Reframing Obsessive–Compulsive Disorder Through the Lens of Mentalization: A Narrative Review of Mentalization-Based Psychotherapy

Abstract

Historically, Obsessive-Compulsive Disorder (OCD) has been analyzed through behavioural and cognitive-behavioural paradigms. These frameworks focus on learning that doesn’t work, beliefs that don’t work, and compulsive avoidance. Even though Exposure and Response Prevention (ERP) is still the best treatment, many patients only respond partially, have lingering symptoms, or have a relapse. Recent studies suggest that people with OCD may have trouble understanding their own and other people’s behaviour in terms of mental states. This may lead to obsessive doubt, intolerance of uncertainty, rigid moral reasoning, and inability to clearly distinguish one’s own physical, emotional, and mental states from those of others. Mentalization-Based Psychotherapy (MBP), initially developed for borderline personality disorder, provides a relational and metacognitive framework that may address fundamental mechanisms of obsessive-compulsive pathology. Unlike ERP, MBP specifically aim to improve patients’ ability to comprehend and reflect on their own and others’ mental states, potentially diminishing obsessive doubt and fortifying healthy self-boundary setting. This narrative examination looks at both old and recent studies on how MBP principles might be used to treat OCD and how mentalisation works. We define the notion of mentalisation, outline relevant evaluation tools and emerging therapy protocols, and compare MBP with ERP. Finally, we discuss how this can be applied in medicine, its limitations, and the potential future research directions. Reconceptualising OCD within a mentalisation framework may enhance current therapy and foster psychological flexibility and interpersonal relationships.