Mentalization difficulties in behavioral addictions: a scoping review

Background: Patients with addictive disorders often suffer from difficulties with affect, emotion regulation and mentalization. Mentalization is defined as the capacity to understand one’s own and others’ behaviors in terms of intentional mental states such as thoughts, feelings, needs, desires, and motivations, and the ability to mentalize has been described as vital for affect regulation. Mentalization difficulties have been described in several mental disorders including borderline personality disorder, eating disorders, depressive and anxiety disorders. Less is known in the case of behavioral addictions. The aim of the present scoping review was to map existing research of the potential link between behavioral addictions and mentalization difficulties as well as to identify gaps in the research. Methods: The search was conducted in three electronic databases and those studies that met the inclusion criteria were retrieved. Results: Most of the studies were conducted among patients with gambling disorder and to a lesser extent among patients with food addiction, gaming disorder and internet addiction. Mentalization impairments were associated with greater severity of the disorder. Specific impairments in mentalizing such as hypomentalization and hypermentalization were found to be particularly present in patients with behavioral addictions and to explain some of the core symptoms of the disorder. Mentalization difficulties in other behavioral addictions such as sexual addiction and shopping addiction have been barely studied. Conclusions: Subjects with behavioral addictions show relevant difficulties in mentalization and mentalization-based therapy constitutes a promising treatment for this group of disorders. Further research is needed to better understand how mentalization difficulties occur, the profile of patients most affected with these difficulties and to establish the efficacy and benefits of mentalization-based treatment for behavioral addictions.