Personality disorders with over‐regulation of emotions and poor self‐reflectivity—The case of a man with avoidant and not‐otherwise specified personality disorder and social phobia treated with Metacognitive Interpersonal Therapy

Treating patients with personality disorders (PD) with significant over‐regulation of affects, poor metacognition and a restricted interpersonal schema repertoire requires specialized procedures. We present here the case of a man in his 30s suffering from Avoidant PD and overall 21 PD criteria met, with co‐occurring axis I disorders. Metacognitive Interpersonal Therapy was used, and after 1 year of therapy, outcome was good, although therapy is still continuing. First, a more nuanced understanding of mental states and then attempts at change began, which led to a modification of the patient's negative self‐image and a reduction of social avoidance. The possible relevance and generalization of formalized procedures, applied with a careful case formulation, is discussed to successfully treat persons with this type of complex PD. Copyright © 2012 John Wiley & Sons, Ltd.