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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    • "In a study examining the association between mentalizing and BPD in adolescents, Sharp et al. (2011) found empirical support for the hypermentalizing hypothesis. Employing the MASC, results indicated that BPD was associated with the hypermentalizing subscale of the MASC, while no relation was found between BPD and a lack of mentalizing, supporting the hypothesis that hypermentalizing is a core feature of BPD in adolescents. "
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    ABSTRACT: Borderline personality disorder (BPD) has been shown to be a valid and reliable diagnosis in adolescents and associated with a decrease in both general and social functioning. With evidence linking BPD in adolescents to poor prognosis, it is important to develop a better understanding of factors and mechanisms contributing to the development of BPD. This could potentially enhance our knowledge and facilitate the design of novel treatment programs and interventions for this group. In this paper, we outline a theoretical model of BPD in adolescents linking the original mentalization-based theory of BPD, with recent extensions of the theory that focuses on hypermentalizing and epistemic trust. We then provide clinical case vignettes to illustrate this extended theoretical model of BPD. Furthermore, we suggest a treatment approach to BPD in adolescents that focuses on the reduction of hypermentalizing and epistemic mistrust. We conclude with an integration of theory and practice in the final section of the paper and make recommendations for future work in this area. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
    No preview · Article · Dec 2015 · Personality Disorders: Theory, Research, and Treatment
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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.
    Full-text · Article · Nov 2015 · Comprehensive psychiatry
    • "Faux pas tasks can be completed from 6 years onwards, so it would be informative to find out when these problems emerge and if they predict emergence of BPD. We already have indications that Theory of Mind problems at age 4 or 5 may predict BPD in adolescence [35], and hypermentalizing in adolescents with BPD also predicts poorer outcomes [11] [36]. Petersen et al. [34] also investigated whether there was a relationship between current mentalizing and childhood adversity. "
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    ABSTRACT: The papers in this special issue offer evidence of personality disorder as a dysfunction of higher-order cognition, which is conceptualized variously as a disorder of mentalizing, metacognition, mindfulness, social cognition and reflective function. While there may be differences in the scope of these concepts, they all imply that higher-order mental processing is at the core of personality function. In this commentary, the authors use mentalizing as an umbrella term for these concepts, and argue that it is the complex interaction of adversity, attachment and mentalizing that leads to the characteristic symptoms of borderline personality disorder and other personality disorders. Evidence is provided from the papers in this special issue, comments made on the findings and further avenues for research are recommended.
    No preview · Article · Nov 2015 · Comprehensive psychiatry
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