Attachment-related mentalization moderates the relationship between psychopathic traits and proactive aggression in adolescence

Atypical functional connectome is associated with low reflective functioning in incarcerated adolescents

Introduction

While functional neuroimaging studies have reported on the neural correlates of severe antisocial behaviors, such as delinquency, little is known about whole brain resting state functional connectivity (FC) of incarcerated adolescents (IA). The aim of the present study is to identify potential differences in resting state connectivity between a group of male IA, compared to community adolescents (CA). The second objective is to investigate the relations among FC and psychological factors associated with delinquent behaviors, namely psychopathic traits (callous unemotional traits, interpersonal problems, and impulsivity), socio-cognitive (empathy and reflective functioning RF) impairments and psychological problems (externalizing, internalizing, attention and thought problems).

Methods

31 male IA and 30 male CA participated in 8 minutes resting state functional MRI. Network Based Statistics (NBS) was used to compare FC among 142 brain regions between the two groups. Correlation and regressions analysis were performed to explore the associations between FC and the self-reported psychopathic traits, empathy, RF, and psychological problems.

Results

Compared to the CA, the IA group presented significantly increased resting state FC in a distributed subnetwork including medial prefrontal, posterior and dorsal cingulate, temporal, and occipital regions. Both within the IA group and across the whole sample, increased mean connectivity of the subnetwork correlated with lower RF (RF uncertainty). Across the whole sample, the mean connectivity was associated with higher scores of externalizing problems and impulsivity dimension of psychopathy.

Discussion

While extending the characterization of whole brain resting state FC in IA, our results also provide insights into the neurofunctional mechanisms linking low reflective functioning abilities to externalizing behavior during adolescence.

Influences of maternal reflective functioning on adolescents' psychosocial adjustment: The mediating role of adolescent's reflective functioning

This study examines the relationship between maternal reflective functioning and adolescents' reflective functioning and psychosocial adjustment. In Study 1, The Parental Reflective Functioning Questionnaire for Adolescents (PRFQ-A) and Reflective Functioning Questionnaire for Youth (RFQ-Y), multidimensional scales used to assess reflective functioning in parents and adolescents, respectively, were validated in groups of Korean adolescents and mothers. In the results, the three factors were extracted (non-mentalizing, certainty, interest/curiosity) that were similar to those from the original version of the scale. However, the items comprising the interest/curiosity factor of the Korean validated RFQ-Y differed from the original scale. Both the reliability and validity of the scale were confirmed. Study 2 examined the mediating effects of adolescent reflective function on the relationship between parental reflective functioning and adolescent psychosocial adjustment. The structural equation modeling showed a good fit for all three models (adolescents' uncertainty/confusion, certainty, and interest/curiosity). However, some mediating effects of adolescents' reflective function were not confirmed. In conclusion, the results indicate that maternal reflective function influences the adolescents' psychosocial function through the mediating factor of adolescent reflective function, Unexpectedly, maternal interest/curiosity did not have a significant effect on adolescents' reflective function and psychosocial adjustment. Based on the results, altering Korean mothers' parenting attitudes may have a positive effect on adolescents' psychosocial adjustment. This work highlights that further research is needed to understand parent-child relationships in terms of reflective functioning, taking into account the influence of cultural context.

Large-scale meta-analyses and network analyses of neural substrates underlying human escalated aggression

Escalated aggression represents a frequent and severe form of violence, sometimes manifesting as antisocial behavior. Driven by the pressures of modern life, escalated aggression is of particular concern due to its rising prevalence and its destructive impact on both individual well-being and socioeconomic stability. However, a consistent neural circuitry underpinning it remains to be definitively identified. Here, we addressed this issue by comparing brain alterations between individuals with escalated aggression and those without such behavioral manifestations. We first conducted a meta-analysis to synthesize previous neuroimaging studies on functional and structural alterations of escalated aggression (325 experiments, 2997 foci, 16,529 subjects). Following-up network and functional decoding analyses were conducted to provide quantitative characterizations of the identified brain regions. Our results revealed that brain regions constantly involved in escalated aggression were localized in the subcortical network (amygdala and lateral orbitofrontal cortex) associated with emotion processing, the default mode network (dorsal medial prefrontal cortex and middle temporal gyrus) associated with mentalizing, and the salience network (anterior cingulate cortex and anterior insula) associated with cognitive control. These findings were further supported by additional meta-analyses on emotion processing, mentalizing, and cognitive control, all of which showed conjunction with the brain regions identified in the escalated aggression. Together, these findings advance the understanding of the risk biomarkers of escalated aggressive populations and refine theoretical models of human aggression.

Validation of the Three-Factor Reflective Functioning Questionnaire for Youth in a Chinese Adolescent Sample

Purpose

This study focused on the validation of the Three-Factor Reflective Functioning Questionnaire for Youth(RFQY) within a sample of Chinese adolescents.

Patients and Methods

All the items of the RFQY were translated into Chinese language through the process of translation and back translation. A total of 532 adolescents aged between 12-20 years completed the Chinese version of RFQY, McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Basic Empathy Scale (BES), and the 20-item Toronto Alexithymia Scale (TAS-20).

Results

Twenty items meeting psychometric standards were retained in the Chinese version of the RFQY. The indices for confirmatory factor analysis, including χ2/df (2.354), SRMR (0.053), GFI (0.930), CFI (0.921), TLI (0.910), and RMSEA (0.050), all conformed to the requirements of psychometrics. The Cronbach's alpha coefficients for the three factors, "uncertainty/confusion", "interest/curiosity", and "excessive certainty", were 0.820, 0.673, and 0.839, respectively, with test-retest reliability scores of 0.751, 0.643, and 0.764. A significant positive correlation was found between uncertainty/confusion and symptoms of borderline personality disorder (BPD), particularly in adolescents with high BPD traits. Excessive certainty was positively correlated with unstable interpersonal relationships, while the interest/curiosity factor shows no significant correlation with BPD symptoms. The uncertainty/confusion factor demonstrates a complex relationship with empathy, correlating positively with affective empathy but negatively with cognitive empathy. The uncertainty/confusion factor shows a significant positive correlation with alexithymia, while the factor of excessive certainty demonstrates the opposite effect. Additionally, a significant negative correlation exists between the interest/curiosity factor and the externally oriented thinking.

Conclusion

This study validates the Chinese version of the Reflective Functioning Questionnaire for Youth (RFQY), demonstrating its reliability and validity in assessing reflective functioning among Chinese adolescents. This enhances the understanding of reflective functioning and its role in adolescent mental health.

Attachment Problems and Mentalizing Capacity Relate to Parent-Child Informant Discrepancies in Female Adolescents with Borderline Personality Disorder

Parent-child informant discrepancies on psychopathology provide important knowledge on the parent-child relationship and the child's mental health, but mechanisms underlying parent-child informant discrepancies are largely unknown. Therefore, we investigated the relationship between attachment problems and mentalizing capacity and parent-child informant discrepancies on borderline personality disorder (BPD) severity, internalizing, and externalizing pathology in a clinical sample of 91 adolescent girls with BPD and their parents. Results showed that more attachment problems to parents and peers were related to adolescents reporting more severe BPD than parents. Adolescents who described more internalizing symptoms relative to parents, reported more parental attachment problems, but enhanced peer attachment, suggesting those adolescents who do not feel recognized by their parents might turn to their friends. When parents rated adolescents higher on externalizing behaviors, the adolescent reported more attachment problems to parents and lower mentalizing capacity, indicating that this sub-group of adolescents may reflect less about how their behavior affects others.

The mediating role of reflective functioning and general psychopathology in the relationship between childhood conduct disorder and adult aggression among offenders

BACKGROUND

The nature of the pathway from conduct disorder (CD) in adolescence to antisocial behavior in adulthood has been debated and the role of certain mediators remains unclear. One perspective is that CD forms part of a general psychopathology dimension, playing a central role in the developmental trajectory. Impairment in reflective functioning (RF), i.e., the capacity to understand one's own and others' mental states, may relate to CD, psychopathology, and aggression. Here, we characterized the structure of psychopathology in adult male-offenders and its role, along with RF, in mediating the relationship between CD in their adolescence and current aggression.

METHODS

A secondary analysis of pre-treatment data from 313 probation-supervised offenders was conducted, and measures of CD symptoms, general and specific psychopathology factors, RF, and aggression were evaluated through clinical interviews and questionnaires.

RESULTS

Confirmatory factor analyses indicated that a bifactor model best fitted the sample's psychopathology structure, including a general psychopathology factor (p factor) and five specific factors: internalizing, disinhibition, detachment, antagonism, and psychoticism. The structure of RF was fitted to the data using a one-factor model. According to our mediation model, CD significantly predicted the p factor, which was positively linked to RF impairments, resulting in increased aggression.

CONCLUSIONS

These findings highlight the critical role of a transdiagnostic approach provided by RF and general psychopathology in explaining the link between CD and aggression. Furthermore, they underscore the potential utility of treatments focusing on RF, such as mentalization-based treatment, in mitigating aggression in offenders with diverse psychopathologies.

A systematic review of callous-unemotional traits and attachment in children and adolescents

METHODS

The systematic review and meta-analysis included 17 research articles from 1994 to 2022. Results were summarized by developmental periods.

RESULTS

Attachment insecurity was associated with CU traits across development (r = .17). This association was marginally stronger for high-risk samples (e.g., clinical, justice) and for continuous attachment measures versus coding schemes. From early to middle childhood, attachment disorganization was associated with CU traits (r = .17).

IMPLICATIONS

Research on attachment and CU traits in childhood is still in its infancy. Changes in attachment measures from childhood to adolescence make developmental comparisons difficult. Results suggest attachment as a potential developmental mechanism for youth with CU traits, however, the area requires more research.

Spanish version of Multidimensional Mentalizing Questionnaire (MMQ): Translation, adaptation and psychometric properties in a Chilean population

This paper presents the first translation and adaptation of the Multidimensional Mentalizing Questionnaire (MMQ) into Spanish for a native Spanish-speaking sample in Chile. The study examines the psychometric properties and internal consistency of the translated MMQ. The instrument undergoes modifications based on a confirmatory factor analysis of the original structure, resulting in the elimination of items with cross-loadings and improvement in model fit. The modified scale is then analyzed, demonstrating strong psychometric properties. Convergent evidence is assessed by correlating MMQ subscales with the Interpersonal Reactivity Index (IRI) and Empathy Quotient (EQ), while divergent evidence is assessed by correlating aggressive traits using the Buss-Perry Aggression Questionnaire (BPAQ). The study also explores gender differences and age. Results reveal positive correlations between good mentalizing and empathy, particularly cognitive empathy, supporting the significance of positive mentalization in empathy. Negative mentalization is associated with difficulties in perspective-taking and social skills, as well as aggressive traits. Gender differences in mentalizing capacities are observed, and negative aspects of mentalization decrease with age. The availability of the Spanish translation of the MMQ, the first self-reporting scale measuring mentalization adapted to Chilean population, contributes to research aiming to understand its relationship with other psychological phenomena in different cultural context and facilitating clinical interventions with different population groups. We therefore encourage further investigation into cultural, gender and age differences in mentalization.

The Moderating Role of Maternal Praise and Positivity in the Association Between Callous-Unemotional (CU) Traits and Later Aggression: A Prospective Study in Preschool Children in Colombia

Our previous findings in the UK and Colombia show that CU traits predict later aggression specifically among children who are already aggressive. We hypothesised that this effect would be reduced in the presence of maternal praise and positivity. In a sample of 220 mothers and children from Colombia, mother-child interactions were coded for maternal praise and positivity, and mothers reported on children's CU traits at age 3.5 and aggression at ages 3.5 and 5 years. The results show three-way interactions between CU traits, child aggression and observed parenting at age 3.5 years in the prediction of later child aggression, and two-way interactions indicating a protective effect of positive parenting in the high aggressive children. Based on our finding, it is plausible that positive parenting may modify the effect of CU traits in the highly vulnerable group of children who are already aggressive in early childhood.

Enhancing mentalization by specific interventions within mentalization-based treatment of adolescents with conduct disorder

Objective

Mentalization is discussed as a mechanism of change in psychotherapy due to its positive effects on psychological functioning. In order to specifically apply mentalization-based interventions, a better understanding of the relationship between interventions and in-session mentalization is needed. The study aimed to explore the association between interventions and effective mentalizing.

Method

Fifteen therapy sessions of three therapies with male adolescents with conduct disorder were transcribed and rated with the Reflective Functioning (RF) Scale and a newly developed Mentalization-based Treatment (MBT) intervention coding manual. The coded interventions were categorized into intervention levels according to the MBT manual. Fisher's exact tests were performed to test differences in frequencies of interventions in high-RF sequences (RF score ≥ 4) compared with remaining therapy sequences (RF score ≤ 3).

Results

Specific MBT interventions such as demand questions, affectelaboration, empathic validation, change of subject, challenge, patienttherapist relation and mentalizing for the patient were related to effective mentalizing. Moreover, intervention levels such as supportive & empathic, basic- mentalizing & affect mode and relational mentalizing were positively associated with effective mentalizing.

Conclusion

MBT interventions seem to promote effective mentalizing at various intervention levels. Interventions that enhance effective mentalizing seem to be patient specific. In line with MBT theory, their effect on effective mentalizing might depend on various variables, such as the patients' arousal and pre-mentalizing mode.

Parental Attachment and Proactive-Reactive Aggression in Adolescence: The Mediating Role of Self-Control and Perspective Taking

Introduction

Identifying risk and protective factors of aggressive behavior during adolescence is beneficial for the intervention and prevention treatments. Although studies show that attachment quality is closely related to aggression, the underlying psychological mechanisms remain unclear. This study aimed to investigate the links of parental attachment with proactive and reactive aggression and to examine the mediating role of perspective taking and self-control among Chinese adolescents.

Methods

A cluster sampling method was used to recruit participants from several high schools located in the central regions of China. A total of 2982 participants (Mage = 17.28, SD = 0.83, range 15~20 years; 1602 girls, 1380 boys) were included in the final analysis.

Results

Correlation analysis showed that participants possessing higher attachment security with parents were more likely to report lower levels of proactive and reactive aggression. And, self-control and perspective taking were positively associated with parental attachment, and negatively associated with both types of aggression. Moreover, structural equation models indicated that parental attachment directly, and indirectly predicted proactive and reactive aggression through self-control and perspective taking.

Discussion

Overall, this study contributes to a more comprehensive understanding of the explanatory mechanisms that link adolescent-parent attachment and aggression, and suggest that high quality of adolescent-parent interactions may promote adolescents' self-control and perspectives taking, which further reduces their aggression propensity.

Does clinical training improve mentalization skills in future therapists? A comparison of first and last year students of clinical psychology and of engineering

Objective

Mentalization has been suggested as a therapist skill that might be important for therapeutic success. The aim of this study was to explore whether the mentalization capacity of students of clinical psychology differs from other students, and whether last-year students differ from first-year students.

Method

A total of 297 students participated in this study, recruited from first and last years of psychology and engineering study programs. All participants filled out the MentS, a self-report measure of mentalization capacity.

Results

No significant differences were found in self-reported mentalization capacity between first and last year students of clinical psychology. The results did however show that first year students of psychology had significantly higher self-reported mentalization skills compared to students of engineering, and higher MentS-scores were associated with gender (female) and higher age.

Conclusion

The finding that students of clinical psychology rate themselves as having a higher capacity to mentalize compared to students of engineering might suggest that individuals with a higher capacity to mentalize are more likely to engage in clinical psychology and become therapists. However, the lack of significant difference in self-reported mentalization capacity in last year students of clinical psychology compared to first year students might indicate that the Norwegian education in clinical psychology does not succeed in enhancing mentalization in future therapists. Clinical psychology study programs might benefit from targeted mentalization training.

Antisocial personality disorder in group therapy, kindling pro-sociality and mentalizing

Patients with antisocial personality disorder (ASPD) are known for being difficult to treat. Treatment for ASPD is debated and lacking evidence. Among several reasons for treatment difficulties concerning ASPD, negative countertransference in health personnel is one central topic. Mentalization based treatment (MBT) is a reasonable candidate treatment for ASPD. From an ongoing pilot-study on MBT with substance using ASPD patients, we explore therapist experiences. Four experienced MBT therapists together with the principal investigator performed a focus group together. The therapists were themselves involved in performing this study and analyses are made as an autoethnographic study, with thematic analyses as methodological approach. As this study involved a qualitative investigation of own practice, reflexivity of the processes was performed. The aim was to explore in depth: therapist experiences and therapist wellbeing in MBT-ASPD. We found four main themes on therapist experiences: i) gaining safety by getting to know them better; ii) gaining cooperation through clear boundaries and a non-judgmental stance; iii) shifting inner boundaries; and iv) timing interventions in a high-speed culture. These four themes point to different therapist experiences one can have in MBT-ASPD. Our findings resonate well with the clinical literature on ASPD, the findings imply that clinical teams should have a focus on therapist countertransference and burnout, ensure that therapists uphold boundaries and open-mindedness in treatment of ASPD and that therapists experience vitalizing feelings in this line of work.

Synergy between callous-unemotional traits and aggression in preschool children: Cross-informant and cross-cultural replication in the UK Wirral Child Health and Development Study, and the Colombian La Sabana Parent-Child Study

Incremental prediction of aggression from callous-unemotional (CU) traits is well established, but cross-cultural replication and studies of young children are needed. Little is understood about the contribution of CU traits in children who are already aggressive. We addressed these issues in prospective studies in the United Kingdom and Colombia. In a UK epidemiological cohort, CU traits and aggression were assessed at age 3.5 years, and aggression at 5.0 years by mothers (N = 687) and partners (N = 397). In a Colombian general population sample, CU traits were assessed at age 3.5 years and aggression at 3.5 and 5.0 years by mother report (N = 220). Analyses consistently showed prediction of age-5.0 aggression by age-3.5 CU traits controlling for age-3.5 aggression. Associations between age-3.5 CU traits and age-5.0 aggression were moderated by aggression at 3.5 years, with UK interaction terms, same informant, β = .07 p = .014 cross-informant, β = .14 p = .002, and in Colombia, β = .09 p = .128. The interactions arose from stronger associations between CU traits and later aggression in those already aggressive. Our findings with preschoolers replicated across culturally diverse settings imply a major role for CU traits in the maintenance and amplification of already established aggression, and cast doubt on their contribution to its origins.

Attachment, Trauma, and Mentalization in Intimate Partner Violence: A Preliminary Investigation

Intimate partner violence (IPV) has been examined from a range of theoretical perspectives, including attachment theory, with the aim of assessing psychosocial risk factors. Previous research has shown that a child's exposure to violence in the family is a major predictor of IPV victimization later in life. Furthermore, research on abused and traumatized adult samples has shown high frequencies of unresolved/disorganized attachment styles. In particular, disorganized attachment is associated with major problems of affect regulation and deficits in mentalizing ability. The present research had three aims: (a) to assess the childhood traumatic experiences of female victims of IPV; (b) to investigate and identify the attachment patterns of female victims of IPV; and (c) to examine reflective functioning and prementalistic modes in female victims of IPV, in relation to attachment and trauma. A sample of 31 women, recruited through anti-violence centers, were administered the Adult Attachment Interview (AAI) and the Reflective Functioning Questionnaire. The Complex Trauma Questionnaire and the Reflective Functioning Scale (RFS) were also applied to the AAI transcripts. Interviews were audio recorded and transcribed verbatim. Coding was conducted by two trained coders and certified as reliable for the AAI and RFS. Clinicians completed the Modes of Mentalization Scale (MMS) to assess participants' mentalization style. The data showed a high percentage of women with insecure attachment and lower reflective functioning. The results are discussed in terms of their clinical and theoretical implications-particularly their application to psycho-forensics, through the development of preventive programs and interventions for IPV. Efforts to understand the etiology of IPV and to intervene to prevent recidivism are fundamental in reducing this public health threat.

Mentalizing in Adolescents With and Without Prominent Borderline Features: Validation of the Reflective Functioning Questionnaire for Youths (RFQY) and an Investigation of the Factor Structure of Hypo- and Hypermentalizing

The Reflective Functioning Questionnaire for Youths (RFQY) is a self-report measure of reflective functioning (RF) also referred to as mentalizing. Lower levels of RF are characteristic of a wide range of mental disorders and are especially relevant in the assessment of personality pathology. The goal of the current study is to examine the psychometric properties of a Danish translation of the RFQY and to corroborate previous research on the measure's ability to differentiate between adolescents with and without borderline personality disorder (BPD) features. 889 adolescents were administered the RFQY and divided into three subsamples: a community sample (n = 644), a clinical non-personality disorder sample (n = 64), and a BPD sample (n = 181). Construct validity was examined through bivariate correlations between RFQY and a dimensional assessment of borderline personality features. Analysis of variance (ANOVA) supported the utility of the RFQY to discriminate between adolescents with and without BPD features. Moreover, a two-factor structure based on previous research of the adult version of the RFQ was examined. A series of exploratory and confirmatory factor analyses yielded a two-factor structure corroborating previous research. Implications for prevention, assessment, and treatment are discussed along with methodological limitations and suggestions for future research.

Reflective functioning and Alexithymia as mediators between attachment and psychopathology symptoms: cross-sectional evidence in a community sample

This study sought to examine the role of Reflective Functioning and Alexithymia as mediators in the association between Attachment and Psychopathology. Questionnaires were administered to 1099 adults aged between 18 and 30 years. Results showed relations between Attachment Anxiety, Reflective Functioning, Alexithymia and Psychopathology. Moreover, Alexithymia was a mediator between Attachment, Reflective Functioning and Psychopathology.Current results provided evidence of the role of both Reflective Functioning and Alexithymia in the relationship between Attachment and Psychopathology. Implications are discussed.

Difficulties in Emotion Regulation Mediated the Relationship Between Reflective Functioning and Borderline Personality Symptoms Among Non-Clinical Adolescents

The literature has established the associations between reflective functioning (RF), affect regulation, and the development of borderline personality disorder (BPD) symptoms. We aimed to examine the mediator role of difficulties in emotion regulation on the relationship between RF and BPD symptoms in a non-clinical adolescent sample. The sample was composed of 546 Turkish adolescents with a mean age of 16.18 (SD = 1.67). Of the sample, 62.5% were adolescent girls and 37.5% of boys. In the present cross-sectional research, volunteer adolescents along with parental permission filled out Socio-Demographics Form, Reflective Functioning Questionnaire, Difficulties in Emotion Regulation Scale, and Borderline Personality Inventory on paper during counseling sessions at schools. Process macro was used to conduct mediation analyses. Compromised RF was related to an increase in adolescent borderline personality symptoms, both directly and indirectly via difficulties in emotion regulation. In this non-clinical adolescent sample, a lower degree of certainty, as well as a higher degree of uncertainty about the mental states, were related to a propensity to emotion dysregulation, specifically experiencing emotions less clearly, approaching emotions impulsively, and facing emotions without a modulation strategy. These associations were in turn related to an increase in borderline personality symptoms. The present research results suggest RF and emotion regulation problems as one field of early intervention for adolescents with BPD symptoms.

Adolescents' Attachment to Parents and Reactive-Proactive Aggression: The Mediating Role of Alexithymia

Aggressive behaviors can serve different functions, which might be understood by distinguishing between reactive (RA) and proactive (PA) aggression. Few studies were conducted on adolescents’ family precursors and emotional processes associated with RA or PA. Accordingly, the current study compared RA and PA by evaluating their association with adolescents’ attachment to parents and alexithymia. N = 453 Italian adolescents aged 15–19 years (Mage = 16.48; SD = 0.69; 33.6% males) participated in the study filling in self-report measures. Results showed that PA and RA are significantly associated and that PA was higher among males. Moreover, four mediational models were performed to assess the influence of adolescents’ attachment to mothers vs. fathers on RA or PA, considering the mediating role of alexithymia. Gender was included as a covariate. Mediational models’ results showed a direct and indirect effect, through lower alexithymia, of adolescents’ attachment to mothers and fathers on RA. Differently, only attachment to mothers showed a direct effect on PA, while attachment to fathers only an indirect effect, mediated by lower alexithymia, on PA was shown. Findings support the greater relevance of emotional processes for RA while highlighting the differential contribution of adolescents’ attachment to mothers vs. fathers upon PA. Implications are discussed, and suggestions for future research are provided.

Mentalizing and Group Psychotherapy: A Novel Treatment for Antisocial Personality Disorder

Antisocial personality disorder (ASPD) is a common condition associated with interpersonal and social violence, and current treatments are unsatisfactory. Mentalizing, which has developmental roots in attachment processes, offers a framework to reconsider treatment for ASPD, in which dysfunction of the attachment system temporarily inhibits affect regulation and reduces mentalizing abilities, resulting in impulsivity and relational reactivity. Mentalization-based treatment for ASPD (MBT-ASPD), which focuses on the mental and relational processes central to personality disorder rather than on anger management and violent behavior, is a promising intervention. Implemented as a group psychotherapy, MBT-ASPD targets the mentalizing vulnerabilities and attachment patterns of patients by using a semi-structured group process focused on personal formulation and by establishing group values to promote learning from other members and generating "we-ness." The treatment then emphasizes mentalizing in relationships. This article discusses the mentalizing model of ASPD and outlines strategies for MBT-ASPD from a therapy group conducted in Great Britain.

The Italian version of the Reflective Functioning Questionnaire: Validity within a sample of adolescents and associations with psychological problems and alexithymia

Objectives

This study aims to test the psychometric proprieties of the Reflective Functioning Questionnaire (RFQ) applied to younger (13–16 years) and older (17–20 years) Italian adolescents examining (1) the factorial structure of RFQ; (2) its invariance across age and sex; (3) correlations between RFQ subscale scores, as well as the associations of the RFQ with (4) psychological problems and alexithymia dimensions.

Methods

A cross‐sectional study was conducted with 593 adolescents between the ages of 13 and 20 years old recruited from the community within Italy. These participants completed the RFQ, Symptom Checklist‑90, and Toronto Alexithymia Scale.

Results

The two‐factor structure of the RFQ was confirmed. However, higher internal consistency of RFQ was obtained by removing two items that seemed problematic within this sample. Using a six‐item version of RFQ, the two‐factor structure was invariant across adolescent age and sex. Significant correlations among RFQ subscale scores, and between RFQ subscales with both psychological problems and alexithymia dimensions were found.

Conclusions

Preliminary results reveal a short version of RFQ (six‐item) is a suitable measure to assess mentalizing in adolescents in the Italian context.

Patterns and Predictors of Different Youth Responses to Attachment-Based Parent Intervention

Objective: Few studies have evaluated attachment-based parent interventions for pre-teens and teens, and in particular, differential adolescent trajectories of response. This study examined distinct patterns, and multi-level predictors, of intervention response among youth with serious behavioral and mental health problems whose parents participated in Connect, an attachment- and trauma-informed parent program.Method: Participants included 682 parents (M_age = 42.83, 86% mothers) and 487 youth (M_age = 13.95, 53% female, 28.1% ethnic minority) enrolled in a community-based evaluation of Connect. Parents and youth reported on youth externalizing and internalizing problems (EXT and INT) at six time points from baseline through 18-months post-intervention. Demographic and youth and family level predictors were assessed at baseline.Results: Growth mixture modeling revealed three distinct trajectory classes in both the parent and youth models based on different patterns of co-occurring EXT and INT and degree of improvement over time. Youth with severe EXT showed the largest and fastest improvement, and, interestingly, were characterized by higher callous-unemotional traits and risk-taking at program entry. Youth with comorbid EXT/INT demonstrated a partial or moderate response to intervention in the parent and youth model, respectively, and were characterized by more attachment anxiety at baseline. Most youth showed relatively moderate/low levels of EXT/INT at baseline which gradually improved. Caregiver strain also predicted trajectory classes.Conclusions: These results have significance for tailoring and personalizing interventions for high-risk youth and provide new understanding regarding the profiles of subgroups of youth who show different responses to an attachment-based parent intervention.

Mentalizing mediates the association between emotional abuse in childhood and potential for aggression in non-clinical adults

BACKGROUND

Emotional abuse in childhood has been linked to a higher expression of aggressive behavior in adulthood. The identification of protective factors that mitigate this association is needed. Mentalizing-the capacity to understand behavior in terms of intentional mental states-appears to be a promising candidate factor that possibly modifies maladaptive consequences of early emotional abuse.

OBJECTIVE

This study investigated associations between the history of emotional abuse, aggressive behavior in adulthood and mentalizing capacities in a non-clinical sample of adults.

METHODS

214 healthy adults completed questionnaires measuring retrospectively rated experiences of emotional abuse in childhood, mentalizing capacities and aggressive behavior in a cross-sectional design.

RESULTS

Results indicated associations between emotional abuse in childhood, uncertainty about mental states, and aggressive behavior in adulthood. Moreover, certainty about mental states counteracted the negative effect of emotional abuse and partially mediated the associations between emotional abuse and aggressive behavior in adulthood.

CONCLUSION

This study extends current research and sheds further light on the relationship between emotional abuse in childhood, the health-promoting capacity of mentalizing, and aggressive behavior in non-clinical adults.

Confía en mí, Confío en ti: Applying developmental theory to mitigate sociocultural risk in Latinx families

Ed Zigler was a champion for underprivileged youth, one who worked alongside communities to fight for long-lasting systemic changes that were informed by his lifespan and ecological perspective on the development of the whole child. This paper reports on the development, implementation, and preliminary outcomes of an intervention that embodied the Zigler approach by adopting a community participatory research lens to integrate complementary insights across community-based providers (promotoras), Latinx immigrant families, and developmental psychologists in the service of promoting parent-child relationship quality and preventing youth aggression and violence. Analyses from the first 112 Latinx mother-youth dyad participants (46% female children, ages 8-17) in the resultant, Confía en mí, Confío en ti, eight-week intervention revealed significant pre-post increases in purported mechanisms of change (i.e., attachment security, reflective functioning) and early intervention outcomes (i.e., depressive, anxiety, and externalizing problems). Treatment responses varied by youth age. A case analysis illustrated the lived experiences of the women and children served by this intervention. We discuss future directions for the program, as well as challenges to its sustainability. Finally, we consider Ed's legacy as we discuss the contributions of this work to developmental science and our understanding of attachment relationships among low-income immigrant Latinx families.

Mentalization, attachment, and defense mechanisms: a Psychodynamic Diagnostic Manual-2-oriented empirical investigation

Mentalizing capacities depends on the quality of primary attachment interactions with caregivers who thinks of the child as a subject with mental states. Operationalized as reflective functioning, mentalization is crucial for regulating emotions and developing of a coherent sense of identity, for interacting with individuals making sense to own and others mental states, and for distinguishing internal and external realities without distortions. Although the clinical literature on interplay between mentalization, attachment, and emotional regulation is rich, the empirical research is limited. This study sought to explore connections between reflective functioning, attachment styles, and implicit emotion regulation, operationalized as defense mechanisms, in a group of depressive patients. Twenty-eight patients were interviewed using the adult attachment interview (AAI) and diagnosed using the Psychodynamic Chart-2 of the Psychodynamic Diagnostic Manual, Second Edition. The reflective functioning scale and the defense mechanisms rating scale Qsort were applied to AAI transcriptions to assess reflective functioning and defensive profile. Patients with secure attachment showed significantly higher levels in reflective functioning and overall defensive functioning as compared to those with insecure attachment. Good reflective functioning and secure attachment correlated with mature defenses and specific defensive mechanisms that serve in better regulating affective states. Overall, the relationship between mentalization, attachment and emotion regulation lay the foundations for the delineation of defensive profiles associated with attachment patterns and reflective functioning in depressive patients. The systematic assessment of these psychological dimensions with gold-standard tools may help in tailoring personalized therapeutic interventions and promoting more effective treatments.

Aggressiveness in Adopted and Non-Adopted Teens: The Role of Parenting, Attachment Security, and Gender

The aim of this study was to examine the relationship among aggressiveness, parenting practices, and attachment security in adolescents, assessing maternal and paternal effects separately. Two different subsamples of adolescents between 12 and 16 years old participated in the study (n = 157): 67 adopted adolescents (61.2% girls) and 90 non-adopted adolescents (56.7% girls). Partial and full mediation models were analyzed in multi-group structural equation models (using maximum likelihood estimates), allocating non-adoptive and adoptive adolescents into two different groups. Results showed that whereas acceptance/involvement of each parent predicted attachment security towards the corresponding parental figure, only the father's coercion/imposition predicted aggressiveness, and only attachment security to the mother was a (negative) predictor of adolescent's aggressiveness. The partial mediation model provided the most parsimonious explanation for the data, showing no differences between adopted and non-adopted subsamples and supporting a good model fit for both boys and girls in a multi-group invariance analysis. The implications of these results are discussed in light of the protective effects of care relationships in early adolescence (vs. late adolescence) as well as the differential role of parent figures.

Emotional Comprehension Is Not Related to Duration of Distress from Daily Life Events

The main aim of this paper is to analyze to what extent insight (i.e., mentalization referring to one’s own mental state) moderates recovering from daily life events. A total of 110 participants (84.5% women; mean age: M = 21.5; SD = 3.2) filled in the Trait Meta-Mood Scale (TMMS-24) and the Eysenck Personality Questionnaire (EPQ-R), and were interviewed about impairment derived from daily life events (everyday life stresses) during the past year. Multivariate regression models were adjusted for neuroticism, sex, and socioeconomic status to analyze whether different degrees of insight moderated the relationship between the intensity and the duration of emotional distress. Results showed that the global measure of insight did not moderate recovering from daily-life distress. Regarding the subdimensions, attention to emotional reactions was related to an increased duration of distress. Results showed that, against our hypothesis, deeper comprehension of emotional reactions, operationalized here as “true insight”, was not associated to faster recovery. Limitations and recommendations for further studies are discussed considering these results.

Epistemic Trust and the Emergence of Conduct Problems: Aggression in the Service of Communication

Fonagy and colleagues have recently proposed that deficits in the capacity for epistemic trust (i. e., the expectation that interpersonal communication is relevant to the addressee) are fundamental to psychopathology. In this paper, we consider the implications of this hypothesis for understanding the role of aggression in conduct disorder and conduct problems more generally. Our main proposal is to view conduct problems not only as reflecting dysregulation, but as an adaptation that allows communication with others who are (or are perceived to be) unreliable. Our formulation hinges on two propositions. The first one is to view aggression as a modality of communication adapted to scenarios in which the communicator expects the audience to have low epistemic trust in the communicator. The second idea is to conceptualize the failed "unlearning of aggression" as reflecting a lack of interest in maintaining one's reputation as a communicator, which in turn stems from a lack of epistemic trust in other communicators. In this paper, we discuss these ideas and examine how they may account for the developmental pathways that lead young people to develop conduct problems.

Mentalization for Offending Adult Males (MOAM): study protocol for a randomized controlled trial to evaluate mentalization-based treatment for antisocial personality disorder in male offenders on community probation

BACKGROUND

Antisocial personality disorder (ASPD), although associated with very significant health and social burden, is an under-researched mental disorder for which clinically effective and cost-effective treatment methods are urgently needed. No intervention has been established for prevention or as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment that has shown some promising preliminary results for reducing personality disorder symptomatology by specifically targeting the ability to recognize and understand the mental states of oneself and others, an ability that is compromised in people with ASPD. This paper describes the protocol of a multi-site RCT designed to test the effectiveness and cost-effectiveness of MBT for reducing aggression and alleviating the wider symptoms of ASPD in male offenders subject to probation supervision who fulfil diagnostic criteria for ASPD.

METHODS

Three hundred and two participants recruited from a pool of offenders subject to statutory supervision by the National Probation Service at 13 sites across the UK will be randomized on a 1:1 basis to 12 months of probation plus MBT or standard probation as usual, with follow-up to 24 months post-randomization. The primary outcome is frequency of aggressive antisocial behaviour as assessed by the Overt Aggression Scale - Modified. Secondary outcomes include violence, offending rates, alcohol use, drug use, mental health status, quality of life, and total service use costs. Data will be gathered from police and criminal justice databases, NHS record linkage, and interviews and self-report measures administered to participants. Primary analysis will be on an intent-to-treat basis; per-protocol analysis will be undertaken as secondary analysis. The primary outcome will be analysed using hierarchical mixed-effects linear regression. Secondary outcomes will be analysed using mixed-effects linear regression, mixed-effects logistic regression, and mixed-effects Poisson models for secondary outcomes depending on whether the outcome is continuous, binary, or count data. A cost-effectiveness and cost-utility analysis will be undertaken.

DISCUSSION

This definitive, national, multi-site trial is of sufficient size to evaluate MBT to inform policymakers, service commissioners, clinicians, and service users about its potential to treat offenders with ASPD and the likely impact on the population at risk.

TRIAL REGISTRATION

ISRCTN 32309003 . Registered on 8 April 2016.

Reflective Function and Borderline Traits in Adolescents

Despite the developmental roots of the relation between attachment-based reflective function (RF) and borderline pathology, there is a lack of empirical studies examining this link in youth. We examined this link taking into account potential relations between RF and internalizing and externalizing pathology. A total of 421 clinical adolescents between the ages of 12 and 17 completed the Child Attachment Interview (CAI; Shmueli-Goetz, Target, Fonagy, & Datta, 2008), which was coded using the Child and Adolescent Reflective Functioning Scale (CARFS; Ensink, Target, & Oandasan, 2013), alongside a self-report measure of borderline pathology and parent-reported measures of internalizing and externalizing pathology. Exploratory analyses revealed no direct relation between RF and borderline features or internalizing psychopathology but a negative relation with externalizing pathology. Moderation analyses showed that externalizing pathology moderated the relation between RF and borderline pathology. Implications for understanding the various ways in which impaired RF may present in adolescents with BPD are discussed.

Exploring mentalization, trust, communication quality, and alienation in adolescents

INTRODUCTION

A growing body of evidence has demonstrated the importance of mentalization for adolescents' psychosocial functioning; however, further research is needed to understand links between mentalization and other socio-cognitive factors. The aim of this quantitative, cross-sectional study was to investigate the relationship between a teen's capacity to mentalize and three attachment-related factors: parent-teen trust, parent-teen communication, and parent-teen alienation.

METHODS

In an online survey, 82 (mainly) Australian adolescents (57 female; 23 male; 2 non-binary; mean age 17.09 years) completed: i) The Children's Eyes Test, which measured mentalization; and ii) The Inventory of Parent and Peer Attachment-45, which measured trust, communication quality, and alienation.

RESULTS

In teens' relationships with both mothers and fathers, trust and communication quality were significantly positively correlated (p = .001) when controlling for age and gender. Both were significantly negatively correlated with alienation (p = .001) with control variables included. Capacity to mentalize did not correlate with trust, communication quality, or alienation in relationships with either mothers or fathers (p ≤ .05).

CONCLUSIONS

Possible reasons are proposed for why no relationship was found between mentalization and trust, communication quality, or alienation. Implications for future research are discussed.

Mentalization-Based Training Program for Child Care Workers in Residential Settings

Most of the children placed in child welfare residential care have experienced complex traumas linked to various forms of abuse and neglect, which have many important developmental impacts. Research shows that maltreatment is associated with increased aggression and disruptive behavior, internalizing difficulties, violence towards self and others, sexualized behaviors, academic difficulties, and early drug abuse. These experiences also negatively affect the attachment system and the mentalization process of the child. Consequently, working with this population represents a challenge for child care workers. This article describes a mentalization-based training program for child care workers who care for children aged six to 12 years old. First, the general framework of the training program is presented. Then, some of the therapeutic strategies used to improve the children's mentalizing capacity are described. Those strategies are adapted to the psychic functioning level of the child. Finally, a summary of a preliminary study of the program's efficacy are presented. This work suggests that mentalization-based interventions might represent a valuable approach in child welfare residential care.

Longitudinal Relationships Between Reflective Functioning, Empathy, and Externalizing Behaviors During Adolescence and Young Adulthood

Reflective functioning (RF) refers to the understanding of one's own and others' behaviors in terms of mental states, whereas empathy entails the abilities to understand (cognitive empathy) and to share (affective empathy) the emotions of others. Low RF and low empathy have been previously related to externalizing behaviors, such as aggression and rule breaking. However, few longitudinal studies have simultaneously examined the relationships between these variables during adolescence. The aim of the present study is to investigate the longitudinal effects of both RF and empathy on potential changes in externalizing behaviors over time, in a group of 103 adolescents and young adults from the general population assessed repeatedly up to four times. We conducted multilevel analysis in order to examine the effects of RF and empathy on the initial levels and the trajectories of externalizing behaviors over time, while accounting for other variables previously associated with externalizing behaviors, such as age, gender, internalizing problems, and cognitive abilities. The results suggest that the ability to reflect on behaviors in terms of mental states predicted a sharper decrease in externalizing behaviors over time. Moreover, externalizing behaviors at the first assessment were associated with RF impairments and low affective empathy. Age, gender, cognitive abilities, and cognitive empathy were not associated with externalizing behaviors. We discuss how our results, based on a typically developing population, might inform primary or indicated prevention strategies for externalizing behaviors by focusing on socio-cognitive processes such as RF and affective empathy.

Dimensions of Psychopathic Traits in a Community Sample

Abstract. There are valid measures of psychopathic traits in youth, such as the Youth Psychopathic Traits Inventory (YPI). However, it is unclear how another self-report measure, which is based on a different conceptualization of psychopathy relates to the YPI in youth and to antisocial behavior. We therefore, compared the construct validity of two measures: the personality-based Psychopathic Personality Inventory-Revised (PPI-R) and the YPI – based on adult antisocial personality traits. First, both measures showed sufficient model fit and some overlap in their variance, particularly YPI impulsive-irresponsible and grandiose-manipulative factors with PPI-R self-centered impulsivity, as well as YPI callous-unemotional with PPI-R coldheartedness. We found that although overall delinquency was correlated with PPI-R and YPI subscales, only the self-centered impulsivity factor of the PPI-R and only the Impulsive-Irresponsibility domain of the YPI were statistically predictive of self-reported antisocial behavior. Thus, the PPI-R and the YPI both show moderate construct validity and criterion validity for use among young community adults.

Moral competence and conduct disorder among Filipino children in conflict with the law

Aims

The numbers of children in conflict with the law continue to rise in Asia, yet few studies have been conducted regarding factors associated with it. It has been theorized that children with conduct disorder represent majority of children in conflict with the law, and that poor moral competence mediates the association between conduct disorder and antisocial behavior. This study aimed to present a profile of Filipino children in conflict with the law, determine the prevalence of conduct disorder in the sample, and investigate variables associated with conduct disorder.

Methods

This was a cross‐sectional study conducted at a conflict with the law Custodial Care Center in the Philippines. The procedure entailed a diagnostic interview and questionnaire administration conducted by psychiatrists. Questionnaires administered included the Moral Competence Test and Parental Warmth and Acceptance Scale. Statistical analyses of data included descriptive statistics, chi‐square tests, and independent t tests. SPSS v.23.0 was used for data encoding and analysis.

Results

Twenty‐three participants were included in the study, with 10 participants with conduct disorder and 13 controls. Majority were male adolescents between the ages of 16 and 18 years. Conduct disorder was associated with commission of multiple violations, particularly theft and homicide, the presence of a substance use disorder, and a history of abuse. Participants with conduct disorder had lower moral competence levels compared to participants without conduct disorder.

Conclusion

Conduct disorder was associated with high‐risk antisocial behavior and lower levels of moral competence.

This paper examines the relationship between moral competence and conduct disorder among Filipino children in conflict with the law. Aside from the association found between low moral competence and conduct disorder, other associations uncovered in this study include the relationship between conduct disorder and the presence of substance use as a dual diagnosis and history of child abuse. As of the time of publication, this is the first paper of its kind to have been conducted in the Philippines.

Influence of maternal reflective functioning on mothers' and children's weight: A follow-up study

Based on cross-sectional research linking poor reflective functionining (RF) to eating disorders, the current follow-up study tested whether maternal RF would explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. During pregnancy (Time 1 [T1]), 51 women were administered the Difficulties in Emotion Regulation Scale (DERS) and interviewed using the Adult Attachment Interview (AAI). Seven months after delivery (Time 2 [T2]), mother-baby dyads who remained in the study (n = 44) were videotaped (Feeding Scale) during their feeding interaction. Last (Time 3 [T3]), the weight of the 34 children who were still in the study was collected at 3 years of age. Maternal AAI-RF at T1 did not correlate with the DERS at T1 nor with the quality of the feeding interacions at T2. However, it correlated, significantly, with maternal body mass index (BMI) at T1, r = -.298, P = .034, and marginally significantly with baby's BMI at T3, r = -.296, P = .089. Moreover, multiple regression models showed a trend indicating that maternal AAI-RF might explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. These findings suggest that working on maternal mentalization might contribute to helping prevent childhood obesity from pregnancy.

The Mediating Role of Romantic Attachment in the Relationship Between Attachment to Parents and Aggression

BACKGROUND

A secure attachment style could promote more intimacy in romantic relationships, while an insecure attachment style could be correlated with less positive romantic relationships in adulthood. Numerous studies have noted that a secure attachment to parents was correlated with lower levels of aggression, whereas insecure attachments were associated with higher levels of aggression. We aimed to investigate the role of the attachment system as a mediator of the expression of aggressiveness during adolescence. Specifically, we considered that the attachment to parents and peers could influence one's attachment to a romantic partner.

METHODS

We empirically tested whether there were relationships of parent and peer attachment on aggressiveness mediated by romantic attachment style. Participants of the study included 411 students.

RESULTS

Results indicated that for males an insecure father-child attachment style seems to be associated with higher levels of anxiety and avoidance in romantic attachments and then with aggressiveness. For females, an insecure mother-child attachment style seems to be associated with higher levels of aggressiveness.

CONCLUSION

The attachment to parents and to peers plays a key role in defining romantic attachment according to gender, and these dimensions in turn tend to affect the levels of aggressiveness.

To know or not to know? Mentalization as protection from somatic complaints

Somatization processes are usually associated with a lack of insight or with emotional unawareness, especially in adolescents where the ability for self-reflection is beginning to mature. However, the extent to which different levels of insight explain variations in somatization remains understudied. This study aimed to evaluate whether high-level emotional awareness (comprehension) but not low-level awareness (only attention) is needed to psychologically cope with suffering, thus leading to lower somatization. Specific predictions were: 1) High attention along with High comprehension will be associated with significantly lower frequency of somatic complaints than other combinations (Low attention and Low comprehension, or High attention but Low comprehension); 2) In absence of comprehension, no attention will be more optimal than attention only, because only-attention might work as an amplificatory of suffering without the possibility of processing it. Self-reports of meta-cognitive processes, somatization, and control variables were obtained from 264 adolescents from a non-clinical population (54.5% female; aged 12-18, M = 14.7, SD = 1.7). In line with expectations, results revealed significant differences in the effects of insight positions on somatization: Attention+Comprehension (M = 4.9, SE = 0.9) < Nothing (M = 7.1, SE = 0.3) < Only attention (M = 8.9, SE = 0.7). Compared to Nothing, Attention+comprehension was associated with significantly reduced somatic complaints (B = -2.2, p = 0.03, 95% CI -4,1 to 0.2). However, Only attention was associated with increased somatic complaints compared to the other two conditions (B = 1.8, p = 0.03, 95% CI 0.2 to 3.4; B = 4, CI 95% 1.6-6.3, p = 0.001, respectively). This highlights the role of higher-order awareness (i.e., comprehension or clarity) in the processing of suffering and stresses its value in the adaptive coping of emotional distress.

Attachment and reflective functioning in children with somatic symptom disorders and disruptive behavior disorders

Our goal in conducting this study was to examine whether children with somatic symptom disorders (SSD) and disruptive behavior disorders (DBD) have higher rates of insecure or disorganized attachment and difficulties in mentalizing (operationalized as reflective functioning) as compared to a control group. Participants were 131 children (8-15 years) spanning two groups-a clinical group (n = 85), comprised of children fitting the criteria of our target diagnostic classifications (SSD: N = 45; DBD: N = 40), as well as a comparison group of healthy control children (n = 46). Children completed the Child Attachment Interview, which was later coded by reliable raters for attachment security and reflective functioning (RF). Consistent with our predictions, children in the clinical group had significantly lower RF and were significantly more likely to have insecure (over 80%) and disorganized attachment (over 40%) than children in the comparison group. In addition, RF was significantly lower in children with DBD than children with SSD. Furthermore, in the SSD group, children's RF regarding self was significantly lower than RF regarding others. Finally, consistent with prior studies, RF and attachment were associated. The findings indicate that school-aged children with SSD and DBD have higher rates of insecure and disorganized attachment. Consistent with theory, RF and attachment were loosely coupled, but RF alone differentiated among the diagnostic subgroups. Implications for treatment and prevention are discussed.

To Better Understand the Link between Psychopathy and Antisocial Behavior: Moderation by Dispositional Mindfulness

BACKGROUND

Dispositional mindfulness deficits and psychopathic personality traits have been shown to be closely associated and independent predictors of antisocial behaviors (AB) in young adults. However, the interaction effects of these 2 factors have not yet been explored. The aim of this study was to examine the contribution of dispositional mindfulness and psychopathic traits to ABs in a college student sample.

METHODS

Participants were 1,572 students from different French universities who completed self-report questionnaires. Regression analyses were conducted in order to test a moderation model between psychopathic traits and AB.

RESULTS

Moderation analyses revealed that dispositional mindfulness interacted with psychopathic personality traits in predicting AB. In males with high levels of dispositional mindfulness, as psychopathic traits increased, AB increased less than in males with low levels of dispositional mindfulness.

CONCLUSIONS

The present study suggests possible implications for prevention and treatment of AB among non-clinical young adults with relatively high psychopathic traits.

Beyond diagnosis: Mentalization and mental health from a transdiagnostic point of view in adolescents from non-clinical population

An increasing volume of evidence suggests that mentalization (MZ) can be an important factor in the transition from mental health to mental illness and vice versa. However, most studies are focused on the role of MZ in specific disorders. This study aims to evaluate the relationship between MZ and mental health as a trans-diagnostic process. A sample of 172 adolescents aged 12 to 18 years old (M = 14.6, SD = 1.7; 56.4% of girls) was assessed on measures of MZ, psychopathology and psychological functioning from a multimethod and multi-informant perspective. Contrary to predictions, MZ was not associated with general psychopathology and comorbidity, even when explored from a broad, trans-diagnostic perspective. However, we observed a robust association linking MZ to functioning and well-being across many dimensions, involving social, role and several psychological indicators of adjustment and mental health. These results suggest that MZ may contribute to mental health beyond symptoms, not so much associated with psychopathology, but rather resilience and well-being.

Neural processing of social exclusion in individuals with psychopathic traits: Links to anger and aggression

Psychopathy is a cluster of personality traits associated with high rates of aggression. While research on psychopathic traits largely focuses on neurobiological factors implicated in aggression, other research suggests that contextual factors, such as social exclusion, also contribute to promoting aggression. Yet, the relationships among psychopathic traits, neural processing of exclusion, and aggression remain unknown. A sample of 76 adolescents and young adults completed Cyberball, a task involving conditions of social inclusion, ambiguous exclusion, and unambiguous exclusion. During Cyberball, a slow wave (SW) event-related potential (an index of elaborative processing) and self-reported anger were measured. Additionally, acts of real-world aggression were assessed. Results indicated that as psychopathic traits increased, SW during ambiguous exclusion also increased, but SW during inclusion decreased. However, the combination of smaller SW during ambiguous exclusion and higher psychopathic traits predicted heightened anger following Cyberball and more frequent real-world aggression. This response to social exclusion among individuals with elevated psychopathic traits may represent an unreflective, reactive style that exacerbates anger and aggression in certain contexts. These data suggest that neurobiological dysfunction in elaborative processing is related to psychopathic traits, and social context comprises another important influence on the aggression of individuals with elevated psychopathic traits.

Childhood behavioral inhibition is associated with impaired mentalizing in adolescence

Recent advances suggest that impairment in social cognition (SC) may play a role in the development of social anxiety (SA). However, very few studies have analyzed whether SA fosters poorer social-cognitive development as it leads to social avoidance. This study aimed to analyze whether retrospectively assessed behavioral inhibition (BI) (i.e., an early form of SA) in childhood is associated with a deficit in social cognition operationalized as impairment of mentalizing (MZ) in adolescence. A sample of 256 adolescents (range: 12-18 years; mean age: 14.7 years; SD = 1.7) from general population were assessed for MZ capacities and retrospective BI through self-report and interview measures. Results comparing three groups of adolescents with different levels of childhood BI (low, moderate or high) and controlling for concurrent SA and depression reveal that the higher the level of BI, the lower the level of MZ. These results were consistent for almost all mentalization measures, including when both extreme (i.e., high vs. low BI) and non-extreme (i.e., high vs. moderate BI) were compared in both self-report and interview measures and in both dimensions of MZ (i.e., MZ referred to others' and to own mental states). These findings support that childhood forms of SA are associated to deficit in SC in adolescence. A possible bi-directional relationship between SA and SC, and the role that it may play in the pathway to clinical SA are discussed.

Psychosocial Features of Neurofibromatosis Type 1 in Children and Adolescents

Neurofibromatosis type 1 (NF1) is a common neurologic condition associated with a wide variety of developmental deficits that have an important impact on children and adolescents.

OBJECTIVE

This article aims to document the psychosocial features of NF1 and to report the interventions described to address the needs of pediatric patients with NF1.

METHODS

A literature review was conducted concerning the social life, mental health, and quality of life (QOL) of children and adolescents with NF1 as well as the psychosocial interventions addressed to this population.

RESULTS

Compared to unaffected children and adolescents of the general population, pediatric patients with NF1 have an increased risk of having social difficulties, mental health disorders, behavioral and emotional problems, as well as diminished QOL. Only 3 articles describe interventions within the NF1 population to address these difficulties.

CONCLUSION

There is a need to develop and assess psychosocial interventions for patients with NF1.

Does reflective functioning mediate the relationship between attachment and personality?

Mentalization, operationalized as reflective functioning (RF), can play a crucial role in the psychological mechanisms underlying personality functioning. This study aimed to: (a) study the association between RF, personality disorders (cluster level) and functioning; (b) investigate whether RF and personality functioning are influenced by (secure vs. insecure) attachment; and (c) explore the potential mediating effect of RF on the relationship between attachment and personality functioning. The Shedler-Westen Assessment Procedure (SWAP-200) was used to assess personality disorders and levels of psychological functioning in a clinical sample (N = 88). Attachment and RF were evaluated with the Adult Attachment Interview (AAI) and Reflective Functioning Scale (RFS). Findings showed that RF had significant negative associations with cluster A and B personality disorders, and a significant positive association with psychological functioning. Moreover, levels of RF and personality functioning were influenced by attachment patterns. Finally, RF completely mediated the relationship between (secure/insecure) attachment and adaptive psychological features, and thus accounted for differences in overall personality functioning. Lack of mentalization seemed strongly associated with vulnerabilities in personality functioning, especially in patients with cluster A and B personality disorders. These findings provide support for the development of therapeutic interventions to improve patients' RF.

Mentalization and depressive symptoms in a clinical sample of adolescents and young adults

BACKGROUND

Increasing evidence supports that mentalization deficits may have a role in the genesis of young age depression; however, few studies examined this issue in clinical populations.

METHODS

Outpatients aged 14-21, suffering from various psychiatric disorders, were assessed using the Mentalization Questionnaire (MZQ), the Beck Depression Inventory (BDI), and the Childhood Trauma Questionnaire (CTQ), using data from age-matched healthy students for comparison. The relationship between CTQ, MZQ, and BDI scores was examined at the cross-sectional level, including mediation analyses, and longitudinally, in a subsample who underwent a psychotherapy intervention.

RESULTS

Of 83 subjects, 33 (39.8%) had mentalization levels that were 1 standard deviation below those of comparison subjects. In the whole sample, the levels of mentalization were inversely associated with BDI (r = -.68, p < .001) and CTQ scores (r = -.30, p = .006). Moreover, MZQ scores mediated a large part of the effect of childhood trauma on depression (total effect: 10.6, 95% CI: 5.3, 15.9; direct effect: 6.5, 95% CI: 2.1, 10.8; indirect effect: 4.1, 95% CI: 1.5, 7.4). This effect was almost entirely explained by the Affect Regulation subscale. In patients re-evaluated after four sessions (n = 37), the decrease in BDI scores correlated with the increase in MZQ scores (r = .40, p = .02).

CONCLUSIONS

In a juvenile clinical sample, deficits of mentalization abilities were associated with the severity of depression and explained part of the depressogenic effects of childhood trauma.