Dr. Sharp and her colleagues worked with 111 teenagers ages 11 to 17 years old, who were being treated in a residential psychiatric facility and tested them for the way they “mentalize.” Mentalize is a technical term that means to act like an armchair psychiatrist in order to understand why others behave the way they do and to predict their future behaviors.
One Way to Identify Borderline Personality Disorder Is by Testing “Mentalization” Skills (link)
Borderline personality disorder probably shows up before adulthood, and now a new study has found a way to detect it in teenagers.
The conventional thinking is to diagnose personality disorders only in adults over age 18 years old, because the human personality is still forming in adolescence. However, Dr. Carla Sharp, an associate professor and director of the Developmental Psychopathology Lab at the University of Houston, believes there could be benefits to diagnosing the disorder she studies earlier.
Dr. Sharp’s specialty is borderline personality disorder, a serious condition characterized by turbulent emotional reactions, impulsive behaviors, anxiety, depression, suicidal ideation, and intense fears of abandonment. The disorder is more frequently found in women.
“We know that the brain is only fully developed by age 25, so how can we diagnose a personality disorder in someone if they don’t have a fully developed brain?” she said. “On the one hand, we are finding in our research that kids do have a stable pattern of interaction with others. Parents will describe their kids to you in terms that remain stable over time. Therefore, personality researchers have highlighted the point that teens do not wake up at age 19 and have a personality disorder on the first day of their 19th year, so there must be some precursors to the disorders. This group of people, including myself, are advocating that we do not necessarily diagnose borderline personality disorder in adolescents, but that we access for it to make sure that we don’t miss these children.”
Dr. Sharp and her colleagues worked with 111 teenagers ages 11 to 17 years old, who were being treated in a residential psychiatric facility and tested them for the way they “mentalize.” Mentalize is a technical term that means to act like an armchair psychiatrist in order to understand why others behave the way they do and to predict their future behaviors. Everyone mentalizes about other people based on their own experiences as human beings, but there is such a thing as normal mentalization as performed by healthy personalities. People with autism usually under-mentalize, which means they do not or cannot put a normal effort into understanding others’ feelings, motivations, and behaviors. People with borderline personality disorder, on the other hand, tend to over-mentalize or even hyper-mentalize, which means they think too much about others and are therefore more likely to misread other people. Since borderline personality disorder is characterized by an inability to regulate one’s own emotions, misreading other people can lead to a borderline’s “flying off the handle” and overreacting.
Dr. Sharp had the participants watch a movie about four different characters and then relate how they understood the characters’ thinking and feeling. About 23% of the participants met the criteria for borderline personality, and this group had a higher frequency of over-mentalizing their responses to questions about the movie. Hyper-mentalization was also linked to emotional regulation. When this group hyper-mentalized and then misread people, they became upset, had more problems with emotional regulation, and experienced an increase in their symptoms.
“This research is groundbreaking in that it is the first to provide empirical evidence of a link between borderline personality disorder and mentalizing in adolescents,” said Dr. Sharp. “By identifying and treating BPD early in adolescence, we can use validated treatments to help these children. The danger of not recognizing precursors in adolescents is that it can lead to years of confusion and pain for family members and the individual with misdiagnosis and lack of appropriate treatment.”
Borderline personality disorder, especially in young people, is often misdiagnosed as bipolar disorder, conduct disorder, or even as Asperger’s syndrome.
The study was published in the Journal of the American Academy of Child and Adolescent Psychiatry.