Mentalising (or mentalisation) refers to “the ability to understand one’s own and others’ mental states, thereby comprehending one’s own and others’ intentions and affects” ([1], p.1). This ability can be regarded as a metacognitive process [2] which enables an individual to interpret one own’s or others’ behaviors through attributions of mental states (i.e., emotions, thoughts, beliefs, intentions, wishes) that might underlie these behaviors [3]. Mentalizing is thought to be related to, but potentially distinct from, the concept of “theory of mind”, as the former focuses more specifically on affective and cognitive mental states in the context of emotional arousal [2, 4], whereas the latter reflects “epistemic states” such as intentions, beliefs and persuasions ([2], p.730). Mentalizing constitutes an important determinant of mental health [5]. It is recognized as a core element for healthy personality development and social cognition, as it plays a major role in one’s ability to feel/express empathy, to communicate, to regulate emotions and impulse control, to experience well-being, as well as in entertaining relationships and overall interpersonal functioning [3, 5, 6]. As such, a lack or deficiency in mentalizing ability was shown to be significantly linked to a range of psychopathology, such as psychotic disorders [7] - including at the early stages of disease progression [8]-, bipolar disorders [9], Major depressive disorders [10], eating disorders [11], borderline personality disorder [12], and substance use disorders [13]. Mentalising deficits has also been found to be involved in the psychological functioning within a range of psychiatric conditions, including autism and psychosis [14]. In light of these findings, researchers have recently turned to mentalising in an attempt to provide a better understanding and more efficacious treatments for severe, yet poorly understood and inadequately managed diseases such as schizophrenia [15], or dual diagnosis personality disorder and substance use disorder [16]. Therefore, measuring and exploring mentalising abilities should be considered a growing need for both clinicians and researchers involved in these psychiatric disorders’ diagnosis, management and rehabilitation.
Measurement tools of mentalising
Several measurement instruments are currently available to assess mentalising, but no benchmark or gold standard measure exists. The existing measures can be classified based on their nature and the targeted population group. For instance, there are interview-based tools specifically designed for use among older adolescents (aged 16 years and over) and adults, such as the Metacognition Assessment Scale [17] and the Reflective Functioning Scale [18]. Other tools consist of narrative-based or task-based measures that were developed to be used among children and/or young adolescents, such as the Mentalizing Stories for Adolescents [19] or the Affect Task [20]. Although these measures have proven to be psychometrically sound, their administration requires dedicated time and trained personnel during a clinical session [20]. A good alternative to overcome these limitations could be mentalising measures based on self-report. Examples of self-administered measures include the 33-item Multidimensional Mentalizing Questionnaire [21], the 22-item Mentalising Imbalances Scale [22], the 20-item Interactive Mentalizing Questionnaire [23], and the 15-item Mentalising Questionnaire [24].
While these measures have the major advantage of being self-report without the problems inherent in interviewer-administered measures, they can be time-consuming to administer with their many items, making them less suitable for use in highly specialized clinical contexts and large-scale, multi-time-point studies involving large samples. In addition, most of them were mainly designed as clinical screening instruments to be used in clinical rather than community populations [21]. Furthermore, several previous mentalising measures were of questionable validity, as they often had untested or poor psychometric characteristics. Moreover, there have been concerns about what construct it is really meant to be evaluated, as some tools claim to measure mentalising, whereas other concepts such as emotion processing are actually being measured [25]. Other tools combined and conflated many constructs, including mentalising, empathy and emotion perception [26]. In an effort to address these limitations, Clutterbuck et al. [27] developed the Four-Item Mentalising Index (FIMI), a self-report scale aimed specifically assessing the mentalising construct while simplifying its conceptual complexity, and enabling its use in applied clinical and research settings.
The FIMI
The FIMI was designed to selectively measure mentalising abilities in community adults [27]. The FIMI is composed of the following four items: (1) “I find it easy to put myself in somebody else’s shoes”, (2) “I sometimes find it difficult to see things from other people’s point of view”, (3) “I sometimes try to understand my friends better by imagining how things look from their perspective”, and (4) “I can usually understand another person’s viewpoint, even if it differs from my own ‘’. Through a series of studies investigating its psychometric properties in both clinical (i.e. autistic) and non-clinical English-speaking adults from the US and UK, the FIMI was demonstrated to be methodologically and conceptually a robust measure to assess mentalising abilities in the adult population. In particular, the FIMI showed a solid unidimensional factor structure, and data supported its internal consistency reliability, measurement invariance by sex, test-retest reliability, and construct validity of its scores against autistic traits, a cognitive mentalising task, and comparing scores in non-autistic and autistic individuals [27]. More recently, the FIMI was adapted, translated and validated to the German language in 283 German-speaking adults from Germany, Austria, and Switzerland [28]. The German version showed adequate psychometric properties in terms of factor structure, inner consistency, and relationships with relevant validity criteria (including autistic traits) [28]. However, no previous studies examining the psychometric properties of the FIMI in the Arabic language could be found in the literature.
Rationale and aim of this study
Our study was motivated by some key needs. First, despite a sizeable amount of research literature has been undertaken on mentalising in children, much less attention has been devoted to exploring mentalising in adulthood [29]. Second, no studies have yet examined mentalising in adults from Arab countries as far as we know, which may be explained by the lack of locally validated instrument to measure this construct in the Arabic-speaking adult population. Studying mentalising in general population adults is crucial to the understanding of social-cognitive changes that occur as one ages [30], and to gain knowledge on clinical phenomena that are characterised by mentalising problems, such as autism [31]. Third, a meta-analysis showed that the conceptualization of mentalising can differ between cultures (e.g., self < other mentalising in collectivistic cultures such as Arab societies, self > other mentalising in individualistic cultures such as Western societies) [32], which emphasizes the strong need to make available mentalising measures that are appropriate for different cultural contexts. Therefore, this study aimed to investigate the psychometric properties of an Arabic translation of the FIMI in a multi-national sample of non-clinical adults. Following the English and German versions of the FIMI, we hypothesise that the Arabic FIMI will yield a single-factor solution, as well a good internal consistency reliability and adequate construct validity. In addition, it is anticipated that the factor structure will show measurement invariance across sex and country.