Mentalization in borderline individuals: an attempt to integrate contradictory research results
More details
Hide details
Submission date: 2017-09-08
Final revision date: 2018-09-07
Acceptance date: 2018-09-13
Online publication date: 2018-12-19
Publication date: 2018-12-17
Current Issues in Personality Psychology 2018;6(4):266–278
Researchers have been striving to explore the functioning of patients with borderline personality disorder from the perspective of their capacity to mentalize. Analyzing the expanding body of literature, it is nevertheless difficult to reach a clear conclusion. There are studies that confirm mentalization deficits in this group; however, there are also reports suggesting better or at last equal mentalizing in borderline individuals compared to controls. This paper discusses a hypothetical explanation of these contradictory results by analyzing three fundamental issues. It is assumed that: (1) different aspects of mentalization are measured in studies – some of them are disordered, while others remain intact in borderline individuals; (2) mentali­zation can be understood not only as a trait but also as a state, and its level may differ in the same person depending on measurement conditions; (3) the borderline group is heterogeneous in terms of mentalizing because other variables determine the level of this capacity.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: APA Publishing.
Arntz, A., Bernstein, D., Oorschot, M., & Schobre, P. (2009). Theory of mind in borderline and cluster-C personality disorder. The Journal of Nervous and Mental Disease, 197, 801–807.
Baez, S., Marengo, J., Perez, A., Huepe, D., Font, F. G., Rial, V., Gonzalez-Gadea, M. L., Manes F., & Ibanez, A. (2014). Theory of mind and its relationship with executive functions and emotion recognition in borderline personality disorder. Journal of Neuropsychology, 9, 203–218.
Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001). The “Reading the Mind in the Eyes” Test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 42, 241–251.
Bateman, A., & Fonagy, P. (2010). Mentalization based treatment for borderline personality disorder. World Psychiatry, 9, 11–15.
Bączkowski, B. M., & Cierpiałkowska, L. (2015). Mentalization within close relationships: The role of specific attachment style. Polish Psychological Bulletin, 46, 285–299.
Beaulieu-Pelletier, G., Bouchard, M.-A., & Philippe, F. L. (2013). Mental States Task (MST): development, validation, and correlates of a self-report measure of mentalization. Journal of Clinical Psychology, 69, 671–695.
Beeney, J. E., Stepp, S. D., Hallquist, M. N., Scott, L. N., Wright, A. G. C., Ellison, W. D., Nolf K. A., & Pilkonis, P. A. (2015). Attachment and social cognition in borderline personality disorder: Specificity in relation to antisocial and avoidant personality disorders. Personality Disorders: Theory, Research, and Treatment, 6, 207–215.
Białecka-Pikul, M. (2012). Narodziny i rozwój refleksji nad myśleniem [The Birth and Development of Reflection on Thinking]. Kraków: Wydawnictwo Uniwersytetu Jagiellońskiego.
Bora, E., & Pantelis, C. (2013). Theory of mind impairments in first-episode psychosis, individuals at ultra-high risk for psychosis and in first-degree relatives of schizophrenia: systematic review and meta-analysis. Schizophrenia Research, 144, 31–36.
Brüne, M., Walden, S., Edel, M.-A., & Dimaggio, G. (2016). Mentalization of complex emotions in borderline personality disorder: The impact of parenting and exposure to trauma on the performance in a novel cartoon-based task. Comprehensive Psychiatry, 64, 29–37.
Carcione, A., Dimaggio, G., Conti, L., Fiore, D., & Semerari, A. (2010). Metacognition Assessment Scale v. 4.0. Unpublished manuscript.
Cierpiałkowska, L., & Gościniak, J. (2010). Współczesna psychoanaliza. Modele konfliktu i deficytu [Contemporary psychoanalysis. Models of conflict and deficit]. Poznań: Wydawnictwo Naukowe UAM.
Cierpiałkowska, L., & Górska, D. (Eds.). (2016). Mentalizacja z perspektywy rozwojowej i klinicznej [Mentalization from the developmental and clinical perspective]. Poznań: Wydawnictwo Naukowe UAM.
Cierpiałkowska, L., Kwiecień, A., & Miśko, N. (2016). Zdolność do mentalizacji w kontekście relacji przywiązania u osób z zaburzeniami borderline [The ability to mentalize in the context of attachment relation in individuals with borderline disorders]. In L. Cierpiałkowska & D. Górska (Eds.), Mentalizacja z perspektywy rozwojowej i klinicznej [Mentalization from the developmental and clinical perspective] (pp. 182–207). Poznań: Wydawnictwo Naukowe UAM.
Diamond, D., Levy, K. N., Clarkin, J. F., Fischer-Kern, M., Cain, N. M., Doering, S., Hörz S., & Buchheim, A. (2014). Attachment and mentalization in female patients with comorbid narcissistic and borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 5, 428–433.
Dimaggio, G., Carcione, A., Nicolò, G., Conti, L., Fiore, D., Pedone, R., Popolo R., Procacci M., & Semerari, A. (2009). Impaired decentration in personality disorder: a series of single cases analysed with the Metacognition Assessment Scale. Clinical Psychology & Psychotherapy, 16, 450–462.
Dimaggio, G., Procacci, M., Nicolò, G., Popolo, R., Semerari, A., Carcione, A., & Lysaker, P. H. (2007). Poor metacognition in Narcissistic and Avoidant Personality Disorders: four psychotherapy patients analysed using the Metacognition Assessment Scale. Clinical Psychology & Psychotherapy, 14, 386–401.
Dinsdale, N., & Crespi, B. J. (2013). The borderline empathy paradox: evidence and conceptual models for empathic enhancements in borderline personality disorder. Journal of Personality Disorders, 27, 172–195.
Dolan, M., & Fullam, R. (2004). Theory of mind and mentalizing ability in antisocial personality disorders with and without psychopathy. Psychological Medicine, 34, 1093–1102.
Dziobek, I., Fleck, S., Kalbe, E., Rogers, K., Hassenstab, J., Brand, M., Kessler, J., Woike, J. K., Wolf, O. T., & Convit, A. (2006). Introducing MASC: a movie for the assessment of social cognition. Journal of Autism and Developmental Disorders, 36, 623–636.
Dziobek, I., Preissler, S., Grozdanovic, Z., Heuser, I., Heekeren, H. R., & Roepke, S. (2011). Neuronal correlates of altered empathy and social cognition in borderline personality disorder. NeuroImage, 57, 539–548.
Ensink, K., Normandin, L., Plamondon, A., Berthelot, N., & Fonagy, P. (2016). Intergenerational pathways from reflective functioning to infant attachment through parenting. Canadian Journal of Behavioural Science, 48, 9–18.
Fertuck, E. A., Jekal, A., Song, I., Wyman, B., Morris, M. C., Wilson, S. T., Brodsky, B. S., Stanley, B. (2009). Enhanced “Reading the Mind in the Eyes” in borderline personality disorder compared to healthy controls. Psychological Medicine, 39, 1979–1988.
Fischer-Kern, M., Buchheim, A., Hörz, S., Schuster, P., Doering, S., Kapusta, N. D., Taubner, S., Tmej, A., Rentrop, M., Buchheim P., & Fonagy, P. (2010). The relationship between personality organization, reflective functioning, and psychiatric classification in borderline personality disorder. Psychoanalytic Psychology, 27, 395–409.
Flury, J. M., Ickes, W., & Schweinle, W. (2008). The borderline empathy effect: Do high BPD individuals have greater empathic ability? Or are they just more difficult to “read”? Journal of Research in Personality, 42, 312–332.
Fonagy, P. (1996). Attachment, the development of the self, and its pathology in personality disorders. Psychomedia. Retrieved from
Fonagy, P., & Luyten, P. (2009). A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Development and Psychopathology, 21, 1355–1381.
Fonagy, P., Luyten, P., & Strathearn, L. (2011). Borderline personality disorder, mentalization, and the neurobiology of attachment. Infant Mental Health Journal, 32, 47–69.
Fonagy, P., Target, M., Steele, M., & Steele, H. (2002). Manual for Coding Reflective Functioning. Version 5. University College London Dept of Psychology. Retrieved from
Fossati, A., Borroni, S., Dziobek, I., Fonagy, P., & Somma, A. (2017). Thinking About Assessment: Further Evidence of the Validity of the Movie for the Assessment of Social Cognition as a Measure of Mentalistic Abilities. Psychoanalytic Psychology, 35, 127–141.
Fossati, A., Feeney, J., Maffei, C., & Borroni, S. (2014). Thinking about feelings: Affective state mentalization, attachment styles, and borderline personality disorder features among Italian nonclinical adolescents. Psychoanalytic Psychology, 31, 41–67.
Franzen, N., Hagenhoff, M., Baer, N., Schmidt, A., Mier, D., Sammer, G., Gallhofer, B., Kirsch, P., & Lis, S. (2011). Superior “theory of mind” in borderline personality disorder: An analysis of interaction behavior in a virtual trust game. Psychiatry Research, 187, 224–233.
Ghiasi, H., Mohammadi, A., & Zarrinfar, P. (2016). An Investigation into the Roles of Theory of Mind, Emotion Regulation, and Attachment Styles in Predicting the Traits of Borderline Personality Disorder. Iranian Journal of Psychiatry, 11, 206.
Ghiassi, V., Dimaggio, G., & Brüne, M. (2010). Dysfunctions in understanding other minds in borderline personality disorder: a study using cartoon picture stories. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 20, 657–667.
Gooding, D. C., & Pflum, M. J. (2011). Theory of Mind and psychometric schizotypy. Psychiatry Research, 188, 217–223.
Górska, D. (2015). Mentalization, specific attachment, and relational satisfaction from the intrapsychic and interpersonal perspectives. Polish Psychological Bulletin, 46, 393–400.
Górska, D., & Cierpiałkowska, L. (2016). Mentalizacja jako stan i jako cecha – perspektywa strukturalno-procesualna [Mentalization as a state and as a trait – a structural and processual perspective]. In L. Cierpiałkowska & D. Górska (Eds.), Menta­lizacja z perspektywy rozwojowej i klinicznej [Mentalization from the developmental and clinical perspective] (pp. 13–42). Poznań: Wydawnictwo Naukowe UAM.
Górska, D., & Marszał, M. (2014). Mentalization and theory of mind in borderline personality organization: exploring the differences between affective and cognitive aspects of social cognition in emotional pathology. Psychiatria Polska, 48, 503–513.
Ha, C., Sharp, C., Ensink, K., Fonagy, P., & Cirino, P. (2013). The measurement of reflective function in adolescents with and without borderline traits. Journal of Adolescence, 36, 1215–1223.
Happé, F. G. E. (1994). An advanced test of theory of mind: Understanding of story characters’ thoughts and feelings by able autistic, mentally handicapped, and normal children and adults. Journal of Autism and Developmental Disorders, 24, 129–154.
Harari, H., Shamay-Tsoory, S. G., Ravid, M., & Levkovitz, Y. (2010). Double dissociation between cognitive and affective empathy in borderline personality disorder. Psychiatry Research, 175, 277–279.
Inoue, Y., Tonooka, Y., Yamada, K., & Kanba, S. (2004). Deficiency of theory of mind in patients with remitted mood disorder. Journal of Affective Disorders, 82, 403–409.
James, R., & Blair, R. (2007). Empathic dysfunction in psychopathic individuals. In T. Farrow & P. Woodruff (Eds.), Empathy in Mental Illness (pp. 3–16). Cambridge University Press.
Kernberg, O. F. (2004). Borderline Personality Disorder and Borderline Personality Organization: Psychopathology and Psychotherapy. In J. J. Mag­navita (Ed.), Handbook of Personality Disorders: Theory and Practice (pp. 92–119). Hoboken, NJ: John Wiley & Sons, Inc.
Laranjo, J., Bernier, A., Meins, E., & Carlson, S. M. (2014). The roles of maternal mind-mindedness and infant security of attachment in predicting preschoolers’ understanding of visual perspective taking and false belief. Journal of Experimental Child Psychology, 125, 48–62.
Lecours, S., & Bouchard, M.-A. (2011). Verbal elaboration of distinct affect categories and BPD symptoms. Psychology and Psychotherapy, 84, 26–41; discussion 98–110.
Levy, K. N., & Blatt, S. J. (1999). Attachment theory and psychoanalysis: Further differentiation within insecure attachment patterns. Psychoanalytic Inquiry, 19, 541–575.
Levy, K. N., Meehan, K. B., Weber, M., Reynoso, J., & Clarkin, J. F. (2005). Attachment and borderline personality disorder: implications for psychotherapy. Psychopathology, 38, 64–74.
Levy, K. N., Scala, J. W., Temes, C. M., & Clouthier, T. L. (2015). An integrative attachment theory framework of personality disorders. In S. K. Huprich (Ed.), Personality disorders: Toward theoretical and empirical integration in diagnosis and assessment (pp. 315–343). Washington, DC: American Psychological Association.
Luyten, P., & Fonagy, P. (2015). The neurobiology of mentalizing. Personality Disorders: Theory, Research, and Treatment, 6, 366–379.
Marszał, M. (2014). Specyficzne wewnętrzne modele operacyjne przywiązania osób z organizacją osobowości borderline [Relationship-specific attachment models in individuals with borderline personality organization]. Psychologia Rozwojowa, 19, 69–82.
Marszał, M. (2015). Mentalizacja w kontekście przywiązania. Zdolność do rozumienia siebie i innych u osób z osobowością borderline [Mentalization in the context of attachment. The ability to understand self and others in people with borderline personality]. Warszawa: Difin.
Marszał, M. (2016). Metody pomiaru zdolności do mentalizacji [Methods of measuring the ability to mentalize]. In L. Cierpiałkowska & D. Górska (Eds.), Mentalizacja z perspektywy rozwojowej i klinicznej [Mentalization from the developmental and clinical perspective] (pp. 65–93). Poznań: Wydawnictwo Naukowe UAM.
Marszał, M., & Jańczak, A. (2017). Emotion Dysregulation, Mentalization and Romantic Attachment in the Nonclinical Adolescent Female Sample. Current Psychology, 37, 1–11. doi: 10.1007/s12144-017-9573-0.
Marszał, M., & Kamza, A. (2016). Poznawcze źródła mentalizacji – koncepcja teorii umysłu [Cognitive roots of mentalization – the concept of the theory of mind]. In L. Cierpiałkowska & D. Górska (Eds.), Mentalizacja z perspektywy rozwojowej i klinicznej [Mentalization from the developmental and clinical perspective] (pp. 65–93). Poznań: Wydawnictwo Naukowe UAM.
Meins, E., Fernyhough, C., Wainwright, R., Das Gupta, M., Fradley, E., & Tuckey, M. (2002). Maternal mind-mindedness and attachment security as predictors of theory of mind understanding. Child Development, 73, 1715–1726.
Mikulincer, M., & Shaver, P. R. (2003). The Attachment Behavioral System in Adulthood: Activation, Psychodynamics, and Interpersonal Processes. In M. P. Zanna (Ed.), Advances in experimental social psychology (Vol. 35, pp. 53–152). San Diego, CA: Elsevier Academic Press.
Müller, C., Kaufhold, J., Overbeck, G., & Grabhorn, R. (2006). The importance of reflective functioning to the diagnosis of psychic structure. Psychology and Psychotherapy: Theory, Research and Practice, 79, 485–494.
Oldershaw, A., Treasure, J., Hambrook, D., Tchanturia, K., & Schmidt, U. (2011). Is anorexia nervosa a version of autism spectrum disorders? European Eating Disorders Review, 19, 462–474.
Ontai, L. L., & Thompson, R. A. (2008). Attachment, Parent-Child Discourse and Theory-of-Mind Development. Social Development, 17, 47–60.
Petersen, R., Brakoulias, V., & Langdon, R. (2016). An experimental investigation of mentalization ability in borderline personality disorder. Comprehensive Psychiatry, 64, 12–21.
Preißler, S., Dziobek, I., Ritter, K., Heekeren, H. R., & Roepke, S. (2010). Social Cognition in Borderline Personality Disorder: Evidence for Disturbed Recognition of the Emotions, Thoughts, and Intentions of others. Frontiers in Behavioral Neuroscience, 4, 182.
Richell, R. A., Mitchell, D. G. V., Newman, C., Leonard, A., Baron-Cohen, S., & Blair, R. J. R. (2003). Theory of mind and psychopathy: can psychopathic individuals read the “language of the eyes”? Neuropsychologia, 41, 523–526.
Ritter, K., Dziobek, I., Preißler, S., Rüter, A., Vater, A., Fydrich, T., Lammers, C. H., Heekeren, H. R., & Roepke, S. (2011). Lack of empathy in patients with narcissistic personality disorder. Psychiatry Research, 187, 241–247.
Sayin, A., Oral, N., Utku, C., Baysak, E., & Candansayar, S. (2010). Theory of mind in obsessive-compulsive disorder: Comparison with healthy controls. European Psychiatry: The Journal of the Association of European Psychiatrists, 25, 116–122.
Schilling, L., Wingenfeld, K., Löwe, B., Moritz, S., Terfehr, K., Köther, U., & Spitzer, C. (2012). Normal mind-reading capacity but higher response confidence in borderline personality disorder patients. Psychiatry and Clinical Neurosciences, 66, 322–327.
Scott, L. N., Levy, K. N., Adams, R. B., & Stevenson, M. T. (2011). Mental state decoding abilities in young adults with borderline personality disorder traits. Personality Disorders, 2, 98–112.
Semerari, A., Carcione, A., Dimaggio, G., Nicoló, G., Pedone, R., & Procacci, M. (2005). Metarepresentative functions in borderline personality disorder. Journal of Personality Disorders, 19, 690–710.
Semerari, A., Colle, L., Pellecchia, G., Buccione, I., Carcione, A., Dimaggio, G., Nicolò, G., Procacci, M., & Pedone, R. (2014). Metacognitive dysfunctions in personality disorders: correlations with disorder severity and personality styles. Journal of Personality Disorders, 28, 751–766.
Semerari, A., Colle, L., Pellecchia, G., Carcione, A., Conti, L., Fiore, D., Moroni, F., Nicolò, G., Procacci, M., & Pedone, R. (2015). Personality Disorders and Mindreading: Specific Impairments in Patients with Borderline Personality Disorder Compared to Other PDs. The Journal of Nervous and Mental Disease, 203, 626–631.
Sharp, C. (2014). The Social-Cognitive Basis of BPD: A Theory of Hypermentalizing. In C. Sharp & J. L. Tackett (Eds.), Handbook of Borderline Personality Disorder in Children and Adolescents (pp. 211–225). New York, NY: Springer.
Sharp, C., & Fonagy, P. (2008). The Parent’s Capacity to Treat the Child as a Psychological Agent: Constructs, Measures and Implications for Developmental Psychopathology. Social Development, 17, 737–754.
Sharp, C., & Kalpakci, A. (2015). Mentalization in borderline personality disorder: From bench to bedside. Personality Disorders: Theory, Research, and Treatment, 6, 347–355.
Sharp, C., Pane, H., Ha, C., Venta, A., Patel, A. B., Sturek, J., & Fonagy, P. (2011). Theory of mind and emotion regulation difficulties in adolescents with borderline traits. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 563–573.e1.
Shorey, H. S., & Snyder, C. (2006). The role of adult attachment styles in psychopathology and psychotherapy outcomes. Review of General Psychology, 10, 1–20.
Stawicka, M., & Górska, D. (2016). Mentalizacja w kontekście przywiązania [Mentalization in the context of attachment]. In L. Cierpiałkowska & D. Górska (Eds.), Mentalizacja z perspektywy rozwojowej i klinicznej [Mentalization from the developmental and clinical perspective] (pp. 42–65). Poznań: Wydawnictwo Naukowe UAM.
Taubner, S., White, L. O., Zimmermann, J., Fonagy, P., & Nolte, T. (2013). Attachment-related mentalization moderates the relationship between psychopathic traits and proactive aggression in adolescence. Journal of Abnormal Child Psychology, 41, 929–938.
White, S., Hill, E., Happé, F., & Frith, U. (2009). Revisiting the strange stories: revealing mentalizing impairments in autism. Child Development, 80, 1097–1117.