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

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Abstract

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.

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References

  1. Burt SA (2012) How do we optimally conceptualize the heterogeneity within antisocial behavior? An argument for aggressive versus non-aggressive behavioral dimensions. Clin Psychol Rev 32:263–279. https://doi.org/10.1016/j.cpr.2012.02.006

    Article  PubMed  Google Scholar 

  2. Tremblay RE, Vitaro F, Côté SM (2018) Developmental origins of chronic physical aggression: a bio-psycho-social model for the next generation of preventive interventions. Annu Rev Psychol 69:383–407. https://doi.org/10.1146/annurev-psych-010416-044030

    Article  PubMed  Google Scholar 

  3. Tremblay RE (2010) Developmental origins of disruptive behaviour problems: the “original sin” hypothesis, epigenetics and their consequences for prevention. J Child Psychol Psychiatry Allied Discip 51:341–367. https://doi.org/10.1111/j.1469-7610.2010.02211.x

    Article  Google Scholar 

  4. Moffitt TE, Caspi A, Harrington H, Milne BJ (2002) Males on the life-course-persistent and adolescence-limited antisocial pathways: follow-up at age 26 years. Dev Psychopathol 14:179–207. https://doi.org/10.1017/s0954579402001104

    Article  PubMed  Google Scholar 

  5. Moffitt TE (1993) Adolesence-limited and life-course-persistent antisocial behavior: a developmental taxonomy. Psychol Rev 100:674–701

    Article  Google Scholar 

  6. Tremblay RE (2000) The development of aggressive behaviour during childhood: what have we learned in the past century? Int J Behav Dev 24:129–141. https://doi.org/10.1080/016502500383232

    Article  Google Scholar 

  7. Fonagy P (2004) The developmental roots of violence in the failure of mentalization. In: Pfäfflin F, Adshead G (eds) A matter of security: the application of attachment theory forensic psychiatry and psychotherapy. Jessica Kingsley, London, pp 13–56

    Google Scholar 

  8. Fonagy P, Luyten P (2009) A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol 21:1355–1381. https://doi.org/10.1017/s0954579409990198

    Article  PubMed  Google Scholar 

  9. Fonagy P, Gergely G, Jurist E, Target M (2002) Affect regulation, mentalization and the development of the self. Other Press, New York

    Google Scholar 

  10. Debbané M, Benmiloud J, Salaminios G et al (2016) Mentalization-based treatment in clinical high-risk for psychosis: a rationale and clinical illustration. J Contemp Psychother. https://doi.org/10.1007/s10879-016-9337-4

    Article  Google Scholar 

  11. Fonagy P, Luyten P (2017) Conduct problems in youth and the RDoC approach: a developmental, evolutionary-based view. Clin Psychol Rev. https://doi.org/10.1016/j.cpr.2017.08.010

    Article  PubMed  Google Scholar 

  12. Bateman A, Bolton R, Fonagy P (2013) Antisocial personality disorder: a mentalizing framework. Focus J Lifelong Learn Psychiatry 11:178–186. https://doi.org/10.1176/appi.focus.11.2.178

    Article  Google Scholar 

  13. Taubner S, Zimmermann L, Ramberg A, Schröder P (2016) Mentalization mediates the relationship between early maltreatment and potential for violence in adolescence. Psychopathology 49:236–246. https://doi.org/10.1159/000448053

    Article  PubMed  Google Scholar 

  14. Taubner S, White LO, Zimmermann J et al (2013) Attachment-related mentalization moderates the relationship between psychopathic traits and proactive aggression in adolescence. J Abnorm Child Psychol 41:929–938. https://doi.org/10.1007/s10802-013-9736-x

    Article  PubMed  Google Scholar 

  15. Fonagy P, Target M, Steele H, Steele M (1998) Reflective functioning manual: Version 5 for application to Adult Attachment Interviews. University College, London

    Google Scholar 

  16. Main M, Goldwyn R (1998) Adult attachment scoring and classification system. University of California at Berkeley, Berkeley

    Google Scholar 

  17. Chow C, Nolte T, Cohen D et al (2017) Reflective functioning and adolescent psychological adaptation: the validity of the reflective functioning scale-adolescent version. Psychoanal Psychol 34:404–413

    Article  Google Scholar 

  18. Shmueli-Goetz Y, Target M, Fonagy P, Datta A (2008) The child attachment interview: a psychometric study of reliability and discriminant validity. Dev Psychol 44:939–956. https://doi.org/10.1037/0012-1649.44.4.939

    Article  PubMed  Google Scholar 

  19. Badoud D, Luyten P, Fonseca-Pedrero E et al (2015) The French version of the reflective functioning questionnaire: validity data for adolescents and adults and its association with non-suicidal self-injury. PLoS ONE 10:e0145892. https://doi.org/10.1371/journal.pone.0145892

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fonagy P, Luyten P, Moulton-Perkins A et al (2016) Development and validation of a self-report measure of mentalizing: the reflective functioning questionnaire. PLoS ONE 11:1–28. https://doi.org/10.1371/journal.pone.0158678

    Article  Google Scholar 

  21. Morandotti N, Brondino N, Merelli A et al (2018) The Italian version of the Reflective Functioning Questionnaire: validity data for adults and its association with severity of borderline personality disorder. PLoS ONE 13:e0206433

    Article  Google Scholar 

  22. Levinson A, Fonagy P (2004) Offending and attachment: the relationship between interpersonal awareness and offending in a prison population with psychiatric disorder. Can J Psychoanal 12:225–251

    Google Scholar 

  23. Möller C, Falkenström F, Mattias HL, Holmqvist R (2014) Mentalizing in young offenders. Psychoanal Psychol 31:84–99. https://doi.org/10.1037/a0035555

    Article  Google Scholar 

  24. Bizzi F, Ensink K, Borelli JL et al (2018) Attachment and reflective functioning in children with somatic symptom disorders and disruptive behavior disorders. Eur Child Adolesc Psychiatry. https://doi.org/10.1007/s00787-018-1238-5

    Article  PubMed  Google Scholar 

  25. Ha C, Sharp C, Goodyer I (2011) The role of child and parental mentalizing for the development of conduct problems over time. Eur Child Adolesc Psychiatry 20:291–300. https://doi.org/10.1007/s00787-011-0174-4

    Article  PubMed  Google Scholar 

  26. Vachon DD, Lynam DR, Johnson JA (2014) The (non)relation between empathy and aggression: surprising results from a meta-analysis. Psychol Bull 140:751–773. https://doi.org/10.1037/a0035236

    Article  PubMed  Google Scholar 

  27. Lovett BJ, Sheffield RA (2007) Affective empathy deficits in aggressive children and adolescents: a critical review. Clin Psychol Rev 27:1–13. https://doi.org/10.1016/j.cpr.2006.03.003

    Article  PubMed  Google Scholar 

  28. Decety J (2011) The neuroevolution of empathy. Ann NY Acad Sci 1231:35–45. https://doi.org/10.1111/j.1749-6632.2011.06027.x

    Article  PubMed  Google Scholar 

  29. Blair J (2008) Empathic dysfunctions in psychopathy. In: Sharp C, Fonagy P, Goodyer I (eds) Social cognition and developmental psychopathology. Oxford University Press, Oxford, pp 175–197

    Chapter  Google Scholar 

  30. Blair RJR (2001) Neurocognitive models of aggression, the antisocial personality disorders, and psychopathy. J Neurol Neurosurg Psychiatry 71:727–731. https://doi.org/10.1136/jnnp.71.6.727

    Article  PubMed  PubMed Central  Google Scholar 

  31. Laghi F, Lonigro A, Pallini S, Baiocco R (2018) Emotion regulation and empathy: which relation with social conduct? J Genet Psychol 179:62–70. https://doi.org/10.1080/00221325.2018.1424705

    Article  PubMed  Google Scholar 

  32. Lonigro A, Laghi F, Baiocco R, Baumgartner E (2014) Mind reading skills and empathy: evidence for nice and nasty ToM behaviours in school-aged children. J Child Fam Stud 23:581–590. https://doi.org/10.1007/s10826-013-9722-5

    Article  Google Scholar 

  33. Batanova M, Loukas A (2014) Unique and interactive effects of empathy, family, and school factors on early adolescents’ aggression. J Youth Adolesc 43:1890–1902. https://doi.org/10.1007/s10964-013-0051-1

    Article  PubMed  Google Scholar 

  34. Van der Graaff J, Carlo G, Crocetti E et al (2018) Prosocial behavior in adolescence: gender differences in development and links with empathy. J Youth Adolesc 47:1086–1099. https://doi.org/10.1007/s10964-017-0786-1

    Article  PubMed  Google Scholar 

  35. Van der Graaff J, Branje S, De Wied M, Meeus W (2012) The moderating role of empathy in the association between parental support and adolescent aggressive and delinquent behavior. Aggress Behav 38:368–377. https://doi.org/10.1002/ab.21435

    Article  PubMed  Google Scholar 

  36. Caravita SCS, Di Blasio P, Salmivalli C (2009) Unique and interactive effects of empathy and social status on involvement in bullying. Soc Dev 18:140–163. https://doi.org/10.1111/j.1467-9507.2008.00465.x

    Article  Google Scholar 

  37. Espelage DL, Merrin GJ, Hong JS, Resko SM (2018) Applying social cognitive theory to explore relational aggression across early adolescence: a within- and between-person analysis. J Youth Adolesc. https://doi.org/10.1007/s10964-018-0910-x

    Article  PubMed  PubMed Central  Google Scholar 

  38. López-Romero L, Romero E, Andershed H (2015) Conduct problems in childhood and adolescence: developmental trajectories, predictors and outcomes in a six-year follow up. Child Psychiatry Hum Dev 46:762–773. https://doi.org/10.1007/s10578-014-0518-7

    Article  PubMed  Google Scholar 

  39. Jolliffe D, Farrington DP (2004) Empathy and offending: a systematic review and meta-analysis. Aggress Violent Behav 9:441–476. https://doi.org/10.1016/j.avb.2003.03.001

    Article  Google Scholar 

  40. Dumontheil I, Apperly IA, Blakemore SJ (2010) Online usage of theory of mind continues to develop in late adolescence. Dev Sci 13:331–338. https://doi.org/10.1111/j.1467-7687.2009.00888.x

    Article  PubMed  Google Scholar 

  41. Blakemore SJ, Den Ouden H, Choudhury S, Frith C (2007) Adolescent development of the neural circuitry for thinking about intentions. Soc Cogn Affect Neurosci 2:130–139. https://doi.org/10.1093/scan/nsm009

    Article  PubMed  PubMed Central  Google Scholar 

  42. Blakemore S-J (2008) The social brain in adolescence. Nat Rev Neurosci 9:267–277. https://doi.org/10.1038/nrn2353

    Article  PubMed  Google Scholar 

  43. Brizio A, Gabbatore I, Tirassa M, Bosco FM (2015) “No more a child, not yet an adult”: studying social cognition in adolescence. Front Psychol 6:1–12. https://doi.org/10.3389/fpsyg.2015.01011

    Article  Google Scholar 

  44. Achenbach TM (1991) Manual for the child behavior checklist/4-18 and 1991 profile. University of Vermont Department of Psychiatry, Burlington

    Google Scholar 

  45. Achenbach TM, Rescorla LA (2003) Manual for the ASEBA adult forms and profiles. University of Vermont, Research Center for Children, Youth, and Families, Burlington

    Google Scholar 

  46. Petersen IT, Bates JE, Dodge KA et al (2015) Describing and predicting developmental profiles of externalizing problems from childhood to adulthood. Dev Psychopathol 27:791–818. https://doi.org/10.1017/s0954579414000789

    Article  PubMed  Google Scholar 

  47. Wyss CA, Voelker SL, Cornock BL, Hakim-Larson J (2003) Psychometric properties of a French–Canadian translation of Achenbach’s youth self-report. Can J Behav Sci 35:67–71. https://doi.org/10.1037/h0087189

    Article  Google Scholar 

  48. Le Corff Y, Yergeau E, Proulx-Bourque C et al (2018) Équivalence de la version en français pour le Canada et de la version originale états-unienne de l’ Adult Self-Report. Psychol Fr 63:269–275. https://doi.org/10.1016/j.psfr.2017.05.001

    Article  Google Scholar 

  49. D’Ambrosio F, Olivier M, Didon D, Besche C (2009) The basic empathy scale: a French validation of a measure of empathy in youth. Personal Individ Differ 46:160–165. https://doi.org/10.1016/j.paid.2008.09.020

    Article  Google Scholar 

  50. Wechsler D (1997) Manual of the Wechsler Adult Intelligence Scale-third edition (WAIS-III). Psychological Corporation, New York

    Google Scholar 

  51. Wechsler D (2003) WISC-IV technical and interpretive manual. Psychological Corporation, San Antonio

    Google Scholar 

  52. Sampson RJ, Laub JH (2003) Life-course desisters? Trajectories of crime among delinquent boys followed to age 70. Criminology 41:555–592

    Article  Google Scholar 

  53. Fonagy P, Steele M, Steele H, Higgitt A, Target M (1994) The theory and practice of resilience. J Child Psychol Psychiatry 35:231–257

    Article  Google Scholar 

  54. Kilford EJ, Garrett E, Blakemore S-J (2016) The development of social cognition in adolescence: an integrated perspective. Neurosci Biobehav Rev. https://doi.org/10.1016/j.neubiorev.2016.08.016

    Article  PubMed  Google Scholar 

  55. Ballespí S, Vives J, Debbané M et al (2018) Beyond diagnosis: mentalization and mental health from a transdiagnostic point of view in adolescents from non-clinical population. Psychiatry Res. https://doi.org/10.1016/j.psychres.2018.10.048

    Article  PubMed  Google Scholar 

  56. Twemlow SW, Fonagy P (2006) Transforming violent social systems into non-violent mentalizing systems: an experiment in schools. In: Allen JG, Fonagy P (eds) Handbook of mentalization-based treatment. Wiley, Hoboken, pp 289–306

    Chapter  Google Scholar 

  57. Twemlow SW, Fonagy P, Sacco FC et al (2011) Reducing violence and prejudice in a Jamaican all age school using attachment and mentalization theory. Psychoanal Psychol 28:497–511. https://doi.org/10.1037/a0023610

    Article  Google Scholar 

  58. Bak PL, Midgley N, Zhu JL et al (2015) The Resilience Program: preliminary evaluation of a mentalization-based education program. Front Psychol 6:6–11. https://doi.org/10.3389/fpsyg.2015.00753

    Article  Google Scholar 

  59. Bateman A, O’Connell J, Lorenzini N et al (2016) A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder. BMC Psychiatry 16:304. https://doi.org/10.1186/s12888-016-1000-9

    Article  PubMed  PubMed Central  Google Scholar 

  60. Perroud N, Badoud D, Weibel S et al (2017) Mentalization in adults with attention deficit hyperactivity disorder: comparison with controls and patients with borderline personality disorder. Psychiatry Res 256:334–341. https://doi.org/10.1016/j.psychres.2017.06.087

    Article  PubMed  Google Scholar 

  61. Farrington DP (2007) Origins of violent behaviors over the life span. In: Flannery DJ, Vazsonyi AT, Waldman ID (eds) Cambridge handbook of violent behavior and aggression. Cambridge University Press, New York, pp 19–48

    Chapter  Google Scholar 

  62. Farrington DP (2015) Predictors of violent young offenders. In: Bishop D, Feld BC (eds) Oxford handbook of juvenile crime and juvenile justice. Oxford University Press, Oxford, pp 1–34

    Google Scholar 

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Funding

This work was supported by Swiss National Science Foundation (Grant Number 100019_159440).

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Authors and Affiliations

  1. Faculty of Psychology and Educational Sciences, University of Geneva, 40, Bd du Pont-d’Arve, 1211, Geneva, Switzerland

    Larisa Morosan, Paolo Ghisletta, Deborah Badoud, Elodie Toffel & Martin Debbané

  2. Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland

    Larisa Morosan, Deborah Badoud, Elodie Toffel, Stephan Eliez & Martin Debbané

  3. Faculty of Psychology, Swiss Distance Learning University, Brig, Switzerland

    Paolo Ghisletta

  4. Swiss National Center of Competences in Research LIVES-Overcoming Vulnerability: Life Course Perspectives-University of Geneva, Geneva, Switzerland

    Paolo Ghisletta

  5. Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK

    Martin Debbané

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  1. Larisa Morosan
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Correspondence to Larisa Morosan.

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Morosan, L., Ghisletta, P., Badoud, D. et al. Longitudinal Relationships Between Reflective Functioning, Empathy, and Externalizing Behaviors During Adolescence and Young Adulthood. Child Psychiatry Hum Dev 51, 59–70 (2020). https://doi.org/10.1007/s10578-019-00910-8

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