The mentalizing approach to the development and treatment of psychopathology has gained momentum in recent years. Mentalizing (or reflective functioning) refers to the human capacity to understand oneself and others in terms of internal mental states and plays a key role in our capacity to navigate our complex and essentially interpersonal world. Temporary or chronic impairments in mentalizing have been identified in a wide array of psychiatric disorder, with different types of mental disorder being associated with different types of imbalances between various dimensions of mentalizing. Borderline personality disorder (BPD), for instance, is characterized by the rapid loss of controlled mentalizing in high-arousal contexts, leading to overreliance on fast, automatic, and biased mentalizing. As a result, these individuals show a tendency to conflate the mental states of self and others (also known as identify diffusion). Here, we summarize our emerging knowledge concerning the neural circuits underlying the self–other distinction, with a focus on impairments in self–other distinction in BPD. Implications for both basic research and intervention research are discussed.

The self–other distinction in psychopathology: Recent developments from a mentalizing perspective

Self-other distinction refers to the ability to distinguish between our own and other people's physical and mental states (actions, perceptions, emotions etc.). Both the right temporo-parietal junction and brain areas associated with the human mirror neuron system are likely to critically influence self-other distinction, given their respective contributions to theory of mind and embodied empathy. The degree of appropriate self-other distinction will vary according to the exact social situation, and how helpful it is to feel into, or remain detached from, another person's mental state. Indeed, the emotional resonance that we can share with others affords the gift of empathy, but over-sharing may pose a downside, leading to a range of difficulties from personal distress to paranoia, and perhaps even motor tics and compulsions. The aim of this perspective paper is to consider how evidence from behavioral and neurophysiological studies supports a role for problems with self-other distinction in a range of psychiatric symptoms spanning the emotional, cognitive and motor domains. The various signs and symptoms associated with problematic self-other distinction comprise both maladaptive and adaptive (compensatory) responses to dysfunction within a common underlying neuropsychological mechanism, compelling the adoption of more holistic transdiagnostic therapeutic approaches within Psychiatry.

The Transdiagnostic Relevance of Self-Other Distinction to Psychiatry Spans Emotional, Cognitive and Motor Domains

Die Borderline-Personlichkeitsstorung (BPS) ist eine schwere psychische Storung, die mit weitreichenden Beeintrachtigungen im Selbst und in interpersonellen Funktionen einhergeht. Nicht zuletzt vor dem Hintergrund der breiten Datenbasis bleibt die BPS als einzige kategoriale Personlichkeitsdiagnose in der International Statistical Classification of Diseases and Related Health Problems (ICD) 11 bestehen, wenn auch gekoppelt an die Feststellung von Schweregraden von Beeintrachtigungen. Wir mussen uns also spatestens mit deren Inkrafttreten 2022 mit einer dimensionalen Konzeptualisierung von Personlichkeitsstorungen auseinandersetzen, welche auch durch neurowissenschaftliche Daten unterstutzt wird. Dieses narrative Review gibt einen Uberblick uber neurowissenschaftliche Erkenntnisse zu Beeintrachtigungen im Selbst und in interpersonellen Funktionen bei Patienten mit BPS. Veranderungen im medialen prafrontalen Kortex, temporoparietalen Ubergang und Pracuneus mediieren Defizite im selbstreferenziellen Denken und Mentalisieren der Gefuhle und Intentionen anderer. Erhohte Konnektivitat zwischen Amygdala und Mittellinienstrukturen sind mit Hypermentalisierung assoziiert, die gleichzeitig erhohte Insulaaktivierung scheint dem verstarkten unreflektierten Teilen von Gefuhlen anderer Menschen zu unterliegen. Frontolimbische Veranderungen sind transdiagnostisch mit defizitarer Emotionsregulation und negativer Affektivitat assoziiert, Veranderungen in Belohnungs- und kognitiven Kontrollregionen mit Impulsivitat. Neurowissenschaftliche Befunde tragen zum besseren Verstandnis zugrunde liegender Mechanismen zentraler Funktionsbeeintrachtigungen der BPS bei und konnen den Ubergang zu ICD-11 und die Implementierung neuer Interventionen unterstutzen.

[Neurobiological principles of borderline personality disorder: integration into the ICD-11 model of personality disorders].

Recent meta-analytic studies of social cognition and the functional imaging of empathy have exposed the overlap between their neural substrates and heteromodal association areas. The 'gradient model' of cortical organization proposes a close relationship between these areas and highly connected hubs in the default mode network, a set of cortical areas deactivated by demanding tasks. Here, we used a decision-making task and representational similarity analysis with classic 'empathy for pain' visual stimuli to probe the relationship between high-level representations of imminent pain in others and the high end of the gradient of this model. High-level representations were found to co-localize with task deactivations or the transitions from activations to deactivations. These loci belonged to two groups: those that loaded on the high end of the principal cortical gradient and were associated by meta-analytic decoding with the default mode network, and those that appeared to accompany functional repurposing of somatosensory cortex in the presence of visual stimuli. In contrast to the nonspecific meta-analytic decoding of these loci, low-level representations, such as those of body parts involved in pain or of pain itself, were decoded with matching topics terms. These findings suggest that that task deactivations may set out cortical areas that host high-level representations, but whose functional characterization in terms of simple mappings is unlikely. We anticipate that an increased understanding of the cortical correlates of high-level representations may improve neurobiological models of social interactions and psychopathology.

https://biorxiv.org/content/10.1101/2021.11.28.470235v1.full.pdf

The gradient model of brain organization in decisions involving 'empathy for pain'

Abstract Influential models of cortical organization propose a close relationship between heteromodal association areas and highly connected hubs in the default mode network. The “gradient model” of cortical organization proposes a close relationship between these areas and highly connected hubs in the default mode network, a set of cortical areas deactivated by demanding tasks. Here, we used a decision-making task and representational similarity analysis with classic “empathy for pain” stimuli to probe the relationship between high-level representations of imminent pain in others and these areas. High-level representations were colocalized with task deactivations or the transitions from activations to deactivations. These loci belonged to 2 groups: those that loaded on the high end of the principal cortical gradient and were associated by meta-analytic decoding with the default mode network, and those that appeared to accompany functional repurposing of somatosensory cortex in the presence of visual stimuli. These findings suggest that task deactivations may set out cortical areas that host high-level representations. We anticipate that an increased understanding of the cortical correlates of high-level representations may improve neurobiological models of social interactions and psychopathology. 

The gradient model of brain organization in decisions involving “empathy for pain”

Mirror neuron activations in encoding of psychic pain in borderline personality disorder

BACKGROUND Increasing recognition is being given to the importance of cognitions observed in posttraumatic conditions. These cognitions may reflect the activation of negative schemas. The aim of this work was to evaluate the feasibility of the scrambled-sentences task (SST) to assess individual differences in attributions commonly observed after traumas. Originally developed to assess the tendency to activate negative cognitions in individuals predisposed to depression, the SST is a laboratory task the outcome of which has been shown to predict depression relapse and is associated with depressiveness. SAMPLING AND METHODS We used content from self-rating scales for assessment of the activation of trauma-related schemas to develop a trauma-related SST and evaluated its performance in a behavioral study (n = 43) and a functional neuroimaging study (n = 20). RESULTS In the healthy sample in which we tested it, the trauma-related SST was strongly associated with individual differences in negative affect (scores in depressiveness and neuroticism scales) as well as with the scores on trauma-related cognition scales. However, we failed to detect a clear specificity of trauma-related cognitions in correlations with scores on the trauma-related scales in the healthy participants. The neuroimaging data demonstrated activation of a ventral network of areas that included the perisylvian/temporal cortex and the peri-cingular cortex in handling trauma-related relative to neutral material, replicating previous neuroimaging studies of the SST. CONCLUSION The shattered-assumptions SST demonstrated strong associations with individual differences in all of the rating scales used in the study, suggesting its usefulness in capturing aspects of affective psychopathology. The neuroimaging study confirmed the capacity of this task to elicit specific activations. In future studies, evaluation of the conditions in which these neural substrates are active may shed light on the mechanism of schema selection.

Adaptation of the Scrambled-Sentences Task to Assess "Shattered Assumptions:" Construction of the Test and Investigation of Neural Substrates in an fMRI Study.

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Mirror neuron activations in encoding of psychic pain in borderline personality disorder

Adaptation of the Scrambled-Sentences Task to Assess "Shattered Assumptions:" Construction of the Test and Investigation of Neural Substrates in an fMRI Study.