Roles of age, gender and psychological difficulties in adolescent mentalizing

Mentalizing deficits in borderline personality disorder related to axis I comorbidity: Clinical relevance

AIM

Deficits in mentalization have been described in several mental disorders, but information is still scarce and ambiguous about the types of mentalization errors in each disorder and their specificity and severity in borderline personality disorder (BPD). Due to the high comorbidity between this disorder and axis I disorders, the aim of this work is to study differences in mentalization responses in BPD considering the different comorbidity profiles with other disorders.

METHODS

A total of 141 BPD patients were evaluated using The Mini-International Neuropsychiatric Interview (MINI), to identify comorbid axis I disorders. Mentalizing ability was assessed by the Movie for the Assessment of Social Cognition (MASC). Statistical associations were analysed into the different variables.

RESULTS

Patients with comorbid BPD and anorexia nervosa (AN), suicidal behaviour disorder or post-traumatic stress disorder (PTSD) respectively presented higher overmentalization, undermentalization and absence of mentalization errors, compared with patients with BPD without comorbidity.

CONCLUSIONS

Results show that BPD comorbidity with AN, suicidal behaviour disorder and PTSD affect to the types and severity of mentalizing deficits observed in these patients. This study highlights the importance of the assessment and treatment of axis I comorbid disorders in borderline personality disorder, with the objective of shaping personalized treatment for every patient.

Beyond human-likeness: Socialness is more influential when attributing mental states to robots

We sought to replicate and expand previous work showing that the more human-like a robot appears, the more willing people are to attribute mind-like capabilities and socially engage with it. Forty-two participants played games against a human, a humanoid robot, a mechanoid robot, and a computer algorithm while undergoing functional neuroimaging. We confirmed that the more human-like the agent, the more participants attributed a mind to them. However, exploratory analyses revealed that the perceived socialness of an agent appeared to be as, if not more, important for mind attribution. Our findings suggest top-down knowledge cues may be equally or possibly more influential than bottom-up stimulus cues when exploring mind attribution in non-human agents. While further work is now required to test this hypothesis directly, these preliminary findings hold important implications for robotic design and to understand and test the flexibility of human social cognition when people engage with artificial agents.

Validation of the english version of the Multidimensional Mentalizing Questionnaire (MMQ)

BACKGROUND

Mentalizing refers to the ability to understand one's own and others' mental states. Mentalizing is considered a key component of social cognition and healthy personality development. A multinational assessment tools able to appraise the multidimensional and multifaceted aspects of this complex construct are needed.

OBJECTIVE

The present study had two aims: (a) validate an English version of the Multidimensional Mentalizing Questionnaire (MMQ, 33 items) which was designed to assess mentalizing based on an integrated and multilevel model of mentalizing; (b) explore the correlational relationships between the six dimensions of the MMQ and a set of sociodemographic, psycho-cognitive, mental health, and socio-functional variables.

METHODS

Overall, 1823 individuals (age: 19-76 years old [M = 45; SD = 16]; sex: male = 48.51%, female = 50.57%, non-binary = 0.9%) participated in an online survey. While the participants came from 77 different countries, most of them were residents in UK and USA (95%). Data analytics include confirmatory factorial analysis and Pearson correlations.

RESULTS

The CFA results validated the factorial structure of a 28-items MMQ-English version, with acceptable goodness of fit indices. Regarding the psychometric properties, the MMQ-English version showed good internal reliability and significant positive correlation with another scale designed to assess an analogue construct showing a fair convergent validity. The findings indicated that males, individuals with lower levels of education, lower socio-economic status, depressed, and with a higher score of loneliness are significantly more likely to report poor mentalizing compared with females, individuals with higher education level, greater SES, happier, and with lower scores of loneliness.

CONCLUSION

The present study validated the English version of the MMQ.

The role of self-referential and social processing in the relationship between pubertal status and difficulties in mental health and emotion regulation in adolescent girls in the UK

Adolescence is marked by the onset of puberty, which is associated with an increase in mental health difficulties, particularly in girls. Social and self-referential processes also develop during this period: adolescents become more aware of others' perspectives, and judgements about themselves become less favourable. In the current study, data from 119 girls (from London, UK) aged 9-16 years were collected at two-time points (between 2019 and 2021) to investigate the relationship between puberty and difficulties in mental health and emotion regulation, as well as the role of self-referential and social processing in this relationship. Structural equation modelling showed that advanced pubertal status predicted greater mental health and emotion regulation difficulties, including depression and anxiety, rumination and overall difficulties in emotion regulation, and in mental health and behaviour. Advanced pubertal status also predicted greater perspective-taking abilities and negative self-schemas. Exploratory analyses showed that negative self-schemas mediated the relationships between puberty and rumination, overall emotion regulation difficulties, and depression (although these effects were small and would not survive correction for multiple comparisons). The results suggest that advanced pubertal status is associated with higher mental health and emotion regulation problems during adolescence and that negative self-schemas may play a role in this association. RESEARCH HIGHLIGHTS: This study investigates the relationship between puberty, mental health, emotion regulation difficulties, and social and self-referential processing in girls aged 9-16 years. Advanced pubertal status was associated with worse mental health and greater emotion regulation difficulties, better perspective-taking abilities and negative self-schemas. Negative self-schemas may play a role in the relationships between advanced pubertal status and depression, and advanced pubertal status and emotion regulation difficulties, including rumination.

Efficacy of mentalization-based therapy in treating self-harm: A systematic review and meta-analysis

INTRODUCTION

Mentalization-based therapy (MBT) and its adapted version for adolescents (MBT-A) are repeatedly highlighted as promising treatments for reducing self-harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self-harm, recent meta-analyses have yielded mixed results. To inform best-practice clinical decision-making, we conducted a systematic review and meta-analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(-A) in reducing self-harm (primary outcome) and symptoms of BPD and depression (secondary outcomes).

METHODS

Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre-post, three RCTs) and five MBT-A studies (two pre-post, three RCTs). Aggregated effect sizes were estimated using random-effects models. Meta-regressions were conducted to assess the effect of moderator variables (treatment duration, drop-out rates, and age) on effect sizes.

RESULTS

Overall, both MBT and MBT-A demonstrated promising effects in reducing self-harm (g = -0.82, 95% CI -1.15 to -0.50), borderline personality disorder (g = -1.08, 95% CI -1.38 to -0.77), and depression (g = -1.1, 95% CI -1.52 to -0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(-A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults (g = -0.56, 95% CI -0.88 to -0.24).

CONCLUSION

Although the pre-post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(-A) to control conditions, so that prioritizing the application of MBT (-A) for the treatment of self-harm is not supported. Possible explanations and further implications are discussed.

Visualizing the invisible tie: Linking parent-child neural synchrony to parents' and children's attachment representations

It is a central tenet of attachment theory that individual differences in attachment representations organize behavior during social interactions. Secure attachment representations also facilitate behavioral synchrony, a key component of adaptive parent-child interactions. Yet, the dynamic neural processes underlying these interactions and the potential role of attachment representations remain largely unknown. A growing body of research indicates that interpersonal neural synchrony (INS) could be a potential neurobiological correlate of high interaction and relationship quality. In this study, we examined whether interpersonal neural and behavioral synchrony during parent-child interaction is associated with parent and child attachment representations. In total, 140 parents (74 mothers and 66 fathers) and their children (age 5-6 years; 60 girls and 80 boys) engaged in cooperative versus individual problem-solving. INS in frontal and temporal regions was assessed with functional near-infrared spectroscopy hyperscanning. Attachment representations were ascertained by means of the Adult Attachment Interview in parents and a story-completion task in children, alongside video-coded behavioral synchrony. Findings revealed increased INS during cooperative versus individual problem solving across all dyads (𝛸2(2) = 9.37, p = 0.009). Remarkably, individual differences in attachment representations were associated with INS but not behavioral synchrony (p > 0.159) during cooperation. More specifically, insecure maternal attachment representations were related to higher mother-child INS in frontal regions (𝛸2(3) = 9.18, p = 0.027). Conversely, secure daughter attachment representations were related to higher daughter-parent INS within temporal regions (𝛸2(3) = 12.58, p = 0.006). Our data thus provide further indication for INS as a promising correlate to probe the neurobiological underpinnings of attachment representations in the context of early parent-child interactions. RESEARCH HIGHLIGHTS: We assessed attachment representations using narrative measures and interpersonal neural synchrony (INS) during parent-child problem-solving. Dyads including mothers with insecure attachment representations showed higher INS in left prefrontal regions. Dyads including daughters with secure attachment representations showed higher INS in right temporo-parietal regions. INS is a promising correlate to probe the neurobiological underpinnings of attachment representations in the context of parent-child interactions, especially within the mutual prediction framework.

Unveiling Adolescent Suicidality: Holistic Analysis of Protective and Risk Factors Using Multiple Machine Learning Algorithms

Adolescent suicide attempts are on the rise, presenting a significant public health concern. Recent research aimed at improving risk assessment for adolescent suicide attempts has turned to machine learning. But no studies to date have examined the performance of stacked ensemble algorithms, which are more suitable for low-prevalence conditions. The existing machine learning-based research also lacks population-representative samples, overlooks protective factors and their interplay with risk factors, and neglects established theories on suicidal behavior in favor of purely algorithmic risk estimation. The present study overcomes these shortcomings by comparing the performance of a stacked ensemble algorithm with a diverse set of algorithms, performing a holistic item analysis to identify both risk and protective factors on a comprehensive data, and addressing the compatibility of these factors with two competing theories of suicide, namely, The Interpersonal Theory of Suicide and The Strain Theory of Suicide. A population-representative dataset of 173,664 Norwegian adolescents aged 13 to 18 years (mean = 15.14, SD = 1.58, 50.5% female) with a 4.65% rate of reported suicide attempt during the past 12 months was analyzed. Five machine learning algorithms were trained for suicide attempt risk assessment. The stacked ensemble model significantly outperformed other algorithms, achieving equal sensitivity and a specificity of 90.1%, AUC of 96.4%, and AUCPR of 67.5%. All algorithms found recent self-harm to be the most important indicator of adolescent suicide attempt. Exploratory factor analysis suggested five additional risk domains, which we labeled internalizing problems, sleep disturbance, disordered eating, lack of optimism regarding future education and career, and victimization. The identified factors provided stronger support for The Interpersonal Theory of Suicide than for The Strain Theory of Suicide. An enhancement to The Interpersonal Theory based on the risk and protective factors identified by holistic item analysis is presented.

Neurobiological sensitivity to popular peers moderates daily links between social media use and affect

Social media behaviors increase during adolescence, and quantifiable feedback metrics (e.g., likes, followers) may amplify the value of social status for teens. Social media's impact on adolescents' daily affect may be exacerbated given the neurodevelopmental changes that increase youths' sensitivity to socio-emotional information. This study examines whether neurobiological sensitivity to popularity moderates daily links between social media use and affect. Adolescents (N = 91, Mage=13.6 years, SDage=0.6 years) completed an fMRI task in which they viewed faces of their high (>1 SD above the mean) and low (<1 SD below the mean) popular peers based on peer-nominated sociometric ratings from their school social networks. Two years later, adolescents reported their time spent on social media and affect daily for two weeks. Neural tracking of popularity in the ventromedial and dorsomedial prefrontal cortex moderated the association between time on social media and affect. Specifically, adolescents who tracked high popular peers in the vmPFC reported more positive affect on days when they used social media more. Adolescents who tracked low popular peers in the vmPFC and dmPFC reported more negative affect on days when they used social media more. Results suggest that links between social media and affect depend on individual differences in neural sensitivity to popularity.

The catcher in the mind: validation of the brief-mentalized affectivity scale for adolescents in the Italian population

The concept of mentalized affectivity (MA) encompasses the dimensions of identifying, processing, and expressing emotions and describes the process of making sense of and reevaluating one's affects in light of autobiographical memory. This construct was developed within the theoretical framework of mentalization and, due to its interpersonal nature, added further complexity to the emotion regulation construct. This research aimed to examine the factor structure and psychometric properties of the Brief-Mentalized Affectivity Scale for adolescents (B-MAS-A) on an Italian sample of young people (aged 13-19 years). Data were collected using non-probabilistic sampling and an online survey. Participants were asked to complete a large battery of instruments, including the B-MAS-A, the Toronto Alexithymia Scale, the Reflective Functioning Questionnaire, the Epistemic Trust, Mistrust, and Credulity Questionnaire, the Strengths and Difficulties Questionnaire, and the General Self-Efficacy Scale. In study 1, factor analyses carried out on a total sample of 566 adolescents identified 3 distinct dimensions of the same components of MA found in the adult population: i) identifying; ii) processing; iii) expressing emotions. The subscales showed excellent internal consistency. Study 2 (involving a subsample of 288 participants) demonstrated good levels of construct and criterion validity. These results confirm that the B-MAS-A represents a valid and robust instrument for assessing the complex and multifaceted characteristics of MA in adolescents. The B-MAS-A can make a significant contribution to clinical practice and research and encourage systematic studies on MA in psychotherapy, taking into account the developmental stage of adolescence.

Associations of mentalization and epistemic trust with internalizing and externalizing problems in adolescence: A gender-sensitive structural equation modeling approach

INTRODUCTION

Mentalization, operationalized as reflective functioning (RF), allows individuals to interpret actions as caused by intentional mental states. Previous research highlighted the gender-specific associations between adolescents' internalizing and externalizing difficulties and mentalizing impairments. In addition, research suggested that mentalizing facilitates the creation of epistemic trust (ET) to evaluate social information as accurate, reliable, and relevant. However, few investigations explored the concurrent associations between RF, ET, and adolescent psychopathology.

METHODS

A sample of 447 Italian cisgender adolescents (57% assigned females at birth; age range 12-19 years old; Mage  = 15.54, SD = 1.98) self-reported RF (RFQY-5), ET towards mother, father, and peers (IPPA) and mental health problems (YSR-112). Gender-specific structural equation modeling explored the associations between RF, ET, and internalizing/externalizing problems.

RESULTS

Results suggested an excellent fit for the theoretical model and revealed gender-related associations. In females, findings suggest that ET mediates the association between RF and psychopathology, with indirect associations from RF through ET to lower internalizing and externalizing problems. However, in males, RF and ET display independent associations with psychopathology.

CONCLUSION

Overall, findings suggest that ET might be a transdiagnostic factor playing different roles associated with adolescent psychopathology. Indeed, links between RF and ET might help to explore gender differences in mental health problems in this developmental phase.

Mentalizing in Adolescents with Borderline Personality Disorder

Mentalizing, recognized as the capacity to understand behaviors in the context of our own mental states and those of other people, is being researched more and more commonly in regard to various mental disorders. The research on mentalization focuses on, among other things, borderline personality disorder, which is at present perceived as an emerging problem in the population of adolescents. In order to summarize the currently accessible knowledge of mentalizing in adolescents with borderline personality disorder, we thoroughly analyzed relevant publications. Based on the available literature, it can be concluded that the mentalizing ability of adolescents with borderline personality disorder can be impaired. The evidence demonstrates that they are prone to hypermentalizing, defined as an overattribution of mental states to other people. However, this tendency has not been proven to be specific to teenagers with this disorder. Moreover, the existing data suggest that young people with borderline personality exhibit a reduced capacity to mentalize their own inner states.

Mentalizing in Adolescents and Young Adults with Attention Deficit Hyperactivity Disorder: Associations with Age and Attention Problems

INTRODUCTION

Growing, albeit heterogenous evidence questions whether attention deficit/hyperactivity disorder (ADHD) is associated with socio-cognitive impairments, especially beyond childhood. This study focuses on mentalizing - the socio-cognitive ability to attribute and reason in terms of mental states. We aimed to characterize mentalizing performance in terms of correct scores and types of errors in adolescents and young adults with ADHD.

METHODS

Forty-nine adolescents and adults with ADHD and 49 healthy controls matched for age and gender completed a computerized naturalistic mentalizing task, the Movie for Assessment of Social Cognition (MASC). Repeated measures analyses of variance examined the effects of age group and ADHD diagnosis on MASC performance. Additionally, associations between mentalizing scores, the severity of attention problems, and the presence of comorbidity were explored in the ADHD group.

RESULTS

Results showed an increased prevalence of hypomentalizing errors in adolescents with ADHD. Lower mentalizing scores in adolescents with ADHD were correlated with indices of inattentiveness, impulsivity, and vigilance problems. Hypomentalizing errors in adolescents showed to be particularly associated with inattentiveness, after controlling for age and comorbidity. In contrast, adults with ADHD performed similarly to controls and their scores on the mentalizing task were not correlated to attention problems.

CONCLUSION

These findings highlight potential developmental differences in mentalizing abilities in ADHD youths and their association with attentional impairments.

The mindful trajectory: Developmental changes in mentalizing throughout adolescence and young adulthood

BACKGROUND

Mentalizing and psychological mindedness are two key, partially overlapping facets of social cognition. While mentalizing refers to the ability to reflect on one's own mental states and the mental states of others, psychological mindedness describes the ability for self-reflection and the inclination to communicate with others about one's own mental states.

PURPOSE

This study examined the development of mentalizing and psychological mindedness throughout adolescence and into young adulthood, and the interplay between the two with gender and the Big Five Personality Traits.

METHODS

432 adolescents and young adults (ages 14-30) were recruited from two independent schools and two universities. Participants completed a set of self-report measures.

RESULTS

A curvilinear trend in both mentalizing and psychological mindedness indicated a gradual development of these capacities with age, peaking in young adulthood. Across all age groups, females had consistently higher mentalizing scores than males. For females, scores only changed significantly between age bands 17-18 to 20+ (p<0.001), ES (d = 1.07, 95% CI [.1.52-.62]). However, for males, a significant change in scores appeared between two age bands of 14 to 15-16 (p<0.003), ES (d = .45, 95% CI [.82-.07]), and 17-18 to 20+ (p<0.001), ES (d = .6, 95% CI [.1.08-.1]). The change in psychological mindedness scores differed, and females did not have consistently higher scores than males. Females' scores were only significantly higher for ages 14 (p<0.01), ES (d = .43, 95% CI [.82-.04]), and 15-16 (p<0.01), ES (d = .5, 95% CI [.87-.11]). As with the development of mentalizing abilities, female scores in psychological mindedness remained stable from 14 to 18 years of age, with a significant change between age bands 17-18 and 20+ (p<0.01), ES (d = 1.2, 95% CI [1.7-.67]). Contrastingly, for males significant change occurred between 15-16, 17-18 (p<0.01), ES (d = .65, 95% CI [1.1-.18]) and 20+ (p<0.01), ES (d = .84, 95% CI [1.5-.2]). A significant positive association was found between mentalizing and psychological mindedness and the personality traits of Agreeableness, Openness to Experience and Conscientiousness (p<0.0001). Psychological mindedness had a weaker positive correlation with Extraversion and Openness to Experience (p<0.05).

CONCLUSIONS

The discussion is focused on the interpretation of the findings in light of social cognition and brain development research.

A deeper look at the association between childhood maltreatment and reflective functioning

Childhood maltreatment is theorized as impeding the development of reflective functioning (RF; ability to perceive and interpret oneself and others in terms of mental states). However, previous research typically failed to support this association or yielded small sized and mixed associations. This study aims to provide a deeper look at the association between childhood maltreatment and RF by characterizing two non-mentalizing categories. One-hundred-and-sixteen pregnant women (mean age = 27.62, SD = 4.52) from the community (48.3% with a university degree, 96.5% in a relationship with the other parent) retrospectively reported on childhood abuse and neglect using the Childhood Trauma Questionnaire. They also participated in the Adult Attachment Interview subsequently coded using the Reflective Functioning Scale. Participants with poor to low RF were allocated to one of two groups (disavowal-distancing or distorted-inconsistent) using indicators provided in the RF Scale. No association was found between childhood maltreatment and overall RF when controlling for education level. A multinomial logistic regression revealed that childhood maltreatment was strongly predictive of a disrupted, over-analytical and inconsistent reflection about mental states but not of a tendency to discourse little about mental states. This tendency was rather only predicted by education level. Findings suggest that childhood maltreatment would lead to specific impairments in RF and that not considering how individuals fail to mentalize about attachment relationships may mask strong associations between RF and its determinants and correlates, including childhood maltreatment.

Developmentally appropriate mental health literacy content for school-aged children and adolescents

Although improving the mental health of children and adolescents has become a global priority, resources outlining developmentally appropriate content for improving mental health literacy (MHL) across school-aged children are scarce. A comprehensive, life-course approach to building MHL is needed to address the evolving competencies, needs, capacities, and risk factors for mental health, especially to establish school-based interventions that can be equitably and sustainably implemented. We conducted a theoretical review highlighting the relation of research and practice in building MHL through developmentally appropriate knowledge and competencies for children and adolescents. A two-pronged review of the literature was conducted to provide an overview of (1) research with a focus on neurobiological, psychological, cognitive, and social developmental milestones of school-aged children relevant for building MHL and (2) evidence-based and theory-driven content for the development of universal MHL interventions for children and adolescents considering the four components of MHL. A map of relevant key milestones highlights the range of development that occurs and ample opportunity for increasing universal MHL during these sensitive years primed for learning. We reflect on current understandings and global considerations for MHL interventions with an emphasis on applying developmental science to the future strengthening of intervention development, uptake, adaptation, implementation, evaluation, and scale-up.

Development and Validation of the Certainty About Mental States Questionnaire (CAMSQ): A Self-Report Measure of Mentalizing Oneself and Others

The Certainty About Mental States Questionnaire (CAMSQ) is a self-report measure of the perceived capacity to understand mental states of the self and others (i.e., mentalizing). In two studies (total N = 1828), we developed the CAMSQ in both English and German as a two-dimensional measure of Self- and Other-Certainty, investigated associations with other measures of mentalizing, and explored relationships to personality functioning and mental health. The CAMSQ performed well in terms of convergent and discriminant validity, internal consistency, test-retest reliability, and measurement invariance across the United States and Germany. The present research indicates that the CAMSQ assesses maladaptive forms of having too little or too much certainty about mental states (consistent with hypomentalizing and hypermentalizing). A psychologically adaptive profile of perceived mentalizing capacity appears to be characterized by high Self-Certainty that exceeds Other-Certainty, suggesting that imbalances between Self-Certainty and Other-Certainty (Other-Self-Discrepancy) play an important role within personality pathology.

Investigating Functioning Profile of Adolescents with Anorexia before and during the COVID-19 Pandemic: A Cross-Sectional Study on Mentalizing, Alexithymia, and Impulsiveness

Anorexia nervosa (AN) usually emerges in adolescence when important changes occur in cognitive, emotional, and social processes. Mentalizing, alexithymia, and impulsiveness represent key dimensions for the understanding and interpretation of psychological difficulties in AN. The outbreak of the COVID-19 pandemic has impacted adolescents with AN, showing a worsening of the disease. The main aims of the present paper are (1) to compare adolescents with AN before and during the COVID-19 pandemic and (2) to explore the relationship between mentalizing, alexithymia, impulsiveness, and psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. One hundred and ninety-six AN female adolescents (N = 94 before COVID-19; N = 102 during COVID-19) participated in this study. The results show that adolescents with AN during the COVID-19 pandemic had a more impaired functioning profile than the before COVID-19 group. Mentalizing, alexithymia, and impulsiveness had a predictive role on psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. In conclusion, our data reveal that the COVID-19 pandemic has likely represented a stress condition that affects mental health; worsening the severity of adolescents with AN clinical condition. Lastly, predictive patterns suggest the existence of a link between difficulties in the ability to face the problems of the present time using effective strategies and the severity of psychological symptoms.

Temporal discounting for self and friends in adolescence: A fMRI study

Adolescence is characterized by impulsivity but also by increased importance of friendships. This study took the novel perspective of testing temporal discounting in a fMRI task where choices could affect outcomes for 96 adolescents (aged 10-20-years) themselves and their best friend. Decisions either benefitted themselves (i.e., the Self Immediate - Self Delay' condition) or their friend (i.e., 'Friend Immediate - Friend Delay' condition); or juxtaposed rewards for themselves and their friends (i.e., the 'Self Immediate - Friend Delay' or 'Friend Immediate - Self Delay' conditions). We observed that younger adolescents were more impulsive; and all participants were more impulsive when this was associated with an immediate benefit for friends. Individual differences analyses revealed increased activity in the subgenual anterior cingulate cortex extending in the ventral striatum for immediate relative to delayed reward choices for self. Temporal choices were associated with activity in the prefrontal cortex, parietal cortex, insula, and ventral striatum, but only activity in the right inferior parietal lobe was associated with age. Finally, temporal delay choices for friends relative to self were associated with increased activity in the temporo-parietal junction and precuneus. Overall, this study shows a unique role of the social context in adolescents' temporal decision making.

Childhood trauma and posttraumatic stress symptoms in adolescents and young adults: The mediating role of mentalizing and emotion regulation strategies

OBJECTIVES

Childhood trauma (physical, emotional, sexual abuse and/or physical and emotional neglect) represents a specific risk for developmental perturbations and long-term negative outcomes. Adolescents and young adults with childhood trauma have rarely experienced a single type of traumatic event but rather multiple traumatic experiences. However, studies on adolescent PTSD are sparse. This study examines the possible mediating role of mentalizing, cognitive and interpersonal emotion regulation strategies between multiple types of childhood trauma exposure and PTSD in adolescents and young adults.

METHODS

The sample consisted of 456 adolescents and young adults aged 15 and 25, recruited from four high schools and one university. Participants completed self-report questionnaires assessing childhood trauma, mentalizing, cognitive and interpersonal strategies of emotion regulation and PTSD.

RESULTS

Structural Equation Modeling revealed that multiple types of childhood trauma exposure have a significant indirect effect on PTSD symptoms through its association with hypomentalizing and maladaptive cognitive strategies of emotion regulation (i.e. self-blame, rumination, catastrophizing). Results also showed a significant indirect effect between multiple types of childhood trauma exposure and PTSD symptoms through its association with hypomentalizing and maladaptive interpersonal strategies of emotion regulation (i.e. emotional reactivity and tendency to avoid emotional connection). Indirect paths were also run in reverse to control for the direction of the effect.

CONCLUSION

Our findings show that exposure to multiple types of childhood trauma contributes to severe PTSD through several complex pathways including both hypomentalizing and maladaptive emotion regulation strategies in adolescence and young adulthood.

Hypermentalizing and Borderline Personality Disorder: A Meta-Analytic Review

OBJECTIVE

A hypermentalizing impairment, or tendency to overattribute mental states to others, has been identified among individuals with borderline personality disorder. However, associations between hypermentalizing and other disorders call into question the specificity of this impairment to borderline personality disorder. This study aimed to evaluate the relative strength of the association between hypermentalizing and borderline personality disorder compared with other disorders and to assess the impact of moderators on the relationship between hypermentalizing and psychopathology.

METHODS

The authors conducted a meta-analysis of 36 studies (N=4,188 people) to investigate the relative strength of the association between hypermentalizing and borderline personality disorder, compared with other disorders, and to assess the impact of moderators on this relationship. The Movie for the Assessment of Social Cognition, an ecologically valid experimental instrument, was used to measure hypermentalizing.

RESULTS

Results indicated support for an association between psychopathology and hypermentalizing (r=0.24, 95% confidence interval [CI]=0.17 to 0.31), but the association was not significantly stronger for borderline personality disorder (r=0.26, 95% CI=0.12 to 0.39) than for other disorders (r=0.24, 95% CI=0.14 to 0.33). Neither age nor gender significantly moderated the association between psychopathology and hypermentalizing.

CONCLUSIONS

Hypermentalizing may be related to psychopathology in general rather than borderline personality disorder in particular. The findings are discussed in view of the possibility that features of borderline personality disorder associated with other psychopathology may explain the overall association between psychopathology and hypermentalizing. Clinical implications for mentalization-based treatment and concerns that the measurement used for hypermentalization may be too narrow and not representative of variations in functioning across cultures and race-ethnicity also are discussed.

Co-Rumination and Depressive Symptoms in Adolescence: Prospective Associations and the Mediating Role of Brooding Rumination

Although relationships between co-rumination and depressive symptoms have often been found, little research attention has been given to mechanisms underlying this association. The current study investigated brooding rumination as a mediator of the relationship between co-rumination and depressive symptoms. Analyses were performed on data of 1549 adolescents (53.4% girls; M_age = 12.93, range 9-17) using three waves of data with 1-year intervals. Mediated and indirect effects were investigated by means of cross-lagged analyses. The results indicated that co-rumination was not predictive of depressive symptoms 2 years later. However, co-rumination did have an indirect effect on prospective depressive symptoms through brooding rumination. Additional analyses looking into the directionality of effects showed that neither brooding rumination nor depressive symptoms were predictive of relative increases in one's tendency to co-ruminate. Multi-group analyses further showed that findings were not moderated by gender or age. The current study contributes to the growing literature on the role of interpersonal and intrapersonal affect-regulation styles in predicting depressive symptoms and suggests that passive and catastrophic problem talk with same-sex friends may get internalized into maladaptive and repetitive thinking patterns.

Self and Other Mentalizing Polarities and Dimensions of Mental Health: Association With Types of Symptoms, Functioning and Well-Being

Research suggests that the ability to understand one's own and others' minds, or mentalizing, is a key factor for mental health. Most studies have focused the attention on the association between global measures of mentalizing and specific disorders. In contrast, very few studies have analyzed the association between specific mentalizing polarities and global measures of mental health. This study aimed to evaluate whether self and other polarities of mentalizing are associated with a multidimensional notion of mental health, which considers symptoms, functioning, and well-being. Additionally, the level or depth of mentalizing within each polarity was also analyzed. A sample of 214 adolescents (12-18 years old, M = 14.7, and SD = 1.7; 53.3% female) was evaluated on measures of self- (Trait Meta-Mood Scale or TMMS-24) and other- mentalizing (Adolescent Mentalizing Interview or AMI), multi-informed measures of psychopathology and functioning based on Achenbach's system, and measures of psychological well-being (self-esteem, happiness, and motivation to life goals). Results revealed no association between mentalizing polarities and higher-order symptom factors (internalizing, externalizing, and global symptoms or "p" factor). Self-mentalizing was associated with self-esteem (B = 0.076, p < 0.0005) and motivation to life goals (B = 0.209, p = 0.002), and other-mentalizing was associated to general, social and role functioning (B = 0.475, p < 0.0005; B = 0.380, p = 0.005; and B = 0.364, p = 0.004). This association between aspects of self-other mentalizing and self-other function has important implications for treatment and prevention. Deeper mentalizing within each polarity (i.e., comprehension beyond simple attention to one's own mental states, and mentalizing referred to attachment figures vs. mentalizing referred to the characters of a story) revealed stronger associations with functioning and well-being. Because mentalizing polarities are associated with functioning and well-being but not with symptoms, a new hypothesis is developed: mentalizing does not contribute to resiliency by preventing symptoms, but by helping to deal with them, thus improving functioning and well-being independently of psychopathology. These findings support that promoting mentalizing across development may improve mental health, even in non-clinical population.

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

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.

Aggressiveness in Adopted and Non-Adopted Teens: The Role of Parenting, Attachment Security, and Gender

The aim of this study was to examine the relationship among aggressiveness, parenting practices, and attachment security in adolescents, assessing maternal and paternal effects separately. Two different subsamples of adolescents between 12 and 16 years old participated in the study (n = 157): 67 adopted adolescents (61.2% girls) and 90 non-adopted adolescents (56.7% girls). Partial and full mediation models were analyzed in multi-group structural equation models (using maximum likelihood estimates), allocating non-adoptive and adoptive adolescents into two different groups. Results showed that whereas acceptance/involvement of each parent predicted attachment security towards the corresponding parental figure, only the father's coercion/imposition predicted aggressiveness, and only attachment security to the mother was a (negative) predictor of adolescent's aggressiveness. The partial mediation model provided the most parsimonious explanation for the data, showing no differences between adopted and non-adopted subsamples and supporting a good model fit for both boys and girls in a multi-group invariance analysis. The implications of these results are discussed in light of the protective effects of care relationships in early adolescence (vs. late adolescence) as well as the differential role of parent figures.

Sex differences and brain development during puberty and adolescence

Sex differences in behavior, and whether these behavioral differences are related to sex differences in brain development, has been a longstanding topic of debate. Presumably, sex differences can provide critically important leads for explaining the etiology of various illnesses that show (i) large sex differences in prevalence and (ii) have an origin before or during adolescence. The general aim of this chapter is to provide an overview of scientific studies on sex differences in normative brain and behavioral development across puberty and adolescence, including the (sex) hormone-driven transition phase of puberty. Moreover, we describe the literature on brain and behavioral development in gender dysphoria, a severe and persistent incongruence between the self-identified gender and the assigned sex at birth. From the literature it becomes clear there is evidence for a specific link between pubertal maturation and developmental changes in arousal, motivation, and emotion. However, this link is rather similar between boys and girls. Moreover, although there is substantial evidence for sex differences in mean brain structure, these have not always been linked to sex differences in behavior, cognition, or psychopathology. Furthermore, there is little evidence for sex differences in brain development and thus, studies so far have been unable to explain sex differences in cognition. Suggestions for future research and methodologic considerations are provided.

Designing a range of mentalizing interventions for young people using a clinical staging approach to borderline pathology

Borderline personality disorder (BPD) can have a long-lasting impact on social and professional functioning, even when core symptoms of BPD are in remission. Adolescence may be a critical developmental period to change the potential long-term functional outcome of BPD. This paper presents a range of mentalizing interventions to alter the course and outcome of BPD, based upon a model of clinical staging. Mentalizing interventions have in common a focus on strengthening self-regulatory and interpersonal capacities, aiming to improve adaptive social learning. This paper argues that these interventions should be dosed and organized according to the stage of progression of BPD, which is illustrated by discussing different specific formats for mentalization-based interventions, including an early-intervention program for BPD and a standard program for full BPD.