DSM-5 Personality Dysfunction in a mentalization perspective: the interplay among personality dysfunction, emotion dysregulation and mentalization ability in a sample of Italian community dwelling-adults

Background: Mentalization represents the ability to interpret one’s own and others’ behaviours in terms of intentional mental states. Previous studies have suggested that impairments in mentalization are associated with personality pathology. The aim of our study was to examine the relationships between mentalization and DSM-5 Alternative Model of Personality Disorder Criterion A in a sample of community dwelling adults. Furthermore, since mentalization and personality dysfunction are associated with emotion dysregulation, we aimed to explore the interconnections among these three constructs. Methodology: In a sample of 1225 Italian community dwelling adults and in a sub-sample of 97 participants we evaluated mentalizing ability and personality dysfunction. We relied on two methods that map different mentalization aspects: (a) in the whole sample, we used a self-report questionnaire (Reflective Functioning Questionnaire), and (b) in a sub-sample, we administered a performance test (Movie for the Assessment of Social Cognition). Moreover, in the whole sample, we explored the mediating role of emotion dysregulation on the association between mentalization and personality dysfunction. Results: The results suggested that uncertainty about mental states was a significant predictor of self and interpersonal personality impairment. Considering the sub-sample, interpersonal dysfunction was associated with a mentalization deficit characterized by hypermentalization, hypomentalization and lack of mentalistic abilities. In the whole sample we found that mentalization deficits might affect personality dysfunction via their effect on emotion regulation. Conclusion: Our findings showed that failures in mentalizing can leave an individual vulnerable to personality impairment and support Zettl et al. (2020) work showing that all the dimensions of personality impairment are associated with mentalistic abilities. Moreover, in line with both theoretical and empirical literature, the mediation analyses results could promote the comprehension of the interplay among mentalization, emotion dysregulation and interpersonal dysfunction supporting the psychotherapeutic model that considered these constructs as targets of psychotherapy.