A short version of the reflective functioning questionnaire: Validation in a Greek sample

#Fotios S. Milienos, Alex Desatnik, Christos Rentzios, Vasileios Athanasopoulos, Peter Fonagy

AbstractThis study aims to validate the Greek version of the 54-item Reflective Functioning Questionnaire (RFQ), a measure designed to assess an individual’s capacity for understanding themselves and others based on internal mental states. This capacity, also known as Reflective Functioning (RF) or mentalizing, is believed to play a significant role in both typical and atypical development. The validation process examined the factor structure of the RFQ and its relationship with a variety of psychosocial and clinical constructs that have theoretical and empirical links to RF. Additionally, this research investigated the factor structure’s invariance across gender and age groups to determine the robustness of the instrument. A unique contribution of this work lies in examining the application of the RFQ to attachment classifications through the use of cluster analysis. The sample consisted of 875 Greek adults from the general community with a mean age of 28.5 and a median age of 22. Participants completed the Greek RFQ along with a series of self-report questionnaires assessing psychosocial constructs, including attachment, epistemic trust, emotion regulation, and psychological mindedness, as well as clinical variables such as anxiety, depression, and borderline personality traits. Our findings suggest that a shorter, 31-item version of the questionnaire provides a robust three-factor structure across a non-clinical Greek adult population. The three identified subscales are (a) excessive certainty, (b) interest/curiosity, and (c) uncertainty/confusion, all demonstrating satisfactory reliability and construct validity. The uncertainty subscale was found to be associated with insecure attachment styles, epistemic mistrust and credulity, emotional suppression, and low psychological mindedness. In contrast, the certainty and curiosity subscales were linked to secure attachment, epistemic trust, emotion reappraisal, and psychological mindedness. Uncertainty was further shown to differ significantly across probable clinical and non-clinical groups, as distinguished by cut-off scores for anxiety, depression, and borderline personality disorder (BPD). However, the certainty and interest/curiosity subscales only varied between the two BPD groups. Our results provide the first evidence supporting the use of a 31-item version of the RFQ with three validated subscales to reliably assess reflective functioning in the Greek population, demonstrating stronger psychometric properties compared to other RFQ versions reported in previous studies. Findings suggest that impaired mentalizing capacity, as measured by the RFQ, is linked to insecure attachment, epistemic mistrust and credulity, poor emotion regulation, and low psychological mindedness, and potentially plays a role in adult mental health symptoms.

IntroductionMentalizing, operationalized as reflective functioning (RF), is the human capacity to interpret both the self and others in light of internal mental states such as feelings, desires, wishes, attitudes, and goals [1, 2]. This capacity is suggested to originate in the context of secure attachment relationships, fostered by a child’s experience of being mentally held and mirrored by a secure attachment figure [3].On the other hand, insecure attachment relationships, likely interplaying with genetic and environmental vulnerabilities, have been linked with impaired mentalizing [4, 5]. Impairments in mentalizing have been associated with a broad spectrum of mental disorder symptoms, including but not limited to borderline personality disorder (BPD), depression, and anxiety [6–14].Within this context, RF appears to mediate the relationship between insecure adult attachment and mental health or personality variables [15–18]. The mentalizing process enables individuals to perceive and label emotions related to difficult life experiences, as well as to reflect on these experiences, which may ultimately reduce their negative impact [19]. As a result, mentalizing is connected with critical psychological competencies such as emotion regulation [20, 21], distress tolerance [22], and the related construct of psychological mindedness, an important element of mental health [23].Alongside attachment and mentalizing, two significant developmental processes associated with mental health, a person’s capacity for epistemic trust (the trust in socially conveyed knowledge or information) is also rooted in secure attachment. Epistemic trust (ET) refers to humans’ capacity to identify the knowledge conveyed by others as personally relevant and applicable to various contexts, thereby making it memorable and integrated into their knowledge schemas [24]. This capacity for mentalizing and recognizing the trustworthiness of the information source is considered crucial for how a child establishes the relationship between their internal and external world [25]. This could potentially account for some developmental vulnerabilities to psychopathology, particularly more severe mental disorders such as BPD [26, 27].A questionnaire measure proposed by Campbell et al. [28] captures this epistemic social system using three factors: epistemic trust

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