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: 6.35). 06/2011; 50(6):563-573.e1. DOI: 10.1016/j.jaac.2011.01.017
Source: PubMed

ABSTRACT 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, Aug 13, 2015
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    • "Similarly, investigating the ability to understand other minds, some studies found no differences between patients with BPD and control groups (Fertuck et al., 2009; Ghiassi et al., 2010), whereas other studies discovered that patients with BPD presented a selective dysfunction of cognitive empathy (synonymous with mindreading, or the ability to reflect on other people's minds), but that their emotional empathy was intact (defined as the ability to resonate emotionally with other people's mental states; New et al., 2012). On the same direction, Sharp et al. (2011) highlighted that borderline traits in normal population strongly correlated with the tendency to over-interpret other people's mental states (hypermentalization). "
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    ABSTRACT: The capacity of understanding mental states is a complex function which involves several components. Single components can be selectively impaired in specific clinical populations. It has been suggested that impairments in mindreading are central for borderline personality disorder (BPD). However, empirical findings are inconsistent, and it is debatable whether BPD presents a specific profile of mindreading impairments. The aim of this study is to compare BPD and other PDs in mindreading. Seventy-two patients with BPD and 125 patients with other PD diagnoses were assessed using the Metacognition Assessment Interview. BPD showed difficulties in two mindreading functions, differentiation and integration, even when the severity of psychopathology was controlled. These results suggest a specific mindreading impairment in BPD and a strong relationship between these impairments and the severity of psychopathology.
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    • "The challenge is that therapeutic contact inevitably provokes anxiety. This is likely to reduce both the client's and the " helper's " mentalizing capacity, unleashing defensive dismissing, preoccupied, or disorganized attachment strategies that further reduce mentalizing capacity (Fonagy & Bateman, 2006; Sharp et al., 2011). Bateman and Fonagy (2012) have described a " therapist's mentalizing stance " that comprises curiosity and a tolerance of not-knowing, with an explicit focus on identifying and exploring (through " What? " questions rather than " Why? " questions) any patterned breaks in mentalizing that are noticed, as well as explicitly limiting the intensity of affect in sessions (often with self-deprecating humor) and stressing ordinariness in communication . "
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    • "Symptoms of PD reflect poor mentalizing in both frequent unwarranted assumptions about the mental states of other (hyper-mentalizing) and concrete thinking where excessive significance is given to subjective experiences (Ghiassi, Dimaggio, & Brune, 2010; Harari, Shamay- Tsoory, Ravid, & Levkovitz, 2010; Preissler, Dziobek, Ritter, Heekeren, & Roepke, 2010). A recent study of adolescents with BPD found hyper-mentalizing linked to borderline symptoms via emotion dysregulation (Sharp et al., 2011). There is accumulating evidence that therapeutic efforts at addressing mentalizing deficits result in a reduction of borderline symptoms, particularly self-harm and depression (Bateman & Fonagy, 2008, 2009). "
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