Mentalization: Ontogeny, Assessment, and Application in the Treatment of Borderline Personality Disorder
Abstract
This article aims to review the development of the concept of mentalization, its applications in the understanding and treatment of borderline personality disorder, and the issue of its assessment. While conceptually derivative of theory of mind, Fonagy's concept of mentalization concerns more affectively and interpersonally complex understandings of oneself and others, reflecting abilities that enable an individual not only to navigate the social world effectively but also to develop an enriched, stable sense of self. The components of mentalization can be organized around self-/other-oriented, implicit/explicit, and cognitive/affective dimensions. Concepts of mindfulness, psychological mindedness, empathy, and affect consciousness are shown to partially overlap with mentalization within these three dimensions. Mentalization is assessed by the measure of reflective function, a scale to be used adjunctively on semistructured narrative interviews such as the Adult Attachment Interview. Its validity has not been fully tested, and its usage has been hampered by the time and expense it requires. Although the concept of mentalization is a useful heuristic that enables clinicians to adopt a coherent treatment approach, it may be too broad and multifaceted to be operationalized as a marker for specific forms of psychopathology such as borderline personality disorder. Research elucidating the relationship between reflective function, overlapping concepts, and features of borderline psychopathology is needed.
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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 [29]
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“The concept of mentalization has been appropriately criticized as a marker of a specific form of psychopathology such as BPD because in its original formulation the concept was too broad and multifaceted to be operationalized (Choi-Kain & Gunderson, 2008; Holmes, 2005).”
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Maunder, R., & Hunter, J. (2008) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2008.10.007 · Cited by 101 · see citing works
“Reflective function has been assessed with an alternative scoring procedure for AAI transcripts [27,28].”
Lysaker, P. H., Dimaggio, G., Daroyanni, P., Buck, K. D., LaRocco, V. A., Carcione, A., & Nicolò, G. (2010) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608309x481117 · Cited by 101 · 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
Sulzer, S. H. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.08.008 · Cited by 100 · see citing works
An experimental investigation of mentalization ability in borderline personality disorder
Petersen, R., Brakoulias, V., & Langdon, R. A. (2015) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2015.10.004 · Cited by 104 · see citing works
“These concerns highlight the need for rigorous empirical research that may better elucidate the mentalization deficits that are theorized to underlie BPD, and to demonstrate robustly that mentalization difficulties distinguish individuals with BPD from healthy controls [12].”
BackgroundCassel, A., McDonald, S., Kelly, M., & Togher, L. (2016) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2016.1257435 · Cited by 99 · see citing works
“…slowed progress of research in this area as inconsistent term use abounds in the literature to describe similar concepts despite social cognition being widely regarded as critical to the understanding of human experiences (Choi-Kain & Gunderson, 2008; Green et al., 2008; Keysers & Gazzola, 2006).”
BackgroundMentalized affectivity: A new model and assessment of emotion regulation
Greenberg, D. M., Kolasi, J., Hegsted, C. P., Berkowitz, Y., & Jurist, E. L. (2017) · PLoS ONE · doi:10.1371/journal.pone.0185264 · Cited by 102 · see citing works
Translation: Mentalizing as treatment target in borderline personality disorder.
Fonagy, P., Luyten, P., & BATEMAN, A. W. (2015) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000113 · Cited by 101 · see citing works
“Mentalizing is therefore a fundamental psychological process and so interfaces with all major mental disorders and has generic applicability in psychiatric care (Allen, Bleiberg, & Haslam-Hopwood, 2003; Choi-Kain & Gunderson, 2008).”
BackgroundTheory of Mind in Borderline and Cluster-C Personality Disorder
Arntz, A., Bernstein, D., Oorschot, M., & Schobre, P. (2009) · Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181be78fb · Cited by 100 · see citing works
“needed for advanced understanding of other people (Choi-Kain and Gunderson, 2008).”
BackgroundResultInfluentialPincus, D. (2010) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2010.00134 · Cited by 91 · see citing works
“Functional neuroimaging studies consistently find abnormal ventral limbic and paralimbic activity in depression (Price and Drevets, 2009) – the very same regions implicated in the mediation of social relatedness and mentalization (Choi-Kain and Gunderson, 2008; Hartmann, 2009).”
Brüne, M., Dimaggio, G., & Lysaker, P. H. (2011) · Current Psychiatry Reviews · doi:10.2174/157340011797183210 · Cited by 91 · see citing works
Therapist Reflective Functioning, Therapist Attachment Style and Therapist Effectiveness
Cologon, J. J., Schweitzer, R., King, R., & Nolte, T. (2017) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-017-0790-5 · Cited by 90 · see citing works
“Thus, reflective functioning bears close relationships to constructs such as theory of mind, mind-mindedness, metacognition, psychological mindedness, mind reading, and perspective taking (Allen 2006; Choi-Kain and Gunderson 2008; Fonagy 2015).”
BackgroundOffenders With Antisocial Personality Disorder Display More Impairments in Mentalizing
Newbury-Helps, J., Feigenbaum, J., & Fonagy, P. (2016) · Journal of Personality Disorders · doi:10.1521/pedi_2016_30_246 · Cited by 90 · see citing works
Lysaker, P. H., Ringer, J. M., Buck, K. D., Grant, M. L. A., Olesek, K. L., Leudtke, B. L., & Dimaggio, G. (2012) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3182439533 · Cited by 87 · see citing works
Correlates of autistic traits among patients with borderline personality disorder
Dell’Osso, L., Cremone, I. M., Carpita, B., Fagiolini, A. M., Massimetti, G., Bossini, L., Vita, A., Barlati, S., Carmassi, C., & Gesi, C. (2018) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2018.01.002 · Cited by 88 · see citing works
Meulemeester, C. D., Vansteelandt, K., Luyten, P., & Lowyck, B. (2017) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000256 · Cited by 84 · see citing works
Competing Theories of Borderline Personality Disorder
Gunderson, J. G., Fruzzetti, A. E., Unruh, B. T., & Choi-Kain, L. W. (2018) · Journal of Personality Disorders · doi:10.1521/pedi.2018.32.2.148 · Cited by 83 · see citing works
Self-citationParis, J. (2010) · Current Psychiatry Reports · doi:10.1007/s11920-009-0083-0 · Cited by 82 · see citing works
“Similar conclusions were reached by Choi-Kain and Gunderson [ 25 ] in a recent review of the mentalization literature.”
ResultPatients with Borderline Personality Disorder in Emergency Departments
Shaikh, U., Qamar, I., Jafry, F., Hassan, M., Shagufta, S., Odhejo, Y. I., & Ahmed, S. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00136 · Cited by 74 · see citing works
Livesley, W. J. (2012) · Journal of Personality Disorders · doi:10.1521/pedi.2012.26.1.17 · Cited by 78 · see citing works
“…impairments associated with PD include general difficulties in understanding the mental state of self and others (Bateman & Fonagy, 2004; Choi-Kain & Gunderson, 2008; Semerari et al., 2007) and more specific problems such as recognizing and communicating about emotions (Domes, Schulze,…”
BackgroundGillespie, S. M., Garofalo, C., & Velotti, P. (2018) · Journal of Criminal Justice · doi:10.1016/j.jcrimjus.2018.07.006 · Cited by 76 · see citing works
Capturing the Interpersonal Process of Psychiatric Nurses: A Model for Engagement
Delaney, K. R., Shattell, M. M., & Johnson, M. E. (2017) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2017.08.003 · Cited by 75 · see citing works
“Attunement is depicted by Fongay as mentalization, a process where the practitioner deliberately attempts to imagine the patient's mental state (Choi-Kain & Gunderson, 2008).”
BackgroundLysaker, P. H., Gumley, A. I., & Dimaggio, G. (2011) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/j.2044-8341.2010.02007.x · Cited by 73 · see citing works
Antonsen, B. T., Johansen, M. S., Rø, F. G., Kvarstein, E. H., & Wilberg, T. (2015) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2015.05.016 · Cited by 73 · see citing works
“[14] One reason for the lack of an association between Self-control and RF could be that RF measured by AAI primarily captures mentalizing abilities related to early attachment relationships, and is neither a score of patients’ general mentalization abilities nor a score that captures other specific deficits in mental…”
BackgroundLysaker, P. H., Vohs, J. L., Hamm, J. A., Kukla, M., Minor, K. S., de Jong, S., van Donkersgoed, R. J. M., Pijnenborg, G. H. M., Kent, J. S., Matthews, S. C., et al. (2014) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.04.011 · Cited by 70 · see citing works
“…al., 2010; Warner et al., 1989), both phenomena which may lead to decrements in metacognition in the absence of psychosis (Bateman and Fonagy, 2004; Choi-Kain and Gunderson, 2008; Gumley, 2010; Liotti and Prunetti, 2010; LeMoult et al., 2009; Pears and Fisher, 2005; Yagmurlu et al., 2005; Colvert…”
Luyten, P., Campbell, C., Moser, M., & Fonagy, P. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102380 · Cited by 77 · see citing works
Mentalizing during social InterAction: A four component model
Wu, H., Liu, X., Hagan, C. C., & Mobbs, D. (2020) · Cortex · doi:10.1016/j.cortex.2019.12.031 · Cited by 71 · see citing works
Ghiassi, V., Dimaggio, G., & Brüne, M. (2010) · Psychotherapy Research · doi:10.1080/10503307.2010.501040 · Cited by 70 · see citing works
“Taken together, the biopsychosocial model (Choi-Kain & Gunderson, 2008; Ad-Dab’bagh & Greenfield, 2001; Liotti, 2002; Millon, 2000; Moriguchi et al., 2006) of BPD has received increasing acceptance, where general risk factors seem to reside in adverse early developmental conditions (e.g.,…”
BackgroundTaubner, S., Zimmermann, L., Ramberg, A., & Schröder, P. (2016) · Psychopathology · doi:10.1159/000448053 · Cited by 70 · see citing works
In search of a framework for the treatment of alexithymia
Vanheule, S., Verhaeghe, P., & Desmet, M. (2010) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608310x520139 · Cited by 67 · see citing works
Dysfunction 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
Zeifman, R. J., & Wagner, A. C. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.11.001 · Cited by 67 · see citing works
Lysaker, P. H., Kukla, M., Belanger, E. A., White, D. A., Buck, K. D., Luther, L., Firmin, R. L., & Leonhardt, B. L. (2015) · Psychiatry · doi:10.1080/00332747.2015.1063916 · Cited by 66 · see citing works
“…the same sense that differing forms of psychotherapy have been developed to address the ability of persons with personality disorders to develop the capacity to think about their own thinking (Choi-Kain & Gunderson, 2008; Dimaggio, Semerari, Carcione, Nicolò, & Procacci, 2007; Fonagy et al., 2004).”
BackgroundBuilding blocks of social cognition: Mirror, mentalize, share?
Alcalá-López, D., Vogeley, K. T., Binkofski, F., & Bzdok, D. (2018) · Cortex · doi:10.1016/j.cortex.2018.05.006 · Cited by 72 · see citing works
Ensink, K., Maheux, J., Normandin, L., Sabourin, S., Diguer, L., Berthelot, N., & Parent, K. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.800950 · Cited by 66 · see citing works
Parental reflective functioning and the neural correlates of processing infant affective cues.
Rutherford, H. J. V., Maupin, A. N., Landi, N., Potenza, M. N., & Mayes, L. C. (2017) · Social Neuroscience · doi:10.1080/17470919.2016.1193559 · Cited by 65 · see citing works
“…06520, USA © 2016 Informa UK Limited, trading as Taylor & Francis Group their need for administration, transcription, and coding, as well as their potential to overlook the multidimensional nature of reflective functioning (Choi-Kain & Gunderson, 2008; Fonagy & Luyten, 2009; Luyten et al., 2012).”
BackgroundVelotti, P., Garofalo, C., D’Aguanno, M., Petrocchi, C., Popolo, R., Salvatore, G., & Dimaggio, G. (2015) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2015.08.004 · Cited by 64 · see citing works
“Our findings partially supported the idea that problems in mindfulness, which is considered part of the mentalizing or metacognitive network of skills [41,42], are related to ASPD traits.”
ResultMcMain, S., Links, P. S., Guimond, T. H., Wnuk, S., Eynan, R., Bergmans, Y., & Warwar, S. H. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.838653 · Cited by 65 · see citing works
“The effectiveness of psychotherapy for individuals with BPDmay be strengthened by carefully assessing patients’ abilities to self-reflect on emotions and cognitions and tailoring interventions to their level of reflective abilities (Choi-Kain & Gunderson, 2008; Dimaggio et al., 2012).”
BackgroundFischer‐Kern, M., & Tmej, A. (2019) · Zeitschrift für psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2019.65.2.162 · Cited by 64 · see citing works
van Donkersgoed, R. J. M., de Jong, S., van der Gaag, M., Aleman, A., Lysaker, P. H., Wunderink, L., & Pijnenborg, G. H. M. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-27 · Cited by 64 · see citing works
“Several forms of psychotherapy have successfully promoted metacognitive capacity in persons with various mental disorders other than psychosis [23], including work from a psychoanalytic [24] and a cognitive frame of reference [25].”
BackgroundAttachment and Reflective Functioning in Women With Borderline Personality Disorder
Badoud, D., Prada, P., Nicastro, R., Germond, C., Luyten, P., Perroud, N. A., & Debbané, M. (2017) · Journal of Personality Disorders · doi:10.1521/pedi_2017_31_283 · Cited by 64 · see citing works
Lysaker, P. H., Gumley, A. I., Brüne, M., Vanheule, S., Buck, K. D., & Dimaggio, G. (2011) · Consciousness and Cognition · doi:10.1016/j.concog.2010.12.018 · Cited by 62 · see citing works
“A range of literature which has examined metacognitive functioning in persons with personality disorders (Bateman & Fonagy, 2004; Choi-Kain & Gunderson, 2008; Dimaggio, Semerari, Carcione, Nicolò, & Procacci, 2007) suggests that heightened levels of emotional arousal disrupt metacognitive…”
BackgroundAffects, Trauma, and Mechanisms of Symptom Formation: A Tribute to John C. Nemiah, MD (1918–2009)
Taylor, G. J. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000320119 · Cited by 63 · see citing works
“pp. 199–200]. Alexithymia, Nemiah suggested, could occur as a result of a failure in one or more of these elements, such that the activity of the somatic component of affect or some other physiological system could be increased and lead to somatic symptoms. To date, empirical investigations of the relation between ale…”
MethodEmotion Regulation and Mentalization in People at Risk for Food Addiction
Innamorati, M., Imperatori, C., Harnic, D., Erbuto, D., Patitucci, E., Janiri, L., Lamis, D. A., Pompili, M., Tamburello, S., & Fabbricatore, M. (2015) · Behavioral Medicine · doi:10.1080/08964289.2015.1036831 · Cited by 62 · see citing works
To know or not to know? Mentalization as protection from somatic complaints
Ballespí, S., Vives, J., Alonso, N., Sharp, C., Jiménez, M. S. R., Fonagy, P., & Neus Barrantes-vidal, A. (2019) · PLoS ONE · doi:10.1371/journal.pone.0215308 · Cited by 63 · see citing works
Alexithymia in adolescents with borderline personality disorder
Loas, G., Speranza, M., Pham‐Scottez, A., Pérez-Díaz, F., & Corcos, M. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.11.006 · Cited by 60 · see citing works
“Among the different conceptual overlaps of the construct of mentalization, Choi-Kain and Gunderson [4] have underlined the notion of affect consciousness (and its absence), which resembles the concept of alexithymia.”
BackgroundArntz, A. R., & ten Haaf, J. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.07.002 · Cited by 59 · see citing works
“An important recent qualification is that factors as relationship context, distress level, and affect intensity influence mentalization capacities (Choi-Kain & Gunderson, 2008; Fonagy & Bateman, 2007).”
Lind, M., Jørgensen, C. R., Heinskou, T., Simonsen, S., Bøye, R., & Thomsen, D. K. (2019) · Psychotherapy · doi:10.1037/pst0000184 · Cited by 58 · see citing works
Social Judgement in Borderline Personality Disorder
Nicol, K., Pope, M., Sprengelmeyer, R., Young, A. W., & Hall, J. (2013) · PLoS ONE · doi:10.1371/journal.pone.0073440 · Cited by 58 · see citing works
Fossati, A., Borroni, S., Dziobek, I., Fonagy, P., & Somma, A. (2017) · Psychoanalytic Psychology · doi:10.1037/pap0000130 · Cited by 58 · see citing works
“For instance, it has been suggested that mentalizing is not a clearly defined construct (Choi-Kain & Gunderson, 2008); concepts of mindfulness, psychological mindedness, empathy, and affect consciousness have been proposed to partially overlap with mentalization within three dimensions: namely,…”
BackgroundInfluentialMeulemeester, C. D., Lowyck, B., Vermote, R., Verhaest, Y., & Luyten, P. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.09.061 · Cited by 58 · see citing works
Trauelsen, A. M., Gumley, A. I., Jansen, J. E., Pedersen, M. B., Nielsen, H. L., Trier, C. H., Haahr, U., & Simonsen, E. H. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.02.003 · Cited by 57 · see citing works
Addressing Metacognitive Capacity in the Psychotherapy for Schizophrenia: A Case Study
Buck, K., & Lysaker, P. (2009) · Clinical Case Studies · doi:10.1177/1534650109352005 · Cited by 59 · see citing works
“As noted by Choi-Kain and Gunderson (2008), a number of forms of psychotherapy exist which focus on promoting metacognitive capacity (sometimes referred to as mentalizing) in persons with mental disorders generally less severe than schizophrenia.”
BackgroundGoodman, G., Midgley, N., & Schneider, C. (2015) · Psychotherapy Research · doi:10.1080/10503307.2015.1049672 · Cited by 58 · see citing works
“Choi-Kain and Gunderson (2008) suggested three different dimensions of mentalization: (1) implicit/explicit, (2) self/other, and (3) cognitive/affective.”
BackgroundLivesley, W. J. (2012) · Psychodynamic Psychiatry · doi:10.1521/pdps.2012.40.1.47 · Cited by 54 · see citing works
Fossati, A., Feeney, J. A., Maffei, C., & Borroni, S. (2014) · Psychoanalytic Psychology · doi:10.1037/a0033960 · Cited by 58 · see citing works
Dell’Osso, L., Cremone, I. M., Nardi, B., Tognini, V., Castellani, L., Perrone, P., Amatori, G., & Carpita, B. (2023) · Brain Sciences · doi:10.3390/brainsci13060862 · Cited by 56 · see citing works
Psychopharmacologic treatment of borderline personality disorder
Ripoll, L. H. (2013) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2013.15.2/lripoll · Cited by 54 · see citing works
“arious theoretical orientations have converged upon the conceptualization of borderline personality disorder (BPD) as a disturbance in mental representations of self and other, contributing to core difficulties in identity, intimacy, empathy, and self-directed motivation.(1-3) In BPD, this core psychopathology contrib…”
BackgroundRecent Advances in the Developmental Aspects of Borderline Personality Disorder
Sharp, C., & Kim, S. (2015) · Current Psychiatry Reports · doi:10.1007/s11920-015-0556-2 · Cited by 52 · see citing works
Ballespí, S., Vives, J., Sharp, C., Chanes, L., & Neus Barrantes-vidal, A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.566254 · Cited by 54 · see citing works
Affect integration and reflective function: Clarification of central conceptual issues
Solbakken, O. A., Hansen, R. S., & Monsen, J. (2011) · Psychotherapy Research · doi:10.1080/10503307.2011.583696 · Cited by 57 · see citing works
“As can be readily seen by the preceding considerations, there is substantial overlap between the AC and mentalization frameworks (see also Choi-Kain & Gunderson, 2008), regarding both the conceptual content-domain and the underlying assumptions of the models: In essence, they are both attempts at…”
BackgroundMethodInfluentialCognitive but Not Affective Theory of Mind Deficits in Mild Relapsing-Remitting Multiple Sclerosis
Roca, M., Manes, F., Gleichgerrcht, E. L., Ibáñez, A. M., de Toledo, M. E. G., Marenco, V., Bruno, D., Torralva, T., & Sinay, V. J. (2014) · Cognitive and Behavioral Neurology · doi:10.1097/wnn.0000000000000017 · Cited by 52 · see citing works
- Authors
- Choi-Kain, L. W., & Gunderson, J. G.
- Affiliations
- Harvard University (US)
- ORCID
- Choi-Kain, Lois W.
- Venue
- American Journal of Psychiatry
- Published
- 2008-09
- Volume
- 165
- Issue
- 9
- Pages
- 1127-1135
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2018329493
- Cited by
- 565
- References
- 59
- Citations by year
- 2026: 31 · 2025: 22 · 2024: 38 · 2023: 33 · 2022: 23 · 2021: 42 · 2020: 28 · 2019: 33 · 2018: 50 · 2017: 34 · 2016: 39 · 2015: 38 · 2014: 31 · 2013: 26 · 2012: 33
- FWCI
- 3.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- mentalization, borderline personality disorder, theory of mind, reflective functioning, Adult Attachment Interview, mindfulness, psychological mindedness, empathy, self-other orientation, attachment, treatment of borderline personality disorder
- MeSH terms
- Affect, Borderline Personality Disorder, Cognition Disorders, Consciousness, Culture, Humans, Interpersonal Relations, Interview, Psychological, Mental Processes, Object Attachment, Psychological Theory, Severity of Illness Index, Narration
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