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Development and Validation of a Self-Report Measure of Mentalizing: The Reflective Functioning Questionnaire
Open accessAbstract
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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“Study 1 focused on the development of the RFQ and its factor structure in a sample of patients with BPD and EDs (n = 108) and a sample of normal controls (n = 295).”
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Self-citationMinding the Baby: A Mentalization‐Based Parenting Program
Sadler, L. S., Slade, A., & Mayes, L. C. (2006) · Wiley eBooks · doi:10.1002/9780470712986.ch14 · Cited by 115
Psychodynamic Psychotherapy for Personality Disorders: A Clinical Handbook
Fonagy, P., & Gabbard, G. O. (2010) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615376643 · Cited by 114
Self-citationEating one's words, Part II: the embodied mind and reflective function in anorexia nervosa—theory
Skårderud, F. (2007) · European Eating Disorders Review · doi:10.1002/erv.778 · Cited by 113 · cited 1×
“Such impairments have been shown to play a key role in a variety of disorders and problem behaviors such as BPD [8], eating disorders (EDs) [9, 10], depression [11], and antisocial personality disorder [12].”
BackgroundThe Development of Mentalisation in Children From a Theory of Mind Perspective
Ensink, K., & Mayes, L. C. (2010) · Psychoanalytic Inquiry · doi:10.1080/07351690903206504 · Cited by 110
Lemma, A., Target, M., & Fonagy, P. (2011) · Psychiatry · doi:10.1521/psyc.2011.74.1.41 · Cited by 109
Self-citationDevelopmental science and psychoanalysis. Integration and innovation
(2008) · Psychoanalytic Psychotherapy · doi:10.1080/02668730802102708 · Cited by 93
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“RFQ_C, in turn, was generally negatively related to caseness, but may be more specifically related to types of psychopathology characterized by hypermentalizing, as is, for instance, observed in patients with eating disorders [13, 60, 103] or adolescents with BPD features, [104, 105].”
BackgroundAttachment and Reflective Functioning in Women With Borderline Personality Disorder
Badoud, D., Prada, P., Nicastro, R., Germond, C., Luyten, P., Perroud, N. A., & Debbané, M. (2017) · Journal of Personality Disorders · doi:10.1521/pedi_2017_31_283 · Cited by 64 · cited 2×
“Despite these limitations, together with two recent similar studies with the French version of the RFQ [42, 61], this study lends preliminary evidence for the reliability and validity of the RFQ as a brief measure of RF.”
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Levy, K. N., Beeney, J. E., & Temes, C. M. (2010) · Current Psychiatry Reports · doi:10.1007/s11920-010-0169-8 · Cited by 63 · cited 1×
“Additionally, the RFQ_U was highly significantly associated with clinical features that have been proposed as core features of personality pathology by many authors from various theoretical orientations, including selfharm [76], indices of structural personality pathology, including identity diffusion, the use of prim…”
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“Also, trajectories of change as a result of maturation or psychosocial interventions might differ for both types of impairments, and they might have different developmental and neurobiological underpinnings [25, 40, 41].”
BackgroundOn tolerating mental states: Theory of mind in borderline patients
Fonagy, P. (1989) · UCL Discovery (University College London) · Cited by 52
Self-citationReflective Functioning in 70 Patients Suffering from Bulimia Nervosa
Pedersen, S. H., Lunn, S., Katznelson, H., & Poulsen, S. (2012) · European Eating Disorders Review · doi:10.1002/erv.2158 · Cited by 50 · cited 2×
“RFQ_C, in turn, was generally negatively related to caseness, but may be more specifically related to types of psychopathology characterized by hypermentalizing, as is, for instance, observed in patients with eating disorders [13, 60, 103] or adolescents with BPD features, [104, 105].”
BackgroundResultAttachment and personality pathology
Fonagy, P., Luyten, P., BATEMAN, A. W., Gergely, G., Strathearn, L., Target, M., & Allison, E. (2010) · UCL Discovery (University College London) · Cited by 50
Self-citationBrief Dynamic Interpersonal Therapy: A Clinician's Guide
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“RFQ_C, in turn, was generally negatively related to caseness, but may be more specifically related to types of psychopathology characterized by hypermentalizing, as is, for instance, observed in patients with eating disorders [13, 60, 103] or adolescents with BPD features, [104, 105].”
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“The RFQ_C scale was associated with comorbidity between BPD and ED diagnosis, which is congruent with other studies suggesting substantial hyper-reflectivity in patients with these features [26, 39, 60].”
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“Hypomentalizing has been related to vulnerability for a wide range of disorders, including BPD [25], EDs [9], and depression [32, 33].”
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Leptin—a parameter for body fat measurement in patients with eating disorders
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The mentalizing approach to psychopathology: State of the art and future directions
Luyten, P., Campbell, C., Allison, E., & Fonagy, P. (2020) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-071919-015355 · Cited by 748
“…such impairments and substance abuse, violence, eating disorders, and self-harm, which can all be seen as attempts to regulate, through specific goal-directed behavior, unbearable and unmentalized self-states (Fonagy et al. 2016, Jewell et al. 2016, Suchman et al. 2018, Taubner et al. 2016).”
BackgroundSelf-citationZeegers, M. A. J., Colonnesi, C., Stams, G. J. J. M., & Meins, E. (2017) · Psychological Bulletin · doi:10.1037/bul0000114 · Cited by 478
“The effect size was calculated from the average association of the three PRFQ subscales (i.e., prementalizing modes, certainty of mental states, and interest and curiosity of in mental states) with infant attachment security.”
BackgroundMethodInfluentialDevelopment and validation of a self-report measure of epistemic trust
Campbell, C., Tanzer, M., Saunders, R., Booker, T. L., Allison, E., Li, E. T., O’Dowda, C., Luyten, P., & Fonagy, P. (2021) · PLoS ONE · doi:10.1371/journal.pone.0250264 · Cited by 230
“The Reflective Function Questionnaire (RFQ) [29].”
InfluentialSelf-citationThe bodymind model: a platform for studying the mechanisms of change induced by art therapy
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The Mentalization Scale (MentS): A Self-Report Measure for the Assessment of Mentalizing Capacity
Dimitrijević, A., Hanak, N., Dimitrijević, A. A., & Marjanović, Z. J. (2017) · Journal of Personality Assessment · doi:10.1080/00223891.2017.1310730 · Cited by 221
“It is only very recently that this gap has been filled by the Reflective Functioning Questionnaire (RFQ; Badoud et al., 2015; Fonagy et al., 2016).”
Background
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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