An Exploration of the Relationship Between Ineffective Modes of Mentalisation and Difficulties Related to Borderline Personality Disorder: A Network Approach

Background: Borderline personality disorder (BPD) is a complex mental health problem whose comprehension, classification and aetiology is still debated. The mentalisation-based understanding of BPD emphasises volatile interpersonal functioning, which has been suggested to originate from ineffective modes of mentalisation. However, it is not yet fully understood how ineffective mentalising relates to specific difficulties associated with BPD. Network theory provides a novel tool to measure the assumption that individual but interlinked mental difficulties (‘symptoms’) form ‘disorders’ via the self-perpetuating interactions between them. Therefore, ineffective modes of mentalisation can be included in the network of BPD-related difficulties to explore their role in the activation and maintenance of BPD. Objective: The purpose of this study was to evaluate the pairwise interactions between ineffective modes of mentalisation and BPD-related difficulties and compare these between groups of people with (clinical group) and without (community group) a BPD diagnosis via a network analysis approach. Methods: A cross-sectional secondary data analysis using network analysis (Mixed Graph Model) was conducted in 575 people (350 in the clinical group, 225 in the community group) to assess the relationship between ineffective modes of mentalisation (hypermentalisation, hypomentalisation and lack of mentalisation) as measured with the MASC and self-reported BPD-related difficulties. Group differences were investigated in the whole sample via moderation network analysis with group membership employed as moderator variable. Significant and robust interactions were followed up within each group separately. Results: The moderation network analysis confirmed the presence of significant associations between ineffective modes of mentalisation and specific interpersonal BPD-related difficulties that were moderated by the presence of BPD diagnosis. The pattern of association between mentalising and interpersonal difficulties differed greatly between groups. Conclusion: The findings provide novel insights into the relationship between hypermentalisation and hypomentalisation and BPD-related problems. Implications for clinical practice, theory development, and future research are discussed.