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Development and Validation of a Self-Report Measure of Mentalizing: The Reflective Functioning Questionnaire
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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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“Internal consistency of RFQc and RFQu respectively are α = 0.65 and α = 0.77 in a clinical sample and α = 0.67 and α = 0.63 in a non-clinical sample, respectively [55].”
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“Mentalization is defined as the capacity to interpret self and others in terms of internal mental states such as wishes, feelings, intentions, and desires (Fonagy et al., 2016), often described as “the ability to see others from the inside and ourselves from the outside” (Bateman and Fonagy, 2016).”
BackgroundValidation of the english version of the Multidimensional Mentalizing Questionnaire (MMQ)
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“That is, the RFQ is not suitable to be used among general population, since was not designed to capture the different dimensions of mentalizing, nor to assess the process of mentalizing as it unfolds in social interactions [17].”
BackgroundInfluentialThe efficacy of psychodynamic psychotherapy for young adults: a systematic review and meta-analysis
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“We used the 8-item, reduced version of this instrument [26].”
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“Pilot testing revealed the PRFQ and RFQ each detected intervention impacts and were acceptable to patients.”
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“Reflective Functioning Questionnaire (RFQ; Fonagy et al., 2016) is as a brief, self-report, screening measure of reflective functioning.”
BackgroundReflective thinking, allyship and mental well-being: a correlational study
Mulik, M., & Gawali, G. (2023) · Reflective Practice · doi:10.1080/14623943.2023.2246385 · Cited by 2
“Individuals with competent reflective functioning can carry multiple concomitant views in mind, and they can understand self and other mental states simultaneously (Fonagy et al., 2016).”
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A multi-method study of interpersonal complementarity and mentalization
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“Items were rated using a 7-point scale ranging from 1 (“Strongly disagree”) to 7 (“Strongly agree”) (see Fonagy et al., 2016 for scoring details).”
InfluentialCiccarelli, M., Pizzini, B., Griffiths, M. D., Cosenza, M., Nigro, G., & D’Olimpio, F. (2024) · BMC Psychology · doi:10.1186/s40359-024-01651-7 · Cited by 2
“…bias [44], and completed the South Oaks Gambling Screen (SOGS; [45, 46]), the Gambling Craving Scale (GACS; [29, 47]), and the Reflective Functioning Questionnaire (RFQ-8; [48, 49]) to assess the degree of problem gambling severity, gambling-related craving, and mentalization, respectively.”
BackgroundWhat Is the Relationship Between Social Cognition and PTSD?
Wiseman, C. E. (2024) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.12013 · Cited by 2
“Individuals with a tendency to hypermenta-lize will often overestimate their abilities at this skill due to the amount of mentalizing they attempt to do [25].”
Trombetta, T., Paradiso, M. N., Santoniccolo, F., & Rollè, L. (2025) · Behavioral Sciences · doi:10.3390/bs15030288 · Cited by 2
“Mentalization: To assess mentalization, the Italian version (Morandotti et al., 2018) of the Reflective Functioning Questionnaire (RFQ; Fonagy et al., 2016) was used.”
InfluentialSchwarzer, N.-H., Behringer, N., Dees, P., Fonagy, P., Gingelmaier, S., Henter, M., Hutsebaut, J., Kirsch, H., Kreuzer, T. F., Langnickel, R., et al. (2025) · Prävention und Gesundheitsförderung · doi:10.1007/s11553-025-01209-4 · Cited by 5
Self-citationPitzen, J., Lawler, J. M., Chow, C. M., Arble, E. P., & Huth‐Bocks, A. C. (2025) · British Journal of Developmental Psychology · doi:10.1111/bjdp.12560 · Cited by 5
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“However, recent studies have scrutinized the original scoring method proposed for the RFQ ‐ 8 (Müller et al. 2022; Wo ź niak ‐ Prus et al. 2022).”
InfluentialSkovbjerg, S., Kolls, M., Kjærbye‐Thygesen, A., & Fjorback, L. O. (2025) · Pilot and Feasibility Studies · doi:10.1186/s40814-025-01670-0 · Cited by 2
“Parental reflective functioning refers to the caregiver’s capacity to reflect upon his/her own internal mental experiences as well as those of the child [42].”
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“Beyond alexithymia, mentalization-the ability to understand one’s own and others’ mental states-has been increasingly implicated in the development of aggression 14 .”
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“The Dutch translation of the AAI (Bakermans-Kranenburg & van IJzendoorn, 1993) was administered to participants to measure trait-mentalizing with the Reflective Functioning Scale (RFS (Fonagy et al., 2016)).”
Salaminios, G., Hazlitt, A., Fonagy, P., Debbané, M., & Nolte, T. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf095 · Cited by 3
“Fifteen of these were task-based measures of ToM and three were ( 20 1 9 ) 33 C r o ss - s ec t i on a l 68 18 Self-report questionnaire 54-item self-report questionnaire measuring mentalizing by evaluating the respondent’s certainty (RFQc scale) and uncertainty (RFQu scale) about the mental states of themselves and o…”
InfluentialSelf-citationTrauma, personality structure and psychopathology: a cartography of psychodynamic constructs
Fuchshuber, J., Blüml, V., Kapusta, N. D., Löffler‐Stastka, H., Alexopoulos, J., Renner, E., Senra, H., & Unterrainer, . (2025) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-025-00308-0 · Cited by 2
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“In order to evaluate students ’ mentalizing ability , it was administered the Re fl ective Functioning Questionnaire (RFQ; Fonagy et al., 2016; Italian validation by Morandotti et al., 2018), an 8-item self-report that measures mentalizing operationalization, namely re fl ective functioning (RF), on…”
Doyle, M., Collins, A., Wheeler, A., McAndrew, J., Burgess, N., Byrne, G., O’Keeffe, D., & Naughton, S. (2025) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2025.10085 · Cited by 3
“Hypomentalizing is a barrier to developing complex models of the minds of others, leading to concrete, or psychic equivalence modes of functioning (Fonagy et al., 2016).”
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“There are no known cut-off scores for the PRFQ, however visual analysis of the data indicated that a proportion of parents scored quite low on the pre-mentalising scale at baseline.”
InfluentialRossi, A. A., Tagliagambe, A., Mannarini, S., & Ragione, L. D. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1703521 · Cited by 2
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“The Reflective Functioning Questionnaire (RFQ; Fonagy et al. , 2016; Morandotti et al. , 2018) is an 8-item self-report measure of reflective functioning assessing individuals’ ability in understanding and interpreting their own and others’ behaviors in terms of mental states.”
Evolutionary systems therapy for personality pathology: a proof-of-concept single-arm trial
Cheli, S., Brüne, M., Goldzweig, G., Bui, S., Velicogna, F., & Cavalletti, V. (2026) · Current Psychology · doi:10.1007/s12144-025-08606-0 · Cited by 2
“Reflective Functioning Questionnaire (RFQ) is the brief 8-item measure aimed to evaluate reflective func - tioning (Fonagy et al., 2016).”
Individual differences in mentalizing skills and their relationship to concept processing
Corenblum, H. T., & Pexman, P. M. (2026) · Acta Psychologica · doi:10.1016/j.actpsy.2026.106362 · Cited by 2
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“Although enhancing emotional awareness is generally beneficial, excessive rumination or overanalysis may exacerbate distress (Fonagy et al., 2016 ; Luyten & Fonagy, 2020).”
Chokhani, R., Lloyd, A., Viding, E. M., Gerin, M. I., & McCrory, E. J. P. (2026) · Clinical Psychology Review · doi:10.1016/j.cpr.2026.102722 · Cited by 3
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“Reflective capacity may be assessed using the Reflective Functioning Questionnaire (RFQ; Fonagy et al., 2016), which provides a validated self-report measure of mentalizing capacity, or through qualitative pre–post analysis of therapists’ case formulation narratives coded for hypothesis diversity…”
Passarini, S., Parisi, M., Guerrera, S., Vicari, S., & Fucà, E. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01639-1 · Cited by 2
“…e [ 33 ] ; W C S T = W i s c o n s i n C a r d S o r t T a s k [ 34 ] ; R F Q = R e fl e c t i v e F u n c t i o n i n g Q u e s t i o nn a i r e [ 35 ] ; E R - 40 = P e nn E m o t i o n R e c o g n i t i o n T e s t ; A D O S - 2 = A u t i s m D i a g n o s t i c O b s e r v a t i o n S c h e d…”
Adaptive and maladaptive networks using ecological momentary assessment
Hufschmidt, B., Ebert, M., Nemani, A., Kohl, V., Pahlen, L., Müller, S., Hofmann, S. G., & Stangier, U. (2026) · Clinical Psychology in Europe · doi:10.32872/cpe.17891 · Cited by 2
“Incorporating measures such as reflective functioning (Fonagy et al., 2016) could reveal whether interindividual differences in data quality are moderated by the capacity to reflect on internal states (Fonagy et al., 2016).”
Maphisa, J. M., Mogotsi, O. P., Machola, O. K., Maswabi, K. M., Motsamai, T. B., & Mosupiemang, B. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-038175 · Cited by 2
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Self-citationPischiutta, L., Garzitto, M., Zamparutti, G., Moratti, E., Albert, U., Colizzi, M., & Balestrieri, M. (2023) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2023.100497 · Cited by 6
Tohme, P., Fadel, N. A., Yaktine, N., & Abi‐Habib, R. (2023) · JMIR Formative Research · doi:10.2196/43770 · Cited by 2
“The Reflective Functioning Questionnaire-8 (RFQ-8) [29] originally consisted of a 54-item self-report scale measuring mentalizing capacities.”
MethodBahramkhani, M., Hoseini, S. M., & Sarichloo, M. E. (2024) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs-136239 · Cited by 2
Yirmiya, K., Constantinou, M., Simes, E., BATEMAN, A. W., Wason, J. M. S., Yakeley, J., McMurran, M., Crawford, M., Frater, A. P., Moran, P., et al. (2024) · Psychological Medicine · doi:10.1017/s003329172400062x · Cited by 4
“The BRFQ is derived from the Reflective Functioning Questionnaire (Fonagy et al., 2016), which shows good test-retest reliability and convergent validity within clinical and non-clinical samples (Euler et al., 2021).”
MethodSelf-citationWolfs, B. (2024) · Psychodynamic Practice · doi:10.1080/14753634.2024.2343697 · Cited by 2
“These questions may be approached from a quantitative perspective, perhaps using an RCT in which mentalisation (operationalised as reflective functioning ; Fonagy et al., 1998, 2016) is measured as a secondary outcome.”
Cerciello, F., Esposito, C., Penna, I. L., Sica, L. S., & Frolli, A. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1407933 · Cited by 2
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“Further analysis through EFA led to the exclusion of items 2, 11, and 29, either due to their failure to load adequately on any factor or because of cross-loading issues.”
MethodRaouna, A., Girard, L., & MacBeth, A. M. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.10.096 · Cited by 4
Devi, K. D., Bhola, P., & Chandra, P. S. (2024) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_350_24 · Cited by 2
“The Reflective Functioning Questionnaire (RFQ‑8) The 8-item self-report measure, RFQ, [20] assesses certainty (RFQc) and uncertainty about mental states of self and others (RFQu).”
Madsen, E. B., Egmose, I., Stuart, A. C., Krogh, M. T., Haase, T. W., Karstoft, K., & Væver, M. S. (2024) · Parenting · doi:10.1080/15295192.2024.2423808 · Cited by 3
“Hypermentalization is some-times described as intrusive mentalization, reflecting the tendency to project false models of mental states onto the child which are not rooted in cues from the child (Fonagy et al., 2016; Luyten, Mayes, et al., 2017, 2017).”
InfluentialRipoll, E. A., Krischer, M., & Vegué, J. (2024) · Springer eBooks · doi:10.1007/978-3-031-68062-5_6 · Cited by 2
Ozdemir, E., MacBeth, A. M., & GRIFFITHS, H. M. (2025) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12589 · Cited by 3
“The uncertainty about mental states scale of the Reflective Functioning Questionnaire-8 (RFQ; Fonagy et al., 2016) was used to examine mentalizing difficulties.”
Fostini, A., Zaravinos-Tsakos, F., Kolaitis, G. A., & Giannakopoulos, G. (2025) · Psychology International · doi:10.3390/psycholint7020031 · Cited by 6
Sierra, J. O., Debbané, M., Lucas‐Molina, B., Pérez‐Albéniz, A., Díez-Gómez, A., & Fonseca‐Pedrero, E. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.05.001 · Cited by 2
Madsen, E. B., Egmose, I., Stuart, A. C., Krogh, M. T., Haase, T. W., Karstoft, K., & Væver, M. S. (2025) · Infant Mental Health Journal · doi:10.1002/imhj.70021 · Cited by 2
“Types of mentalization are often described and hypothesized (Fonagy et al., 2016; Luyten, Mayes, Nijssens, et al., 2017; Sharp et al., 2011), reflecting genuine mentalization, deficient mentalization, and excessive mentalization, yet these types have rarely been empirically examined.”
Mentalisierungsfähigkeit und Behandlungserfolg in der Psychosomatischen Rehabilitation
Peters, M., Budde, A., Jeising, A., Lindner, J., & Schulz, H. (2022) · Zeitschrift für psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2022.68.4.397 · Cited by 2
Taking Psychoanalytic and Psychometric Perspectives toward a Binocular Vision of Religion
Keller, B. (2020) · Brill Research Perspectives in Religion and Psychology · doi:10.1163/25897128-12340004 · Cited by 2
Misdrahi, S., Louët, E., Eymard, B., Gargiulo, M., & Luca, M. D. (2021) · L Évolution Psychiatrique · doi:10.1016/j.evopsy.2020.12.001 · Cited by 2
Zihinselleştirmenin Kültürel Özellikleri ve Psikolojik Belirtiler ile İlişkisi Üzerine Bir Derleme
Halfon, S., & Coşkun-Toker, A. (2021) · Nesne Psikoloji Dergisi · doi:10.7816/nesne-09-22-09 · Cited by 2
Schwarzer, N.-H., Kirsch, H., Nolte, T., & Gingelmaier, S. (2022) · Zeitschrift für Entwicklungspsychologie und Pädagogische Psychologie · doi:10.1026/0049-8637/a000254 · Cited by 3
Obese Adolescents Have Reduced Mentalizing AbilityPreprint
Taheri, A., Mazaheri, M. A., Zabihzadeh, A., & Robinson, P. H. (2021) · Research Square · doi:10.21203/rs.3.rs-252931/v1 · Cited by 2
Mora, R. C. R., Vinaccia, S., Jiménez, Y., Vinasco, B., & Vidal, Y. B. (2020) · doi:10.31234/osf.io/a7wcm · Cited by 2
Jewell, T. (2021) · OSF Preprints (OSF Preprints) · doi:10.31219/osf.io/ru8sd · Cited by 2
Taubner, S., Hauschild, S., Korhas, L., Kaess, M., Sobanski, E., Gablonski, T., Schröder‐Pfeifer, P., & Volkert, J. (2020) · Research Square · doi:10.21203/rs.3.rs-63999/v1 · Cited by 2
The Structure of Self-Related Core BeliefsPreprint
Mussel, P. (2023) · doi:10.31234/osf.io/ky4vu · Cited by 2
Psychometric Properties of the Reflective Function Questionnaire in Iranian Prisoners
Mohammadi, M., Suksatan, W., Ali, M. H., Abdollahi, A., Allen, K., Majeed, M. S., & Salahian, A. (2022) · International Journal of Offender Therapy and Comparative Criminology · doi:10.1177/0306624x221110811 · Cited by 1
“The inability to identify and express mental states component of the TAS questionnaire had a positive relationship with the RFQ. Patients with BPD can have significant challenges with relationships and mental-ization (the ability to interpret the actions of self and others; Fonagy et al., 2016).”
BackgroundMethodInfluentialDIFFERENTIATION OF SELF AS A PREDICTOR OF CAPACITY FOR MENTALIZATION
Todosijević, M. N., & Kojić, D. (2022) · Godišnjak Studijske grupe za psihologiju · doi:10.46630/gpsi.19.2022.04 · Cited by 1
Milan, S., & Dáu, A. L. B. T. (2023) · Journal of Personality Disorders · doi:10.1521/pedi.2023.37.4.369 · Cited by 2
Raimondi, G., Imperatori, C., Gostoli, S., Gremigni, P., & Innamorati, M. (2023) · Behavioral Sciences · doi:10.3390/bs13100843 · Cited by 1
“There is a substantial body of research [13–15] assessing the mediating role Behav.”
BackgroundAldunate, N., López‐Silva, P., Brotfeld, C., Guerra, E., & Kronmüller, E. (2024) · PLoS ONE · doi:10.1371/journal.pone.0296691 · Cited by 2
Attachment and mentalization among survivors of sexual abuse: A questionnaire survey
Bloch, M. S., Høgenhaug, S. S., & Thomsen, J. B. B. (2024) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2024.88.1.3 · Cited by 1
Esposito, G., Cangiano, P., Maro, A. D., & Passeggia, R. (2024) · PSICOLOGIA DELLA SALUTE · doi:10.3280/pds2024-001005 · Cited by 1
Deniz, P., & Uluç, S. (2024) · Ayna Klinik Psikoloji Dergisi · doi:10.31682/ayna.1399049 · Cited by 1
Minding mentalizing - convergent validity of the Mentalization Breakdown Interview
Ulvestad, D. A., Johansen, M. S., Kvarstein, E. H., Pedersen, G., & Wilberg, T. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1380532 · Cited by 1
Caregivers’ Social Conformity Predicts Their Judgments of Toddlers’ Moral Agency
Essler, S., & Paulus, M. (2024) · Early Education and Development · doi:10.1080/10409289.2024.2389366 · Cited by 1
“Reflective functioning or mentalizing refers to the capacity to engage in the reflection of internal states such as feelings, goals, and desires with respect to oneself and others (Fonagy et al., 2016; Luyten et al., 2017).”
Francis, L. M., Speranza, B. E., Graeme, L. G., Curtis, A., Enticott, P. G., & Macdonald, J. A. (2025) · Journal of Personality · doi:10.1111/jopy.13029 · Cited by 1
“Trait anger is also associated with poorer self-reported mentalizing (i.e., the ability to interpret and understand the mental states and emotions of one-self and others; Fonagy et al. 2016; Francis et al. 2024).”
Lakhani, S., Bhola, P., Mehta, U. M., & Bhaskarapillai, B. (2025) · Journal of Personality Assessment · doi:10.1080/00223891.2025.2509501 · Cited by 3
“These observations demonstrate that mentalizing measured on MVT is associated with reflective functioning assessed by the measures that are known to be valid and reliable in their assessment of mentalizing (e.g., Dimitrijević et al., 2018; Fonagy et al., 2016; Perroud et al., 2017).”
Metadata
- 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
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2016-07-08
- Volume
- 11
- Issue
- 7
- Pages
- e0158678
- ISSN
- 1932-6203 (ISSN-L)
- 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
- 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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