The Relationship between Reflective Functioning and Alexithymia

Danilo Calaresi, Nadia Barberis


Background: The aim of this study was to verify the relationship between the construct of reflective functioning and the construct of alexithymia, taking also into account the role of gender differences. Methods: Participants in the study were 216. Every participant had an Italian nationality and ages ranging from 18 to 30 (50% males), and were recruited through social networks. Participants completed a sociodemographic questionnaire, the Toronto Alexithymia Scale (TAS-20), and the Reflective Functioning Questionnaire (RFQ-8). Results: The findings of the study showed that alexithymia scores were associated with reflective functioning scores. In particular, results showed that certainty of mental states was negatively correlated with alexithymia, while uncertainty of mental states was positively correlated with alexithymia. Certainty of mental states was also negatively with an externally-oriented thinking, while uncertainty of mental states was not significantly correlated with an externally-oriented thinking. Furthermore, effects on gender were also found. In particular, results showed that the difficulty in describing feelings was higher for males. Conclusions: These results might help to extend the current correlational studies of this field. By a clinical point of view, the findings of this study might encourage the choice of different approaches in the treatments of patients with both alexithymic and reflective functioning issues.

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Allen, J. G., Fonagy, P., & Bateman, A. W. (2008). Mentalizing in clinical practice Washington-London: American Psychiatric Publishing.

Arancibia, M., & Behar, R. (2015). Alexithymia and depression: Evidence, controversies, and implications. Revista Chilena De Neuro-Psiquiatria, 53(1), 24–34.

Beadle, J. N., Brown, V., Keady, B., et al. (2012). Trait empathy as a predictor of individual differences in perceived loneliness. Psychological Reports, 110, 3-15.

Bender, D. S., Morey, L. C., & Skodol, A. E. (2011). Toward a model for assessing level of personality functioning in DSM–5, Part I: A review of theory and methods. Journal of Personality Assessment, 93, 332–346.

Bouchard, M. A., Target, M., Lecours, S., Fonagy, P., Tremblay, L. M., Schachter, A., et al. (2008). Mentalization in adult attachment narratives: Reflective functioning, mental states, and affect elaboration compared. Psychoanalytic Psychology, 25, 47–66.

Bressi, C., Fronza, S., Minacapelli, E., Nocito, E. P., Dipasquale, E., Magri, L., et al. (2017). Short‐Term Psychodynamic Psychotherapy with Mentalization‐Based Techniques in Major Depressive Disorder patients: Relationship among alexithymia, reflective functioning, and outcome variables – A Pilot study. Psychology and Psychoterapy: Theory, Research and Practice, 90, 299-313.

Bressi, C., Taylor, G., Parker, J., Bressi, S., Brambilla, V., Aguglia, E., et al. (1996). Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: An Italian multicenter study, Journal of Psychosomatic Research, 41(6), 551-559, ISSN 0022-3999.

Busch, F. N., (2008). Mentalization: Theoretical Considerations, Research Findings, and Clinical Implications, 118-120. New York: The Analytic Press.

D’onofrio, E., Pace, C. S., Cavanna, D. (2015). Qualitative research in adolescent psychotherapy: Attachment and Reflective Functioning as psychotherapy’s outcomes of an adolescent with anorexia nervosa. Research in Psychotherapy: Psychopathology, Process and Outcome, 18(2), 93-101. ISSN 2239-8031.

De M'Uzan, M. (2003). Slaves of quantity. Psychoanalytic Quarterly, 72(3), 711–725.

De Panfilis, C., Salvatore, P., Marchesi, C., Cazzolla, R., Tonna, M., & Maggini, C. (2008). Parental bonding and personality disorder: The mediating role of alexithymia. Journal of Personality Disorder, 22, 496–508.

Eibl-Eibesfeldt, I. (1971). Love and hate: a natural history of behavior patterns (foundations of human behavior). London: Methuen.

Fonagy, P., & Allison, E. (2012). What is Mentalization? The concept and its Foundations in Developmental Research and Social-Cognitive Neuroscience. In: Midgley, N., & Vrouva, I. (ed.), Minding the child: Mentalization-based interventions with children, young people and their families, 11-34. Routledge: Hove, UK.

Fonagy, P., & Target, M. (1997) Attachment and reflective function: their role in self-organization. Development and Psychopathology, 9(4), 679–700.

Fonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y. W., Warren, F., Howard, S., et al. (2016). Development and validation of a self-report measure of mentalizing: The reflective functioning questionnaire. PLOSE ONE, 11(7).

Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective-functioning Manual, Version 5.0, for Application to Adult Attachment Interviews. London: University College London.

Franz, M., Popp, K., Schaefer, R., Sitte, W., Schneider, C., Hardt, J., et al. (2008). Alexithymia in the German general population. Social Psychiatry and Psychiatric Epidemiology, 43, 54−62.

Freeman, C. (2016). What is mentalizing? An overview. Br J Psychother., 32, 189–201.

Górska, D., & Marszał, M. (2014). Mentalization and theory of mind in borderline personality organization: exploring the differences between affective and cognitive aspects of social cognition in emotional pathology. Psychiatria Polska, 48(3), 503–513.

Larsen, J. K., Van Strien, T., Eisinga, R., & Engels, R. C., (2006). Gender differences in the association between alexithymia and emotional eating in obese individuals. Journal of Psychosomatic Research, 60(3), 237–243.

Leo, M., Terry, D. J., Bedoy, E. H., Ladrazo, L. M., & Barchard, K. A. (2014). Hidden emotion: Sex differences in Alexithymia. Poster presented at the Western Psychological Association annual convention, Portland, April.

Levant, R. F. (1992). Toward the reconstruction of masculinity. Journal of Family Psychology, 5(3-4), 379-402.

Levant, R. F., Hall, R. J., Williams, C. M., & Hasan, N. T. (2009). Gender differences in alexithymia. Psychology of Men & Masculinity, 10(3), 190-203.

Levy, K. N., Clarkin, J. F., Yeomans, F. E., Scott, L. N., Wasserman, R. H., & Kernberg, O. F. (2006). The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy. Journal of Clinical Psychology, 62, 481–501.

Liotti, G. (2005). Il ruolo dell'attaccamento nella conoscenza e regolazione delle emozioni. In B. Bara, (ed.), Nuovo manuale di psicoterapia cognitiva, 1. Torino: Bollati Boringhieri Editore.

Luyten, P., & Fonagy, P. (2017). The Reflective Functioning Questionnaire (RFQ). Available from: 13.09.2017

Main, M., & Goldwyn, R. (1994). Adult Attachment Rating and Classification System, Manual in Draft, Version 6.0. Unpublished manuscript: University of California at Berkeley.

Marszał, M., & Jańczak, A. (2017). Emotion Dysregulation, Mentalization and Romantic Attachment in the Nonclinical Adolescent Female Sample. Current Psychology, 37(4), 894-904

Mattila, A. K., Salminen, J. K., Nummi, T., & Joukamaa, M. (2006). Age is strongly associated with alexithymia in the general population. Journal of Psychosomatic Research, 61, 629−635.

Messina, A., Beadle, J. N., & Paradiso, S. (2014). Towards a classification of alexithymia: primary, secondary and organic. Journal of Psychopathology, 20, 38-49.

Messina, A., Fogliani, A. M., & Paradiso, S. (2010). Association between alexithymia, neuroticism, and social desirability scores among Italian graduate students. Psychological Reports, 107, 185-192.

Moriguchi, Y., Ohnishi, T., Lane, R. D., Maeda, M., Mori, T., Nemoto, K., et al. (2006). Impaired self-awareness and theory of mind: An fMRI study of mentalizing in alexithymia, NeuroImage, 32(3), 1472-1482.

Motan, I., Gençöz, T. (2007). The relationship between the dimensions of alexithymia and the intensity of depression and anxiety. Turkish Journal of Psychiatry, 18(4), 333-43.

Nam, G., Lee, J., & Hur, J. (2018). Gender Differences in Phenomenology of Alexithymia. Conference: ACP2018. Stream: General Psychology.

Nicolò, G., Semerari, A., Lysaker, P.H., et al. (2011). Alexithymia in personality disorders: correlations with symptoms and interpersonal functioning. Psychiatry Research, 190, 37-42.

Ogrodniczuk, J. S., Piper, W. E., & Joyce, A. S. (2011). Effect of alexithymia on the process and outcome of psychotherapy: a programmatic review. Psychiatry Research, 190, 43-8.

Pandey, R., Mandal, M. K., Taylor, G. J., Parker, J. D. (1996): Cross-cultural alexithymia: development and validation of a Hindi translation of the 20-Item Toronto Alexithymia Scale. Journal of Clinical Psychology, 52, 173-176.<173::AID-JCLP8>3.0.CO;2-V

Pinaquy, S., Chabrol, H., Simon, C., Louvet, J. P., & Berbe, P. (2003). Emotional eating, alexithymia and binge eating disorder in obese women. Obesity Research & Clinical Practice, 11, 195−201.

Sifneos, P.E. (1967). Clinical observations on some patients suffering from psychosomatic diseases. In: F. Antonelli, & L. Ancona (ed.), Acta Psychotherapeutica et Psychosomatica, 7, 1-10. Roma: SIMP.

Sleuwaegen, E., Houben, M., Claes, L., Berens, A., &Sabbe, B. (2017). The relationship between non-suicidal self-injury and alexithymia in borderline personality disorder: “Actions instead of words”. Comprehensive Psychiatry, 77, 80–88.

Suchman, N. E., Ordway, M. R., de Las Heras, L., & McMahon, T. J. (2016). Mothering from the Inside Out: results of a pilot study testing a mentalization-based therapy for mothers enrolled in mental health services. Attachment and Human Development, 18(6), 596-617.

Swart, M., Kortekaas, R., & Aleman, A. (2009). Dealing with Feelings: Characterization of Trait Alexithymia on Emotion Regulation Strategies and Cognitive-Emotional Processing. Plose One, 4(6).

Taylor, G. J., & Bagby, R. M. (2000). An overview of the alexithymia construct. In: R. Baron, & J. D. A. Parker (Ed.), The handbook of emotional intelligence: Theory, development, assessment and application at home, school and in the workplace. Jossey-Bass, San Francisco, 40–67.

Taylor, G. J., Bagby, R. M., & Parker, (1994). The twenty item Toronto alexithymia scale I. Item selection and crossvalidation of the factor structure Journal of Psychosomatic Research, 38, 23-32.

Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (1997). Disorders of affect regulation alexithymia in medical and psychiatric illness, 7−25. Cambridge, UK: Cambridge University Press.

Wallin, D. J. (2007). Attachment in psychotherapy. New York: Guilford Press.



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