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

Fonagy, P; Luyten, P; (2009) A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. DEV PSYCHOPATHOL , 21 (4) 1355 - 1381. 10.1017/S0954579409990198. Green open access

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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 feature,,, 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 oil 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.

Type: Article
Title: A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder
Open access status: An open access version is available from UCL Discovery
DOI: 10.1017/S0954579409990198
Publisher version: http://dx.doi.org/10.1017/S0954579409990198
Language: English
Additional information: © 2009 Cambridge University Press
Keywords: CHILDHOOD SEXUAL-ABUSE, SOCIAL COGNITION, ATTACHMENT-STYLE, NEURAL BASIS, NONMALTREATED PRESCHOOLERS, DISORGANIZED ATTACHMENT, MALTREATED CHILDREN, PREFRONTAL LESIONS, MATERNAL-BEHAVIOR, SUICIDAL-BEHAVIOR
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
URI: https://discovery.ucl.ac.uk/id/eprint/168730
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