The relationship between mentalization and borderline personality features in adolescents: mediating role of emotion regulation

Abstract

Dysfunctions in both emotion regulation and mentalization capacity might be reasons behind borderline personality features. This study investigated the mediating role of emotion regulation between mentalization and borderline personality features in adolescents. We recruited 218 adolescents (mean of age = 16.45 ± 1.01 years old, 62.0% girls) based on convenience sampling from high school students. We evaluated mentalization using reflective functioning questionnaire (RFQ), emotion regulation with difficulties in emotion regulation scale (DERS), and borderline personality features with borderline personality features scale for children (BPFSC). There were significant associations between mentalization, emotion regulation, and borderline personality features. Difficulties in emotion regulation mediated between mentalization and borderline personality features. Mentalization deficits and emotion dysregulation contribute significantly to borderline personality features in adolescents. Mentalization deficits might affect borderline personality features' development via its effect on emotion regulation. Prevention and treatment plans for borderline personality disorder should focus on emotion regulation and mentalization.

The Reflective Functioning Questionnaire–Revised– 7 (RFQ-R-7): A new measurement model assessing hypomentalization

“…Both rumination and worry can be conceptualized as maladaptive emotion regulation forms as they can show positive relationships with adverse outcomes of mental health [24,25]. Therefore, the co-occurrence of high levels of rumination, worry and mentalization difficulties is in accordance with those previous findings which showed positive correlations between difficulties in emotion regulation, maladaptive emotion regulation strategies and impairments in reflective functioning [2,[10][11][12][13][14]. The positive correlations between these variables might be accounted for the overlap between the items of the RFQ-R-7 and general emotion regulation difficulties (e.g., the item of "People's thoughts are a mystery to me"), whereas other items of the RFQ-R-7 show similar characteristics to rumination and worry (e.g., the item of "Strong feelings often cloud my thinking").…”

“…For example, difficulties in emotion regulation and mentalizing are overlapping constructs to some degree (e.g., the ability to understand emotions is considered in both emotion regulation and mentalization processes) and show neurobiological-level functional relationships. Therefore, previous studies consistently showed positive associations between difficulties in emotion regulation, maladaptive emotion regulation strategies and impairments in reflective functioning in clinical and non-clinical samples [2,[10][11][12][13][14]. In addition to this, some studies also reported positive correlations between impulsivity and mentalization difficulties which also can be explained by the similarities between these constructs (e.g., negative urgency-related characteristics, lack of premeditation can be considered as a form of reflective functioning difficulties) [10,11,15].…”

Difficulties in Emotion Regulation Mediated the Relationship Between Reflective Functioning and Borderline Personality Symptoms Among Non-Clinical Adolescents

“…Furthermore, the Cronbach’s alpha reliability of RFQu subscale was slightly lower than 0.70. Even though this finding is quite consistent with similar research (Badoud et al, 2015; Vahidi et al, 2021), critical evaluations of RFQ raises some questions about the robustness of this questionnaire to measure two dimensions of hyper and hypomentalizing (Euler et al, 2021). We preferred to use RFQ for its research utility in relatively large samples.…”

“…The mentalizing view of the self and others subsequently allows someone to regulate affect (Fonagy et al, 1998(Fonagy et al, , 2016Schwarzer et al, 2021) as both mentalizing and affect regulation capacities are developmental achievements, rooted in early attachment relationships. Supportive research indicated links between mentalizing, emotion regulation, and BPD (Herpertz et al, 2018;Sharp et al, 2011Sharp et al, , 2013Vahidi et al, 2021). Our findings are in line with these theoretical postulations and empirical findings in that adolescents who lacked a functional degree of reflective stance towards the mental states of the self and others were more likely to experience difficulty in regulating their emotions, and subsequently to suffer from BPD symptoms.…”

“…Research conducted with adult patients diagnosed with BPD suggests that hypomentalizing, emotion dysregulation, and attentional impulsiveness were associated with interpersonal problems in the context of BPD (Euler et al, 2021). Rare studies in adolescent samples (Fossati et al, 2013; Sharp et al, 2011; Vahidi et al, 2021) provided evidence supporting mentalization’s influence on borderline traits through mediating role of emotion dysregulation.…”