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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Available from: Carolyn Ha, Oct 02, 2015
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    • "s , asking whether there are significant group differences in the types of errors made by participants with BPD or SZ , respectively . We have no specific hypotheses regarding group differences , but expect based on our previous work ( Fretland et al . , 2015 ) that women with SZ will commit both under - and overmentalizing errors , and , based on Sharp et al . ' s ( 2011 ) study reviewed above , that women with BPD will make overmentalizing errors ."
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    ABSTRACT: Although borderline personality disorder (BPD) and schizophrenia (SZ) are notably different mental disorders, they share problems in social cognition-or understanding the feelings, intentions and thoughts of other people. To date no studies have directly compared the social cognitive abilities of individuals with these two disorders. In this study, the social cognitive subdomain theory of mind was investigated in women with BPD (n = 25), women with SZ (n = 25) and healthy women (n = 25). An ecologically valid video-based measure (Movie for the Assessment of Social Cognition) was used. For the overall score, women with SZ performed markedly below both healthy women and women with BPD, whereas women with BPD did not perform significantly different compared to the healthy control group. A statistically significant error type × group interaction effect indicated that the groups differed with respect to kind of errors. Whereas women with BPD made mostly overmentalizing errors, women with SZ in addition committed undermentalizing errors. Our study suggests different magnitude and pattern of social cognitive problems in BPD and SZ.
    Frontiers in Psychology 09/2015; 6:1239. DOI:10.3389/fpsyg.2015.01239 · 2.80 Impact Factor
    • "thoughts in relation to themselves ( Sharp , Fonagy , & Goodyer , 2006 ; Sharp et al . , 2007 ; Sharp & Venta , 2012 ) , deficits in emotion un derstanding ( Pelc , Kornreich , Foisy , & Dan , 2006 ; Sharp , 2008 ) , anomalies in trust behavior , especially with regard to trustworthiness ( Malti , Averdijk , Ribeaud , Rotenberg , & Eisner , 2013 ; Sharp et al . , 2011 ) , and reduced empathy ( Sterzer et al . , 2007 ) ."
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    ABSTRACT: The process of diagnosis and treatment planning for adolescents requires clinicians to integrate information about various domains of functioning especially: clinical signs and symptoms, social cognition and family functioning. In the current study we applied an integrative analytic approach to mirror case conceptualization by clinicians. Our analyses were performed on the data gathered from the 328 inpatient adolescents. We used a broad range of measures of social-cognitive constructs, family functioning and parent-and self-reported psychopathology. Using a combination of variable-based (PCA) and person-centered (LCA) analyses we determined class membership of adolescents based on variation in social cognition, psychopathology, and family functioning. We identified five latent classes: two internalizing groups, two externalizing groups and a severe psychopathology group. Patterns of general hyperfunctioning (characterized by hypermentalizing and hypervigilance to emotional stimuli) and hypofunctioning (manifested in undermentalizing and under-reactivity to emotional stimuli), can be observed in these groups.
    Journal of Adolescence 09/2015; 45:31-43. DOI:10.1016/j.adolescence.2015.08.010 · 2.05 Impact Factor
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    • "HyperToM may be considered not so much as a deficit but rather as a cognitive strategy or style (Sharp et al. 2011), that in part depends on brain maturation and learning (Abu-Akel, 2003). As the great majority of the sample did not express HyperToM at age 11–12 years, this may indicate a maturational delay in the children who do express this alteration in ToM. "
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    ABSTRACT: Background: Knowledge on the risk mechanisms of psychotic experiences (PE) is still limited. The aim of this population-based study was to explore developmental markers of PE with a particular focus on the specificity of hyper-theory-of-mind (HyperToM) as correlate of PE as opposed to correlate of any mental disorder. Method: We assessed 1630 children from the Copenhagen Child Cohort 2000 regarding PE and HyperToM at the follow-up at 11-12 years. Mental disorders were diagnosed by clinical ratings based on standardized parent-, teacher- and self-reported psychopathology. Logistic regression analyses were performed to test the correlates of PE and HyperToM, and the specificity of correlates of PE v. correlates of any Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) mental disorder. Results: Univariate analyses showed the following correlates of PE: familial psychiatric liability; parental mental illness during early child development; change in family composition; low family income; regulatory problems in infancy; onset of puberty; bullying; concurrent mental disorder; and HyperToM. When estimating the adjusted effects, only low family income, concurrent mental disorder, bullying and HyperToM remained significantly associated with PE. Further analyses of the specificity of these correlates with regard to outcome revealed that HyperToM was the only variable specifically associated with PE without concurrent mental disorder. Finally, HyperToM did not share any of the investigated precursors with PE. Conclusions: HyperToM may have a specific role in the risk trajectories of PE, being specifically associated with PE in preadolescent children, independently of other family and child risk factors associated with PE and overall psychopathology at this age.
    Psychological Medicine 09/2015; DOI:10.1017/S0033291715001567 · 5.94 Impact Factor
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