Sharp et al. (2011) recently demonstrated that in adolescents with borderline traits the loss of mentalization is more apparent in the emergence of unusual alternative strategies (excessive theory of mind or hypermentalizing) than in the loss of the capacity per se (no mentalizing or undermentalizing). This suggests that hypermentalizing could be a worthwhile social-cognitive treatment target in adolescents with borderline traits. The aim of the current study was to examine (1) whether a reduction in excessive theory of mind or hypermentalizing is achieved between admission and discharge for adolescent inpatients; (2) whether the hypothesized reduction is more apparent in adolescents meeting criteria for BPD compared with psychiatric controls; and (3) whether other forms of mentalizing would also be sensitive to and malleable by inpatient treatment in the same way we expected hypermentalizing to be. The "Movie for the Assessment of Social Cognition" Task (Dziobek et al., 2006) was administered to consecutive admissions to an adolescent inpatient setting (n = 164) at admission and discharge, alongside measures of borderline symptomology and interview-based diagnosis of BPD. Results demonstrated that 41% (n = 68) of the sample met full or intermediate criteria for BPD on an interview-based measure of BPD. A relation between borderline traits and hypermentalizing that appears to be independent of internalizing and externalizing problems was demonstrated. Hypermentalizing, but not other forms of social-cognitive reasoning (as measured by the Child Eyes Test, Basic Empathy Scale and the Mentalizing Stories Test for Adolescents), was found to be malleable through a milieu-based inpatient treatment. Clinical implications of the findings for the organization of treatment settings for adolescents are discussed.

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While studies have documented significant associations between insecure attachment, emotion dysregulation, and borderline personality disorder (BPD) features, no research to date has empirically delineated the specific mechanisms by which these constructs are related. The present study brings together 2 lines of research that have hitherto separately examined attachment disturbance and emotion dysregulation as they respectively manifest in the pathogenesis of BPD, and explores the complex relations between the 2 well-established correlates of borderline traits in a clinical sample of adolescents (N = 228). We examined the adolescents' use of positive and negative emotion regulation strategies, along with their maternal and paternal attachment security. Results indicated that positive and negative emotion regulation strategies were differentially implicated in the link between attachment insecurity and BPD features. Attachment security functioned as a buffer against adolescent BPD by enhancing positive emotion regulation strategies, while negative emotion regulation strategies served to dilute the protective effect of attachment and positive regulation strategies, culminating in clinically significant levels of borderline traits. Findings are discussed with regard to interventions in the developmental trajectory of BPD as it unfolds during adolescence.