Reflective function and identity in adolescents with clinical and nonclinical symptoms

Both, Luciane Maria; Benetti, Sílvia Pereira da Cruz; Goodman, Geoff

doi:10.1590/2237-6089-2018-0067

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Original Articles • Trends Psychiatry Psychother. 41 (2) • Apr-Jun 2019 • https://doi.org/10.1590/2237-6089-2018-0067 copy

Reflective function and identity in adolescents with clinical and nonclinical symptoms

Função reflexiva e identidade em adolescentes com sintomas clínicos e não clínicos

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Reflective function is developed in the context of secure attachment and corresponds to the ability to understand one’s mental states and those of others. Thus, identity develops, which relates to the experience of self as unique, continuous and coherent.

Objective

To identify reflective function and identity features in adolescents with clinical and nonclinical symptoms of mental health problems.

Method

Participants were 188 Brazilian high school students aged 14-17 years: 30.3% with clinical symptoms and 69.9% with nonclinical symptoms.

Results

Adolescents with clinical symptoms showed lower levels of reflective function and greater disintegration of identity.

Conclusion

Adolescence is a vulnerable time for mental health problems associated with reflective function and identity. Early identification of symptoms is a matter that needs attention to prevent future consequences.

Keywords
Reflective function; mentalizing; identity; adolescence

Level	Father	Mother
Illiterate	4 (2.1)	2 (1.1)
Complete primary education	77 (41)	61 (32.4)
Complete high school	65 (34.6)	76 (40.4)
Technical education	5 (2.7)	12 (6.4)
Complete higher education	23 (12.2)	34 (18.1)
The student does not know	14 (7.4)	3 (1.6)

	Scale 1: Identity-Continuity vs. Discontinuity	Scale 2: Identity-Coherence vs. Incoherence
	Ego-stability, intuitive-emotional “I” (“changing while staying the same”)	Ego-strength, defined “Me” (“non-fragmented self with clear boundaries”)
Self-related intrapersonal Me and I	Sub 1.1: Stability in attributes/goals vs. lack of perspective - F1: capacity to invest/stabilizing commitment to interests, talents, perspectives, life goals - F2: stable inner timeline, historical biographical self, subjective self sameness, sense of continuity - F3: stabilizing moral guidelines and inner rules	Sub 2.1: Consistent self image vs. contradictions - F1: same attributes and behaviors with different friends or situations, consistent appearance - F2: no extreme subjective contradictions/diversity of self representations, coherent self-concept - F3: awareness of a defined core and inner substance
Social-related interpersonal Me and You	Sub 1.2: Stability in relations/roles vs. lack of affiliation - F1: capacity to invest/stabilizing commitment to lasting relationships - F2: positive identification with stabilizing roles (ethnic - cultural - family - self) - F3: positive body-self	Sub 2.2: Autonomy/ego-strength vs. over-identification, suggestibility - F1: assertiveness, ego-strength, no over-identification or over-matching - F2: independent intrinsic self-worth, no suggestibility - F3: autonomous self (affect) regulation
Mental representations, accessibility and complexity concerning own and others’ emotions/motives	Sub 1.3: Positive emotional self-reflection vs. distrust in stability of emotions - F1: understanding own feelings, good emotional accessibility - F2: understanding others’ feelings, trust in stability of others’ feelings	Sub 2.3: Positive cognitive self-reflection vs. superficial, diffuse representations - F1: understanding motives and behavior, good cognitive accessibility - F2: differentiated and coherent mental representations
Alfa	α = 0.86	α = 0.94

	Female		Male		t	p

	M	SD	M	SD
SDQ
Externalizing symptoms	16.86	3.65	15.22	3.09	3.20	0.002*
Conduct problems	1.31	0.46	1.12	0.33	2.89	0.004*
Hyperactivity/inattention	1.20	0.40	1.20	0.40	0.10	0.917
Internalizing symptoms	16.68	3.61	15.27	3.16	2.70	0.010^†
Emotional symptoms	1.33	0.47	1.12	0.33	3.21	0.002*
Relationship problems	1.26	0.44	1.28	0.45	-0.22	0.826
Prosocial behavior	1.16	0.36	1.12	0.33	0.68	0.49
AIDA
Continuity total	57.97	15.19	52.88	11.01	2.19	0.030^†
Continuity sub 1	16.65	5.93	14.63	5.23	2.33	0.021^†
Continuity sub 2	16.38	9.10	14.06	5.77	1.76	0.080
Continuity sub 3	11.10	7.96	8.39	4.72	2.45	0.015^†
Coherence total	44.75	24.08	37.13	19.00	2.00	0.047^†
Coherence sub 1	16.58	10.82	14.35	8.85	1.34	0.18
Coherence sub 2	16.47	8.36	13.67	6.29	2.26	0.025^†
Coherence sub 3	11.64	6.69	8.70	5.88	3.04	0.003^†
RFQY
Reflective function	4.19	0.39	4.34	0.38	-2.20	0.030^†

	RFQY total	SDQ total	Prosocial behavior	Internalizing symptoms	Externalizing symptoms
RFQY total score	1
SDQ total score	-0.184*	1
Prosocial behavior	0.228^†	0.130	1
Internalizing symptoms	-0.181*	0.684^†	0.131	1
Externalizing symptoms	-0.184*	0.674^†	0.178*	0.454^†	1

	Continuity/discontinuity total						Coherence/incoherence total

	Clinical			Nonclinical			Clinical			Nonclinical

	M	SD	n	M	SD	n	M	SD	n	M	SD	n
Total SDQ	65.08*	15.85	47	52.85*	11.78	119	59.74*	23.17	47	34.67*	17.96	110
Emotional symptoms	65.40*	15.15	45	52.94*	12.18	121	61.46*	21.84	39	35.80*	19.20	118
Conduct problems	61.26^†	13.31	41	54.69^†	14.07	125	51.63^†	22.21	41	38.83^†	22.04	116
Hyperactivity/inattention	63.06^†	11.26	33	54.64^†	14.31	133	58.21*	23.18	33	37.91*	20.68	124
Relationship problems	64.34*	16.46	43	53.51*	12.10	123	54.90*	19.97	43	37.37*	21.90	114
Prosocial behavior	62.75^‡	11.29	24	55.23^‡	14.31	142	50.80^‡	25.98	26	40.46^‡	21.72	131

Sex	Nonclinical	Clinical	Total
Females
Mean score	79	45	124
% in sex	63.7%	36.3%	100.0%
Males
Mean score	52	12	64
% in sex	81.2%	18.8%	100.0%

Associação de Psiquiatria do Rio Grande do Sul Av. Ipiranga, 5311/202, 90610-001 Porto Alegre RS/ Brasil, Tel./Fax: (55 51) 3024 4846 - Porto Alegre - RS - Brazil
E-mail: trends@aprs.org.br

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[1] Correspondence: Luciane Maria Both. Av. Unisinos, 1505, apto 102-A 93022-750 - São Leopoldo, RS - Brazil Tel.: +55 (54) 996145522 E-mail: lucianeboth@gmail.com