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The present study investigated transparency estimation, that is, the ability to estimate how observable one's emotions are, in patients diagnosed with borderline personality disorder (BPD) (n = 35) and healthy controls (HCs; n = 35). Participants watched emotionally evocative video clips and estimated the transparency of their own emotional experience while watching the clip. Facial expression coding software (FaceReader) quantified their objective transparency. BPD patients felt significantly less transparent than HCs, but there were no differences in objective transparency. BPD patients tended to underestimate the transparency of their emotions compared to HCs, who in turn overestimated their transparency. This suggests that BPD patients expect that others will not know how they feel, irrespective of how observable their emotions actually are. We link these findings to low emotional awareness and a history of emotional invalidation in BPD, and we discuss their impact on BPD patients’ social functioning.

Transparency estimation, that is, estimating the extent to which one’s mental states are observable to others, requires the simultaneous representation of the self and of others’ perspective on the self. Individuals with borderline personality disorder (BPD) have difficulty integrating multiple perspectives when mentalizing, which may be reflected in impaired transparency estimation. Sixty-two participants high and low in BPD features watched emotionally evocative video clips, and estimated the transparency of their emotional experience while facial expression coding software (FaceReader) quantified their objective transparency. Individuals high in BPD features showed a larger discrepancy between estimated and objective transparency than individuals low in BPD features, showing that they both over- and underestimated their transparency. Indeed, estimated transparency positively predicted objective transparency in individuals low in BPD features, but not in individuals high in BPD features. Moreover, the ability to estimate intraindividual variability in one’s own objective transparency was moderated by self-reported arousal in the participants high in BPD features. Impairments in transparency estimation were correlated with self-report measures of borderline features, attachment, and mentalizing. In conclusion, we found that borderline features relate to a reduced capacity to estimate the extent to which one’s own emotional states are observable to others. Although replication in clinical samples of BPD patients is needed, the present study provides evidence for problems in mentalizing the (embodied) self from another person’s perspective in BPD. ispartof: Personality Disorders-Theory Research And Treatment vol:13 issue:3 pages:1-13 ispartof: location:United States status: Published online

Self-other distinction (SOD) refers to the ability to distinguish one's own body, actions, and mental representations from those of others. Problems with SOD are considered to be a key feature of borderline personality disorder (BPD). However, empirical studies on SOD in BPD are scarce. Here, we present a study providing preliminary support for the usefulness and validity of a self-other facial morphing task to capture the capacity for SOD in a sample of nonclinical participants high (n = 30) and low (n = 32) in BPD features. Participants had to watch a video sequence in which their own face was gradually morphed into the face of an unfamiliar other (self-to-other) or vice versa (other-to-self), requiring them to indicate at which point they judged the morph to look more like the target face than the starting face. Consistent with predictions, results showed that participants in the high-BPD group judged the morph to look like themselves for longer in the self-to-other direction (suggestive of egocentric bias), but only with a relatively more attractive target face. In the other-to-self direction, the high-BPD group had more difficulty recognizing their own face (i.e., an altercentric bias), but this time only with the relatively less attractive face. Further research is needed to replicate these findings in clinical samples, but overall they suggest that the current task might be suited to investigate SOD problems in BPD. (PsycInfo Database Record (c) 2021 APA, all rights reserved). ispartof: Personality Disorders-Theory Research And Treatment vol:12 issue:4 pages:377-388 ispartof: location:United States status: published

Extant research suggests that borderline personality disorder (BPD) is associated with impairments in mentalizing, that is, comprehending behavior in terms of underlying mental states. However, the precise nature of these impairments remains unclear. The literature is mixed concerning mentalizing based on external features of others, and specifically facial emotion recognition (FER) in BPD patients. This study investigated FER differences in 79 BPD patients and 79 matched healthy controls using the Reading the Mind in the Eyes Test (RMET). The authors also investigated attachment dimensions and childhood trauma in relation to mentalizing based on external features. Results showed that BPD patients performed worse on positive and negative emotions. Furthermore, avoidant attachment was negatively related to FER for neutral emotions, particularly in the control group. Trauma was negatively related to FER at trend level, particularly in BPD patients. The implications for this understanding of mentalizing basedon external features in BPD are discussed. ispartof: Journal of Personality Disorders vol:33 issue:6 pages:1-15 ispartof: location:United States status: Published online

The mentalizing approach to the development and treatment of psychopathology has gained momentum in recent years. Mentalizing (or reflective functioning) refers to the human capacity to understand oneself and others in terms of internal mental states and plays a key role in our capacity to navigate our complex and essentially interpersonal world. Temporary or chronic impairments in mentalizing have been identified in a wide array of psychiatric disorder, with different types of mental disorder being associated with different types of imbalances between various dimensions of mentalizing. Borderline personality disorder (BPD), for instance, is characterized by the rapid loss of controlled mentalizing in high-arousal contexts, leading to overreliance on fast, automatic, and biased mentalizing. As a result, these individuals show a tendency to conflate the mental states of self and others (also known as identify diffusion). Here, we summarize our emerging knowledge concerning the neural circuits underlying the self–other distinction, with a focus on impairments in self–other distinction in BPD. Implications for both basic research and intervention research are discussed.

OBJECTIVE: A recent meta-analysis of 17 randomized, controlled trials (RCTs) showed that Short-term Psychodynamic Psychotherapy (STPP) for functional somatic disorders (FSD) reduced somatic symptoms compared to wait list, minimal treatment, and treatment-as-usual controls. A clinically important yet unanswered question is how much improvement patients experience within STPP treatment. METHODS: Following a systematic search, we identified STPP trials presenting data at baseline and post-treatment/follow-up. Meta-analyses determined the magnitude of changes in somatic symptoms and other outcomes from before to after STPP, and analyses examined effect sizes as a function of study, therapy, and patient variables. RESULTS: We identified 37 trials (22 pre-post studies and 15 RCTs) totaling 2094 patients treated an average of 13.34 sessions for a range of FSD. Across all studies, somatic symptoms improved significantly from pre-treatment to short-term follow-up with a large effect size (SMD = -1.07), which was maintained at long-term follow-up (SMD = -0.90). After excluding two outlier studies, effects at short- and medium-term follow-up remained significant but were somewhat reduced in magnitude (e.g., short-term SMD = -0.73). Secondary outcomes including anxiety, depression, disability, and interpersonal problems had medium to large effects. Effects were larger for studies of STPP that were longer than 12 sessions or used an emotion-focused type of STPP, and for chronic pain or gastrointestinal conditions than for functional neurological disorders. CONCLUSIONS: STPP results in moderate to large improvements in multiple outcome domains that are sustained in long-term follow-up. STPP is an effective treatment option for FSD and should be included in treatment guidelines. ispartof: Journal Of Psychosomatic Research vol:145 pages:1-9 ispartof: location:England status: Published online

Impairments in maintaining a differentiated sense of "self" and "other" are thought to be a central feature of borderline personality disorder (BPD). However, studies directly focusing on self-other distinction (SOD) in BPD are scarce, and these findings have not yet been integrated with novel insights into the neural mechanism involved in SOD. Here, we present a narrative review of recent behavioral and neuroimaging findings focusing on impairments in SOD in BPD. Behavioral findings of SOD at the embodied level provide preliminary evidence for impairments in multisensory integration in BPD. Furthermore, both behavioral and neuroscientific data converge to suggest that SOD impairments in BPD reflect an inability to shift between self and other representations according to task demands. Research also suggests that disruptions in infant-caregiver synchrony may play a role in the development of these impairments. Based on these findings, we present a new, integrative model linking impairments in SOD to reduced neural and behavioral synchrony in BPD. The implications of these findings for future research and clinical interventions are outlined. ispartof: Neuroscience And Biobehavioral Reviews vol:127 pages:242-254 ispartof: location:United States status: Published online

Introduction: Functionalsomatic disorders (FSD) are common and costly, thereby driving the need for the development of effective brief treatment options. Short-term psychodynamic psychotherapy (STPP) is one candidate treatment method. Objective: To review and meta-analyze, where possible, randomized controlled trials (RCTs) of STPP for FSD. Methods: Following a systematic search of the literature, we performed a meta-analysis of available RCT groups to determine the effects of STPP on a range of outcomes after treatment, and medium- and long-term follow-ups. Results: In meta-analyses of 17 RCTs, STPP significantly outperformed minimal treatment, treatment as usual, or waiting list controls on somatic symptom measures at all time frames, with small to large magnitude effect sizes. Descriptive reviews of 5 RCTs suggest that STPP performed at least as well as other bona fide psychological therapies. Limitations of this meta-analysis include small samples of studies and possible publication bias. Conclusions: STPP is a valid treatment option for diverse FSD conditions resulting in somatic symptom reductions that persist over time. STPP should be included in FSD treatment guidelines.

This paper describes recent progress in our understanding of patients with persistent somatic complaints, based on a broad and integrative attachment approach. Attachment theory indeed provides a powerful lens through which to understand patients with persistent somatic complaints and the often extremely negative states in which they find themselves. It was Bowlby's genius to describe how the attachment system is activated in times of threat and distress and normatively serves to seek the proximity of others in an attempt to co-regulate stress. Yet, this primary attachment strategy typically increasingly fails when faced with the continuous distress associated with chronic somatic complaints. What often ensues is a negative vicious cycle characterised by an excessive reliance on secondary attachment strategies (either hyperactivation or deactivating the attachment system), problems with (embodied) mentalizing, and severe problems with epistemic trust, that is, trust in others as a reliable source of knowledge, including knowledge of the patient's physical and mental state. These issues are discussed in relation to Bowlby's original formulations and contemporary thinking about persistent somatic complaints and functional somatic disorders. We also summarise implications for clinical practice.

© 2019 Elsevier Inc. All rights reserved. This chapter provides a contemporary psychodynamic approach to the understanding and treatment of patients with somatic symptom disorder or functional somatic disorder (FSD). We focus on three related biobehavioral systems that are central in current psychoanalytic approaches to patients with these conditions: the attachment system, the mentalizing system, and impairments in epistemic trust. Empirical evidence supporting these views is summarized. We also discuss the evidence base of psychodynamic treatments for these patients, and we outline the treatment principles of dynamic interpersonal therapy for patients with FSDs. We conclude this chapter with a brief description of the psychodynamic treatment of a female patient with functional somatic symptoms.

Individuals with borderline personality disorder (BPD) are characterized by problems in interpersonal functioning and their long-term social integration often remains problematic. Extant theories have linked identity diffusion to many of the interpersonal problems characteristic of BPD patients. Recent theoretical accounts have suggested that identity diffusion results from problems with mentalizing or reflective functioning, that is, the capacity to understand oneself and others in terms of intentional mental states. In this study we tested these assumptions, i.e., whether identity diffusion plays a mediating role in the relationship between mentalizing difficulties and interpersonal problems, in a sample of 167 BPD patients. Highly significant correlations were found between mentalizing impairments, identity diffusion and interpersonal problems. Mediation analyses showed that identity diffusion fully mediated the relationship between mentalizing difficulties and interpersonal problems. This study provides preliminary evidence that impairments in mentalizing are related to identity diffusion, which in turn is related to interpersonal problems in BPD. Further longitudinal research is needed to further substantiate these conclusions. ispartof: Psychiatry Research vol:258 pages:141-144 ispartof: location:Ireland status: published