Comorbid antisocial and borderline personality disorders: mentalization-based treatment

Area of Science:

• Psychology
• Psychiatry
• Neuroscience

Background:

• Mentalization involves interpreting actions based on mental states.
• This process is impaired in comorbid antisocial personality disorder (ASPD) and borderline personality disorder (BPD).
• ASPD characteristics can rigidify mentalizing, increasing vulnerability to collapse and violence.

Observation:

• Individuals with ASPD misinterpret others' motives, often leading to violence.
• Humiliation triggers a collapse in mentalizing capacity, avoided through violence and control.
• Violence can stem from a momentary inhibition of mentalization.

Findings:

• Mentalization-based treatment (MBT) adapted for ASPD focuses on maintaining mentalizing under personal challenge.
• Treatment combines group and individual therapy.
• ASPD patients may lack mental pain related to others' states, making victim-focused interventions ineffective.

Implications:

• Understanding the link between disrupted mentalization and ASPD is crucial for effective treatment.
• Adapted MBT offers a new approach for individuals with ASPD and comorbid BPD.
• Treatment strategies must account for the unique empathic deficits in ASPD.