Distinct and shared mentalizing patterns in borderline personality disorder and somatic symptom and related disorders
Year: 2026
Type: article
Study design: Observational Study
Abstract: Mentalizing impairments have been documented in borderline personality disorder (BPD) and somatic symptom and related disorders (SSRD), yet direct comparisons remain rare. This cross-sectional case-control study compared mentalizing patterns among individuals with BPD (n = 37), SSRD (n = 40), and community controls (n = 37). Task-based and self-report measures assessed uncertainty about mental states, mentalizing across relational contexts, self- and other-mentalizing, mentalized affectivity, and related constructs (empathy, theory of mind, attachment, interpersonal functioning). Both clinical groups demonstrated greater impairment than controls in uncertainty about mental states, processing emotions, and mentalizing across relational contexts; empathy and theory of mind did not differ from controls. BPD showed greater impairment than SSRD in uncertainty about mental states and emotion processing, but not in mentalizing across relational contexts (Mentalizing Vignettes Task-24). Self-mentalizing was lower than controls in BPD only. SSRD showed impairments in processing, but not in identification of emotions, contrary to prior accounts of broad emotional-awareness deficits. Mentalizing difficulties in both clinical groups were most apparent in uncertainty about mental states, emotional processing, and mentalizing within relational contexts. Disorder-specific patterns (self-mentalizing in BPD and emotional processing in SSRD) may inform assessment and intervention research. What is already known about this topic:Mentalizing difficulties have been reported in both Borderline Personality Disorder (BPD) and Somatic Symptom and Related Disorders (SSRD), but direct comparison between the two remains rare.Both disorders are also associated with affective dysregulation, attachment difficulties, and interpersonal problems, with maybe related to difficulties in mentalizing.Mentalizing is increasingly viewed as a multidimensional and context-dependent process rather than a single global capacity. Mentalizing difficulties have been reported in both Borderline Personality Disorder (BPD) and Somatic Symptom and Related Disorders (SSRD), but direct comparison between the two remains rare. Both disorders are also associated with affective dysregulation, attachment difficulties, and interpersonal problems, with maybe related to difficulties in mentalizing. Mentalizing is increasingly viewed as a multidimensional and context-dependent process rather than a single global capacity. What this topic adds:Direct comparison between BPD and SSRD identified both shared and disorder-specific mentalizing vulnerabilities, with BPD showing more widespread difficulties across domains of mentalizing and related constructs of attachment and interpersonal functioning, including impaired self-mentalizing not seen in SSRD.Difficulties in both groups were most pronounced in processing emotions (mentalized affectivity), uncertainty about mental states, and mentalizing across relational contexts, whereas empathy and theory of mind did not differ significantly from community controls.Difficulties were most apparent on measures capturing mentalizing in emotional or relational contexts, highlighting the value of multidimensional and contextual assessment. Direct comparison between BPD and SSRD identified both shared and disorder-specific mentalizing vulnerabilities, with BPD showing more widespread difficulties across domains of mentalizing and related constructs of attachment and interpersonal functioning, including impaired self-mentalizing not seen in SSRD. Difficulties in both groups were most pronounced in processing emotions (mentalized affectivity), uncertainty about mental states, and mentalizing across relational contexts, whereas empathy and theory of mind did not differ significantly from community controls. Difficulties were most apparent on measures capturing mentalizing in emotional or relational contexts, highlighting the value of multidimensional and contextual assessment.
Source: Figshare
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7225557880