Systematic Review: The Interplay of Mentalization, Emotion Regulation, Attachment, and Impulsivity in Borderline Personality Disorder

Abstract: Borderline Personality Disorder (BPD) is a complex condition characterized by instability in interpersonal relationships, self-image, affect, and marked impulsivity. Deficits in mentalization, emotion dysregulation, insecure attachment, and heightened impulsivity are considered key etiological factors. This systematic review synthesizes findings from empirical studies to elucidate the relationships between these constructs and BPD features across diverse populations. A systematic search identified eight eligible studies. Results indicate that emotion dysregulation is robustly associated with BPD traits and often mediates the impact of mentalizing deficits on BPD symptomatology and interpersonal problems. Mentalization impairments, manifesting as both hypo- and hypermentalizing, are consistently linked to BPD, with some evidence suggesting developmental differences in their presentation. Insecure attachment styles predict BPD traits and are associated with poorer mentalizing and emotion regulation. Impulsivity, particularly attentional aspects, contributes to BPD-related difficulties. This review highlights the interconnectedness of these domains, underscoring their importance as targets for comprehensive BPD interventions. Keywords: Borderline Personality Disorder, Mentalization, Reflective Functioning, Emotion Dysregulation, Attachment, Impulsivity, Interpersonal Problems, Systematic Review.