Cited by 754Personality Disorders and PsychopathologyPersonality Traits and PsychologyPsychoanalysis and Psychopathology Research

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Development and Validation of a Self-Report Measure of Mentalizing: The Reflective Functioning Questionnaire

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Fonagy, Peter, Luyten, Patrick, Moulton-Perkins, Alesia, Lee, Ya-Wen, Warren, Fiona, Howard, Susan, Ghinai, Rosanna, Fearon, Pasco, Lowyck, Benedicte·2016·PLOS ONE

DOI 10.1371/journal.pone.0158678PMC PMC4938585

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Abstract

Reflective functioning or mentalizing is the capacity to interpret both the self and others in terms of internal mental states such as feelings, wishes, goals, desires, and attitudes. This paper is part of a series of papers outlining the development and psychometric features of a new self-report measure, the Reflective Functioning Questionnaire (RFQ), designed to provide an easy to administer self-report measure of mentalizing. We describe the development and initial validation of the RFQ in three studies. Study 1 focuses on the development of the RFQ, its factor structure and construct validity in a sample of patients with Borderline Personality Disorder (BPD) and Eating Disorder (ED) (n = 108) and normal controls (n = 295). Study 2 aims to replicate these findings in a fresh sample of 129 patients with personality disorder and 281 normal controls. Study 3 addresses the relationship between the RFQ, parental reflective functioning and infant attachment status as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. In both Study 1 and 2, confirmatory factor analyses yielded two factors assessing Certainty (RFQ_C) and Uncertainty (RFQ_U) about the mental states of self and others. These two factors were relatively distinct, invariant across clinical and non-clinical samples, had satisfactory internal consistency and test-retest stability, and were largely unrelated to demographic features. The scales discriminated between patients and controls, and were significantly and in theoretically predicted ways correlated with measures of empathy, mindfulness and perspective-taking, and with both self-reported and clinician-reported measures of borderline personality features and other indices of maladaptive personality functioning. Furthermore, the RFQ scales were associated with levels of parental reflective functioning, which in turn predicted infant attachment status in the SSP. Overall, this study lends preliminary support for the RFQ as a screening measure of reflective functioning. Further research is needed, however, to investigate in more detail the psychometric qualities of the RFQ.

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Self-citation
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Background
Machine learning detects predictors of symptom severity and impulsivity after dialectical behavior therapy skills training group in borderline personality disorder
Jiménez, S. E., Ángeles-Valdéz, D., Rodríguez-Delgado, A., Fresán, A., Miranda, E., Alcalá‐Lozano, R., Duque-Alarcón, X., de Montis, I. A., & Garza‐Villarreal, E. A. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.03.063 · Cited by 9
Reliability and validity of the Chinese version of the Mentalization Scale in the general population and patients with schizophrenia: A multicenter study in China
Wen, Y., Fang, W., Wang, Y., Du, J., Dong, Y., Zu, X., Wang, H., Zhu, C., Zhang, L., & Wang, K. (2022) · Current Psychology · doi:10.1007/s12144-022-04093-9 · Cited by 12
“The Reflective Functioning Questionnaire (RFQ) (Badoud et al., 2015; Fonagy et al., 2016; Morandotti et al., 2018) demonstrated good internal consistency coefficients in both clinical and non-clinical samples.”
Method
Mentalizing in individuals with state and trait risk for psychosis: a systematic review
Salve, F. D., Rossi, C., & Oasi, O. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1214385 · Cited by 9
To be a freshman during the COVID‐19 pandemic: A cross‐lagged model of depression, mentalizing, and epistemic trust
Coninck, D. D., Matthijs, K., Bavel, J. V., & Luyten, P. (2023) · Personality and Mental Health · doi:10.1002/pmh.1598 · Cited by 9
“We used the validated Dutch version of the Reflective Functioning Questionnaire (RFQ) (range: 1 = strongly disagree to 7 = strongly agree) to assess impairments in mentalizing (Badoud et al., 2015; Fonagy et al., 2016).”
Self-citation
Brief early adolescent multi-family therapy (BEAM) trial for anorexia nervosa: a feasibility randomized controlled trial protocol
Baudinet, J., Eisler, I., Simic, M., & Schmidt, U. H. (2021) · Journal of Eating Disorders · doi:10.1186/s40337-021-00426-4 · Cited by 13
“It has been shown to be a valid measure of mentalizing capacity [64].”
BackgroundMethodInfluential
Mentalizing in Adolescents With and Without Prominent Borderline Features: Validation of the Reflective Functioning Questionnaire for Youths (RFQY) and an Investigation of the Factor Structure of Hypo- and Hypermentalizing
Lund, S. H., Bo, S., Bach, B., Jørgensen, M. S., & Simonsen, E. H. (2022) · Journal of Personality Assessment · doi:10.1080/00223891.2022.2055474 · Cited by 14
“Fonagy et al. (2016) did not find sufficient evidence for the construct validity of either polar or median-scored scales on the RFQ.”
BackgroundMethodResultInfluential
Understanding Children’s Emotions: Differences in Mothers With a History of Childhood Maltreatment
Milan, S., Carlone, C., Printz, D. M. B., & Perez, S. D. (2020) · Child Maltreatment · doi:10.1177/1077559520972188 · Cited by 11
“General reflective functioning (RFQ; Fonagy et al., 2016).”
BackgroundMethodInfluential
Who Posts Selfies and Why?: Personality, Attachment Style, and Mentalization as Predictors of Selfie Posting on Social Media
Adler, N. L. (2017) · CUNY Academic Works (City University of New York) · Cited by 9
Mindfulness-based stress reduction adapted to pregnant women with psychosocial vulnerabilities—a protocol for a randomized feasibility study in a Danish hospital-based outpatient setting
Skovbjerg, S., Birk, D., Bruggisser, S., Wolf, A. L. A., & Fjorback, L. (2021) · Pilot and Feasibility Studies · doi:10.1186/s40814-021-00860-w · Cited by 8
“periences as well as those of the child [34].”
Background
Capturing a mentalized moment: A pilot study of the psychometric properties of a novel assessment method of mentalizing in daily life
Steinberg, N., Moshe-Cohen, R., Sheena, L., & Kivity, Y. (2024) · Current Psychology · doi:10.1007/s12144-023-04963-w · Cited by 8
“To our knowledge, ours is one of the few studies that have examined the relation between self-reported and non-self-reported measures of mentalizing, and previous find - ings show that they do not tend to correlate (Fonagy et al., 2016; Müller et al., 2023).”
Single-session Mentalization-based Treatment Group for Law Enforcement Officers
Drozek, R. P., Bateman, A., Henry, J., Connery, H., Smith, G. W., & Tester, R. D. (2021) · International journal of group psychotherapy · doi:10.1080/00207284.2021.1922083 · Cited by 7
Does clinical training improve mentalization skills in future therapists? A comparison of first and last year students of clinical psychology and of engineering
Fagerbakk, S. A., Sørhøy, S. H., Nilsen, T., & Laugen, N. J. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1066154 · Cited by 9
“However, it has some problems with internal consistency, its validity can be questioned as it seems to only assess some of the aspects of mentalization, and it is argued that it can only capture hypomentalizing but not likely the maladaptive forms of hypermentalizing (Fonagy et al., 2016; Dimitrijević et al., 2018; Mü…”
Background
Childhood Trauma and Its Link to Adult Dissociation: The Role of Mentalizing and Disorganized Attachment in a Chinese Adult Sample
Li, A., Wang, S., Paetzold, R. L., Rholes, W. S., & Liu, X. (2023) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2023.2195395 · Cited by 9
“The Chinese version of the twelve item Reflective Functioning Questionnaire (Fonagy et al., 2016; Xu, 2018) measured people’s reflective functioning.”
BackgroundInfluential
Failure in reflective functioning as a key factor in the association between problematic social networking sites use, attachment and childhood maltreatment: A network analysis approach on gender differences
Bassi, G., Mancinelli, E., Salcuni, S., Gori, A., & Musetti, A. (2023) · Development and Psychopathology · doi:10.1017/s0954579423001268 · Cited by 8
“The RFQ_U items has been rescored in order to indicate high scores of uncertainties about mental states, which could reflect hypomen-talization (Fonagy et al., 2016).”
Background
Dimensional model of adolescent personality pathology, reflective functioning, and emotional maltreatment
Ensink, K., Deschênes, M., Bégin, M., Cimon, L., Gosselin, T., Wais, M., Normandin, L., & Fonagy, P. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1302137 · Cited by 9
Self-citation
Offline and online parental mentalizing in mothers with symptoms of postpartum depression: Examining the association between self‐reported parental reflective functioning and interactional mind‐mindedness
Wendelboe, K. I., Stuart, A. C., Smith‐Nielsen, J., Linkhorst, T. B., & Væver, M. S. (2024) · Infant Mental Health Journal · doi:10.1002/imhj.22109 · Cited by 8
Construct Validity and Measurement Invariance of the Difficulties in Emotion Regulation Scale - Short Form (DERS-SF): Further Evidence From Community and Student Samples
Asgarizadeh, A., Mazidi, M., Preece, D., & Dehghani, M. (2024) · Journal of Personality Assessment · doi:10.1080/00223891.2024.2340506 · Cited by 9
Developmental couple therapy for complex trauma: Results of an implementation pilot study.
MacIntosh, H. B. (2024) · Journal of Marital & Family Therapy · doi:10.1111/jmft.12711 · Cited by 6
Mechanism-based modular psychotherapy versus cognitive behavioural therapy for adolescents and young adults with childhood trauma experiences: study protocol for a feasibility trial within the German Center for Mental Health
Seitz, K. I., Schouler, N., Hundertmark, J., Wilhelm, M., Franz, S., Bauer, S., Taubner, S., Korn, C. W., Haun, M. W., Ditzen, B., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-090476 · Cited by 9
The mediation effect of mentalization in the relationship between attachment and aggression on the road
Herrero‐Fernández, D., Parada‐Fernández, P., Arcos, I. R., Amaya-Carrillo, L., González-Sáez, M. E., & González, M. R. (2022) · Transportation Research Part F Traffic Psychology and Behaviour · doi:10.1016/j.trf.2022.03.009 · Cited by 8
Hormonal and behavioral responses to an infant simulator in women with and without children
Sinisalo, H., Bakermans‐Kranenburg, M. J., & Peltola, M. J. (2022) · Developmental Psychobiology · doi:10.1002/dev.22321 · Cited by 11
“The questionnaire also included items assessing depressive symptoms (CES-D; Radloff, 1977), anxiety (STAI; Bieling et al., 1998), relationship satisfaction (CSI; Funk&Rogge, 2007), and reflective functioning (RFQ; Fonagy et al., 2016).”
Method
Deployment-related PTSD symptomatology and social functioning: Probing the mediating roles of emotion regulation and mentalization in an outpatient veteran sample
Janssen, P. G. J., Stoltz, S. E. M. J., Cillessen, A. H. N., & van Ee, E. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.10.050 · Cited by 8
Mentalising and depression: a mini-review on behavior, neural substrates, and treatment options
Langenbach, B. P., Koelkebeck, K., & Knoch, D. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1116306 · Cited by 9
Observer-based and computerized measures of the patient’s mentalization in psychotherapy: A scoping review
Hüwe, L., Laser, L., & Andreas, S. (2023) · Psychotherapy Research · doi:10.1080/10503307.2023.2226812 · Cited by 8
“Among these are the Mentalization Questionnaire (MZQ; Hausberg et al., 2012), the Reflective Functioning Questionnaire (Fonagy et al., 2016) and the Mentalization Scale (Dimitri-jevic ́ et al., 2018), as well as the newly developed Certainty About Mental States Questionnaire (Müller et al., 2021)…”
Background
Childhood adversity and adolescent acting-out behaviors: the mediating role of mentalizing difficulties and epistemic vigilance
Malcorps, S., Vliegen, N., & Luyten, P. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-023-02302-9 · Cited by 15
Self-citation
A short version of the reflective functioning questionnaire: Validation in a greek sample
Karagiannopoulou, E., Milienos, F. S., Desatnik, A., Rentzios, C., Athanasopoulos, V., & Fonagy, P. (2024) · PLoS ONE · doi:10.1371/journal.pone.0298023 · Cited by 7
Self-citation
Detecting recollection: Human evaluators can successfully assess the veracity of others’ memories
Gamoran, A., Gilead, M., Gilead, M., Dobbins, I. G., & Sadeh, T. (2023) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2310979121 · Cited by 10
“Mentalizing abilities differ between individuals, with some individuals more adept at inferring mental states than others (30–32).”
The Emotional Personality of Psychotherapists: A Pilot Research with Gestalt-Therapy Clinicians
Alcaro, A., Isidoro, S. I., Conversi, D., Accoto, A., & Lobb, M. S. (2020) · Psychology · doi:10.4236/psych.2020.1111103 · Cited by 8
Common factors, Responsiveness and Outcome in Psychotherapy (CROP): study protocol for a naturalistic prospective cohort study of psychotherapy in Denmark
Lauritzen, L. R., Jacobsen, C. F., Nielsen, J., Lunn, S., Mathiesen, B. B., Falkenström, F., & Poulsen, S. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-072277 · Cited by 8
Eating Disorders, Impaired Mentalization, and Attachment: Implications for Child and Adolescent Family Treatment
Kelton-Locke, S. (2016) · Journal of Infant Child and Adolescent Psychotherapy · doi:10.1080/15289168.2016.1257239 · Cited by 8
“The measure was validated in three studies and shown to correlate with measures of empathy and perspective-taking (Fonagy et al., 2016).”
Result
Oriented mentalization-based treatment for borderline personality disorder patients: preliminary results at Camposampiero Mental Health Center
Carrera, S., Pandolfi, G., Cappelletti, J. Y., Padoani, W., & Salcuni, S. (2018) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2018.336 · Cited by 7
“RFQ rated at T0 and T1 enlightened a significant improvement of the Certain Mentalization (M=1.08, sd=1.53, and M=.33, sd=.47, respectively), and conversely an impoverishment of Uncertain Mentalization (M=.83, sd=1.18 and M=1.92, sd=.59, respectively).”
BackgroundInfluential
Versión Española del Cuestionario de Función Reflexiva Parental (CFRP-18)
Gordo, L., Elejalde, L. I., & Martínez‐Pampliega, A. (2020) · Revista Iberoamericana de Diagnóstico y Evaluación - e Avaliação Psicológica · doi:10.21865/ridep55.2.01 · Cited by 12
“Con el objetivo de poder superar esta limitación, uno de los objetivos de la investigación reciente ha sido crear instrumentos de autoinfome que evaluaran el funcionamiento reflexivo parental (Fonagy et al., 2016; Luyten, Fonagy, Lowyck, & Vermote, 2012).”
Background
Metacognitive training for negative symptoms: Support for the cognitive model
Swanson, L., GRIFFITHS, H. M., Moritz, S., & Červenka, S. (2022) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2809 · Cited by 7
“The treatment effect was hypothesized to be mediated by less stigma (as measured by the Personal Belief about Illness Questionnaire (PBIQ); Birchwood et al., 1993) and increased reflective ability (as measured by the Reflective Function Questionnaire (RFQ); Fonagy et al., 2016).”
Effectiveness of the mentalisation‐based serious game ‘You & I’ for adults with mild to borderline intellectual disabilities: A randomised controlled trial
Derks, S. D. M., Willemen, A. M., Wouda, M., & Sterkenburg, P. S. (2023) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.13170 · Cited by 7
The development of the Epistemic Trust Rating System (ETRS)
Fisher, S., Guralnik, T., Fonagy, P., & Zilcha‐Mano, S. (2024) · Psychotherapy Research · doi:10.1080/10503307.2023.2299213 · Cited by 10
“By leveraging this rating approach, we stand to access layers of understanding that may elude self-reporting, thus fostering a more subtle and holistic grasp of their patients’ experiences (Fonagy et al., 2016).”
Self-citation
Study development and protocol for a cohort study examining the impact of baseline social cognition on response to treatment for people living with post-traumatic stress disorder
Wiseman, C. E., Lawrence, A. D., Bisson, J. I., Hotham, J., Karl, A., & Zammit, S. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008198.2022.2093036 · Cited by 10
“low that produces certain and uncertain reflective functioning scores (Fonagy et al., 2016).”
BackgroundMethodInfluential
Clinical predictors and psychosocial risk factors of suicide attempt severity
González–Ortega, I., Díaz‐Marsá, M., López-Peña, P., Fernández-Sevillano, J., Andreo-Jover, J., Bobes, J., Bravo‐Ortiz, M. F., Cebrià, A. I., Crespo‐Facorro, B., de la Torre‐Luque, A., et al. (2023) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.sjpmh.2023.07.002 · Cited by 7
Total Pain and Fear of Recurrence in Post-Treatment Cancer Patients: Serial Mediation of Psychological Flexibility and Mentalization and Gender Moderation
Krok, D., Telka, E., Falewicz, A., & Szczęśniak, M. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13071974 · Cited by 6
“The Reflective Functioning Questionnaire (RFQ) is an eight-item scale measuring mentalization, which is understood as the capacity to perceive and interpret a person’s own and others’ behavior in terms of intentionally motivated states (e.g., “People’s thoughts are a mystery to me”) [46].”
Background
Mentalization based treatment for a broad range of personality disorders: a naturalistic study
Rizzi, E., Weijers, J. G., ten Kate, C., & Selten, J. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05865-2 · Cited by 9
Linking mentalizing capacity, shame, and depressive symptoms in the context of childhood maltreatment
Schwarzer, N.-H., Nolte, T., Fonagy, P., Feigenbaum, J., King‐Casas, B., Rüfenacht, E., Gingelmaier, S., Leibowitz, J., Pilling, S., & Montague, P. R. (2024) · Children and Youth Services Review · doi:10.1016/j.childyouth.2024.107787 · Cited by 8
Self-citation
Borderline personality disorder is an innate empathy anomaly: a scoping and narrative review
Hayward, D., MacIntyre, D. J., & Steele, J. D. (2024) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2024.2420662 · Cited by 9
“…empathetic ability in people with BPD came to the same conclusion: For example, ‘impaired reflective functioning (difficulty understanding human behaviour in terms of the underlying mental state; a cognitive empathy impairment) is a consistent and robust feature of BPD’ (Fonagy et al., 2016).”
Kalpten Bir Ev: Koruyucu Aile Müdahale Programının Çocuk ve Ebeveynler Üzerindeki Etkisi
KİTİŞ, S., & Söylemez, Y. (2021) · Toplum ve sosyal hizmet(Online)/Toplum ve sosyal hizmet · doi:10.33417/tsh.794922 · Cited by 9
Psychometric evaluation of the German version of the Brief Reflective Functioning Interview
Andreas, S., Plümer, P., Reichholf, K., Dehoust, M., Schulz, H., Müllauer, P., Rudden, M., Senft, B., Gaugeler, R., & Hayden, M. C. (2021) · Psychology and psychotherapy · doi:10.1111/papt.12360 · Cited by 7
Dimensional Personality Traits and Non-suicidal Self Injury Among Emerging Adults: The Mediating Role of Mentalization
Shruthi, P. S., & Bhola, P. (2022) · Psychological Studies · doi:10.1007/s12646-022-00663-w · Cited by 7
“Badoud et al (2015) reported a significant association between higher levels of uncertainty about mental states measured on the Reflective Functioning Questionnaire (RFQ; Fonagy et al., 2016), among young adults with a history of recent non-suicidal self-injury.”
Background
Perspective Chapter: The Impact of COVID-19 on Mental Health – The Protective Role of Resilience and Capacity for Mentalizing
Safiye, T., Gutić, M., Milidrag, A., Zlatanović, M., & Radmanović, B. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.106161 · Cited by 8

Authors: Fonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y.-W., Warren, F., Howard, S., Ghinai, R., Fearon, P., & Lowyck, B.
Affiliations: University College London (GB)
University of Surrey (GB)
KU Leuven (BE)
Corresponding author: Fonagy, Peter
ORCID: Fonagy, Peter
Luyten, Patrick
Fearon, Pasco
Lowyck, Benedicte
Venue: PLOS ONE
Publisher: Public Library of Science (PLoS)
Published: 2016-07-08
Volume: 11
Issue: 7
Pages: e0158678
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0158678
PMC: PMC4938585
OpenAlex: W2468117220
Cited by: 754
References: 113
Citations by year: 2026: 102 · 2025: 106 · 2024: 112 · 2023: 108 · 2022: 84 · 2021: 95 · 2020: 54 · 2019: 34 · 2018: 32 · 2017: 21 · 2016: 3
FWCI: 39.84
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: PLoS ONE (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Lirias (KU Leuven) (submittedVersion, other-oa)
RePEc: Research Papers in Economics (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
UCL Discovery (University College London) (submittedVersion)
Funders: National Institute for Health Research (NF-SI-0514-10157)
Economic and Social Research Council (RES-060-25-0044)
Topics: Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: mentalization, reflective functioning, self-report measure development, borderline personality disorder, eating disorders, parental reflective functioning, infant attachment, Strange Situation Procedure, empathy, mindfulness, perspective taking, psychometric validation, factor structure
MeSH terms: Female, Humans, Male, Psychometrics, Surveys and Questionnaires, Theory of Mind, Self Report

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Development and Validation of a Self-Report Measure of Mentalizing: The Reflective Functioning Questionnaire

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