Does the reflective functioning mediate the relationship between attachment and personality?

A growing body of research seems to support that attachment insecurity and reflective functioning (RF) deficits can play a crucial role in the understanding of the psychopathological factors that underlie personality pathology. Attachment theory provides a comprehensive developmental perspective to get a more articulate awareness of relational and affect-regulatory patterns related to personality disorders (PDs). Likewise, RF impairments were found to be associated with the severity of a wide range of mental disorders, mostly the borderline conditions (Bateman & Fonagy, 2016). However, our knowledge about the impact of attachment security/insecurity and RF on the personality and its functioning is not conclusive. The aim of this study was to examine: (1) the association between the levels of RF and the cluster A, B and C personality disorders, as well as personality functioning; and (2) the possible mediated effect of RF on the relationship between attachment and personality functioning. The sample consisted of N=90 outpatients recruited through clinical private practice networks and public mental health services. Each patient was interviewed with the Adult Attachment Interview (George et al., 1985) and the AAI transcripts were assessed with the RF Scale (Fonagy et al., 1998). Moreover, the Clinical Diagnostic Interview (Westen, Muderrisoglu, 2003) was administered to apply the Shedler-Westen Assessment Procedure-200 (Westen, Shedler, 1999) for the personality evaluation. Overall, the findings showed that lower levels of RF and attachment insecurity are mostly related to patients with cluster A and B personality pathology; conversely, greater levels of RF and attachment security are related to higher personality functioning. Moreover, it seems that patients’ RF mediates the relationship between attachment and high-functioning of personality suggesting that the impact of RF is more sizable than attachment. The clinical implications of these findings were addressed.