Exploring mentalizing in adolescents with anorexia nervosa and borderline personality disorder: A comparative study of psychiatric inpatients and healthy controls.

Laura Cortés-García,Ömer Faruk Akça,Kiana Wall,Carla Sharp

doi:10.21307/sjcapp-2021-003

Abstract

Background:Impaired mentalizing, i.e., difficulties in understanding oneself and others in terms of mental states, has been associated with the development of Anorexia Nervosa (AN), mainly among adults. However, few studies have addressed this question in clinical samples of adolescents with AN. Moreover, no study has explored mentalizing abilities among inpatient adolescents presenting with AN and Borderline Personality Disorder (BPD), despite their high comorbidity in a highly relevant age group.Objective:This study attempted, for the first time, to further examine differences in mentalizing abilities and to identify specific mentalizing impairments in different psychiatric inpatient groups and healthy adolescents.Methods:Using samples of female adolescents aged 12–17, comparison analyses were performed between psychiatric inpatient adolescents with AN (n = 44), BPD (n = 101), AN+BPD (n = 48), other psychopathology (n = 163) and healthy adolescents (n = 129). Structured and semi-structured clinical interviews, and two experimental tasks were administered to assess AN, BPD and mentalizing, respectively.Results:Comparison analyses showed that patients with BPD and other psychiatric disorders evidenced higher levels of hypermentalizing compared to healthy adolescents. Hypermentalizing was also reported among inpatients with AN+BPD, although to a lesser extent. BPD and AN scores were positively correlated with hypermentalizing responses.Conclusions:Our results suggest that hypermentalizing is a specific mentalization impairment in inpatient adolescents, particularly with BPD and both AN+BPD. Further investigation into the efficacy of mentalization based treatments for adolescents with BPD and AN+BPD is recommended. Prospective studies are needed to assess mentalizing using experimental tasks among adolescents with AN, taking into account the potential influence of temporality and severity of the disorders’ symptoms.

Highlights

Adolescence is a developmental period characterized by significant biological, psychological and social changes; it is a vulnerable period for the development of various psychological disorders [1], including Anorexia Nervosa (AN) [2] and Borderline Personality Disorder (BPD) [3, 4]
Regarding the group of inpatient adolescents with AN+BPD, we considered the possibility that these individuals may experience a synergistic effect of the disorders, where both diagnoses increase mentalizing difficulties more so than either disorder alone
Among the patients who participated in the study, 44 (12.36%) received a diagnosis of AN, 101 (28.37%) received a diagnosis of BPD and 48 (13.48%) received both AN+BPD diagnoses

Summary

Introduction

Adolescence is a developmental period characterized by significant biological, psychological and social changes; it is a vulnerable period for the development of various psychological disorders [1], including Anorexia Nervosa (AN) [2] and Borderline Personality Disorder (BPD) [3, 4]. AN is among the most difficult mental disorders to treat, is associated with severe health complications, and has a high risk of chronicity and mortality [5, 6]. BPD is a complex psychiatric disorder, which often results in severe functional impairment and is associated with a high risk of suicide and extensive use of treatment [7]. No study has explored mentalizing abilities among inpatient adolescents presenting with AN and Borderline Personality Disorder (BPD), despite their high comorbidity in a highly relevant age group. Objective: This study attempted, for the first time, to further examine differences in mentalizing abilities and to identify specific mentalizing impairments in different psychiatric inpatient groups and healthy adolescents. Conclusions: Our results suggest that hypermentalizing is a specific mentalization impairment in inpatient adolescents, with BPD and both AN+BPD. Prospective studies are needed to assess mentalizing using experimental tasks among adolescents with AN, taking into account the potential influence of temporality and severity of the disorders’ symptoms

Objectives

Methods

Results

Conclusion