Trauma in childhood and adolescence and impaired executive functions are associated with uncertain reflective functioning in mothers with substance use disorder

Impairments in reflective functioning are known to have adverse effects on the ability to display sensitive parenting as a caregiver.

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Several factors are associated with impairments in reflective functioning, such as impaired executive functioning and experienced trauma. We investigated how these factors contribute to an impaired reflective functioning style, such as pathological certain or uncertain reflective functioning. Extreme scores on these two subscales reflect two kinds of impairments in reflective functioning. We assessed executive functions, reflective functioning, and trauma in 43 mothers diagnosed with substance use disorders (SUD).


Certain or uncertain reflective functioning were assessed using the Reflective Functioning Questionnaire 8 (RFQ-8). Executive functions and trauma were assessed by administering various questionnaires, interviews and neuropsychological tests.


High uncertain reflective functioning was more than six times as common (odds ratio) in mothers reporting high amounts of trauma in childhood and adolescence compared with mothers reporting low amounts of trauma. Impaired executive functions were also significantly associated with high uncertain reflective functioning. Certain reflective functioning did, however, not show any significant associations.


When the SUD mothers give information about relational trauma in childhood and adolescence, it might therefore be worth investigating and addressing the potential tendency to have an uncertain reflective functioning style.

Addictive Behaviors Reports, 2020, 11,

Published June 29, 2020 6:00 AM