An Investigation into the Roles of Theory of Mind, Emotion Regulation, and Attachment Styles in Predicting the Traits of Borderline Personality Disorder

  • Hamed Ghiasi PhD Student in Clinical Psychology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Abolalfazl Mohammadi Mail Assistant Professor of Clinical Psychology, Department of Psychiatry, Tehran University of Medical Sciences, Roozbeh Hospital,Tehran, Iran.
  • Pouria Zarrinfar MA in Clinical Psychology, Islamic Azad University, Science and Research Branch, Tehran, Iran.
Attachment Styles, Borderline Personality Disorder, Emotion Regulation, Theory of Mind


Objective: Borderline personality disorder is one of the most complex and prevalent personality disorders. Many variables have so far been studied in relation to this disorder. This study aimed to investigate the role of emotion regulation, attachment styles, and theory of mind in predicting the traits of borderline personality disorder.

Method: In this study, 85 patients with borderline personality disorder were selected using convenience sampling method. To measure the desired variables, the questionnaires of Gross emotion regulation, Collins and Read attachment styles, and Baron Cohen's Reading Mind from Eyes Test were applied. The data were analyzed using multivariate stepwise regression technique.

Results: Emotion regulation, attachment styles, and theory of mind predicted 41.2% of the variance criterion altogether; among which, the shares of emotion regulation, attachment styles and theory of mind to the distribution of the traits of borderline personality disorder were 27.5%, 9.8%, and 3.9%, respectively.‎‎

Conclusion: The results of the study revealed that emotion regulation, attachment styles, and theory of mind are important variables in predicting the traits of borderline personality disorder and that these variables can be well applied for both the treatment and identification of this disorder.


Association AP. Diagnostic and statistical manual of mental disorders, text revision (DSM-5): American Psychiatric Association; 2013.

Blashfield RK, Intoccia V. Growth of the literature on the topic of personality disorders. Am J Psychiatry 2000; 157: 472-473.

Hoffman PD, Fruzzetti AE, Buteau E. Understanding and engaging families: An education, skills and support program for relatives impacted by borderline personality disorder. Journal of Mental Health 2007; 16: 69-82.

Markowitz JC, Bleiberg K, Pessin H, Skodol AE. Adapting interpersonal psychotherapy for borderline personality disorder. Journal of Mental Health 2007; 16: 103-116.

Conklin CZ, Bradley R, Westen D. Affect regulation in borderline personality disorder. J Nerv Ment Dis 2006; 194: 69-77.

Salsman NL, Linehan MM. An investigation of the relationships among negative affect, difficulties in emotion regulation, and features of borderline personality disorder. J Psychopathol Behav Assess 2012; 34: 260-267.

Yen S, Zlotnick C, Costello E. Affect regulation in women with borderline personality disorder traits. J Nerv Ment Dis 2002; 190: 693-696.

Blatt SJ, Auerbach JS, Levy KN. Mental representations in personality development, psychopathology, and the therapeutic process. Review of General Psychology 1997; 1: 351.

Fonagy P, Target M, Gergely G. Attachment and borderline personality disorder. A theory and some evidence. Psychiatr Clin North Am 2000; 23: 103-122.

Gunderson JG. The borderline patient's intolerance of aloneness: insecure attachments and therapist availability. Am J Psychiatry 1996; 153: 752-758.

Yeomans FE, Levy KN. An object relations perspective on borderline personality. Acta Neuropsychiatr 2002; 14: 76-80.

Franzen N, Hagenhoff M, Baer N, Schmidt A, Mier D, Sammer G, et al. Superior 'theory of mind' in borderline personality disorder: an analysis of interaction behavior in a virtual trust game. Psychiatry Res 2011; 187: 224-233.

Sharp C, Pane H, Ha C, Venta A, Patel AB, Sturek J, et al. Theory of mind and emotion regulation difficulties in adolescents with borderline traits. J Am Acad Child Adolesc Psychiatry 2011; 50: 563-573.

Harari H, Shamay-Tsoory SG, Ravid M, Levkovitz Y. Double dissociation between cognitive and affective empathy in borderline personality disorder. Psychiatry Res 2010; 175: 277-279.

McGlashan TH, Grilo CM, Sanislow CA, Ralevski E, Morey LC, Gunderson JG, et al. Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders. Am J Psychiatry 2005; 162: 883-889.

Barnow S, Limberg A, Stopsack M, Spitzer C, Grabe HJ, Freyberger HJ, et al. Dissociation and emotion regulation in borderline personality disorder. Psychol Med 2012; 42: 783-794.

Westen D. Toward an Integrative Model of Affect Regulation: Applications to Social‐Psychological Research. Journal of Personality 1994; 62: 641-667.

Westen D. Cognitive-behavioral interventions in the psychoanalytic psychotherapy of borderline personality disorders. Clinical Psychology Review 1991; 11: 211-230.

Gross JJ, Thompson RA. Emotion regulation: Conceptual foundations. 2007.

Gunderson JG. Disturbed relationships as a phenotype for borderline personality disorder. Am J Psychiatry 2007; 164: 1637-1640.

Frith CD, Singer T. The role of social cognition in decision making. Philos Trans R Soc Lond B Biol Sci 2008; 363: 3875-3886.

Premack D, Woodruff G. Does the chimpanzee have a theory of mind? Behavioral and brain sciences 1978; 1: 515-526.

Ward T, Keenan T, Hudson SM. Understanding cognitive, affective and intimacy deficits in sexual offenders: A developmental perspective. Aggression and Violent behavior 2000; 5: 41-62.

Shamay-Tsoory SG, Harari H, Aharon-Peretz J, Levkovitz Y. The role of the orbitofrontal cortex in affective theory of mind deficits in criminal offenders with psychopathic tendencies. Cortex 2010; 46: 668-677.

Baron-Cohen S, Wheelwright S, Hill J, Raste Y, Plumb I. The "Reading the Mind in the Eyes" Test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. J Child Psychol Psychiatry 2001; 42: 241-251.

Kaland N, Moller-Nielsen A, Callesen K, Mortensen EL, Gottlieb D, Smith L. A new 'advanced' test of theory of mind: evidence from children and adolescents with Asperger syndrome. J Child Psychol Psychiatry 2002; 43: 517-528.

MacDonald K, Berlow R, Thomas ML. Attachment, affective temperament, and personality disorders: a study of their relationships in psychiatric outpatients. J Affect Disord 2013; 151: 932-941.

Bornstein RF, Becker-Matero N, Winarick DJ, Reichman AL. Interpersonal dependency in borderline personality disorder: clinical context and empirical evidence. J Pers Disord 2010; 24: 109-127.

Scott LN, Levy KN, Pincus AL. Adult attachment, personality traits, and borderline personality disorder features in young adults. J Pers Disord 2009; 23: 258-280.

Wei M, Vogel DL, Ku T-Y, Zakalik RA. Adult Attachment, Affect Regulation, Negative Mood, and Interpersonal Problems: The Mediating Roles of Emotional Reactivity and Emotional Cutoff. Journal of counseling psychology 2005; 52: 14.

Kobak RR, Sceery A. Attachment in late adolescence: working models, affect regulation, and representations of self and others. Child Dev 1988; 59: 135-146.

Levy KN. The implications of attachment theory and research for understanding borderline personality disorder. Dev Psychopathol 2005; 17: 959-986.

Shavelson RJ. Statistical reasoning for the behavioral sciences. 1988.

Mahmood aliloo M, Bakhshi poor A, Bafandeh gharamaleki H, Khanjani z, Ranjbar F. Investigation of theory of mind deficits in schizophrenic people with positive and negative symptoms in comparison with healthy people. JOURNAL OF PSYCHOLOGY. 2012;6: 79-96.

nejati V, zabihzadeh a, nikfarjam M, pournaghdali a, naderi z. Correlation between Mindfulness and Mind Reading in the Eye. Zahedan Journal of Research in Medical Sciences. 2012;14: 37-42.

Collins NL, Read SJ. Adult attachment, working models, and relationship quality in dating couples. J Pers Soc Psychol 1990; 58: 644-663.

Pakdaman S. The relationship between attachment and society seeking in young adults. Psychological sciences. 2001; 3: 25-49.

Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol 2003; 85: 348-362.

Mohsen aligh A, Vafaii M. Cross-cultural study of emotional intelligence, emotional regulation processes and psycho-social empowerment between Iranian and Lebanese students Tehran: Tarbiat Modarres University; 2004.

Claridge G, Broks P. Schizotypy and hemisphere function—I: Theoretical considerations and the measurement of schizotypy. Personality and Individual Differences 1984; 5: 633-648.

Mohammadzadeh A, Goodarzi M, Taghavi M, Mollazadeh M. The Study of Factor structure, Validity, reliability and Standardization of borderline personality scale in Shiraz university students. J Fund Ment Heal 2005; 7: 75-89.

Gibbon M, Spitzer RL, First MB. User's guide for the structured clinical interview for DSM-IV axis II personality disorders: SCID-II: American Psychiatric Pub; 1997.

Bakhtiari M. Mental disorders in patients with Body Dysmorphic Disorder. Tehran Iran university of medical science; 2000.

Mohammad Pour Anjrdy A, Mahmoud aliloo M, Ghaffari A. personality disorders cluster "B" and emotional regulation. Contemporary psychology. 2013; 7: 2687-2690.

Gross JJ. Emotion regulation in adulthood: Timing is everything. Current directions in psychological science 2001; 10: 214-219.

Gross JJ. Emotion regulation: affective, cognitive, and social consequences. Psychophysiology 2002; 39: 281-291.

Cheavens JS, Zachary Rosenthal M, Daughters SB, Nowak J, Kosson D, Lynch TR, et al. An analogue investigation of the relationships among perceived parental criticism, negative affect, and borderline personality disorder features: the role of thought suppression. Behav Res Ther 2005; 43: 257-268.

Klonsky ED. The functions of self-injury in young adults who cut themselves: clarifying the evidence for affect-regulation. Psychiatry Res 2009; 166: 260-268.

Rosenthal MZ, Cheavens JS, Lejuez CW, Lynch TR. Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms. Behav Res Ther 2005; 43: 1173-1185.

Roemer L, Borkovec TD. Effects of suppressing thoughts about emotional material. J Abnorm Psychol 1994; 103: 467-474.

Wegner DM, Schneider DJ, Carter SR, 3rd, White TL. Paradoxical effects of thought suppression. J Pers Soc Psychol 1987; 53: 5-13.

Timmerman IG, Emmelkamp PM. The relationship between attachment styles and Cluster B personality disorders in prisoners and forensic inpatients. Int J Law Psychiatry 2006; 29: 48-56.

Nickell AD, Waudby CJ, Trull TJ. Attachment, parental bonding and borderline personality disorder features in young adults. J Pers Disord 2002; 16: 148-159.

Meyer B, Pilkonis PA, Proietti JM, Heape CL, Egan M. Attachment styles and personality disorders as predictors of symptom course. J Pers Disord 2001; 15: 371-389.

Besharat A. Explanation of personality disorders based on attachment theory. Contemporary psychology 2006; 2: 41-49.

Mohammadzadeh A. The Explanation of Schizotypal and Borderline Traits According to Attachment Dimensions and Basic Personality Traits. Iranian Journal of Psychiatry and Clinical Psychology 2013; 18: 322-330.

George C, West M. Developmental vs. social personality models of adult attachment and mental ill health. Br J Med Psychol 1999; 72: 285-303.

ahmadzadeh L, mahmood aliloo M. Theory of mind in people with borderline personality disorder traits among students. Contemporary psychology 2013; 7: 62- 66.

Astington JW. Sometimes necessary, never sufficient: False-belief understanding and social competence. 2003.

Ghafari m, Rezaei A. Relationship between attachment style and identity style with borderline personality disorder of students. Journal of Ilam University of Medical Sciences 2013; 6.

Bowlby J. Attachment (Attachment and loss series, Vol. 1). New York 1969.

Main M, Cassidy J. Categories of response to reunion with the parent at age 6: predictable from infant attachment classifications and stable over a 1-month period. Developmental psychology. 1988; 24: 415-426.

Russell JA. Is there universal recognition of emotion from facial expression? A review of the cross-cultural studies. Psychol Bull 1994; 115: 102-141.

How to Cite
Ghiasi H, Mohammadi A, Zarrinfar P. An Investigation into the Roles of Theory of Mind, Emotion Regulation, and Attachment Styles in Predicting the Traits of Borderline Personality Disorder. Iran J Psychiatry. 11(4):206-213.
Original Article(s)