The relative strength of the relationship between hypermentalizing and borderline personality disorder in the context of other disorders: A meta-analytic review

A hypermentalizing deficit, or a tendency to over attribute mental states to others, has been identified for Borderline Personality Disorder (BPD). However, associations between other disorders and hypermentalizing call the specificity of this deficit to BPD into question. The aims of the current study were to use meta-analytic methods to 1) evaluate the relative strength of the hypermentalizing deficit associated with BPD in the context of other disorders, and 2) assess the impact of moderators on the relationship between hypermentalizing and psychopathology. The Movie for the Assessment of Social Cognition (MASC), an ecologically valid experimental task, was used as the measure of hypermentalizing. Meta-analyses and moderator analyses were performed with 10 studies (n = 1,471) investigating the relationship between BPD and hypermentalizing and 30 studies (n = 3,339) investigating the relationship between non-BPD psychopathology and hypermentalizing. Results indicate that the extant literature does not support the specificity of hypermentalizing to BPD as defined by a significantly stronger association for BPD (r = 0.26; 95% CI = [0.12, 0.39]) than for non-BPD psychopathology (r = 0.22; 95% CI = [0.11, 0.31]). However, overlap between BPD and the general factors of psychopathology and personality pathology indicates the possibility that the association between non-BPD psychopathology and hypermentalizing may be explained by this overlap; BPD features present in other psychopathology may be behind the association, even if the construct of BPD is completely subsumed by the general factors. Additionally, age significantly moderated the association between non-BPD psychopathology and hypermentalizing, while percent female moderated the association between BPD and hypermentalizing. Concerns regarding lack of race reporting, predominately Caucasian samples, and the MASC’s potential bias against non-Caucasian individuals limit the generalizability of current results to non-Caucasian racial groups.