Theory of Mind and Emotion Regulation Difficulties in Adolescents With Borderline Traits

Department of Psychology, University of Houston, Houston, TX 77024, USA.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 7.26). 06/2011; 50(6):563-573.e1. DOI: 10.1016/j.jaac.2011.01.017
Source: PubMed


Dysfunctions in both emotion regulation and social cognition (understanding behavior in mental state terms, theory of mind or mentalizing) have been proposed as explanations for disturbances of interpersonal behavior in borderline personality disorder (BPD). This study aimed to examine mentalizing in adolescents with emerging BPD from a dimensional and categorical point of view, controlling for gender, age, Axis I and Axis II symptoms, and to explore the mediating role of emotion regulation in the relation between theory of mind and borderline traits.
The newly developed Movie for the Assessment of Social Cognition (MASC) was administered alongside self-report measures of emotion regulation and psychopathology to 111 adolescent inpatients between the ages of 12 to 17 (mean age = 15.5 years; SD = 1.44 years). For categorical analyses borderline diagnosis was determined through semi-structured clinical interview, which showed that 23% of the sample met criteria for BPD.
Findings suggest a relationship between borderline traits and "hypermentalizing" (excessive, inaccurate mentalizing) independent of age, gender, externalizing, internalizing and psychopathy symptoms. The relation between hypermentalizing and BPD traits was partially mediated by difficulties in emotion regulation, accounting for 43.5% of the hypermentalizing to BPD path.
Results suggest that in adolescents with borderline personality features the loss of mentalization is more apparent in the emergence of unusual alternative strategies (hypermentalizing) than in the loss of the capacity per se (no mentalizing or undermentalizing). Moreover, for the first time, empirical evidence is provided to support the notion that mentalizing exerts its influence on borderline traits through the mediating role of emotion dysregulation.

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    • "These findings are consistent with the report of Levy et al [31] that patients with BPD had difficulties in forming a coherent image of the therapist. It is also consistent with other findings that BPD patients struggle to reason about the mental states of others in situations which call for the integration of complex social cues [32] [33] [34] [35]. "
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    ABSTRACT: Objectives: Borderline personality disorder traits have been observed to be linked with both insecure attachment styles as well as deficits in mentalizing and metacognition. Less is known, however, about how attachment style does or does not interact with deficits in mentalizing and metacognition to create, sustain, or influence levels of borderline personality disorder traits. In this study, we examined the hypothesis that metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems, moderates the relationship of anxious attachment style with the severity of borderline personality disorder traits. Methods: Concurrent assessments were gathered of metacognitive mastery using the Metacognitive Assessment Scale Abbreviated, anxious attachment style using the Experiences of in Close Relationships Scale, and borderline personality disorder traits using the Structured Clinical Interview for DSM-IV Axis II Disorders. Participants were 59 adults in an early phase of recovery from substance use disorders in a residential setting. Results: Multiple regression revealed that metacognitive mastery moderated the relationship of anxious attachment style with the number of borderline personality disorder traits. A median split of the anxious attachment and metacognitive mastery scores was performed yielding 4 groups. An analysis of covariance revealed that participants with higher levels of anxious attachment and poorer metacognitive mastery had more borderline personality disorder traits did than the other groups after controlling for levels of psychopathology. Conclusion: Insecure attachment may be associated with higher number of borderline personality disorder traits in the presence of deficits in metacognitive mastery. Patients with substance use and borderline personality disorder traits may benefit from treatment which addresses metacognitive mastery.
    Comprehensive psychiatry 11/2015; DOI:10.1016/j.comppsych.2015.10.002 · 2.25 Impact Factor
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    • "That mentalizing can be operationalized and therefore assessed in the research and clinical setting as discussed earlier, and because mentalizing has been shown to be sensitive to therapeutic intervention (Rossouw & Fonagy, 2012; Sharp et al., 2013), mentalizing can be seen as a malleable therapeutic target that is not only influenced by effective treatment, but also by other moderating or mediating factors. An immediate candidate variable in this regard is emotion dysregulation, which has been shown to mediate the association between mentalizing and borderline features in adolescence (Sharp et al., 2011). Other mediators may include experiential avoidance (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996), identity diffusion (Jørgensen, 2006), stress reactivity (Smeets, Dziobek, & Wolf, 2009), and so on. "
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    ABSTRACT: The current special issue focuses on the potential of mentalizing as a translational construct for the understanding and treatment of borderline personality disorder (BPD). Mentalizing, which provides the central construct around which mentalization-based therapy (MBT) and theory is organized, refers to the capacity to meaningfully reflect on the mind of others as well as the self. In this introductory article to the special issue, we begin by discussing the need for and nature of translational research. We contend that translational research in mental health and personality disorder, in particular, lags behind that of other medical disorders because of the challenges inherent in meeting translational criteria. We discuss these criteria and we demonstrate the potential of the construct of mentalizing to meet translational criteria in the context of BPD. This article thereby provides the context for the other 3 papers in this special issue which each represent a different point along the translational spectrum. In all, our aim is to provide a foundation for the further evaluation of the usefulness and potential of mentalizing as translational construct in the context of BPD. (PsycINFO Database Record
    Personality Disorders: Theory, Research, and Treatment 10/2015; 6(4):347-355. DOI:10.1037/per0000106 · 3.54 Impact Factor
    • "The dramatically reduced capacity of BPD patients for reflective functioning (Fonagy et al., 1996) that is necessary for controlled mentalizing has been shown to be reversible by psychotherapy (Levy et al., 2006). The task of the therapist, then, is to help slow down the patient's thinking and move them to a more reflective, explicit form of mentalizing that requires more conscious, verbal attention; all without generating a process of pseudo-reflection or hypermentalizing (Sharp et al., 2011, 2013). "
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    ABSTRACT: The role of mentalizing in relation to borderline personality disorder (BPD) is examined with a view to achieving improved levels of mentalizing in BPD patients as a therapeutic target. The article seeks to explain why mentalizing works as a treatment target for BPD, and suggests that a mentalizing approach to BPD may be at the core of any successful intervention. (PsycINFO Database Record
    Personality Disorders: Theory, Research, and Treatment 10/2015; 6(4):380-392. DOI:10.1037/per0000113 · 3.54 Impact Factor
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