One Way to Identify Borderline Personality Disorder Is by Testing “Mentalization” Skills
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.
2 Comments
Alicia
There are autistic people that have BPD. Autistic people don’t have a problem with mentalization, that is a wrong assumption from some scientists because that lacked the ability to mentalized the way autistic people act and think. Autistic people may not be able to understand body language, the same way a blind person would have problems with interpretating someone feelings if they were being showed only in someone’s face, autistic people are able to mentalize and especially between a relationship between two autistic people the differences in communication disappear and mentalization is more easy.
This false information is based on the myth of autistic lack of empathy, there is no scientific proof for that hypothesis, there are several proofs that the study that determined this didn’t take in consideration autistic disabilities like literal language, I suggest you see the site Autism and Empathy. I have seen several times on your site this misinformation about autism but in this particular post is a problem considering you make it sound that there are no autistic people with BPD, that is not true, autistic children are constantly invalidated and are highly emotional, this can turn into BPD, many suffer abuse and bullying, many spend much time trying to understand others non-autistic people that are so different from them, worrying about the motives of others and being extremely aware of criticism and disapproval. Many autistic people have BPD and the way autistic children are created in an invalidating enviroment may make this problem worse, even some of the “treatments” for autism can be considered invalidating since it doesn’t respect sensory differences that can cause pain and emotions, the way autistic people feel is considered wrong and discouraged Autistic people also have high rates of PTSD, social anxiety disorder and depression.
Some autistic people can become too good in mentalization because of the experience of learning how others non-autistic think, feel and behave, they act more like detectives without assuming wrongly the motivation of others, the opposite is not true and non-autistic people fail to mentalize and feel empathy for the unusual autistic world views.
c
I was told this week by Dr.Marsha Linehan’s PA,(Elaine Franks in Washington) that the DBT programmes in the UK to treat BPD patients were all targeted at under 18’s.She referred me to Dr.Micheala Swales who is based in Bangor,North Wales and who is Marsha Linehan’s main link to what is going on with DBT treatment in th UK.It seems the UK government have decided to put their shamefully limited funds into early prediction and treatment of BPD in children and teenagers.A good thing for their futures,but a shame for the approximately 500,000 adults (mostly women) in the UK in their 20’s,30’s and 40’s and 50’s who suffer terribly from this long-lasting mental illness.Also in our news this week the government admitted their “Complete failure” in addressing the issues and needs of people with paranoid schizophrenia ( a symptom of chronic BPD hence the name ‘borderline’- being on the borders of both paranoia and neuroses),vowing to put more funding into this area of mental health.It would be brilliant if they put more into the emotional well-being of autistic children and adults too, since invalidation of any one (whether autistic or physically or mentally handicapped or otherwise) does contribute to BPD, as does abuse, neglect, inappropriate punishment, misunderstanding and bullying.More validation and understanding is needed all round.Understanding and validation do not cost anything.