Network analysis of emotional disorders with and without comorbid personality disorders: Symptom, metacognition, and...

Emotional Disorders (EDs) with and without comorbid personality disorder (ED-PD vs. ED-noPD) show distinct symptom patterns. ED-PDs involve pervasive, ego-syntonic traits, whereas ED-noPD conditions are more ego-dystonic. This study examined whether these differences extend to the interplay between metacognitive processes, repetitive negative thinking, and symptoms.

962 Italian-speaking adults (mean age = 36.9; 336 males, 626 females) seeking treatment at our outpatients' service (inTHERAPY) participated. Of these, 653 had a primary ED (mainly depressive or anxiety disorders), and 309 had a comorbid PD. Participants completed assessments of repetitive negative thinking styles, metacognitive beliefs, symptoms, and psychosocial functioning. A network analysis was conducted on the total sample and by subgroup, assessing Bridge Expected Influence and network invariance.

Negative metacognitive beliefs about danger and uncontrollability of thoughts, depressive symptoms and depressive rumination were central in both groups. In the ED-noPD group, Negative metacognitive beliefs about danger and uncontrollability of worry exerted the strongest influence, whereas in the ED-PD group, depressive rumination emerged as the most central feature. Bridge connections revealed that depressive rumination and cognitive self-consciousness acted as key links in ED-PD, possibly reinforcing ego-syntonicity. However, no significant structural differences emerged between networks.

Findings indicate that the structure linking symptoms, repetitive negative thinking, and metacognitive beliefs is broadly similar in ED-PD and ED-noPD. Yet, the specific bridge patterns in ED-PD may reflect stronger ego-syntonicity, underscoring the importance of interventions targeting self-focused attention and metacognitive awareness in this subgroup.