Is better mentalization always the remedy? Mentalization and internalising symptoms of psychopathology in children and adolescents: a rapid scoping review

Mentalization theory (MT) is an influential theoretical framework with deficits in mentalizing hypothesised to be a key transdiagnostic factor in the development and treatment of various psychopathologies. While studies of externalising disorders in adults generally support this hypothesis, less is known about how mentalization relates to internalising disorders in children and adolescents. This rapid scoping review aims to evaluate whether, in child and adolescent populations, there is evidence of an inverse correlation between mentalizing ability – operationalised as Reflective Functioning – and internalising symptoms i.e., whether better reflective functioning is associated with fewer symptoms. A total of 490 peer-reviewed publications were screened, with 22 studies included. Eight studies found evidence of an inverse correlation, where better Reflective Functioning was associated with fewer internalising symptoms. Six studies yielded mixed or unclear results, whereas eight studies produced findings that did not align with the theoretical prediction, showing either null or reverse findings. Taken together, the available research provides largely inconclusive evidence for an inverse correlation between mentalizing and internalising symptoms in children and adolescents, with the overall pattern suggesting limited support for a consistent association. Possible explanations, both methodologically and theoretically, are discussed. Further research is needed to elucidate the relationship between mentalization ability and internalising symptoms.