A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder

By Peter Fonagy, P. Luyten. Development and Psychopathology, 2009

965 citations recorded by the source corpus.

Abstract The precise nature and etiopathogenesis of borderline personality disorder (BPD) continues to elude researchers and clinicians. Yet, increasing evidence from various strands of research converges to suggest that affect dysregulation, impulsivity, and unstable relationships constitute the core features of BPD. Over the last two decades, the mentalization-based approach to BPD has attempted to provide a theoretically consistent way of conceptualizing the interrelationship between these core features of BPD, with the aim of providing clinicians with a conceptually sound and empirically supported approach to BPD and its treatment. This paper presents an extended version of this approach to BPD based on recently accumulated data. In particular, we suggest that the core features of BPD reflect impairments in different facets of mentalization, each related to impairments in relatively distinct neural circuits underlying these facets. Hence, we provide a comprehensive account of BPD by showing how its core features are related to each other in theoretically meaningful ways. More specifically, we argue that BPD is primarily associated with a low threshold for the activation of the attachment system and deactivation of controlled mentalization, linked to impairments in the ability to differentiate mental states of self and other, which lead to hypersensitivity and increased susceptibility to contagion by other people's mental states, and poor integration of cognitive and affective aspects of mentalization. The combination of these impairments may explain BPD patients' propensity for vicious interpersonal cycles, and their high levels of affect dysregulation and impulsivity. Finally, the implications of this expanded mentalization-based approach to BPD for mentalization-based treatment and treatment of BPD more generally are discussed.

Subfields: Clinical Psychology, Philosophy

View Paper: https://www.semanticscholar.org/paper/3e25f645e7806f3184f3572fea764396d1289c49

How researchers see this paper

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In Clinical Psychology

1. Peter Fonagy
2. P. Luyten
3. Jon G. Allen
4. Carla Sharp
5. Anthony Bateman
6. Linda C. Mayes
7. J. Belsky
8. D. Shai

In Philosophy

1. Peter Fonagy
2. Carla Sharp
3. J. Belsky
4. D. Shai
5. S. Vanwoerden
6. Anthony Bateman
7. Jon G. Allen
8. P. Luyten

Citations in the corpus

• When Words Just Won’t Do: Introducing Parental Embodied Mentalizing (2011, positive): “…data showing that different brain areas are recruited for automatic (implicit) and controlled (explicit) mentalizing (e.g., Lieberman, 2007) led Fonagy and Luyten (2009) to draw distinctions between implicit (nonconscious , nonverbal, automatic) and explicit (verbal, reflective, controlled)…”
• The widening scope of mentalizing: a discussion (2011, background): “Patients may show impairments in some of these polarities, but not necessarily in others (Fonagy & Luyten, 2009; Luyten et al., 2010) as a function of situational considerations, especially the social context they find themselves in.”
• A mentalization-based approach to the understanding and treatment of functional somatic disorders (2012, background): “the meta-cognitive capacity to interpret oneself and others in terms of mental states (Fonagy & Luyten, 2009 ).”
• Parental Reflective Functioning: Theory, Research, and Clinical Applications (2017, background): “to be associated with an awareness of the influence of trauma on one’s own development and that of one’s child (Fonagy and Luyten, 2009; Fonagy, Luyten, and Strathearn 2011; Berthelot et al. 2015).”
• Mentalization-based Therapeutic Interventions for Families (2012, background): “…attentional problems, the inability to represent the mental state of the self and difficulties in reflecting on the mental states of others can disrupt attachment relationships; and a poor attachment relationship undermines the natural emergence of mentalizing capacities (Fonagy and Luyten, 2009).”
• What is mentalization? The concept and its foundations in developmental research (2012, background): “…attachment we considered above may interface with one or more of a series of a range of neuropsychologically defined components of mentalizing (see Fonagy & Luyten, 2009 for a review) The development of an agentive self: The social acquisition of social cognition If children’s caregiving…”
• Hypermentalizing in Borderline Personality Disorder: A Model and Data (2015, methodology): “Fonagy and colleagues (Fonagy, 1989, 1991; Fonagy, Gergely, Jurist, & Target, 2002; Fonagy & Luyten, 2009; Sharp & Fonagy, 2008) have proposed a mentalization-based theory of BPD that posits that a vulnerability to failures or misinterpretations of actions in terms of underpinning mental states may…”
• On the interaction of social affect and cognition: empathy, compassion and theory of mind (2018, neutral): “It has, however, also been discussed as important in psychopathology, for instance in borderline personality disorder for which a stress related mentalizing deficit has been hypothesized [40].”
• Posttraumatic Stress Disorder: A Social‐Cognitive Perspective (2012, background): “Recently, emerging theory and data have lent support to the proposal that the quality of early attachment relations is an important source of individual differences in mentalizing capacity (Fonagy & Luyten, 2009).”