{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T12:55:24Z","timestamp":1794574524642,"version":"4.9.1"},"reference-count":76,"publisher":"Cambridge University Press (CUP)","issue":"15","license":[{"start":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T00:00:00Z","timestamp":1631836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0033291721003718_sec_a1\"><jats:title>Background<\/jats:title><jats:p>It is widely accepted that borderline personality disorder (BPD) is associated with significant impairments in mentalization and theory of mind (ToM) which are considered as closely related concepts by many authors particularly in psychoanalytical circles. However, for understanding interpersonal difficulties in personality disorders, it is important to distinguish neuro-social cognitive impairment from the abnormal meta-social-cognitive style of patients.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291721003718_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>The current systematic review aimed to conduct separate meta-analyses of \u2018mentalization\u2019 [reflective functioning (RF] and different aspects of ToM in BPD. A literature search was conducted to locate relevant articles published between January 1990 to July 2021. Random-effect meta-analyses were conducted in 34 studies involving 1448 individuals with BPD and 2006 healthy controls.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291721003718_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>A very large impairment in RF was evident in BPD [<jats:italic>d<\/jats:italic> = 1.68, confidence interval (CI) = 1.17\u20132.19]. In contrast, ToM impairment was modest (<jats:italic>d<\/jats:italic> = 0.36, CI = 0.24\u20130.48). BPD patients underperformed healthy controls in ToM-reasoning (<jats:italic>d<\/jats:italic> = 0.44, CI = 0.32\u20130.56) but not ToM-decoding. Increased HyperToM (<jats:italic>d<\/jats:italic> = 0.60, CI = 0.41\u20130.79) and faux pas recognition (<jats:italic>d<\/jats:italic> = 0.62, CI = 0.35\u20130.90) errors in BPD compared to healthy controls were most robust ToM findings in this meta-analysis.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291721003718_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>BPD is characterized by very severe deficits in RF and modest and selective abnormalities in ToM. Interpersonal problems and difficulties in processing social information in BPD can be best explained by patients' maldaptive meta-social cognitive style and top-down effects of these abnormalities rather than having a primary neuro-social cognitive deficit.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291721003718","type":"journal-article","created":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T08:17:59Z","timestamp":1631866679000},"page":"2541-2551","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":60,"title":["A meta-analysis of theory of mind and \u2018mentalization\u2019 in borderline personality disorder: a true neuro-social-cognitive or meta-social-cognitive impairment?"],"prefix":"10.1017","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1598-6832","authenticated-orcid":false,"given":"Emre","family":"Bora","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2021,9,17]]},"reference":[{"key":"S0033291721003718_ref26","doi-asserted-by":"publisher","DOI":"10.1080\/10503307.2010.501040"},{"key":"S0033291721003718_ref41","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2017.06.087"},{"key":"S0033291721003718_ref5","doi-asserted-by":"publisher","DOI":"10.1521\/pedi_2017_31_283"},{"key":"S0033291721003718_ref19","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00156"},{"key":"S0033291721003718_ref37","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0206433"},{"key":"S0033291721003718_ref79","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.114.152108"},{"key":"S0033291721003718_ref60","doi-asserted-by":"publisher","DOI":"10.1521\/pedi_2014_28_146"},{"key":"S0033291721003718_ref72","first-page":"1","article-title":"Cognitive and Affective Theory of Mind in Female Patients With Borderline Personality Disorder","author":"Hillmann","year":"2020","journal-title":"Journal of Personality Disorders"},{"key":"S0033291721003718_ref34","doi-asserted-by":"publisher","DOI":"10.1093\/scan\/nss028"},{"key":"S0033291721003718_ref45","doi-asserted-by":"publisher","DOI":"10.3389\/fnbeh.2010.00182"},{"key":"S0033291721003718_ref77","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18063193"},{"key":"S0033291721003718_ref29","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291707001626"},{"key":"S0033291721003718_ref14","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291715002573"},{"key":"S0033291721003718_ref1","volume-title":"Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR)","year":"2000"},{"key":"S0033291721003718_ref23","first-page":"1","article-title":"Thinking about thinking: Some clinical and theoretical considerations in the treatment of a borderline patient","volume":"72","author":"Fonagy","year":"1991","journal-title":"International Journal of Psycho-Analysis"},{"key":"S0033291721003718_ref24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0158678"},{"key":"S0033291721003718_ref44","doi-asserted-by":"publisher","DOI":"10.1111\/papt.12182"},{"key":"S0033291721003718_ref65","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2017.07.034"},{"key":"S0033291721003718_ref57","doi-asserted-by":"publisher","DOI":"10.1080\/15289168.2015.1004890"},{"key":"S0033291721003718_ref63","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291715000318"},{"key":"S0033291721003718_ref25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0041650"},{"key":"S0033291721003718_ref39","first-page":"1","article-title":"Are impairments in theory of mind specific to borderline personality disorder?","volume":"20","author":"Normann-Eide","year":"2019","journal-title":"Journal of Personality Disorders"},{"key":"S0033291721003718_ref6","doi-asserted-by":"publisher","DOI":"10.1111\/jnp.12046"},{"key":"S0033291721003718_ref59","doi-asserted-by":"publisher","DOI":"10.1162\/089892998562942"},{"key":"S0033291721003718_ref80","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-019-2112-9"},{"key":"S0033291721003718_ref62","doi-asserted-by":"publisher","DOI":"10.1038\/npp.2014.36"},{"key":"S0033291721003718_ref46","doi-asserted-by":"publisher","DOI":"10.1017\/S0140525X00076512"},{"key":"S0033291721003718_ref66","doi-asserted-by":"publisher","DOI":"10.17711\/SM.0185-3325.2019.005"},{"key":"S0033291721003718_ref71","doi-asserted-by":"publisher","DOI":"10.21307\/sjcapp-2021-003"},{"key":"S0033291721003718_ref76","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.01583"},{"key":"S0033291721003718_ref28","doi-asserted-by":"publisher","DOI":"10.1080\/10503307.2012.709325"},{"key":"S0033291721003718_ref18","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbt048"},{"key":"S0033291721003718_ref55","doi-asserted-by":"publisher","DOI":"10.1521\/pedi.2013.27.1.3"},{"key":"S0033291721003718_ref61","first-page":"1","article-title":"Mentalizing based on external features in borderline personality disorder compared with healthy controls: The role of attachment dimensions and childhood trauma","volume":"28","author":"Van Heel","year":"2019","journal-title":"Journal of Personality Disorders"},{"key":"S0033291721003718_ref17","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.00170"},{"key":"S0033291721003718_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2015.07.057"},{"key":"S0033291721003718_ref32","volume-title":"Cognitive-behavioral treatment of borderline personality disorder","author":"Linehan","year":"1993"},{"key":"S0033291721003718_ref42","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2015.10.004"},{"key":"S0033291721003718_ref40","unstructured":"Ower, N. (2014). Effects of oxytocin on social cognition and empathy in women with borderline personality disorder. University of Freiburg (Thesis)."},{"key":"S0033291721003718_ref47","doi-asserted-by":"publisher","DOI":"10.1521\/pedi_2018_32_336"},{"key":"S0033291721003718_ref50","doi-asserted-by":"publisher","DOI":"10.1162\/089892904322926755"},{"key":"S0033291721003718_ref22","first-page":"91","article-title":"On tolerating mental states: Theory of mind in borderline personality","volume":"12","author":"Fonagy","year":"1989","journal-title":"Bulletin of the Anna Freud Centre"},{"key":"S0033291721003718_ref73","doi-asserted-by":"publisher","DOI":"10.1097\/NMD.0000000000001196"},{"key":"S0033291721003718_ref36","first-page":"238","article-title":"Affects and affect consciousness : Initial experiences with the assessment of affect integration","volume":"5","author":"Monsen","year":"1996","journal-title":"The Journal of Psychotherapy Practice and Research"},{"key":"S0033291721003718_ref51","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbs080"},{"key":"S0033291721003718_ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2018.08.049"},{"key":"S0033291721003718_ref64","doi-asserted-by":"publisher","DOI":"10.1521\/jscp.2017.36.1.22"},{"key":"S0033291721003718_ref10","doi-asserted-by":"publisher","DOI":"10.1037\/per0000228"},{"key":"S0033291721003718_ref7","doi-asserted-by":"publisher","DOI":"10.1111\/1469-7610.00715"},{"key":"S0033291721003718_ref12","doi-asserted-by":"publisher","DOI":"10.1002\/eat.22572"},{"key":"S0033291721003718_ref48","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2010.09.013"},{"key":"S0033291721003718_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2015.11.023"},{"key":"S0033291721003718_ref78","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i03"},{"key":"S0033291721003718_ref20","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-006-0107-0"},{"key":"S0033291721003718_ref21","doi-asserted-by":"publisher","DOI":"10.1017\/S003329170900600X"},{"key":"S0033291721003718_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2015.08.003"},{"key":"S0033291721003718_ref58","doi-asserted-by":"publisher","DOI":"10.1186\/s40479-019-0104-5"},{"key":"S0033291721003718_ref74","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2009.09040539"},{"key":"S0033291721003718_ref33","doi-asserted-by":"publisher","DOI":"10.1080\/00332747.1996.11024750"},{"key":"S0033291721003718_ref49","doi-asserted-by":"publisher","DOI":"10.1016\/j.bandc.2003.04.002"},{"key":"S0033291721003718_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2009.03.002"},{"key":"S0033291721003718_ref4","doi-asserted-by":"publisher","DOI":"10.1097\/NMD.0b013e3181be78fb"},{"key":"S0033291721003718_ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s11065-016-9320-6"},{"key":"S0033291721003718_ref43","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2018.01.003"},{"key":"S0033291721003718_ref30","first-page":"855","article-title":"Dimensions of mentalisation: Outlining levels of psychic transformation","volume":"78","author":"Lecours","year":"1997","journal-title":"The International Journal of Psychoanalysis"},{"key":"S0033291721003718_ref35","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2535"},{"key":"S0033291721003718_ref53","doi-asserted-by":"publisher","DOI":"10.1521\/pedi.2005.19.6.690"},{"key":"S0033291721003718_ref15","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2014-309445"},{"key":"S0033291721003718_ref56","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2011.01.017"},{"key":"S0033291721003718_ref8","doi-asserted-by":"publisher","DOI":"10.1521\/bumc.67.3.187.23439"},{"key":"S0033291721003718_ref75","doi-asserted-by":"publisher","DOI":"10.1521\/bumc.2009.73.4.311"},{"key":"S0033291721003718_ref31","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16770-6"},{"key":"S0033291721003718_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2018.03.010"},{"key":"S0033291721003718_ref54","doi-asserted-by":"publisher","DOI":"10.1093\/med\/9780198569183.003.0010"},{"key":"S0033291721003718_ref9","doi-asserted-by":"publisher","DOI":"10.1002\/j.2051-5545.2010.tb00255.x"},{"key":"S0033291721003718_ref52","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1819.2012.02334.x"}],"container-title":["Psychological Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0033291721003718","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T19:17:23Z","timestamp":1636485443000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0033291721003718\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,17]]},"references-count":76,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["S0033291721003718"],"URL":"https:\/\/doi.org\/10.1017\/s0033291721003718","relation":{},"ISSN":["0033-2917","1469-8978"],"issn-type":[{"value":"0033-2917","type":"print"},{"value":"1469-8978","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,17]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2021. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}