Comparison of reflective functioning as measured on the adult attachment interview and the object relations inventory in patients with a personality disorder: a preliminary study

Minding mentalizing - convergent validity of the Mentalization Breakdown Interview

Objectives

Mentalizing difficulties are central to borderline personality disorder (BPD), have severe consequences, and are an explicit focus in mentalization-based treatment. The significance of mentalizing capacity as a predictor or mediator of change is however still uncertain due to a scarcity of research. The Mentalization Breakdown Interview (MBI) was developed as a time saving tool for studying psychotherapy processes and outcome in borderline pathology. This study aimed to investigate the convergent validity of reflective functioning (RF) ratings based on the MBI (MBI-RF) by a comparison with the gold standard, i.e., RF assessments based on the Adult Attachment Interview (AAI-RF). A secondary aim was to investigate how MBI-RF relates to core symptoms of BPD, levels of functional impairment and symptom distress compared with AAI-RF.

Method

Forty-five patients with BPD or significant BPD traits were included. MBI-RF and AAI-RF were rated using the Reflective Functioning Scale. Levels of MBI-RF and AAI-RF and the correlation between the measures were calculated, as well as their associations with the Difficulties in Emotion Regulation Scale, Levels of Personality Functioning-Brief Form 2.0, Work and Social Adjustment Scale, Patient Health Questionnaire, Depression, Generalized Anxiety Disorder-7, self-harm, suicide attempts, and PD diagnostics.

Results

The correlation between MBI-RF and AAI-RF was 0.79 (p<0.01), indicating high convergent validity. There were few significant associations between MBI-RF and AAI-RF and clinical measures.

Conclusions

The study provides support for the convergent validity of the MBI as a BPD-focused RF assessment method. The MBI has the potential as a time saving, reliable and valid method to be applied in treatment research on patients with borderline pathology. The results indicate that measures of MBI-RF and AAI-RF are different from clinical symptoms.

Clinical trial registration

ClinicalTrials.gov ID NCT04157907.

A borderline focused Reflective Functioning measure - Interrater reliability of the Mentalization Breakdown Interview

OBJECTIVE

Mentalizing difficulties can be considered the core psychopathology of borderline personality disorder (BPD). Typical failures of mentalizing are targets in therapy for BPD. They are related to severe distress, relational problems, self-destructive behaviors, violence, or substance misuse. A major obstacle in BPD treatment research is the lack of suitable and easily administrated methods to assess mentalizing ability during treatment. The Mentalization Breakdown Interview (MBI) is a new method for capturing episodic mentalizing difficulties occurring in close relationships. Interviews are videotaped and scored in accordance with the Reflective Functioning Scale (MBI-RF). In this way the patients' ability to retrospectively reflect over such episodes are evaluated. This study investigates the interrater reliability of MBI-RF.

METHODS

The study includes videotapes of MBIs from 32 patients with BPD in an outpatient clinic specialized on mentalization-based treatment (MBT). The MBIs were performed by MBT therapists. Three certified raters scored MBI-RF.

RESULTS

The interrater reliability was good for MBI-RF.

CONCLUSIONS

The MBI is promising as a BPD-focused method for the assessment of Reflective Functioning.

A psychoanalytically informed hospitalization-based treatment of personality disorders

This study presents a model of psychic change in personality disorders focusing on three dimensions: felt safety, mentalization and self-object relations. Based upon this model a hospitalization-based therapy program was created. Four scales to measure these three dimensions on the Object Relation Interview are discussed: the Felt Safety Scale, the Reflective Functioning Scale and the Bion Grid Scale and the Differentiation-Relatedness Scale. A naturalistic symptom outcome study of the program showed a large effect on both symptoms and personality functioning. Furthermore, trajectory based on pre-treatment patient characteristics (i.e., anaclitic versus introjective personality styles). Importantly, we also found a relation between symptomatic and personality change and change in felt safety and object relations. At 5-year follow-up, patients showed sustained improvement in symptomatic distress and further improvement in terms of personality and interpersonal functioning.