Theory of mind and emotion regulation difficulties in adolescents with borderline traits
Open accessAbstract
Objective 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.Method 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.Results 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.Conclusions 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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Mentalising impairments or differences are a feature of borderline personality disorder, which is strongly linked with self-injury.
“Whilst mentalising impairments or differences have not been previously linked to self-injury as such, they are a feature of borderline personality disorder [27–30], which is itself strongly linked with self-injury [31–33].”
From A 'choice', an 'addiction', a way 'out of the lost': Exploring self-injury in autistic people without intellectual disability (2019) · cites this paper as [27]
The role of informal caregiving is mostly assumed by females in a wide array of conditions including advanced cancer.
“the burgeoning recent literature on informal caregiving has highlighted that this role is mostly assumed by females in a wide array of conditions including advanced cancer [28,29,30,31].”
From Failures in Reflective Functioning and Reported Symptoms of Anxiety and Depression in Bereaved Individuals: A Study on a Sample of Family Caregivers of Palliative Care Patients (2022) · cites this paper as [28]
The Abstract describes a study of mentalizing and emotion regulation in adolescent psychiatric inpatients, not informal caregiving. Searches for informal caregiving, female caregivers, and advanced cancer found no passage addressing who assumes caregiving roles. The indexed passages provide no page numbers. (LLM, conf=0.78)
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Sharp, C. (2006) · Wiley eBooks · doi:10.1002/9780470712986.ch4 · Cited by 47 · see citing works
Self-citationSharp, C., & Kine, S. (2008) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2008.00483.x · Cited by 44 · see citing works
Self-citationAdrian, M., Zeman, J. L., Erdley, C., Lisa, L., Homan, K. J., & Sim, L. A. (2009) · Journal of Child Psychology and Psychiatry and Allied Disciplines · doi:10.1111/j.1469-7610.2009.02162.x · Cited by 42 · see citing works
Batshaw, M. L., & Towbin, K. E. (2001) · Pediatric Research · doi:10.1203/00006450-200107000-00001 · Cited by 30 · see citing works
Borderline Personality Disorder in children and adolescents
Lubbe, T. (2010) · Taylor & Francis eBooks · doi:10.4324/9780203361153_chapter_2 · Cited by 24 · see citing works
Social cognition in depressed children and adolescents
Kyte, Z. A., & Goodyer, I. M. (2008) · Oxford University Press eBooks · doi:10.1093/med/9780198569183.003.0008 · Cited by 19 · see citing works
Fonagy (1991) · doi:10.1002/1097-0355(199123)12:3
Flagged first, then by citations
Research works printed but not linked: 3
- Allen JG. Mentalizing. Bull Menninger Clin. 2003;67:91- 112.
- Crick NR, Murray-Close D, Woods K. Borderline personality features in childhood: a short-term longitudinal study. Dev Psychopathol. 2005;17:1051-1070.
- Allen J. Traumatic Attachments. New York: Wiley; 2002.
Cited by
Sorted by citations
Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial
Rossouw, T. I., & Fonagy, P. (2012) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2012.09.018 · Cited by 746 · see citing works
Self-citationFonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y.-W., Warren, F., Howard, S., Ghinai, R., Fearon, P., & Lowyck, B. (2016) · PLOS ONE · doi:10.1371/journal.pone.0158678 · Cited by 754 · see citing works
“The distinction is all the more relevant as both types of impairments in RF might be differentially related to different types, or different aspects, of psychopathology [34, 38].”
BackgroundInfluentialSelf-citationASD in Females: Are We Overstating the Gender Difference in Diagnosis?
Kreiser, N. L., & White, S. W. (2014) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-013-0148-9 · Cited by 367 · see citing works
Chanen, A. M., & McCutcheon, L. (2013) · British Journal of Psychiatry · doi:10.1192/bjp.bp.112.119180 · Cited by 262 · see citing works
Social cognition in borderline personality disorder
Roepke, S., Vater, A., Preißler, S., Heekeren, H. R., & Dziobek, I. (2013) · Frontiers in Neuroscience · doi:10.3389/fnins.2012.00195 · Cited by 184 · see citing works
Thoma, P., Friedmann, C., & Suchan, B. (2013) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.01.024 · Cited by 134 · see citing works
Dricu, M., & Frühholz, S. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.10.020 · Cited by 102 · see citing works
Moseley, R. L., Gregory, N. J., Smith, P., Allison, C., & Baron-Cohen, S. (2019) · Molecular Autism · doi:10.1186/s13229-019-0267-3 · Cited by 97 · see citing works
Posttraumatic stress disorder: a social-cognitive perspective.
Sharp, C., Fonagy, P., & Allen, J. G. (2012) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12002 · Cited by 92 · see citing works
Self-citationWestlund Schreiner, M., Klimes-Dougan, B., Begnel, E. D., & Cullen, K. R. (2015) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2015.09.011 · Cited by 90 · see citing works
Bjureberg, J., Sahlin, H., Hellner, C., Hedman-Lagerlöf, E., Gratz, K. L., Bjärehed, J., Jokinen, J., Tull, M. T., & Ljótsson, B. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1527-4 · Cited by 84 · see citing works
Hypermentalizing and Borderline Personality Disorder: A Meta-Analytic Review
McLaren, V., Gallagher, M., Hopwood, C. J., & Sharp, C. (2022) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.20210018 · Cited by 75 · see citing works
Self-citationIbraheim, M., Kalpakci, A., & Sharp, C. (2017) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-017-0052-x · Cited by 72 · see citing works
“It is worth noting that these findings have been supported by data obtained from self-reports [29, 31, 35] and from behavioral studies [30, 32, 33], with one study taking care to utilize both behavioral and self-report data in order to support this claim [34].”
ResultDysfunction of Empathy and Related Processes in Borderline Personality Disorder: A Systematic Review
Salgado, R. M., Pedrosa, R., & Bastos-Leite, A. J. (2020) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000260 · Cited by 67 · see citing works
Schramm, A. T., Venta, A., & Sharp, C. (2013) · Personality Disorders: Theory, Research, and Treatment · doi:10.1037/a0031389 · Cited by 55 · see citing works
Self-citationRosso, A. M., Viterbori, P., & Scopesi, A. M. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01134 · Cited by 49 · see citing works
Experiential Avoidance Mediates the Link between Maternal Attachment Style and Theory of Mind
Vanwoerden, S., Kalpakci, A. H., & Sharp, C. (2015) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.11.015 · Cited by 39 · see citing works
Emotion regulation in adolescents with mental health problems
Henry, J. D., Castellini, J., Moses, E., & Scott, J. G. (2016) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2015.1100276 · Cited by 19 · see citing works
Buckholdt, K. E., Weiss, N. H., Young, J., & Gratz, K. L. (2015) · Child Psychiatry & Human Development · doi:10.1007/s10578-014-0528-5 · Cited by 14 · see citing works
Lenzo, V., Sardella, A., Musetti, A., Petralia, M. C., Grado, I., & Quattropani, M. C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191911930 · Cited by 10 · see citing works
- Authors
- Sharp, C., Pane, H., Ha, C., Venta, A., Patel, A. B., Sturek, J., & Fonagy, P.
- Affiliations
- University of Houston (US)
- Baylor College of Medicine (US)
- University of Virginia (US)
- University College London (GB)
- Corresponding author
- Sharp, Carla
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2011-06
- Volume
- 50
- Issue
- 6
- Pages
- 563-573.e1
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2133290727
- Cited by
- 492
- References
- 112
- Citations by year
- 2026: 30 · 2025: 35 · 2024: 33 · 2023: 29 · 2022: 30 · 2021: 37 · 2020: 29 · 2019: 44 · 2018: 42 · 2017: 32 · 2016: 28 · 2015: 39 · 2014: 33 · 2013: 32 · 2012: 15
- FWCI
- 28.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Menninger Clinic
- National Alliance for Research on Schizophrenia and Depression
- National Institute for Health and Care Research (NF-SI-0510-10228)
- British Psychological Society
- University College London
- Curry School of Education and Human Development, University of Virginia
- National Institute of Mental Health
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Keywords
- theory of mind, mentalization, emotion regulation, borderline personality disorder, borderline personality traits, adolescents, social cognition, mediation, psychopathy, interpersonal behavior
- MeSH terms
- Adolescent, Mental Disorders, Borderline Personality Disorder, Female, Humans, Internal-External Control, Interview, Psychological, Life Change Events, Male, Personality Assessment, Personality Inventory, Psychometrics, Residential Treatment, Comorbidity, Substance-Related Disorders, Diagnostic and Statistical Manual of Mental Disorders, Theory of Mind, Emotional Intelligence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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