The mediating role of mentalizing capacity between parents and peer attachment and adolescent borderline personality disorder

Emma Beck,Stig Poulsen,Jesper Pedersen,Carla Sharp,Erik Simonsen,Sune Bo

doi:10.1186/s40479-017-0074-4

Abstract

BackgroundInsecure attachment is a precursor and correlate of borderline personality disorder. According to the mentalization-based theory of borderline personality disorder, the presence of insecure attachment derails the development of the capacity to mentalize, potentially resulting in borderline pathology. While one prior study found support for this notion in adolescents, it neglected a focus on peer attachment. Separation from primary caregivers and formation of stronger bonds to peers are key developmental achievements during adolescence and peer attachment warrants attention as a separate concept.FindingsIn a cross-sectional study, female outpatients (Mage 15.78=, SD = 1.04) who fulfilled DSM-5 criteria for BPD (N = 106) or met at least 4 BPD criteria (N = 4) completed self-reports on attachment to parents and peers, mentalizing capacity (reflective function) and borderline personality features. Our findings suggest that in a simple mediational model, mentalizing capacity mediated the relation between attachment to peers and borderline features. In the case of attachment to parents, the mediational model was not significant.ConclusionsThe current study is the first to evaluate this mediational model with parent and peer attachment as separate concepts and the first to do so in a sample of adolescents who meet full or sub-threshold criteria for borderline personality disorder. Findings incrementally support that mentalizing capacity and attachment insecurity, also in relation to peers, are important concepts in theoretical approaches to the development of borderline personality disorder in adolescence. Clinical implications are discussed.

Highlights

Insecure attachment is a precursor and correlate of borderline personality disorder
These analyses revealed that more severe borderline features were significantly associated with lower mentalizing capacity, lower levels of attachment security to both parent and peers and increased level of general psychopathology
While one prior study found support for this notion, this is the first study to evaluate these links for peer attachment and the first to do so in a sample of adolescents with borderline pathology

Summary

Introduction

Insecure attachment is a precursor and correlate of borderline personality disorder. According to the mentalization-based theory of borderline personality disorder, the presence of insecure attachment derails the development of the capacity to mentalize, potentially resulting in borderline pathology. Separation from primary caregivers and formation of stronger bonds to peers are key developmental achievements during adolescence and peer attachment warrants attention as a separate concept. Borderline personality disorder (BPD) typically develops in adolescence [1], and has profound effects on developmental outcomes [2]. In the mentalization-based theory of BPD, Fonagy and colleagues [7] proposed that a central feature of BPD is a profound impairment in the capacity to mentalize. The theory postulates that attachment security is the developmental context through which mentalization develops: A reflective caregiver stimulates attachment bonding and promotes secure attachment, which in turn fosters reflective function

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