A deeper look at the association between childhood maltreatment and reflective functioning

ABSTRACT Childhood maltreatment is theorized as impeding the development of reflective functioning (RF; ability to perceive and interpret oneself and others in terms of mental states). However, previous research typically failed to support this association or yielded small sized and mixed associations. This study aims to provide a deeper look at the association between childhood maltreatment and RF by characterizing two non-mentalizing categories. One-hundred-and-sixteen pregnant women (mean age = 27.62, SD = 4.52) from the community (48.3% with a university degree, 96.5% in a relationship with the other parent) retrospectively reported on childhood abuse and neglect using the Childhood Trauma Questionnaire. They also participated in the Adult Attachment Interview subsequently coded using the Reflective Functioning Scale. Participants with poor to low RF were allocated to one of two groups (disavowal-distancing or distorted-inconsistent) using indicators provided in the RF Scale. No association was found between childhood maltreatment and overall RF when controlling for education level. A multinomial logistic regression revealed that childhood maltreatment was strongly predictive of a disrupted, over-analytical and inconsistent reflection about mental states but not of a tendency to discourse little about mental states. This tendency was rather only predicted by education level. Findings suggest that childhood maltreatment would lead to specific impairments in RF and that not considering how individuals fail to mentalize about attachment relationships may mask strong associations between RF and its determinants and correlates, including childhood maltreatment.

[1]  P. Fonagy,et al.  Attachment, Mentalizing and Trauma: Then (1992) and Now (2022) , 2023, Brain sciences.

[2]  Martin Smith.  Mentalizing and epistemic trust. The work of Peter Fonagy and colleagues at the Anna Freud Centre , 2023, Journal of Social Work Practice.

[3]  G. Overbeek.  Editorial: Prevention is the best cure. , 2022, Journal of child psychology and psychiatry, and allied disciplines.

[4]  D. Cicchetti,et al.  Patterns of childhood maltreatment predict emotion processing and regulation in emerging adulthood. , 2022, Development and psychopathology.

[5]  J. Belsky,et al.  Why and how does early adversity influence development? Toward an integrated model of dimensions of environmental experience , 2022, Development and Psychopathology.

[6]  Marie-Eve Bolduc,et al.  Cumulative childhood trauma and complex psychiatric symptoms in pregnant women and expecting men , 2022, BMC Pregnancy and Childbirth.

[7]  M. Thomason,et al.  Maternal caregiving representations of the infant in the first year of life: Associations with prenatal and concurrent reflective functioning. , 2021, Infant mental health journal.

[8]  J. LeMoult,et al.  Editorial Perspective: Adverse childhood events causally contribute to mental illness - we must act now and intervene early. , 2021, Journal of child psychology and psychiatry, and allied disciplines.

[9]  Martin H. Teicher,et al.  Recognizing the importance of childhood maltreatment as a critical factor in psychiatric diagnoses, treatment, research, prevention, and education , 2021, Molecular Psychiatry.

[10]  C. Lacharité,et al.  Evaluation of the Acceptability of a Prenatal Program for Women With Histories of Childhood Trauma: The Program STEP , 2021, Frontiers in Psychiatry.

[11]  J. Seng,et al.  Using Theories of Posttraumatic Stress to Inform Perinatal Care Clinician Responses to Trauma Reactions. , 2021, Journal of midwifery & women's health.

[12]  R. Duschinsky,et al.  Mentalising and Epistemic Trust , 2021 .

[13]  N. Berthelot,et al.  Maternal childhood abuse and neglect predicts offspring development in early childhood: The roles of reflective functioning and child sex. , 2021, Child abuse & neglect.

[14]  P. Fonagy,et al.  Mentalizing mediates the association between emotional abuse in childhood and potential for aggression in non-clinical adults. , 2021, Child abuse & neglect.

[15]  Ben Isbel,et al.  Longitudinal Research on Perspective Taking in Adolescence: A Systematic Review , 2021, Adolescent Research Review.

[16]  N. Letourneau,et al.  Convergent Validity of Three Measures of Reflective Function: Parent Development Interview, Parental Reflective Function Questionnaire, and Reflective Function Questionnaire , 2020, Frontiers in Psychology.

[17]  Junhui Wu,et al.  The relations between early-life stress and risk, time, and prosocial preferences in adulthood: A meta-analytic review , 2020 .

[18]  R. Lakeman,et al.  The role of mentalization in child psychotherapy, interpersonal trauma, and recovery: A scoping review. , 2020, Psychotherapy.

[19]  K. Gray,et al.  Evaluation of early relational disturbance in high-risk populations: Borderline personality disorder features, maternal mental state, and observed interaction. , 2020, Infant mental health journal.

[20]  J. Feigenbaum,et al.  Multidirectional Pathways between Attachment, Mentalizing, and Posttraumatic Stress Symptomatology in the Context of Childhood Trauma , 2020, Psychopathology.

[21]  D. Schechter,et al.  Maternal reflective functioning, interpersonal violence-related posttraumatic stress disorder, and risk for psychopathology in early childhood , 2020, Attachment & human development.

[22]  P. Fonagy,et al.  The Mentalizing Approach to Psychopathology: State of the Art and Future Directions. , 2020, Annual review of clinical psychology.

[23]  Miguel M. Terradas,et al.  Clinical Assessment of Prementalizing Modes of Psychic Functioning in Children and Their Parents in the Context of Trauma , 2020 .

[24]  Anna R. Hudson,et al.  Early interpersonal trauma reduces temporoparietal junction activity during spontaneous mentalising , 2020, Social cognitive and affective neuroscience.

[25]  M. Maziade,et al.  Shortfall of Intervention Research Over Correlational Research in Childhood Maltreatment: An Impasse to be Overcome. , 2019, JAMA pediatrics.

[26]  M. Muzik,et al.  The protective role of mentalizing: Reflective functioning as a mediator between child maltreatment, psychopathology and parental attitude in expecting parents. , 2019, Child abuse & neglect.

[27]  M. Debbané,et al.  Roles of age, gender and psychological difficulties in adolescent mentalizing. , 2019, Journal of adolescence.

[28]  P. Fonagy,et al.  Borderline personality disorder, complex trauma, and problems with self and identity: A social-communicative approach. , 2019, Journal of personality.

[29]  A. Gumley,et al.  Does childhood trauma predict poorer metacognitive abilities in people with first-episode psychosis? , 2019, Psychiatry Research.

[30]  Sohye Kim,et al.  Unresolved Trauma and Reorganization in Mothers: Attachment and Neuroscience Perspectives , 2019, Front. Psychol..

[31]  M. Del Giudice,et al.  Developmental Adaptation to Stress: An Evolutionary Perspective. , 2019, Annual review of psychology.

[32]  P. Fonagy,et al.  Reflective Functioning on the Parent Development Interview: validity and reliability in relation to socio-demographic factors , 2018, Attachment & human development.

[33]  S. Baron-Cohen,et al.  Elevated empathy in adults following childhood trauma , 2018, PloS one.

[34]  R. Tedeschi,et al.  Posttraumatic Growth , 2018 .

[35]  R. Tedeschi,et al.  Posttraumatic Growth: Theory, Research, and Applications , 2018 .

[36]  P. Fonagy,et al.  Mentalizing impairment as a mediator between reported childhood abuse and outcome in nonaffective psychotic disorder , 2018, Psychiatry Research.

[37]  G. Melvin,et al.  Reflective function mediates the relationship between emotional maltreatment and borderline pathology in adolescents: A preliminary investigation. , 2017, Child abuse & neglect.

[38]  M. Wasserman.  The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma , 2017, Journal of sex & marital therapy.

[39]  M. Pompili,et al.  Mentalization and depressive symptoms in a clinical sample of adolescents and young adults , 2017, Child and adolescent mental health.

[40]  M. Santelices,et al.  Manifestation of Trauma: The Effect of Early Traumatic Experiences and Adult Attachment on Parental Reflective Functioning , 2017, Front. Psychol..

[41]  P. Fonagy,et al.  Mentalizing Family Violence Part 1: Conceptual Framework. , 2017, Family process.

[42]  A. Cnaani,et al.  Salinity-Dependent Shift in the Localization of Three Peptide Transporters along the Intestine of the Mozambique Tilapia (Oreochromis mossambicus) , 2017, Frontiers in Physiology.

[43]  J. Shonkoff.  Capitalizing on Advances in Science to Reduce the Health Consequences of Early Childhood Adversity. , 2016, JAMA pediatrics.

[44]  P. Fonagy,et al.  Development and Validation of a Self-Report Measure of Mentalizing: The Reflective Functioning Questionnaire , 2016, PloS one.

[45]  F. Duckert,et al.  Parental reflective functioning in fathers who use intimate partner violence: Findings from a Norwegian clinical sample , 2016, Nordic psychology.

[46]  P. Fonagy,et al.  RANDOMIZED CONTROLLED TRIAL OF PARENT-INFANT PSYCHOTHERAPY FOR PARENTS WITH MENTAL HEALTH PROBLEMS AND YOUNG INFANTS. , 2016, Infant mental health journal.

[47]  P. Fonagy,et al.  The French Version of the Reflective Functioning Questionnaire: Validity Data for Adolescents and Adults and Its Association with Non-Suicidal Self-Injury , 2015, PloS one.

[48]  P. Fonagy,et al.  Intergenerational transmission of attachment in abused and neglected mothers: the role of trauma-specific reflective functioning. , 2015, Infant mental health journal.

[49]  P. Fonagy,et al.  Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale , 2014, Front. Psychol..

[50]  M. Beeghly,et al.  Secure base scripts are associated with maternal parenting behavior across contexts and reflective functioning among trauma-exposed mothers , 2014, Attachment & human development.

[51]  M. Beeghly,et al.  Maternal reflective functioning among mothers with childhood maltreatment histories: links to sensitive parenting and infant attachment security , 2014, Attachment & human development.

[52]  M. Boyle,et al.  Child abuse and mental disorders in Canada , 2014, Canadian Medical Association Journal.

[53]  P. Fonagy,et al.  Reflective function as a mediator between childhood adversity, personality disorder and symptom distress. , 2014, Personality and mental health.

[54]  S. Taubner,et al.  Mentalization mediates the relation between early traumatic experiences and aggressive behavior in adolescence , 2013 .

[55]  J. Rosenvinge,et al.  Stories from the road of recovery – How adult, female survivors of childhood trauma experience ways to positive change , 2013, Nordic psychology.

[56]  Lao Juan,et al.  Development and Validation of a Scale for Measuring Instructors' Attitudes toward Concept-Based or Reform-Oriented Teaching of Introductory Statistics in the Health and Behavioral Sciences , 2010, 1007.3219.

[57]  E. M. Euser,et al.  Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyses , 2010, Development and Psychopathology.

[58]  A. Arnsten.  Stress signalling pathways that impair prefrontal cortex structure and function , 2009, Nature Reviews Neuroscience.

[59]  P. Fonagy,et al.  The Parent's Capacity to Treat the Child as a Psychological Agent: Constructs, Measures and Implications for Developmental Psychopathology , 2008 .

[60]  Peter Fonagy,et al.  Mentalizing in Clinical Practice , 2008 .

[61]  Jon G. Allen,et al.  Evil, Mindblindness, and Trauma , 2007 .

[62]  L. Mayes,et al.  Minding the Baby , 2005, The Psychoanalytic study of the child.

[63]  Neil H. Altman,et al.  Affect Regulation, Mentalization, and the Development of the Self. , 2003 .

[64]  M. Newcomb,et al.  Development and validation of a brief screening version of the Childhood Trauma Questionnaire. , 2003, Child abuse & neglect.

[65]  W. Katon,et al.  Costs of health care use by women HMO members with a history of childhood abuse and neglect. , 1999, Archives of general psychiatry.

[66]  P Fonagy,et al.  The Emanuel Miller Memorial Lecture 1992. The theory and practice of resilience. , 1994, Journal of child psychology and psychiatry, and allied disciplines.

[67]  H. Steele,et al.  The capacity for understanding mental states - the reflective self in parent and child and its significance for security of attachment , 1991 .

[68]  D Lewin,et al.  [Pregnancy and childbirth]. , 1985, Soins. Gynecologie, obstetrique, puericulture, pediatrie.

[69]  P. Fonagy,et al.  Assessment of mentalizing , 2019 .

[70]  P. Fonagy,et al.  Mentalizing and trauma , 2019 .

[71]  S. Twemlow,et al.  Attachment and Mentalization Efforts to Promote Creative Learning in Kindergarten through Fifth Grade Elementary School Students with broad extension to all grades and some organizations , 2018 .

[72]  M. Brüne,et al.  Mentalization of complex emotions in borderline personality disorder: The impact of parenting and exposure to trauma on the performance in a novel cartoon-based task. , 2016, Comprehensive psychiatry.

[73]  P. Fonagy,et al.  The neurobiology of mentalizing. , 2015, Personality disorders.

[74]  M. Bakermans-Kranenburg,et al.  The Prevalence of Child Maltreatment across the Globe: Review of a Series of Meta‐Analyses , 2015 .

[75]  H. Macintosh.  Mentalizing and its role as a mediator in the relationship between childhood experiences and adult functioning: Exploring the empirical evidence , 2013 .

[76]  S. Lazar,et al.  Handbook of Mentalizing in Mental Health Practice , 2013 .

[77]  Dante Cicchetti,et al.  Child maltreatment. , 2005, Annual review of clinical psychology.

[78]  L. Mayes,et al.  Minding the Baby: Enhancing Parental Reflective Functioning in a Nursing/Mental Health Home Visiting Program , 2005 .

[79]  June Rathbone,et al.  The Adult Attachment Interview , 2001 .

[80]  L. Cohen,et al.  The psychology and psychopathology of pregnancy: Reorganization and transformation. , 2000 .

[81]  H. Steele,et al.  REFLECTIVE-FUNCTIONING MANUAL Version 5 FOR APPLICATION TO ADULT ATTACHMENT INTERVIEWS , 1998 .

[82]  M. Main,et al.  Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. , 1990 .