacognitiva Interpersonale. Milano: Raffaello Cortina.
  33. Dimaggio, G., Popolo, R. & Salvatore, G. (2019). Formulation of functioning for avoidant personality disorder in metacognitive interpersonal therapy (pp. 137-160). In: Case Formulation for Personality Disorders: Tailoring Psychotherapy to the Individual Client. Amsterdam: Elsevier. DOI: 10.1016/B978-0-12-813521-1.00008-4.
  34. Dimaggio, G., Procacci, M., Nicolò, G., Popolo, R., Semerari, A., Carcione, A. & Lysaker, P.H. (2007). Poor metacognition in Narcissistic and Avoidant Personality Disorders: four psychotherapy patients analysed using the Metacognition Assessment Scale. Clinical Psychology & Psychotherapy, 14(5): 386-401. DOI: 10.1002/cpp.541.
  35. Dimaggio, G., Salvatore, G., Fiore, D., Carcione, A., Nicolò, G. & Semerari, A. (2012). General principles for treating personality disorder with a prominent inhibitedness trait: towards an operationalizing integrated technique. Journal of Personality Disorders, 26(1): 63-83. DOI: 10.1521/pedi.2012.26.1.63.
  36. Dimaggio, G., Salvatore, G., MacBeth, A., Ottavi, P., Buonocore, L. & Popolo, R. (2017). Metacognitive Interpersonal Therapy for Personality Disorders: A Case Study Series. Journal of Contemporary Psychotherapy, 47(1): 11-21. DOI: 10.1007/s10879-016-9342-7.
  37. Dimaggio, G. & Semerari, A. (2003). I Disturbi di Personalità. Modelli e trattamento Stati mentali, metarappresentazione, cicli interpersonali. Roma-Bari: Laterza.
  38. Drago, A., Marogna, C. & Søgaard, H. (2016). A Review of Characteristics and Treatments of the Avoidant Personality Disorder. Could the DBT be an Option? International Journal of Psychology and Psychoanalysis, 2. DOI: 10.23937/2572-4037.1510013.
  39. Eikenaes, I., Egeland, J., Hummelen, B. & Wilberg, T. (2015). Avoidant personality disorder versus social phobia: The significance of childhood neglect. PLoS ONE, 10(3). DOI: 10.1371/journal.pone.0122846.
  40. Eikenaes, I., Hummelen, B., Abrahamsen, G., Andrea, H. & Wilberg, T. (2013). Personality functioning in patients with avoidant personality disorder and social phobia. Journal of Personality Disorders, 27(6): 746-763. DOI: 10.1521/pedi_2013_27_109.
  41. Eikenæs, I., Pedersen, G. & Wilberg, T. (2016). Attachment styles in patients with avoidant personality disorder compared with social phobia. Psychology and Psychotherapy: Theory, Research and Practice, 89(3): 245-260. DOI: 10.1111/papt.12075.
  42. Emmelkamp, P.M.G., Benner, A., Kuipers, A., Feiertag, G.A., Koster, H.C. & van Apeldoorn, F.J. (2006). Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder. The British Journal of Psychiatry : The Journal of Mental Science, 189: 60-64. DOI: 10.1192/bjp.bp.105.012153.
  43. Eskedal, G.A. & Demetri, J.M. (2006). Etiology and Treatment of Cluster C Personality Disorders. Journal of Mental Health Counseling, 28(1): 1-17. DOI: 10.17744/mehc.28.1.7yjq6tabcexb1a6j.
  44. Eskildsen, A., Hougaard, E. & Rosenberg, N.K. (2010). Pre-treatment patient variables as predictors of drop-out and treatment outcome in cognitive behavioural therapy for social phobia: A systematic review. Nordic Journal of Psychiatry, 64(2): 94-105. DOI: 10.3109/08039480903426929.
  45. Farstad, S., McGeown, L. & von Ranson, K. (2016). Eating Disorders and Personality, 2004-2016: A Systematic Review and Meta-analysis. Clinical Psychology Review, 46: 91-105. DOI: 10.1016/j.cpr.2016.04.005.
  46. Feske, U., Perry, K.J., Chambless, D.L., Renneberg, B. & Goldstein, A.J. (1996). Avoidant personality disorder as a predictor for treatment outcome among generalized social phobics. Journal of Personality Disorders, 10(2): 174-184. DOI: 10.1521/pedi.1996.10.2.174.
  47. Gabbard, G.O. (2014). APA – Psychodynamic Psychiatry in Clinical Practice Fifth Edition. Washington, DC: American Psychiatric Press.
  48. Garyfallos, G., Adamopoulou, A., Karastergiou, A., Voikli, M., Milis, V., Donias, S., Giouzepas, J. & Parashos, A. (1999). Psychiatric comorbidity in Greek patients with generalized anxiety disorder. Psychopathology, 32(6): 308-318. DOI: 10.1159/000029104.
  49. Gilbert, P. (1989). Human Nature And Suffering. New York: Routledge.
  50. Gjerde, L.C., Czajkowski, N., Røysamb, E., Ystrom, E., Tambs, K., Aggen, S.H., Ørstavik, R.E., Kendler, K.S., Reichborn-Kjennerud, T. & Knudsen, G.P. (2015). A longitudinal, population-based twin study of avoidant and obsessive-compulsive personality disorder traits from early to middle adulthood. Psychological Medicine, 45(16): 3539-3548. DOI: 10.1017/S0033291715001440.
  51. Gordon-King, K., Schweitzer, R.D. & Dimaggio, G. (2018). Metacognitive Interpersonal Therapy for Personality Disorders Featuring Emotional Inhibition: A Multiple Baseline Case Series. Journal of Nervous and Mental Disease, 206(4): 263-269. DOI: 10.1097/NMD.0000000000000789.
  52. Gordon-King, K., Schweitzer, R.D. & Dimaggio, G. (2019). Metacognitive Interpersonal Therapy for Personality Disorders: The Case of a Man with Obsessive–Compulsive Personality Disorder and Avoidant Personality Disorder. Journal of Contemporary Psychotherapy, 49(1): 39-47. DOI: 10.1007/s10879-018-9404-0.
  53. Grant, B.F., Hasin, D.S., Stinson, F.S., Dawson, D.A., Chou, S.P., Ruan, W.J. & Pickering, R.P. (2004). Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. The Journal of Clinical Psychiatry, 65(7): 948-958. DOI: 10.4088/jcp.v65n0711.
  54. Grilo, C.M., Levy, K.N., Becker, D.F., Edell, W.S. & McGlashan, T.H. (1996). Comorbidity of DSM-III-R axis I and II disorders among female inpatients with eating disorders. Psychiatric Services, 47(4): 426-429. DOI: 10.1176/ps.47.4.426.
  55. Gude, T. & Vaglum, P. (2001). One-year follow-up of patients with cluster C personality disorders: a prospective study comparing patients with “pure” and comorbid conditions within cluster C, and “pure” C with “pure” cluster A or B conditions. Journal of Personality Disorders, 15(3): 216-228. DOI: 10.1521/pedi.15.3.216.19210.
  56. Gunderson, J.G., Shea, M.T., Skodol, A.E., McGlashan, T.H., Morey, L.C., Stout, R.L., Zanarini, M.C., Grilo, C.M., Oldham, J.M. & Keller, M.B. (2000). The Collaborative Longitudinal Personality Disorders Study: development, aims, design, and sample characteristics. Journal of Personality Disorders, 14(4): 300-315. DOI: 10.1521/pedi.2000.14.4.300.
  57. Hayes, S.C. & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. Oakland: New Harbinger Publications.
  58. Hayes, S.C., Strosahl, K. & Wilson, K.G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press.
  59. Heimberg, R. (1996). Social phobia, avoidant personality disorder and the multiaxial conceptualization of interpersonal anxiety. New York: John Wiley & Sons.
  60. Herbert, J.D., Hope, D.A. & Bellack, A.S. (1992). Validity of the distinction between generalized social phobia and avoidant personality disorder. Journal of Abnormal Psychology, 101(2): 332-339. DOI: 10.1037//0021-843x.101.2.332.
  61. Holt, C.S., Heimberg, R.G. & Hope, D.A. (1992). Avoidant personality disorder and the generalized subtype of social phobia. Journal of Abnormal Psychology, 101(2): 318-325. DOI: 10.1037//0021-843x.101.2.318.
  62. Hope, D.A., Herbert, J.D. & White, C. (1995). Diagnostic subtype, avoidant personality disorder, and efficacy of cognitive-behavioral group therapy for social phobia. Cognitive Therapy and Research, 19(4): 399-417. DOI: 10.1007/BF02230408.
  63. Hopwood, C.J., Morey, L.C., Donnellan, M.B., Samuel, D.B., Grilo, C.M., McGlashan, T.H., Shea, M.T., Zanarini, M.C., Gunderson, J.G. & Skodol, A.E. (2013). Ten-year rank-order stability of personality traits and disorders in a clinical sample. Journal of Personality, 81(3): 335-344. DOI: 10.1111/j.1467-6494.2012.00801.x.
  64. Hummelen, B., Wilberg, T., Pedersen, G. & Karterud, S. (2007). The relationship between avoidant personality disorder and social phobia. Comprehensive Psychiatry, 48(4): 348-356. DOI: 10.1016/j.comppsych.2007.03.004.
  65. Inchausti, F., Moreno-Campos, L., Prado-Abril, J., Sánchez-Reales, S., Fonseca-Pedrero, E., MacBeth, A., Popolo, R. & Dimaggio, G. (2020). Metacognitive Interpersonal Therapy in Group for Personality Disorders: Preliminary Results from a Pilot Study in a Public Mental Health Setting. Journal of Contemporary Psychotherapy, 50(3): 197-203. DOI: 10.1007/s10879-020-09453-9.
  66. Johnson, S.M. (2021). La teoria dell’attaccamento in pratica. La terapia focalizzata sulle emozioni EFT nel setting individuale, di coppia e familiare. Miano: FrancoAngeli.
  67. Karterud, S., Pedersen, G., Bjordal, E., Brabrand, J., Friis, S., Haaseth, O., Haavaldsen, G., Irion, T., Leirvåg, H., Tørum, E. & Urnes, O. (2003). Day treatment of patients with personality disorders: experiences from a Norwegian treatment research network. Journal of Personality Disorders, 17(3): 243-262. DOI: 10.1521/pedi.17.3.243.22151.
  68. Kato, T.A., Kanba, S. & Teo, A.R. (2020). Defining pathological social withdrawal: proposed diagnostic criteria for hikikomori. World Psychiatry, 19(1): 116-117. DOI: 10.1002/wps.20705.
  69. Kvarstein, E.H., Arnevik, E., Halsteinli, V., Rø, F.G., Karterud, S. & Wilberg, T. (2013). Health service costs and clinical gains of psychotherapy for personality disorders: a randomized controlled trial of day-hospital-based step-down treatment versus outpatient treatment at a specialist practice. BMC Psychiatry, 13: 315. DOI: 10.1186/1471-244X-13-315.
  70. Kvarstein, E.H. & Karterud, S. (2012). Large variations of global functioning over five years in treated patients with personality traits and disorders. Journal of Personality Disorders, 26(2): 141-161. DOI: 10.1521/pedi.2012.26.2.141.
  71. Lampe, L. & Malhi, G.S. (2018). Avoidant personality disorder: current insights. Psychology Research and Behavior Management, 11: 55-66. DOI: 10.2147/PRBM.S121073.
  72. Lampe, L. & Sunderland, M. (2015). Social phobia and avoidant personality disorder: similar but different? Journal of Personality Disorders, 29(1): 115-130. DOI: 10.1521/pedi_2013_27_079.
  73. Leichsenring, F. & Leibing, E. (2007). Psychodynamic psychotherapy: a systematic review of techniques, indications and empirical evidence. Psychology and Psychotherapy, 80(2): 217-228. DOI: 10.1348/147608306X117394.
  74. Lenzenweger, M.F. (1999). Stability and change in personality disorder features: the Longitudinal Study of Personality Disorders. Archives of General Psychiatry, 56(11): 1009-1015. DOI: 10.1001/archpsyc.56.11.1009.
  75. Lenzenweger, M.F., Lane, M.C., Loranger, A.W. & Kessler, R.C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62(6): 553-564. DOI: 10.1016/j.biopsych.2006.09.019.
  76. Linehan, M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.
  77. Liotti, G., Fassone, G. & Monticelli, F. (2017). L’evoluzione dei sistemi motivazionali. Teoria, ricerca e clinica. Milano: Raffaello Cortina.
  78. Liotti, G. & Gilbert, P. (2011). Mentalizing, motivation, and social mentalities: Theoretical considerations and implications for psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice, 84(1): 9-25. DOI: 10.1348/147608310X520094.
  79. Luborsky, L. (1984). Principles of Psychoanalytic Psychotherapy: A Manual for Supportive-Expressive Treatment. New York: Basic Books.
  80. Lynch, T.R. (2018). Radically Open Dialectical Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol. Context Press.
  81. Lynch, T.R. & Cheavens, J.S. (2008). Dialectical behavior therapy for comorbid personality disorders. Journal of Clinical Psychology, 64(2): 154-167. DOI: 10.1002/jclp.20449.
  82. Lynch, T.R., Cheavens, J.S., Cukrowicz, K.C., Thorp, S.R., Bronner, L. & Beyer, J. (2007). Treatment of older adults with co-morbid personality disorder and depression: A dialectical behavior therapy approach. International Journal of Geriatric Psychiatry, 22(2): 131-143. DOI: 10.1002/gps.1703.
  83. Magnavita, J. (2010). Evidence-based treatment of personality dysfunction: Principles, methods, and processes. In: Magnavita, J. (ed.), Evidence-based treatment of personality dysfunction: Principles, methods, and processes. American Psychological Association. DOI: 10.1037/12130-000.
  84. Malan, D.H. (1976). The frontier of brief psychotherapy: An example of the convergence of research and clinical practice. New York-London: Plenum Medical Book.
  85. Massion, A.O., Dyck, I.R., Shea, M.T., Phillips, K.A., Warshaw, M.G. & Keller, M.B. (2002). Personality disorders and time to remission in generalized anxiety disorder, social phobia, and panic disorder. Archives of General Psychiatry, 59(5): 434-440. DOI: 10.1001/archpsyc.59.5.434.
  86. McCullough, L., Kuhn, N., Andrews, S., Kaplan, A., Wolf, J. & Lanza Hurley, C. (2003). Treating Affect Phobia: A Manual for Short-Term Dynamic Psychotherapy. New York: Guilford Press.
  87. McCullough, V.L. (1997). Changing Character: Short-term Anxiety-regulating Psychotherapy For Restructuring Defenses, Affects, And Attachment. New York: Basic Books.
  88. McGlashan, T.H., Grilo, C.M., Sanislow, C.A., Ralevski, E., Morey, L.C., Gunderson, J.G., Skodol, A.E., Shea, M.T., Zanarini, M.C., Bender, D., Stout, R.L., Yen, S. & Pagano, M. (2005). Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders. The American Journal of Psychiatry, 162(5): 883-889. DOI: 10.1176/appi.ajp.162.5.883.
  89. Millon, T. (1981). Disorders of Personality DSM-III: Axis II. Hoboken: John Wiley & Sons.
  90. Millon, T. & Everly, Gsj. (1985). Personality and its disorders: A biosocial learning approach. Hoboken: John Wiley & Sons.
  91. Moran, P., Jenkins, R., Tylee, A., Blizard, R. & Mann, A. (2000). The prevalence of personality disorder among UK primary care attenders. Acta psychiatrica scandinavica, 102(1): 52-57. DOI: 10.1034/j.1600-0447.2000.102001052.x.
  92. Moroni, F., Procacci, M., Pellecchia, G., Semerari, A., Nicolò, G., Carcione, A., Pedone, R. & Colle, L. (2016). Mindreading dysfunction in avoidant personality disorder compared with other personality disorders. Journal of Nervous and Mental Disease, 204(10): 752-757. DOI: 10.1097/NMD.0000000000000536.
  93. Nestadt, G., Di, C., Samuels, J.F., Bienvenu, O.J., Reti, I.M., Costa, P., Eaton, W.W. & Bandeen-Roche, K. (2010). The stability of DSM personality disorders over twelve to eighteen years. Journal of Psychiatric Research, 44(1): 1-7. DOI: 10.1016/j.jpsychires.2009.06.009.
  94. Nicolò, G., Semerari, A., Lysaker, P.H., Dimaggio, G., Conti, L., D’Angerio, S., Procacci, M., Popolo, R. & Carcione, A. (2011). Alexithymia in personality disorders: Correlations with symptoms and interpersonal functioning. Psychiatry Research, 190(1): 37-42. DOI: 10.1016/j.psychres.2010.07.046.
  95. Oddo-Sommerfeld, S., Hain, S., Louwen, F. & Schermelleh-Engel, K. (2016). Longitudinal effects of dysfunctional perfectionism and avoidant personality style on postpartum mental disorders: Pathways through antepartum depression and anxiety. Journal of Affective Disorders, 191: 280-288. DOI: 10.1016/j.jad.2015.11.040.
  96. Oleski, J., Cox, B.J., Robinson, J. & Grant, B. (2012). The predictive validity of Cluster C personality disorders on the persistence of major depression in the national epidemiologic survey on alcohol and related conditions. Journal of Personality Disorders, 26(3): 322-333. DOI: 10.1521/pedi.2012.26.3.322.
  97. Olssøn, I. & Dahl, A.A. (2012). Avoidant personality problems--their association with somatic and mental health, lifestyle, and social network. A community-based study. Comprehensive Psychiatry, 53(6): 813-821. DOI: 10.1016/j.comppsych.2011.10.007.
  98. Oosterbaan, D.B., van Balkom, A.J.L.M., Spinhoven, P., de Meij, T.G.J. & van Dyck, R. (2002). The influence on treatment gain of comorbid avoidant personality disorder in patients with social phobia. The Journal of Nervous and Mental Disease, 190(1): 41-43. DOI: 10.1097/00005053-200201000-00010.
  99. Panksepp, J. (1998). Affective neuroscience: The foundations of human and animal emotions. Oxford: Oxford University Press. psycnet.apa.org/record/1999-02235-000.
  100. Parker, G., Roussos, J., Austin, M.P., Hadzi-Pavlovic, D., Wilhelm, K. & Mitchell, P. (1998). Disordered personality style: higher rates in non-melancholic compared to melancholic depression. Journal of Affective Disorders, 47(1-3): 131-140. DOI: 10.1016/s0165-0327(97)00133-x.
  101. Pellecchia, G., Moroni, F., Colle, L., Semerari, A., Carcione, A., Fera, T., Fiore, D., Nicolò, G., Pedone, R. & Procacci, M. (2018). Avoidant personality disorder and social phobia: Does mindreading make the difference? Comprehensive Psychiatry, 80: 163-169. DOI: 10.1016/j.comppsych.2017.09.011.
  102. Pinto, A., Mancebo, M.C., Eisen, J.L., Pagano, M.E. & Rasmussen, S.A. (2006). The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake. The Journal of Clinical Psychiatry, 67(5): 703-711. DOI: 10.4088/jcp.v67n0503.
  103. Popolo, R., Lysaker, P.H., Salvatore, G., Montano, A., Buonocore, L., Sirri, L., Imbimbo, A. & Dimaggio, G. (2014). Emotional inhibition in personality disorders. In Psychotherapy and Psychosomatics, 83(6): 377-378. DOI: 10.1159/000365110.
  104. Popolo, R., MacBeth, A., Brunello, S., Canfora, F., Ozdemir, E., Rebecchi, D., Toselli, C., Venturelli, G., Salvatore, G. & Dimaggio, G. (2018). Metacognitive interpersonal therapy in group: a feasibility study. Research in Psychotherapy: Psychopathology, Process and Outcome, 21(3): 155-163. DOI: 10.4081/ripppo.2018.338.
  105. Popolo, R., MacBeth, A., Canfora, F., Rebecchi, D., Toselli, C., Salvatore, G. & Dimaggio, G. (2019). Metacognitive Interpersonal Therapy in group (MIT-G) for young adults with personality disorders: A pilot randomized controlled trial. Psychology and Psychotherapy: Theory, Research and Practice, 92(3): 342-358. DOI: 10.1111/papt.12182.
  106. Prabhu, L., Cherian, A.V., Viswanath, B., Kandavel, T., Bada Math, S. & Janardhan Reddy, Y.C. (2013). Symptom dimensions in OCD and their association with clinical characteristics and comorbid disorders. Journal of Obsessive-Compulsive and Related Disorders, 2(1): 14-21. DOI: 10.1016/j.jocrd.2012.10.002.
  107. Practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Association. (2001). The American Journal of Psychiatry, 158(10): 1-52. psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bpd.pdf.
  108. Quirk, S.E., Berk, M., Pasco, J.A., Brennan-Olsen, S.L., Chanen, A.M., Koivumaa-Honkanen, H., Burke, L.M., Jackson, H.J., Hulbert, C.A., Olsson, C., Moran, P., Stuart, A.L. & Williams, L.J. (2017). The prevalence, age distribution and comorbidity of personality disorders in Australian women. The Australian and New Zealand Journal of Psychiatry, 51(2): 141-150. 10.1177/0004867416649032.
  109. Rafaeli, E. & Bernstein, D.P. (2010). Schema Therapy: Distinctive Features. New York: Routledge.
  110. Rees, C.S. & Pritchard, R. (2015). Brief cognitive therapy for avoidant personality disorder. Psychotherapy, 52(1): 45-55. DOI: 10.1037/a0035158.
  111. Reich, J. (2000). The relationship of social phobia to avoidant personality disorder: a proposal to reclassify avoidant personality disorder based on clinical empirical findings. European psychiatry: the journal of the Association of European Psychiatrists, 15(3): 151-159. DOI: 10.1016/s0924-9338(00)00240-6.
  112. Reichborn-Kjennerud, T., Czajkowski, N., Torgersen, S., Neale, M.C., Ørstavik, R.E., Tambs, K. & Kendler, K.S. (2007). The relationship between avoidant personality disorder and social phobia: a population-based twin study. The American Journal of Psychiatry, 164(11): 1722-1728. DOI: 10.1176/appi.ajp.2007.06101764.
  113. Renneberg, B., Goldstein, A.J., Phillips, D. & Chambless, D.L. (1990). Intensive behavioral group treatment of avoidant personality disorder. Behavior Therapy, 21(3): 363-377. DOI: 10.1016/S0005-7894(05)80337-5.
  114. Sanislow, C.A. & Hector, A.D. (2020). Cluster C Anxious-Fearful Personality Pathology and Avoidance (pp. 302-316). In: The Cambridge Handbook of Personality Disorders. Cambridge University Press. DOI: 10.1017/9781108333931.053.
  115. Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolò, G., Procacci, M. & Alleva, G. (2003). How to evaluate metacognitive functioning in psychotherapy? The metacognition assessment scale and its applications. Clinical Psychology & Psychotherapy, 10(4): 238-261. DOI: 10.1002/cpp.362.
  116. Semerari, A., Colle, L., Pellecchia, G., Buccione, I., Carcione, A., Dimaggio, G., Nicolo, G., Procacci, M. & Pedone, R. (2014). Metacognitive dysfunctions in personality disorders: Correlations with disorder severity and personality styles. Journal of Personality Disorders, 28(6): 751-766. DOI: 10.1521/pedi_2014_28_137.
  117. Sexton, M.C., Sunday, S.R., Hurt, S. & Halmi, K.A. (1998). The relationship between alexithymia, depression, and axis II psychopathology in eating disorder inpatients. The International Journal of Eating Disorders, 23(3): 277-286. DOI: 10.1002/(sici)1098-108x(199804)23:3<277::aid-eat5>3.0.co;2-g.
  118. Simon, W. (2009). Follow-up psychotherapy outcome of patients with dependent, avoidant and obsessive-compulsive personality disorders: A meta-analytic review. International Journal of Psychiatry in Clinical Practice, 13(2): 153-165. DOI: 10.1080/13651500802570972.
  119. Simonsen, S., Eikenæs, I.U.M., Nørgaard, N.L., Normann-Eide, E., Juul, S. & Wilberg, T. (2019). Specialized Treatment for Patients with Severe Avoidant Personality Disorder: Experiences from Scandinavia. Journal of Contemporary Psychotherapy, 49(1): 27-38. DOI: 10.1007/s10879-018-9395-x.
  120. Simonsen, S., Popolo, R., Juul, S., Frandsen, F.W., Sørensen, P. & Dimaggio, G. (2022). Treating Avoidant Personality Disorder with Combined Individual Metacognitive Interpersonal Therapy and Group Mentalization-Based Treatment: A Pilot Study. Journal of Nervous and Mental Disease, 210(3): 163-171. DOI: 10.1097/NMD.0000000000001432.
  121. Skewes, S.A., Samson, R.A., Simpson, S.G. & van Vreeswijk, M. (2015). Short-term group schema therapy for mixed personality disorders: a pilot study. Frontiers in Psychology, 5. DOI: 10.3389/fpsyg.2014.01592.
  122. Skodol, A.E., Bender, D.S., Morey, L.C., Clark, L.A., Oldham, J.M., Alarcon, R.D., Krueger, R.F., Verheul, R., Bell, C.C. & Siever, L.J. (2011). Personality disorder types proposed for DSM-5. Journal of Personality Disorders, 25(2): 136-169. DOI: 10.1521/pedi.2011.25.2.136.
  123. Skodol, A.E., Gunderson, J.G., Shea, M.T., McGlashan, T.H., Morey, L.C., Sanislow, C.A., Bender, D.S., Grilo, C.M., Zanarini, M.C., Yen, S., Pagano, M.E. & Stout, R.L. (2005). The Collaborative Longitudinal Personality Disorders Study (CLPS): overview and implications. Journal of Personality Disorders, 19(5): 487-504. DOI: 10.1521/pedi.2005.19.5.487.
  124. Skodol, A.E., Pagano, M.E., Bender, D.S., Shea, M.T., Gunderson, J.G., Yen, S., Stout, R.L., Morey, L.C., Sanislow, C.A., Grilo, C.M., Zanarini, M.C. & McGlashan, T.H. (2005). Stability of functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder over two years. Psychological Medicine, 35(3): 443-451. DOI: 10.1017/s003329170400354x.
  125. Soeteman, D.I., Hakkaart-van Roijen, L., Verheul, R. & Busschbach, J.J.V. (2008). The economic burden of personality disorders in mental health care. The Journal of Clinical Psychiatry, 69(2): 259-265. DOI: 10.4088/jcp.v69n0212.
  126. Sørensen, K.D., Wilberg, T., Berthelsen, E. & Råbu, M. (2019). Lived Experience of Treatment for Avoidant Personality Disorder: Searching for Courage to Be. Frontiers in Psychology, 10: 2879. DOI: 10.3389/fpsyg.2019.02879.
  127. Sperry, L. (2016). Handbook of Diagnosis and Treatment of DSM-5 Personality Disorders. In: Handbook of Diagnosis and Treatment of DSM-5 Personality Disorders. New York: Routledge.
  128. Strauss, J.L., Hayes, A.M., Johnson, S.L., Newman, C.F., Brown, G.K., Barber, J.P., Laurenceau, J.-P. & Beck, A.T. (2006). Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. Journal of Consulting and Clinical Psychology, 74(2): 337-345. DOI: 10.1037/0022-006X.74.2.337.
  129. Stravynski, A., Belisle, M., Marcouiller, M., Lavallée, Y.J. & Elie, R. (1994). The treatment of avoidant personality disorder by social skills training in the clinic or in real-life settings. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 39(8): 377-383. DOI: 10.1177/070674379403900805.
  130. Stuart, S., Pfohl, B., Battaglia, M., Bellodi, L., Grove, W. & Cadoret, R. (1998). The cooccurrence of DSM-III-R personality disorders. Journal of Personality Disorders, 12(4): 302-315. DOI: 10.1521/pedi.1998.12.4.30.
  131. Svartberg, M., Stiles, T.C. & Seltzer, M.H. (2004). Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. The American Journal of Psychiatry, 161(5): 810-817. DOI: 10.1176/appi.ajp.161.5.810.
  132. Tillfors, M., Furmark, T., Ekselius, L. & Fredrikson, M. (2004). Social phobia and avoidant personality disorder: one spectrum disorder? Nordic Journal of Psychiatry, 58(2): 147-152. DOI: 10.1080/08039480410005530.
  133. Tomasello, M., Carpenter, M., Call, J., Behne, T. & Moll, H. (2005). Understanding and sharing intentions: The origins of cultural cognition. Behavioral and Brain Sciences, 28(5): 675-691. DOI: 10.1017/S0140525X05000129.
  134. Torgersen, S. (2009). The nature (and nurture) of personality disorders. Scandinavian Journal of Psychology, 50(6): 624-632. DOI: 10.1111/j.1467-9450.2009.00788.x.
  135. Torgersen, S. (2012). Epidemiology. In The Oxford Handbook of Personality Disorders. Oxford University Press. DOI: 10.1093/oxfordhb/9780199735013.001.0001.
  136. Torgersen, S., Kringlen, E. & Cramer, V. (2001). The prevalence of personality disorders in a community sample. Archives of General Psychiatry, 58(6): 590-596. DOI: 10.1001/archpsyc.58.6.590.
  137. Torvik, F.A., Welander-Vatn, A., Ystrom, E., Knudsen, G.P., Czajkowski, N., Kendler, K.S. & Reichborn-Kjennerud, T. (2016). Longitudinal associations between social anxiety disorder and avoidant personality disorder: A twin study. Journal of Abnormal Psychology, 125(1): 114-124. DOI: 10.1037/abn0000124.
  138. Trull, T.J., Jahng, S., Tomko, R.L., Wood, P.K. & Sher, K.J. (2010). Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. Journal of Personality Disorders, 24(4): 412-426. DOI: 10.1521/pedi.2010.24.4.412.
  139. Turkat, I. (1990). Personality Disorders: A Psychological Approach to Clinical Management. New York: Pergamon.
  140. Ullrich, S., Farrington, D.P. & Coid, J.W. (2007). Dimensions of DSM-IV personality disorders and life-success. Journal of Personality Disorders, 21(6): 657-663. DOI: 10.1521/pedi.2007.21.6.657.
  141. Videler, A.C., van Alphen, S.P.J., van Royen, R.J.J., van der Feltz-Cornelis, C.M., Rossi, G. & Arntz, A. (2018). Schema therapy for personality disorders in older adults: a multiple-baseline study. Aging and Mental Health, 22(6): 738-747. DOI: 10.1080/13607863.2017.1318260.
  142. Weinbrecht, A., Schulze, L., Boettcher, J. & Renneberg, B. (2016). Avoidant Personality Disorder: a Current Review. Current Psychiatry Reports, 18(3): 29. DOI: 10.1007/s11920-016-0665-6.
  143. Widiger, T.A. (1992). Generalized social phobia versus avoidant personality disorder: a commentary on three studies. Journal of Abnormal Psychology, 101(2): 340-343. DOI: 10.1037//0021-843x.101.2.340.
  144. Wilberg, T., Karterud, S., Pedersen, G. & Urnes, Ø. (2009). The impact of avoidant personality disorder on psychosocial impairment is substantial. Nordic Journal of Psychiatry, 63(5): 390-396. DOI: 10.1080/08039480902831322.
  145. Wilberg, T., Pedersen, G., Bremer, K., Johansen, M. & Kvarstein, E. (2023). Combined group and individual therapy for patients with avoidant personality disorder. A pilot study. Frontiers in Psychiatry, 14: 1181686 DOI: 10.3389/fpsyt.2023.1181686.
  146. Winston, A., Laikin, M., Pollack, J., Samstag, L.W., McCullough, L. & Muran, J.C. (1994). Short-term psychotherapy of personality disorders. American Journal of Psychiatry, 151(2): 190-194. DOI: 10.1176/ajp.151.2.190.
  147. Wurmser, L. (1981). The mask of shame. Baltimora: Johns Hopkins University Press.
  148. Young, J.E. & Klosko, J.S. (2003). Schema Therapy: A Practitioner’s Guide. New York: Guilford Press.
  149. Young, J.E., Klosko, J.S. & Weishaar, M.E. (2018). Schema therapy. La terapia cognitivo-comportamentale integrata per i disturbi della personalità. Trento: Erickson.
  150. Zeigler-Hill, V. & Shackelford, T. (2020). Encyclopedia of Personality and Individual Differences. Cham: Springer. DOI: 10.1007/978-3-319-24612-3.
  151. Zimmerman, M., Rothschild, L. & Chelminski, I. (2005). The prevalence of DSM-IV personality disorders in psychiatric outpatients. The American Journal of Psychiatry, 162(10): 1911-1918. DOI: 10.1176/appi.ajp.162.10.1911.

  • Linee guide e indirizzi di buona pratica clinica per i disturbi sintomatici e di personalità sintomatici, il ruolo delle terapie cognitivo-comportamentali: Parte 1 - I disturbi di personalità Ilaria Baiardini, Giancarlo Dimaggio, in QUADERNI DI PSICOTERAPIA COGNITIVA 52/2023 pp.7
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Ilario Mammone, Giancarlo Dimaggio, Suggerimenti di buona pratica clinica per il disturbo evitante di personalità in "QUADERNI DI PSICOTERAPIA COGNITIVA" 52/2023, pp 72-96, DOI: 10.3280/qpc52-2023oa16175