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

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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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          Most cited references 23

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          The eating attitudes test: psychometric features and clinical correlates.

          Psychometric and clinical correlates of the Eating Attitudes Test (EAT) are described for a large sample of female anorexia nervosa (N = 160) and female comparison (N = 140) subjects. An abbreviated 26-item version of the EAT (EAT-26) is proposed, based on a factor analysis of the original scale (EAT-40). The EAT-26 is highly correlated with the EAT-40 (r = 0.98) and the three factors form subscales which are meaningfully related to bulimia, weight, body-image variables and psychological symptoms. Whereas there are no differences between bulimic and restricter anorexia nervosa patients on the total EAT-26 and EAT-40 scores, these groups do indicate significant differences on EAT-26 factors. Norms for the anorexia nervosa and female comparison subjects are presented for the EAT-26, EAT-40 and the EAT-26 factors. It is concluded that the EAT-26 is a reliable, valid and economical instrument which may be useful as an objective measure of the symptoms of anorexia nervosa.
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            Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age.

            While strong retrospective and concurrent associations between maternal and infant patterns of attachment have been noted, this is one of the first reports of a prospective investigation of such associations. The Adult Attachment Interview was administered to 100 mothers expecting their first child, and, at 1-year follow-up, 96 of these were seen with their infants at 12 months in the Strange Situation. Maternal representations of attachment (autonomous vs. dismissing or preoccupied) predicted subsequent infant-mother attachment patterns (secure vs. insecure) 75% of the time. These observed concordances, as well as the discordances, are discussed in terms of the uniquely powerful contribution the Adult Attachment Interview makes to the study of representational and intergenerational influences on the development of the infant-mother attachment.
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              Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology.

              The purpose of this study was to assess the psychometric properties of the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), the first clinician-administered scale for the assessment of change in DSM-IV borderline psychopathology. The questions for the measure were adapted from the BPD module of the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV) to reflect a 1-week time frame and each of the nine criteria for BPD is rated on a five-point anchored rating scale of 0 to 4, yielding a total score of 0 to 36. Two diagnostic interviews that assess the presence of BPD were administered to 200 nonpsychotic patients: the BPD module of the DIPD-IV and the Revised Diagnostic Interview for Borderlines (DIB-R). The ZAN-BPD was also administered, blind to diagnostic information. In addition, each patient filled out a self-report measure of general psychopathology that is often used in borderline treatment studies, the Symptom Checklist 90 (SCL-90). The convergent validity of the ZAN-BPD and relevant scales of the SCL-90 and the DIB-R was assessed and found to be highly significant. The discriminant validity of the various scores of the ZAN-BPD was also found to be highly significant, easily discriminating the 139 patients who met the DSM-IV criteria for BPD from the 61 patients who did not. In addition, internal consistency of the ZAN-BPD was found to be high (Cronbach's alpha=0.85). The interrater reliability of the ZAN-BPD was assessed using 32 conjoint interviews, while same day test-retest reliability was assessed in a separate sample of 40 patients. All reliability raters were blind to all previously collected information concerning each subject. All intraclass correlations were in the good to excellent range. Finally, the sensitivity of the ZAN-BPD to change was assessed using a third sample of 41 patients who were reinterviewed by a blind rater 7 to 10 days after the ZAN-BPD was first administered. The SCL-90 was also readministered at this time. The correlations between difference scores of the ZAN-BPD and difference scores of the SCL-90 were found to be significant, indicating that the ZAN-BPD measures change in a clinically meaningful manner. Taken together, the results of this study suggest that the ZAN-BPD is a promising clinician-administered scale for the assessment of change in borderline psychopathology over time.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                8 July 2016
                2016
                : 11
                : 7
                Affiliations
                [1 ]Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom
                [2 ]Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
                [3 ]Education and Training Department, Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
                [4 ]Freelance Researcher and Trainer, Guildford, United Kingdom
                [5 ]Department of Psychology, University of Surrey, Guildford, United Kingdom
                [6 ]Faculty of Medicine, KU Leuven, Leuven, Belgium
                University of Hertfordshire, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: PF PL AMP FW SH RG PF BL. Performed the experiments: PL AMP RG BL. Analyzed the data: PF PL AMP YWL RG BL. Contributed reagents/materials/analysis tools: PF PL AMP YWL FW RG. Wrote the paper: PF PL AMP YWL FW SH PF BL.

                Article
                PONE-D-15-52038
                10.1371/journal.pone.0158678
                4938585
                27392018
                © 2016 Fonagy et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 2, Tables: 10, Pages: 28
                Product
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000272, National Institute for Health Research;
                Award ID: NF-SI-0514-10157
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100000269, Economic and Social Research Council;
                Award ID: RES-060-25-0044
                Award Recipient :
                The authors received no specific funding for this work.
                Categories
                Research Article
                People and Places
                Population Groupings
                Age Groups
                Children
                Infants
                People and Places
                Population Groupings
                Families
                Children
                Infants
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Personality Disorders
                Biology and Life Sciences
                Psychology
                Personality
                Social Sciences
                Psychology
                Personality
                Biology and Life Sciences
                Psychology
                Psychometrics
                Social Sciences
                Psychology
                Psychometrics
                Research and Analysis Methods
                Research Design
                Survey Research
                Questionnaires
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Research and Analysis Methods
                Research Assessment
                Research Validity
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Eating Disorders
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                As patients did not consent to publicly sharing data, data are available on request from the first author.

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