Peter Fonagy

University College London | UCL · Division of Psychology and Language Sciences

Objective: Individuals with eating disorders are known to have higher rates of insecure attachment compared to community controls, but the factors underlying this finding are poorly understood. We conducted the first meta-analysis comparing attachment in eating disorder samples compared to community controls that included quality assessment, publi...

Background: Perinatal mental health difficulties affect up to 27% of birthing parents during pregnancy and the first postnatal year, and if untreated are associated with difficulties in bonding and long-term adverse outcomes to children. There are large evidence gaps related to psychological treatment, particularly in group therapy approaches and...

This article reviews the current status of research on the relationship between attachment and trauma in developmental psychopathology. Beginning with a review of the major issues and the state-of-the-art in relation to current thinking in the field of attachment about the impact of trauma and the inter-generational transmission of trauma, the revi...

Purpose: There are concerns that the social, economic and health impacts of COVID-19 are unevenly distributed, exacerbating existing inequalities. Here we tested the hypotheses that: (H1) the magnitude of these impacts would be associated with symptoms of depression and anxiety early in the pandemic, and (H2) that these impacts would be associated...

Meeting the complex needs of some of the most vulnerable populations in our society often involves the need for connected networks of care providing health, social care, educational and voluntary sector services. This presents major challenges for both clients and practitioners for this to work well. Adaptive mentalization based integrative treatme...

Background: Short-term psychodynamic psychotherapy (STPP) is frequently used to treat depression, but it is unclear which patients might benefit specifically. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses and identify patient-level moderators. This IPD meta-analysis examin...

Background: Attachment refers to an infant's innate tendency to seek comfort from their caregiver. Research shows that attachment is important in promoting healthy social and emotional development. Many parenting interventions have been developed to improve attachment outcomes for children. However, numerous interventions used in routine practice...

Meeting the complex needs of some of the most vulnerable populations in our society often involves the need for connected networks of care providing health, social care, educational and voluntary sector services. This presents major challenges for both clients and practitioners for this to work well. Adaptive mentalization based integrative treatme...

Play therapy is widely used with children, including children who experienced sexual abuse. This longitudinal study examined whether more pretend play completion (PPC) at Time 1 predicted fewer child difficulties when this was assessed 3 years later at Time 2. Participants were 91 children (aged 3–8 at Time 1), including 51 children who experienced...

The construct of epistemic trust has received much consideration in recent psychological literature, even though mainly from a theoretical perspective. The overall aim of this study was to validate the first self-report measure of epistemic trust–the Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ)–in an Italian sample. Our primary go...

This study aimed to review the existing published and grey literature describing the concepts of self-management, self-care, and self-help, and to capture strategies or techniques related to these concepts, for adolescents with emotional problems. Emotional problems are rising amongst adolescents, yet timely access to specialist mental health treat...

Background International estimates suggest around a third of students arrives at university with symptoms indicative of a common mental disorder, many in late adolescence at a developmentally high-risk period for the emergence of mental disorder. Universities, as settings, represent an opportunity to contribute to the improvement of population ment...

Beschreibung des Movetia-Forschungsprojekts "MentEd.ch - Bringing mentalisation-based education to Switzerland" (Movetia-Projektnr.: 022-1-CH01-IP-0046)

Background When experiencing mental distress, many university students seek support from their peers. In schools and mental health services, formalised peer support interventions have demonstrated some success but implementation challenges have been reported. This study aimed to assess the feasibility, acceptability and safety of a novel manualized...

Background Borderline personality disorder is a severe mental health condition characterised by a pattern of emotional instability, interpersonal dysfunction, disturbed self-image and impulsive behaviour, including self-harm. Symptoms of borderline personality disorder typically emerge during adolescence. Although there is compelling evidence in su...

Parental reflective functioning (PRF) plays a protective role in the development of children with histories of early adversity, including adopted children. This is the first study to investigate the developmental trajectories of PRF and children’s socio-emotional problems in the first 4 years after international adoption ( N = 48 families, mean age...

A current direction of personality disorder research strives to identify key behavioural, cognitive, and ultimately computational facets of patient functioning via the use of engaging social paradigms. Thus far, few such paradigms have been put forward. Here, we introduce a novel task in which subjects interact with previously unknown virtual partn...

This commentary argues the case for developmental psychopathology in understanding social learning. Informed by work on “epistemic disruption,” we have described difficulties with social learning associated with many forms of psychopathology. Epistemic disruption manifests in an inability to move between innovation and conformity, and arises from p...

Dynamic Interpersonal Therapy (DIT) is a brief, time-limited psychodynamic individual therapy in which depressive and anxious symptoms are understood as responses to interpersonal difficulties. Problematic interpersonal representations of the self and others are conceptualized in DIT as the interpersonal affective focus (IPAF), a predominant and re...

Anxiety and depression are increasingly prevalent in adolescents, often causing daily distress and negative long-term outcomes. Despite the significant and growing burden, less than 25% of those with probable diagnosis of anxiety and depression are receiving help in England. Significant barriers to help-seeking exist in this population, with a scar...

A longstanding proposal in developmental research is that childhood family experiences provide a template that shapes the emergence of a capacity for trust-based social relationships. Here, by leveraging longitudinal data from a large cohort of healthy adolescents (n=570, aged 14-25), that includes computational decision-making and psychometric dat...

Objective: Mentalizing is the ability to interpret one's own and others' behavior as driven by intentional mental states. Epistemic trust (openness to interpersonally transmitted information) has been associated with mentalizing. Balanced mentalizing abilities allow people to cope with external and internal stressors. Studies show that social isol...

Plain English summary Eating disorders are among the most serious mental health problems affecting children and young people. There has been accumulating clinical and research evidence that early expert outpatient treatment is effective and can also significantly reduce the need for costly inpatient care, indicating that investing in community-base...

Few studies assessing the effects of COVID-19 on mental health include prospective markers of risk and resilience necessary to understand and mitigate the combined impacts of the pandemic, lockdowns, and other societal responses. This population-based study of young adults includes individuals from the Neuroscience in Psychiatry Network (n = 2403)...

The practice of clinical evaluation and intervention for schizophrenia spectrum and other psychotic disorders (SSPDs) is progressively integrating a developmental perspective, targeting premorbid, clinical high-risk, and early phases along the continuum of symptom severity. Notwithstanding important progress in early intervention, clinical challeng...

The Hierarchical Taxonomy of Psychopathology (HiTOP) organizes phenotypes of mental disorder based on empirical covariation, offering a comprehensive organizational framework from narrow symptoms to broader patterns of psychopathology. We argue that established self‐report measures of psychopathology from the pre‐HiTOP era should be systematically...

Der Beitrag bietet eine Übersicht und Einführung in die Konzeption des Movetia-Forschungsprojekts MentEd.ch. MentEd.ch setzt sich zum Ziel, die Mentalisierungsbasierte Pädagogik in der Schweizer Heilpädagogik zu adaptieren. Dies geschieht auf hochschulischer Ebene durch die curriculare Verankerung an der HfH mit Unterstützung durch ein internation...

Introduction: Individuals with eating disorders are known to have higher rates of insecure attachment compared to community controls, but the factors underlying this finding are poorly understood. We conducted the first meta-analysis comparing attachment in eating disorder samples compared to community controls that included quality assessment, pub...

A review of the relationship between mentalizing theory and psychoanalysis, examining the origins of mentalization-based treatment in traditional psychoanalysis, in particular its compatibility with object relations theory, and areas of divergence, such as the different emphasis upon and management of transference. More recent developments in psych...

There is evidence that young people generally self-manage their mental health using self-care strategies, coping methods and other self-management techniques, which may better meet their needs or be preferable to attending specialist mental health services. LGBTQ+ young people are more likely than their peers to experience a mental health difficult...

The Hierarchical Taxonomy of Psychopathology (HiTOP) organizes phenotypes of mental disorder based on empirical covariation, offering a comprehensive organizational framework from narrow symptoms to broader patterns of psychopathology. We argue that established self-report measures of psychopathology from the pre-HiTOP era should be systematically...

Background Adverse childhood experiences (ACEs) are associated with posttraumatic and complex posttraumatic stress disorder symptoms in adulthood (PTSD/cPTSD), as well as reduced epistemic trust (trust in the authenticity and personal relevance of interpersonally transmitted information) and impaired personality functioning. The present work aims t...

Children’s cognitive and language development is a central aspect of human development and has wide and long-standing impact. The parent-infant relationship is the chief arena for the infant to learn about the world. Studies reveal associations between quality of parental care and children’s cognitive and language development when the former is mea...

Background Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder. However, access to interventions varies widely and there are no evidence-based interventions for this disorder. Objectives (1) To adapt an existing video-feedback intervention to meet the specific needs of foster children in the UK with...

Personality functioning and psychopathology are interrelated, yet clinically they are demarcated. Diagnostically, we can distinguish between affective disorders and personality disorders, but there is overlap between features, and the interrelationship between these features may be important in the consideration of treatment approaches. Taking an i...

Adolescence is a time of profound changes in the physical wiring and function of the brain. Here, we analyzed structural and functional brain network development in an accelerated longitudinal cohort spanning 14 to 25 y ( n = 199). Core to our work was an advanced in vivo model of cortical wiring incorporating MRI features of corticocortical proxim...

Background Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder (RAD). However, access to interventions varies widely, and there are no evidence-based interventions for RAD. Aims To modify an existing parenting intervention for children with RAD in the UK foster care setting, and test the feasibility...

Background There is a dearth of studies evaluating treatment efficacy for adolescents diagnosed with borderline personality disorder. The few available randomized controlled trials that have been conducted show modest results and treatments appear to have equivalent effects. The current paper draws on (a) the lessons learnt from the last 50 years o...

Background Although the relationship between childhood maltreatment, self-harm and suicidality is well-established, less is known about the mediating mechanisms explaining it. Based on a developmental mentalisation-based theoretical framework, childhood adversity compromises mentalising ability and attachment security, which in turn increase vulner...

Sexual differences in human brain development could be relevant to sex differences in the incidence of depression during adolescence. We tested for sex differences in parameters of normative brain network development using fMRI data on N = 298 healthy adolescents, aged 14 to 26 years, each scanned one to three times. Sexually divergent development...

Existing research presents a working understanding of Borderline Personality Disorder (BPD) patients’ symptomatology, traits, and behavior in everyday life, but how they combine and utilize prior and likelihood (current sensory) information when making decisions remains unclear. Bayesian Decision Theory suggests that optimal decision-making behavio...

Dissociation is a clinical phenomenon wherein the normal continuity between aspects of consciousness and experience is disrupted. Pathological dissociative symptoms are present in a number of psychiatric disorders, yet the brain bases of dissociation have primarily been examined within single disorders and findings do not converge across study samp...

Adults with major depressive disorder (MDD) with psychotic features (delusions and/or hallucinations) have more severe symptoms and a worse prognosis. Subclinical psychotic symptoms are more common in adolescents than adults. However, the effects of psychotic symptoms on outcome of depressive symptoms have not been well studied in adolescents. Depr...

Background: The quality of a child's attachment to its primary caregiver plays an important role for its long-term socioemotional development. While 'secure' attachment is associated with better outcomes, 'insecure' attachment is associated with a higher risk of externalizing and internalizing symptoms. Children referred to mental health services...

Most research on alliance rupture-repair processes in psychotherapy has been carried out with adults and little is known about the alliance dynamics with adolescents, especially in psychodynamic treatments. Objective: This study aimed to better understand the process of alliance rupture–resolution and its role in a good-outcome case of a depressed...

Over the past few decades, neuroimaging has become a ubiquitous tool in basic research and clinical studies of the human brain. However, no reference standards currently exist to quantify individual differences in neuroimaging metrics over time, in contrast to growth charts for anthropometric traits such as height and weight ¹ . Here we assemble an...

Early identification of “patients at risk” for not completing regular treatment or not benefitting (sufficiently) from treatment might be among the most cost-effective strategies in mental health care. The recently introduced concept of epistemic trust (ET) may have the potential value to predict patients at risk and therefore act as a marker of tr...

Background : Developmental psychological trauma induces vulnerability to psychosis. However, the mechanisms underlying this association are poorly understood. Impairments in Theory of Mind (ToM) have been observed in adult survivors of developmental trauma and individuals with psychosis. ToM is therefore a candidate mechanism underlying the associa...

Background: There is a dearth of studies evaluating treatment efficacy for adolescents diagnosed with borderline personality disorder. The few available randomized controlled trials that have been conducted show modest results and treatments appear to have equivalent effects. The current paper draws on (a) the lessons learnt from the last 50 years...

Interpersonal psychotherapy (IPT) is an evidence-supported, relationally focused treatment for people living with depression and other psychiatric disorders in the context of stressful life events. Mentalizing, also relationally focused, promotes the ability to perceive, understand, and interpret human behavior in terms of intentional mental states...

Background This scoping review aimed to overview studies that used administrative data linkage in the context of child maltreatment to improve our understanding of the value that data linkage may confer for policy, practice, and research. Methods We searched MEDLINE, Embase, PsycINFO, CINAHL, and ERIC electronic databases in June 2019 and May 2020...

Interpersonal psychotherapy (IPT) is an evidence-supported, relationally focused treatment for people living with depression and other psychiatric disorders in the context of stressful life events. Mentalizing, also relationally focused, promotes the ability to perceive, understand, and interpret human behavior in terms of intentional mental states...

Background: Oxytocin (OT) is a neuropeptide hormone that has anxiolytic and antidepressant effects, and positive effects on social affiliation and behaviour, particularly in parenting and attachment relationships. In women with postnatal depression (PND), each of these are reduced. This study investigated if OT administration reduces low mood in n...

Background There is growing concern about how people with eating disorders are impacted by the widespread societal restructuring during the COVID-19 crisis. Aims We aimed to examine how factors relating to the impact of the pandemic associate with eating disorders and quantify this relationship while adjusting for concurrent and longitudinal param...

Objective: to identify and describe trajectories of change in general psychopathology (p) levels among depressed adolescents who received one of three types of short-term therapies (namely Cognitive-Behavioural Therapy, Short-Term Psychoanalytic Psychotherapy, and a Brief Psychosocial Intervention). Method: Participants were 465 adolescents with...

COVID‐19 has triggered a shift towards remote delivery of therapy and, despite a number of benefits, it risks discriminating against young people already marginalised due to adverse early life experiences, poverty or ethnicity. This editorial perspective considers challenges for remote therapy, focusing on: the financial burden of telehealth; the n...

The peer influence and peer selection effects are two widely replicated findings in the criminological literature that refer to the predictive relationship between antisocial behaviour and delinquent peer association as well as between delinquent peer association and antisocial behaviour, respectively. Research suggests that antisocial cognition mi...

This paper commemorates the work of Carlo Strenger, a prolific writer and unparalleled critic of contemporary culture, with a focus on his thinking concerning the role of cultural changes, and globalization in particular, on the development of what he termed the fear of insignificance. We relate Strenger’s thinking in this regard to socio-evolution...

Anorexia nervosa-focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome. The secondary aims of the study were to inve...