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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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“Conversely, individuals with high mentalization capacity demonstrate greater emotional regulation skills, enabling them to interpret and respond to emotional cues in a flexible and adaptive manner [45].”
InfluentialThe meaning of a measure: p as a general measure of psychopathology
Plutynski, A. (2026) · Philosophical Psychology · doi:10.1080/09515089.2025.2611430
The Meaning of the Child in an Irish Context: Bringing the ‘Why’ into Parenting Capacity Assessments
Molloy, N., Keogh, T., & Grey, B. (2026) · Palgrave texts in counselling and psychotherapy · doi:10.1007/978-3-032-00114-6_15
Bucci, S., Varese, F., Quayle, E., Cartwright, K. L., Larkin, A., Chan, C., Chitsabesan, P., Green, V., Hewins, W., Machin, M., et al. (2026) · Child and Adolescent Mental Health · doi:10.1111/camh.70060
Cohen, M., Nakash, O., Mikulincer, M., & Apter-Levy, Y. (2026) · Current Psychology · doi:10.1007/s12144-025-08725-8
“Following Fonagy et al.’s (2016) scoring procedure, items were recoded into categorical values ranging from 0 to 3.”
Manshadi, Z. D., Fathi, E., Manshadi, M. A. D., & Keyvanmanesh, N. (2025) · American Journal on Intellectual and Developmental Disabilities · doi:10.1080/19447515.2025.2578979 · Cited by 2
Ophir, Y. (2026) · Current Psychology · doi:10.1007/s12144-025-08920-7 · Cited by 1
“These include measures of reflective functioning and men - talization (Fonagy et al., 1998, 2016), assessments of defensive operations (Perry, C. & Henry, 2004), developmental stages (Hy & Loevinger, 1996 ), and psychological flexibil - ity (Kashdan & Rottenberg, 2010).”
Katz, A., & Ben‐Ari, O. T. –. (2026) · Current Psychology · doi:10.1007/s12144-025-08532-1
“The Reflective Functioning Questionnaire (RFQ; Fonagy et al., 2016) consists of 8 items on two dimensions: certainty (RFQc), and uncertainty (RFQu).”
Ecer, E., & Gąsiorowska, A. (2026) · British Journal of Psychology · doi:10.1111/bjop.70060
Sorge, A., Musetti, A., Bianchi, G., Pezzi, M., Franceschini, C., Vagnini, D., & Saita, E. (2026) · International Journal of Prison Health · doi:10.1108/ijoph-09-2025-0074
Simoncini, G., Borghesi, F., Sarcinella, E. D., Chirico, A., & Cipresso, P. (2025) · IEEE International Conference on Metrology for eXtended Reality, Artificial Intelligence and Neural Engineering (MetroXRAINE) · doi:10.1109/metroxraine66377.2025.11340118
“It involves the ability to step back from one’s immediate affective state and engage in higher-order reflection about that experience, evaluating its meaning, appropriateness, and implications for the self and others [13].”
Metacognitive functioning in love addiction: An exploratory brief report
Cavalli, R. G., Bruno, S., Tacchino, C., & Velotti, P. (2026) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2026.101029
Gecha, T. C., Sharp, C., Unzurruzaga, E., Eguren, A., & Pérez, L. (2026) · Adolescent Psychiatry · doi:10.2174/0122106766399314251103061829
Bahramkhani, M., & Isazadeh, M. (2026) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs-162436
“Fonagy et al. believe that successful social functioning depends on accurate reasoning about one’s own and others’ beliefs, intentions, desires, and emotions, and that individuals with social anxiety disorder have deficits in mentalization ability (20, 21).”
Schwarzer, N.-H., Kieschke, U., Dees, P., Gingelmaier, S., Langnickel, R., Link, P.-C., Kirsch, H., & Nolte, T. (2026) · European Journal of Psychology of Education · doi:10.1007/s10212-026-01071-8
“While the RFQ has certain psychometric limitations and primarily captures uncertainty rather than the full multidimensional construct of mentalizing, it has been widely applied in non-clinical samples, including educational contexts, as a pragmatic proxy for ineffective mentalizing (e.g., Safiye et al., 2023).”
InfluentialRoberto, N., Prisco, M. D., Andreo-Jover, J., Arqueros, M., Ahmed, W. A., Bobes-Bascarán, T., Canal‐Rivero, M., Cebrià, A. I., Crespo‐Facorro, B., de la Torre, A., et al. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121306
Deng, Y., Li, P., Xiang, R., Tang, Q., & Liu, X. (2026) · Research on Social Work Practice · doi:10.1177/10497315261423076
Keinänen, M., & Teräsahjo, T. (2026) · Discover Mental Health · doi:10.1007/s44192-026-00393-9
“Two broad forms of such impairments have been described [34].”
Cerciello, F., Cecere, G., Penna, I. L., Esposito, C., Sica, L. S., & Frolli, A. (2026) · Current Psychology · doi:10.1007/s12144-026-09140-3
“The RFQ, on the other hand, focuses on certainty and uncertainty about mental states, identifying two dysfunctional modes—hypermental-ization and hypomentalization (Fonagy et al., 2016).”
Effects of emotion recognition remediation on social cognition in patients with schizophrenia
Hsu, L.-W., Lin, Y.-H., Tseng, H., & Huang, Y. (2026) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2026.100577
Ünver, B. (2026) · Cognitive Processing · doi:10.1007/s10339-026-01335-7
“Brief self-report measures such as the RFQ and MZQ allow rapid screening (Fonagy et al. 2016 ; Hausberg et al. 2012) but provide narrower coverage of the construct, whereas the IMQ emphasizes mentalizing as it unfolds in social interaction (Wu et al. 2022).”
Desatnik, A., Jones, C., Fonagy, P., Britton, J., Hayward, V., Glover, R., Taylor, L., & Lorenzini, N. (2026) · BMC Psychology · doi:10.1186/s40359-026-04048-w
“This contains 8 self-report items with a 7-point Likert scale measuring certainty and uncertainty about mental states [30].”
InfluentialSelf-citationAsgarizadeh, A., Farahani, A. A. A., Amiri, A., Bijarchian, M., & Ghanbari, S. (2026) · Psychiatric Quarterly · doi:10.1007/s11126-026-10273-8
Association between hypomentalizing and suicide reattempt: a 12-month follow-up study
Andreo-Jover, J., Fernández-Jiménez, E., Ayad‐Ahmed, W., Bobes-Bascarán, T., Boti, M. A., Bravo‐Ortiz, M. F., Crespo‐Facorro, B., Cebrià, A. I., de la Torre‐Luque, A., Díaz‐Marsá, M., et al. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-07990-6 · Cited by 1
“Lack of mentalizing, or hypomentalizing, is defined as a difficulty in recognizing internal experiences, such as emotions and thoughts, as well as misunderstanding the motivations and feelings of others [14].”
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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