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The multidimensional construct of mentalization and its relevance to understanding borderline personality disorder 

The multidimensional construct of mentalization and its relevance to understanding borderline personality disorder
Chapter:
The multidimensional construct of mentalization and its relevance to understanding borderline personality disorder
Author(s):

Peter Fonagy

and Patrick Luyten

DOI:
10.1093/med/9780199600526.003.0023
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date: 31 May 2020

This chapter outlines our model of borderline personality disorder (BPD), a pervasive pathology of affect regulation and interpersonal function. It introduces a model which places BPD among the disorders of social cognition, particularly a failure to accurately represent mental states in self and other. We build our model around four dichotomies of mentalization: cognitive versus affective; self versus other; internal versus external; and implicit versus explicit. We argue that ‘psychosocially caused’, but also genetically motivated vulnerabilities leave individuals with BPD imbalanced in relation to these four vectors. The experience of their symptoms can be understood as failures at one end of these polarities, resulting in inappropriate prioritization of the opposite pole. Therapeutic interventions need to focus on re-creating the balance and reducing emphasis on implicit, affective, external cues, and the undue dominance of others’ mental states over the representation of self-states.

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