Autobiographical memory and mentalizing impairment in personality disorders and schizophrenia: clinical and research implications

Clinicians in the fields of mental health, neuroscientists, and social psychologists have been increasingly interested in how persons with psychiatric conditions experience a range of difficulties related to how they think about themselves and others. These difficulties include problems forming and retrieving the specific autobiographical memories (AM) that ground a sense of personal identity (McAdams, 2001). They have also involved diminishments in the capacity to engage in acts of mentalization or metacognition which allow for the understanding of mental states. Both of these forms of dysfunction are of increasing relevance given that each has been commonly observed across different psychiatric conditions, appears relatively independently from symptoms, and is uniquely linked to functional impairment (Dimaggio and Lysaker, 2010; Liu et al., in press). To date deficits in AM and metacognition have mostly been analyzed separately. Psychopathology research has tended to explore either one or the other, thus neglecting the larger issue of how metacognition and AM are produced by systems which are likely closely related and likely feed and support one another (Markowitsch and Staniloiu, 2011). In development, AM and Theory of Mind (ToM) tend be influenced by common factors (Nelson and Fivush, 2004). Persons who present with overgeneralized AM also experience mentalizing problems including reduced affect awareness and poorer ToM (Palmieri et al., 2012). Psychotherapy research and general neuroscience have begun to examine how these functions support one another and how disruptions in either AM or metacognition might lead to decrements in the other. To explore this issue we review psychopathology research concerned separately with problems in AM and metacognition in two forms of mental illness: schizophrenia and personality disorders (PD). We then discuss the advances from psychotherapy research and neuroscience for understanding how these two phenomena are related and comment on opportunities offered by these insights for scientific and clinical work.