Understanding Attachment and Borderline Personality Disorder

Understanding Attachment and Borderline Personality Disorder

This article by Peter Fonagy discusses the link between attachment, mentalization, and Borderline Personality Disorder (BPD). Fonagy’s primary focus is on the concept of mentalization, which is the ability to understand the mental states of oneself and others.

Mentalization and Attachment

Mentalization, or better mentalizing, is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes. Mentalization, or reflective function, is crucial for understanding behaviour in terms of thoughts and feelings. Fonagy argues that caregivers who are good at mentalization help their children develop secure attachments, which in turn fosters the child’s ability to mentalize. This secure attachment allows children to explore their caregiver’s mind, learning about mental states and forming a strong sense of self.

Impact of Trauma on Mentalization

Fonagy suggests that early trauma can severely impact an individual’s ability to mentalize. Children who experience abuse may inhibit their mentalization skills to avoid thinking about their caregiver’s harmful intentions. This defensive inhibition can lead to developmental issues and contribute to severe symptoms of BPD.

Research Findings

Fonagy’s research indicates that caregivers with high mentalization abilities are more likely to have securely attached children. This is especially true in cases where the caregiver or child has faced significant adversity. The studies show that secure attachment and good mentalization skills are interlinked and crucial for the child’s emotional development.

Understanding Attachment and Borderline Personality Disorder

Borderline Personality Disorder and Mentalization Deficits

Fonagy explores the idea that BPD may stem from a disruption in mentalization, often due to childhood trauma. Individuals with BPD might struggle with understanding and interpreting their own and others’ mental states, leading to difficulties in relationships and emotional regulation. This can manifest as impulsivity, emotional instability, and a fragmented sense of self.

Therapeutic Implications

Fonagy emphasizes the importance of psychoanalytic therapy in improving mentalization skills. Effective therapy should establish a secure attachment between the patient and therapist, helping the patient understand their own and others’ mental states. This process can strengthen the patient’s self-awareness and emotional regulation, addressing core issues in BPD.


Fonagy’s work highlights the critical role of attachment and mentalization in emotional development and mental health. Understanding and enhancing mentalization skills can provide significant therapeutic benefits for individuals with BPD, offering a pathway to better emotional stability and healthier relationships.

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