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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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“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).”
BackgroundFonagy, 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
“Although several self-report measures have been developed to assess constructs related to mentalizing [19, 20], such as mindfulness, perspective-taking, empathy, theory of mind, alexithymia, and psychological mindedness, no self-report questionnaire of RF currently exist [20].”
BackgroundMethodThe mentalizing approach to psychopathology: State of the art and future directions
Luyten, P., Campbell, C., Allison, E., & Fonagy, P. (2020) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-071919-015355 · Cited by 748
“Mentalizing encompasses and subsumes a wide range of related concepts focusing on various aspects of social cognition, including empathy, mindfulness, ToM, psychological mindedness, alexithymia, and insightfulness (Choi-Kain & Gunderson 2008).”
BackgroundHow we know our own minds: The relationship between mindreading and metacognition
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“There is less evidence for a primary deficit of mindreading (Choi-Kain & Gunderson 2008).”
BackgroundGuendelman, S., Medeiros, S., & Rampes, H. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00220 · Cited by 577
“The notion of mentalization has a heterogeneous origin, starting from the construct of theory of mind developed in the field of etiology/cognitive science (Premack and Wooddruff, 1978), the concept of symbolization from psychoanalysis (Choi-Kain and Gunderson, 2008) and the notion of meta-cognition from novel developm…”
BackgroundValle, A., Massaro, D., Castelli, I., Intra, F. S., Lombardi, E., Bracaglia, E. A., & Marchetti, A. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01213 · Cited by 448
“The concept of mentalization that Fonagy (1991) proposed derives both from the psychoanalytic term “reflective functioning,” and from the psychological construct of “theory of mind” (Choi-Kain and Gunderson, 2008).”
BackgroundReflective functioning: a review.
Katznelson, H. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.12.003 · Cited by 369
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“Reflective functioning (RF) and mentalization are generally understood to refer to the capacity to think about oneself and others as psychological beings and to consider underlying mental states and motivations when interpreting behaviours in attachment contexts (Choi-Kain & Gunderson, 2008).”
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Theory of Mind and Empathy as Multidimensional Constructs
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“…psychiatric disorders such as Parkinson’s disease (Polleti et al., 2012), multiple sclerosis (Roca et al., 2014), schizophrenia (Shur, Shamay-Tsoory, & Levkovitz, 2008), psychopathy (ShamayTsoory et al., 2010), and borderline personality disorder (Choi-Kain & Gunderson, 2008; Harari et al., 2010).”
BackgroundPsychosocial interventions for self-harm in adults
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The neurobiology of mentalizing.
Luyten, P., & Fonagy, P. (2015) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000117 · Cited by 382
Leichsenring, F., Fonagy, P., Heim, N., Kernberg, O. F., Leweke, F., Luyten, P., Salzer, S., Spitzer, C., & Steinert, C. (2024) · World Psychiatry · doi:10.1002/wps.21156 · Cited by 399
“…meta-analysis of experimental studies 159 also found, in BPD patients compared to healthy controls, a significantly poorer understanding of mental states in others, as assessed with Theory of Mind (ToM) tasks 166 , with a medium effect size (g=– 0.45, 95% CI: – 0.75 to – 0.16, n=24).”
MethodInfluentialLiotti, G., & Gilbert, P. (2010) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608310x520094 · Cited by 273
Interventions for self-harm in children and adolescents
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“Thus, the construct of alexithymia is relevant to mental state understanding (Jurist, 2005; Choi-Kan and Gunderson, 2008; Dimaggio et al., 2009).”
BackgroundParental Reflective Functioning: Theory, Research, and Clinical Applications
Luyten, P., Nijssens, L., Fonagy, P., & Mayes, L. C. (2017) · The Psychoanalytic Study of the Child · doi:10.1080/00797308.2016.1277901 · Cited by 283
Metacognitive Capacities for Reflection in Schizophrenia: Implications for Developing Treatments
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“The inability to provide evidence for mentalization as the mechanism of change in studies investigating the effectiveness of MBT has already been the focus of some criticism (Choi-Kain & Gunderson, 2008 ).”
Bales, D., van Beek, N., Smits, M., Willemsen, S., Busschbach, J. J. V., Verheul, R., & Andrea, H. (2012) · Journal of Personality Disorders · doi:10.1521/pedi.2012.26.4.568 · Cited by 199
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Self-citationEmpathy and Alexithymia in Borderline Personality Disorder: Clinical and Laboratory Measures
New, A. S., Rot, M. A. H., Ripoll, L. H., Pérez-Rodríguez, M. M., Lazarus, S. A., Zipursky, E., Weinstein, S. R., Koenigsberg, H. W., Hazlett, E. A., Goodman, M. S., et al. (2012) · Journal of Personality Disorders · doi:10.1521/pedi.2012.26.5.660 · Cited by 171
Schmahl, C., Herpertz, S. C., Bertsch, K., Ende, G., Flor, H., Kirsch, P., Lis, S., Meyer-Lindenberg, A., Rietschel, M., Schneider, M., et al. (2014) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/2051-6673-1-12 · Cited by 168
Alexithymia in personality disorders: Correlations with symptoms and interpersonal functioning
Nicolò, G., Semerari, A., Lysaker, P. H., Dimaggio, G., Conti, L., D'Angerio, S., Procacci, M., Popolo, R., & Carcione, A. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2010.07.046 · Cited by 168
“Difficulties in translating bodily states into words have been hypothesized to be a core feature of borderline PD (Fonagy, 1991; Bouchard et al., 2008; Choi-Kain and Gunderson, 2008).”
BackgroundMentalizing in female inpatients with major depressive disorder
Fischer-Kern, M., Fonagy, P., Kapusta, N. D., Luyten, P., Boss, S., Naderer, A., Blüml, V., & Leithner, K. (2013) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e3182845c0a · Cited by 157
“Conceptualized for the understanding of personality development and the treatment of borderline personality disorder (BPD), the concept has been proposed to be expanded to other diagnostic groups (Choi-Kain and Gunderson, 2008).”
BackgroundMetacognitive reflection and insight therapy (MERIT) for patients with schizophrenia
de Jong, S., van Donkersgoed, R. J. M., Timmerman, M. E., Rot, M. A. H., Wunderink, L., Arends, J., van der Gaag, M., Aleman, A., Lysaker, P. H., & Pijnenborg, G. H. M. (2018) · Psychological Medicine · doi:10.1017/s0033291718000855 · Cited by 160
“Several forms of individual therapy have successfully improved metacognition in patients with various mental disorders other than psychosis (Fonagy et al. 2002; Dimaggio et al. 2007; Choi-Kain & Gunderson, 2008).”
BackgroundEnsink, K., Berthelot, N., Bernazzani, O., Normandin, L., & Fonagy, P. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.01471 · Cited by 144
“…functioning” and “mentalization” are used interchangeably and refer to the sociocognitive capacity to think about oneself and others as psychological beings and to consider underlying mental states and motivations when interpreting behaviors in attachment contexts (Choi-Kain and Gunderson, 2008).”
BackgroundDimaggio, G., Vanheule, S., Lysaker, P. H., Carcione, A., & Nicolò, G. (2009) · Consciousness and Cognition · doi:10.1016/j.concog.2009.06.003 · Cited by 148
Badoud, D., Luyten, P., Fonseca‐Pedrero, E., Eliez, S., Fonagy, P., & Debbané, M. (2015) · PLoS ONE · doi:10.1371/journal.pone.0145892 · Cited by 177
Metacognition, Self-Reflection and Recovery In Schizophrenia
Lysaker, P. H., Vohs, J. L., Ballard, R., Fogley, R., Salvatore, G., Popolo, R., & Dimaggio, G. (2013) · Future Neurology · doi:10.2217/fnl.12.78 · Cited by 134
The measurement of reflective function in adolescents with and without borderline traits
Ha, C., Sharp, C., Ensink, K., Fonagy, P., & Cirino, P. T. (2013) · Journal of Adolescence · doi:10.1016/j.adolescence.2013.09.008 · Cited by 156
Fischer‐Kern, M., Buchheim, A., Hörz‐Sagstetter, S., Schuster, P., Doering, S., Kapusta, N. D., Taubner, S., Tmej, A., Rentrop, M., Buchheim, P., et al. (2010) · Psychoanalytic Psychology · doi:10.1037/a0020862 · Cited by 130
“Although the capacity assessed by the RF Scale is multidimensional, the rating is done using a single score that cannot be subjected to factor analysis (Choi-Kain & Gunderson, 2008).”
MethodEuler, S., Nolte, T., Constantinou, M., Griem, J., Montague, P. R., & Fonagy, P. (2019) · Journal of Personality Disorders · doi:10.1521/pedi_2019_33_427 · Cited by 157
Lysaker, P. H., Glynn, S. M., Wilkniss, S. M., & Silverstein, S. M. (2010) · Psychological Services · doi:10.1037/a0019115 · Cited by 139
“As was noted by Choi-Kain and Gunderson (2008), a number of forms of psychotherapy exist that focus on promoting metacognitive capacity in persons with mental disorders generally less severe than schizophrenia.”
BackgroundHart, N., McGowan, J. F., Minati, L., & Critchley, H. (2012) · Journal of Personality Disorders · doi:10.1521/pedi_2012_26_049 · Cited by 119
Sharp, C., Williams, L. L., Ha, C., Baumgardner, J., Michonski, J. D., Seals, R. W., Patel, A. B., Bleiberg, E., & Fonagy, P. (2009) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2009.73.4.311 · Cited by 117
Morandotti, N., Brondino, N., Merelli, A. A., Boldrini, A., Vidovich, G. Z. D., Ricciardo, S., Abbiati, V., Ambrosi, P., Caverzasi, E., Fonagy, P., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0206433 · Cited by 122
Impairments in Social Cognition in Early Medicated and Unmedicated Parkinson Disease
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Assessing patterns of adult attachment in medical patients
Maunder, R., & Hunter, J. (2008) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2008.10.007 · Cited by 101
“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 103
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
Sulzer, S. H. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.08.008 · Cited by 100
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 119
“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 112
“…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 116
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 110
“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
“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
“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
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
“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 96
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 95
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 93
Meulemeester, C. D., Vansteelandt, K., Luyten, P., & Lowyck, B. (2017) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000256 · Cited by 96
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 93
Self-citationParis, J. (2010) · Current Psychiatry Reports · doi:10.1007/s11920-009-0083-0 · Cited by 82
“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
Livesley, W. J. (2012) · Journal of Personality Disorders · doi:10.1521/pedi.2012.26.1.17 · Cited by 81
“…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 94
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
“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
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 85
“[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 76
“…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 90
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
Ghiassi, V., Dimaggio, G., & Brüne, M. (2010) · Psychotherapy Research · doi:10.1080/10503307.2010.501040 · Cited by 77
“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
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
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
Zeifman, R. J., & Wagner, A. C. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.11.001 · Cited by 67
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
“…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 75
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
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
“…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 70
“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
“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
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 67
“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
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 66
“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 69
“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
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 67
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
“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
“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
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
Fossati, A., Borroni, S., Dziobek, I., Fonagy, P., & Somma, A. (2017) · Psychoanalytic Psychology · doi:10.1037/pap0000130 · Cited by 68
“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 69
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
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
“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
“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 55
Fossati, A., Feeney, J. A., Maffei, C., & Borroni, S. (2014) · Psychoanalytic Psychology · doi:10.1037/a0033960 · Cited by 69
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 61
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
“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 54
Ballespí, S., Vives, J., Sharp, C., Chanes, L., & Neus Barrantes-vidal, A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.566254 · Cited by 70
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
“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 54
Metadata
- 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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