Comparative Meta-Analysis of Self-Punishment in Patients with Major Depressive Disorder (MDD) and Borderline Personality Disorder (BPD): The Role of Divergent Mentalization Capacities

This comprehensive meta-analysis delves into the comparative prevalence and nature of self-punishment in individuals diagnosed with Major Depressive Disorder (MDD) and Borderline Personality Disorder (BPD), with a critical focus on the differential roles of mentalization capacities. Self-punishment, encompassing behaviors such as non-suicidal self-injury (NSSI), self-mutilation, and severe self-criticism, represents a maladaptive coping mechanism frequently observed across both diagnostic categories. However, emerging research suggests that the underlying cognitive and affective pathways, particularly those related to mentalization—the fundamental human capacity to understand oneself and others in terms of intentional mental states—may diverge significantly between MDD and BPD. A rigorous systematic search was conducted across prominent academic databases, including Google Scholar, PubMed, and relevant Iranian scientific platforms (e.g., SID, Magiran), targeting peer-reviewed studies published between January ۲۰۲۰ and December ۲۰۲۵. The synthesis integrated data from ۱۰ meticulously selected primary studies, involving a total of ۹۱۶ participants. The findings unequivocally demonstrate that while both MDD and BPD patient groups exhibit markedly elevated levels of self-punishment compared to neurotypical controls, patients with BPD consistently present with significantly higher magnitudes of self-punishing behaviors (Hedges’ g = ۱.۸۴, ۹۵% CI: ۱.۶۲–۲.۰۶) and more pronounced impairments in mentalization (Hedges’ g = -۱.۶۲, ۹۵% CI: -۱.۸۵–-۱.۳۹) when directly compared to individuals with MDD. A nuanced analysis further reveals that BPD is predominantly characterized by hypermentalization, an excessive and often distorted interpretation of social cues and others’ mental states, leading to misattributions and paranoia. Conversely, MDD is more frequently associated with hypomentalization, a diminished capacity to process and reflect upon mental states, particularly in emotionally charged contexts. These divergent mentalization profiles offer crucial insights into the distinct psychopathological underpinnings of self-punishment in these disorders and strongly advocate for the implementation of mentalization-based therapeutic interventions specifically tailored to address these unique cognitive-affective vulnerabilities.

کلیدواژه ها:

Self-punishment ، Mentalization ، Major Depressive Disorder ، Borderline Personality Disorder ، Meta-analysis ، Hypermentalization ، Hypomentalization ، Non-suicidal self-injury (NSSI) ، Emotion regulation ، Affective neuroscience