Attachment, Mentalization, and Criterion B of the Alternative DSM-5 Model for Personality Disorders (AMPD)

Abstract

Background The mentalization theory posits that interpersonal difficulties and maladaptive personality traits develop from an insecure attachment pattern with one’s caregiver and corresponding deficits in mentalizing—the ability to understand others’ and one’s own mental states. Mentalizing deficits have been theorized as the basis for all psychopathology, with the paradigmatic case being Borderline Personality Disorder. Nevertheless, developments in the personality field indicate personality pathology is best represented dimensionally, and such a proposal was outlined by the Alternative DSM-5 Model for Personality Disorders (AMPD). Despite evidence linking the mentalization theory to personality disorders, however, it has yet to be applied to Criterion B of the AMPD. The aim of the present study was to evaluate the moderating role of mentalizing in the relation between attachment and Criterion B maladaptive trait function in a sample of undergraduates. We hypothesized a model in which: (1) attachment insecurity would be positively associated with the Negative Affectivity, Antagonism, and Disinhibition personality domains; (2) mentalizing ability would be negatively associated with these domains; and, (3) there would be an interaction effect between attachment and mentalizing when predicting these same domains. Methods Personality domains were measured dimensionally via the Personality Inventory for DSM-5 (PID-5-SF), while the dependence and avoidance domains of attachment were assessed via the Relationship Questionnaire (RQ). Mentalizing ability was tapped by the Movie for the Assessment of Social Cognition (MASC). The AMPD personality domains and trait facets were examined as dependent variables; attachment dependence, attachment avoidance, and overall mentalizing ability were entered as independent variables; and interaction terms between mentalizing and each attachment dimension were used to test moderation via MANCOVAs. Results Consistent with expectations, results indicated overall mentalizing moderated the relation between attachment avoidance and Negative Affectivity. Posthoc analyses revealed similar effects on the relations between attachment avoidance and the Emotional Lability, Hostility, and Perseveration trait facets; however, there were no significant moderation findings related to attachment dependence. Conclusions These results support the mentalization theory’s application to Criterion B of the AMPD, particularly in relation to the links between Negative Affectivity and borderline-related traits, and encourage future research of dimensional maladaptive personality. They further bolster support for understanding maladaptive personality as a dimensional construct.

Comparison of the relative sensitivity of two dimensional personality models to the psychopathological symptoms: the section III DSM-5 maladaptive traits versus affective temperaments

“…Although AMPD was initially proposed only for the diagnosis of PDs, subsequent research has suggested that traits can be used to organize all mental disorders [ 15 ]. For instance, the structure of the hierarchical taxonomy of psychopathology (HiTOP) includes maladaptive traits originally designed to indicate symptoms of personality disorders (PDs), along with the symptoms of other kinds of psychopathology (NPDs) [ 16 , 17 ]. Subsequently, several studies have examined and confirmed the evidence-based structure and clinical and therapeutic application of HiTOP [ 18 – 20 ].…”

Combining novel trait and neurocognitive frameworks to parse heterogeneity in borderline personality disorder

“…We also acknowledge some discrepancies, including the close proximity between negative affectivity and externalizing traits and interpersonal pathology (more frequently associated with internalizing and self‐pathology; Widiger et al, 2019). This may represent a sample (i.e., BPD vs. personality pathology) and/or measure‐type (i.e., behavioral SP vs. self‐report Criterion A) related divergence, as negative affectivity has been associated with mentalization difficulties and externalizing pathology in behavioral SP studies (Ball Cooper et al, 2021; Sundar & Bhola, 2022). Alternatively, some Criterion A research has demonstrated that negative affectivity, antagonism, and Criterion A pathology may load onto joint factors (e.g., Zimmermann et al, 2015); thus, this dimension may represent a convergence of negative affectivity/externalizing pathology with interpersonal dysfunction.…”

Identity pathology and mentalization deficits: An attempt to support clinical theory with data.

“…The MASC has been used to assess mentalization in undergraduate students (Ball-Cooper et al, 2021) and several specific clinical groups, including individuals with personality pathology (e.g., Sharp et al, 2011). The MASC may possess stronger ecological validity over other available measures, as the MASC requires mentalization that more closely resembles that which is required in real-life scenarios (Dziobek et al, 2006; Sharp et al, 2011).…”