1
|
Lampron M, Achim AM, Gamache D, Bernier A, Sabourin S, Savard C. Profiles of theory of mind impairments and personality in clinical and community samples: integrating the alternative DSM-5 model for personality disorders. Front Psychiatry 2024; 14:1292680. [PMID: 38274419 PMCID: PMC10809153 DOI: 10.3389/fpsyt.2023.1292680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/08/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Deficits in theory of mind (ToM)-the ability to infer the mental states of others-have been linked to antagonistic traits in community samples. ToM deficits have also been identified in people with personality disorders (PD), although with conflicting evidence, partly due to the use of categorical diagnoses. The DSM-5 Alternative Model for Personality Disorders (AMPD) provides an opportunity for a more precise understanding of the interplay between ToM abilities and personality pathology. Therefore, the study aims to determine whether and how individuals with diverse ToM profiles differ regarding personality impairment (AMPD Criterion A) and pathological facets (AMPD Criterion B). Method Adults with PD (n = 39) and from the community (n = 42) completed tests assessing ToM skills and self-reported questionnaires assessing AMPD Criteria A and B. Hierarchical agglomerative and TwoStep cluster analyses were consecutively computed using scores and subscores from ToM tests as clustering variables. Multivariate analyses of variance were subsequently performed to compare the clusters on both AMPD Criteria. Five clinically and conceptually meaningful clusters were found. The most notable differences across clusters were observed for Intimacy and Empathy dysfunctions (Criterion A), as well as for the Deceitfulness, Callousness, and Hostility facets from the Antagonism domain and the Restricted affectivity facet from the Detachment domain (Criterion B). Discussion The results support the association between antagonistic personality facets and ToM deficits. However, clusters showing impairments in ToM abilities did not necessarily exhibit high levels of personality dysfunction or pathological facets, emphasizing that both constructs are not isomorphic. Nevertheless, specific profiles can help refine existing interventions to make them more sensitive and specific to the nature of ToM dysfunctions while considering personality functioning and facets.
Collapse
Affiliation(s)
| | - Amélie M. Achim
- CERVO Brain Research Centre, Québec City, QC, Canada
- Department of Psychiatry and Neurosciences, Université Laval, Québec City, QC, Canada
- VITAM – Centre de recherche en santé durable, Québec City, QC, Canada
| | - Dominick Gamache
- CERVO Brain Research Centre, Québec City, QC, Canada
- Department of Psychology, Université du Québec à Trois-Rivières, Québec City, QC, Canada
| | - Allyson Bernier
- School of Psychology, Université Laval, Québec City, QC, Canada
| | | | - Claudia Savard
- CERVO Brain Research Centre, Québec City, QC, Canada
- Department of Educational Fundamentals and Practices, Université Laval, Québec City, QC, Canada
| |
Collapse
|
2
|
Lampron M, Savard C, Bernier A, Payant M, Sabourin S, Achim AM. Contrasting social knowledge and theory of mind patterns in adults with personality disorders, schizophrenia spectrum disorders, and healthy controls. Cogn Neuropsychiatry 2023; 28:361-376. [PMID: 37733030 DOI: 10.1080/13546805.2023.2259021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Personality disorders (PD) and schizophrenia spectrum disorders (SSD) are distinct conditions displaying common symptoms, like impairments in social cognition, that make them hard to distinguish, especially in severe cases. To date, few studies have compared theory of mind skills in these two disorders, and none have compared social knowledge skills. This study aims to compare the social cognitive abilities of patients with these conditions. METHOD Non-parametric analyses of covariance were used to compare severe PD patients (n = 37), SSD patients (n = 44), and healthy controls (HC; n = 49) on the Social Knowledge Test and two measures of theory of mind: the Reading the Mind in the Eyes Test and the Combined Stories Test, which incorporates items from various widely used tests. RESULTS While no significant group differences were found on the Social Knowledge Test, SSD patients performed lower than the HC group on both theory of mind tests. PD patients only had lower performance than the HC group on specific items from the Combined Stories Test. CONCLUSIONS PD and SSD patients demonstrated distinctive patterns of social cognitive impairments, with items of greater complexity or with an affective orientation being the most discriminant for PD.
Collapse
Affiliation(s)
| | - Claudia Savard
- CERVO Brain Research Centre, Québec, Canada
- Department of Educational Fundamentals and Practices, Université Laval, Québec, Canada
| | | | - Maude Payant
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada
| | | | - Amélie M Achim
- CERVO Brain Research Centre, Québec, Canada
- Department of Psychiatry and neurosciences, Université Laval, Québec, Canada
- VITAM - Centre de recherche en santé durable, Québec, Canada
| |
Collapse
|
3
|
Weijers JG, van Kaam F, Selten JP, de Winter RFP, ten Kate C. Diverging effects of mentalization based treatment for patients with borderline personality disorder and schizophrenia: an explorative comparison. Front Psychiatry 2023; 14:1226507. [PMID: 37692309 PMCID: PMC10485774 DOI: 10.3389/fpsyt.2023.1226507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction There is robust evidence that both patients with schizophrenia (SCZ) and borderline personality disorder (BPD) display mentalizing difficulties. Less is known however about differences in the way mentalization based treatment (MBT) impacts mentalizing capacity in SCZ and BPD patients. This study compares the impact of MBT on mentalizing capacity in individuals with SCZ and BPD. Method The thematic apperception test was used to measure mentalizing capacity. It was administered at the beginning and end of treatment to 26 patients with SCZ and 28 patients with BPD who enrolled in an 18-month long MBT program. For comparison a sample of 28 SCZ patients who did not receive MBT was also included. Using the social cognition and object-relations system, these narratives were analyzed and scored. Missing data was imputed and analyzed using intention-to-treat ANCOVAs with post-treatment measures of mentalizing capacity as dependent variables, group type as independent variable and baseline mentalizing capacities as covariates. Results Results showed that patients with BPD showed significantly more improvement on several measures of mentalizing, including complexity of representation (ηp2 = 0.50, ppooled < 0.001), understanding of social causality (ηp2 = 0.41, ppooled < 0.001) and emotional investment in relationships (ηp2 = 0.41, ppooled < 0.001) compared to patients with SCZ who received MBT. No differences were found regarding affect-tone of relationships (ηp2 = 0.04, ppooled = 0.36). SCZ patients who received MBT showed greater performance on understanding of social causality (ηp2 = 0.12, ppooled = 0.01) compared to SCZ patients who did not receive MBT, but no differences were observed on complexity of representations, capacity for emotional investment or affect-tone of relationships. Discussion Patients with BPD performed better after receiving MBT on three dimensions of mentalizing capacity than SCZ patients who received MBT. Remarkably, SCZ patients who received MBT performed better on one dimension of mentalizing capacity compared to SCZ patients who did not receive MBT. Whereas MBT for BPD clearly involves improvement on most aspects of mentalizing, MBT for SCZ seems to thwart a further decline of other-oriented, cognitive mentalizing. Treatment goals should be adapted toward these disorder-specific characteristics.
Collapse
Affiliation(s)
- Jonas G. Weijers
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
| | - Fleur van Kaam
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
| | - Jean-Paul Selten
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Remco F. P. de Winter
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Coriene ten Kate
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
| |
Collapse
|
4
|
Sarig-Shmueli Y, Kurman J, Talmon S, Yoeli N, Gur E, Stein D, Rothschild-Yakar L. Mentalizing ability, mentalizing impairments, and anorexia nervosa: Validation of the Hebrew version of the Movie for the Assessment of Social Cognition (MASC). Clin Psychol Psychother 2023; 30:873-881. [PMID: 36869582 DOI: 10.1002/cpp.2848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/14/2022] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Abstract
The goal of this study was to validate the Hebrew version of the Movie for the Assessment of Social Cognition (MASC)-an ecological measure for assessing mentalizing ability-among patients with anorexia nervosa (AN) and healthy individuals. We examined the validity of the MASC's general mentalizing ability scale and of its mentalizing impairments subscales using validated measures of mentalizing ability (Reading the Mind in the Eyes test, Cambridge Mindreading Face-Voice Battery, and Reflective Function questionnaire) among female patients with AN (N = 35) and control participants (N = 42). ED symptoms were assessed via self-report questionnaires. The MASCHeb correlated with measures of mentalizing ability and was found to significantly differentiate patients with AN from controls. In addition to differing on general mental ability, the groups differed on hypomentalizing (but not hypermentalizing). Based on our findings, the MASCHeb proved to be an ecologically valid tool for assessing mentalizing ability and impairments among patients with AN. Moreover, our findings demonstrated the role played by general mentalizing ability in EDs and specifically pointed to the importance of hypomentalization in EDs. These findings have therapeutic implications, as outlined in the Discussion section.
Collapse
Affiliation(s)
| | - Jenny Kurman
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Shira Talmon
- Department of Psychology, University of Haifa, Haifa, Israel
| | | | - Eitan Gur
- Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Stein
- Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | |
Collapse
|
5
|
Burghardt J, Gradl S, Knopp M, Sprung M. Psychopathology and Theory of Mind in patients with personality disorders. Borderline Personal Disord Emot Dysregul 2023; 10:18. [PMID: 37259167 DOI: 10.1186/s40479-023-00224-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/09/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE People with mental disorders frequently suffer from deficits in the ability to infer other's mental states (Theory of Mind; ToM). Individuals with borderline personality disorder (BPD) show ToM deficits characterized by exceeding ToM (over-attributions of mental states). The present study analyzed associations between ToM, BPD severity, and depression severity in patients with BPD and other personality disorders. METHOD We analyzed ToM abilities in 128 patients with BPD and 82 patients with 'mixed and other personality disorders' (MOPD). MOPD are diagnosed if symptoms of multiple personality disorders are present without any set of symptoms being dominant enough to allow a specific diagnosis. We used the movies for the assessment of social cognition (MASC) to measure ToM abilities, the Patient Health Questionnaire (PHQ-9) to assess severity of depression and the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) to assess the severity of BPD symptoms. RESULTS Both symptoms of BPD and depression were associated with exceeding ToM in separate regressions. Using a stepwise regression, only the association of depression severity with exceeding ToM was reliable. Patients with BPD and MOPD did not differ in exceeding ToM. Age was most reliably associated with ToM. CONCLUSION The results imply that exceeding ToM is associated with general psychopathology instead of BPD-symptoms in specific. Patients with MOPD show deficits similar to BPD patients.
Collapse
Affiliation(s)
- Juliane Burghardt
- Division of Clinical Psychology, Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems an Der Donau, 3500, Austria
| | - Silvia Gradl
- Division of Clinical Psychology, Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems an Der Donau, 3500, Austria.
- University Hospital for Psychosomatic Medicine Eggenburg, Grafenberger Straße 2, Eggenburg, 3730, Austria.
- Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilians-Universität München, Leopoldstraße 13, Munich, 80802, Germany.
| | - Magdalena Knopp
- Division of Clinical Psychology, Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems an Der Donau, 3500, Austria
- Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilians-Universität München, Leopoldstraße 13, Munich, 80802, Germany
| | - Manuel Sprung
- Division of Clinical Psychology, Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems an Der Donau, 3500, Austria
- University Hospital for Psychosomatic Medicine Eggenburg, Grafenberger Straße 2, Eggenburg, 3730, Austria
| |
Collapse
|
6
|
Flechsenhar A, Kanske P, Krach S, Korn C, Bertsch K. The (un)learning of social functions and its significance for mental health. Clin Psychol Rev 2022; 98:102204. [PMID: 36216722 DOI: 10.1016/j.cpr.2022.102204] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/11/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023]
Abstract
Social interactions are dynamic, context-dependent, and reciprocal events that influence prospective strategies and require constant practice and adaptation. This complexity of social interactions creates several research challenges. We propose a new framework encouraging future research to investigate not only individual differences in capacities relevant for social functioning and their underlying mechanisms, but also the flexibility to adapt or update one's social abilities. We suggest three key capacities relevant for social functioning: (1) social perception, (2) sharing emotions or empathizing, and (3) mentalizing. We elaborate on how adaptations in these capacities may be investigated on behavioral and neural levels. Research on these flexible adaptations of one's social behavior is needed to specify how humans actually "learn to be social". Learning to adapt implies plasticity of the relevant brain networks involved in the underlying social processes, indicating that social abilities are malleable for different contexts. To quantify such measures, researchers need to find ways to investigate learning through dynamic changes in adaptable social paradigms and examine several factors influencing social functioning within the three aformentioned social key capacities. This framework furthers insight concerning individual differences, provides a holistic approach to social functioning, and may improve interventions for ameliorating social abilities in patients.
Collapse
Affiliation(s)
- Aleya Flechsenhar
- Department Clinical Psychology and Psychotherapy, Ludwig-Maximilians-University Munich, Germany.
| | - Philipp Kanske
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Sören Krach
- Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Christoph Korn
- Section Social Neuroscience, Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Katja Bertsch
- Department Clinical Psychology and Psychotherapy, Ludwig-Maximilians-University Munich, Germany; NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany; Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
7
|
Felsenheimer AK, Kieckhäfer C, Rapp AM. Irony detection in patients with borderline personality disorder: an experimental study examining schizotypal traits, response biases and empathy. Borderline Personal Disord Emot Dysregul 2022; 9:24. [PMID: 36192806 PMCID: PMC9531442 DOI: 10.1186/s40479-022-00194-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In verbal irony we often convey meanings that oppose the literal words. To look behind these words, we need to integrate perspectives of ourselves, others, and their beliefs about us. Although patients with borderline personality disorder (BPD) experience problems in social cognition and schizotypal symptoms, research on irony comprehension mainly focused on the schizophrenic spectrum. Accounting for possible negative biases in BPD, the current study examined the detection of praising and critical irony in a text messaging interface. METHODS The cross-sectional study included 30 patients and 30 matched controls, who completed measures of cognitive and affective empathy (Interpersonal Reactivity Index, IRI), schizotypal (Schizotypal Personality Questionnaire; SPQ), and borderline symptoms (Borderline Symptom List; BSL-23) and the irony detection task. The irony task contained critical and praising remarks embedded in text messages. Asking for literality (ironic vs. literal) and intention ratings (critical to praising) of the stimuli, it allowed to analyze the sensitivity of literality detection as well as implicit and explicit response biases in a signal detection framework. RESULTS Borderline symptoms explained lower sensitivity for the detection of literal and ironic statements across groups. Whereas HC showed a negativity bias when implicitly asked about the literalness of the statement, patients with BPD perceived praising utterances as less praising when explicitly asked about their perceived intention. Neither empathy nor schizotypy explained outcomes beyond borderline symptoms. CONCLUSIONS This was the first study to show lower detection of verbal irony in patients with BPD. While patients were less biased when asked about the literality of a statement, they perceived praising remarks as less positive on explicit measurements. The results highlight the importance of congruent, transparent communication in promoting epistemic trust in individuals with BPD.
Collapse
Affiliation(s)
- Anne Katrin Felsenheimer
- Department of Psychiatry and Psychotherapy, University of Tübingen, 72076, Tübingen, Germany.
- Max Planck School of Cognition , Max Planck Institut for Human Cognitive and Brain Sciences , Leipzig, Germany.
| | - Carolin Kieckhäfer
- LVR Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Alexander Michael Rapp
- Department of Psychiatry and Psychotherapy, University of Tübingen, 72076, Tübingen, Germany
| |
Collapse
|
8
|
Archer M, Shnyien A, Mansfield S, Draycott S. Mentalizing in first-episode psychosis: Correlates with symptomatology and traits of borderline personality disorder. Early Interv Psychiatry 2022. [PMID: 36181363 DOI: 10.1111/eip.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/13/2022] [Accepted: 09/18/2022] [Indexed: 11/28/2022]
Abstract
AIM To explore the associations between mentalizing, positive and negative symptoms of psychosis, and traits of borderline personality disorder, in a sample of patients with first-episode psychosis, and in a non-clinical sample. METHODS A quantitative cross-sectional design was employed. Thirty-two adults with first-episode psychosis and 148 non-clinical participants were assessed using the reflective functioning questionnaire. The questionnaire measures two dimensions of mentalizing, certainty and uncertainty about mental states. Traits of borderline personality disorder and symptoms of psychosis were measured using the self-report version of the Zanarini rating scale, the Community Assessment of Psychotic Experiences, and the Green et al., paranoid thought scale. RESULTS Patients with first-episode psychosis reported increased mentalizing impairments, characterized as hypomentalizing tendencies, compared to the non-clinical group. Regression analysis showed significant associations between higher scores on the uncertainty about mental states scale and negative symptoms of psychosis in both groups. No associations were found between mentalizing impairments and traits of borderline personality disorder in the clinical sample, although associations were found in the non-clinical sample. CONCLUSIONS The present findings suggests that impairments in mentalizing may be associated with negative symptoms of psychosis across both clinical and non-clinical samples. Mentalizing impairments was found to be associated with traits of borderline personality disorder, but this finding was only confirmed in the non-clinical sample. Mentalizing should therefore be considered in the early assessment and treatment of patients experiencing difficulties with negative symptoms of psychosis.
Collapse
Affiliation(s)
| | - Ali Shnyien
- University of Surrey, Guildford, England, UK
| | - Sarah Mansfield
- South West London and St George's Mental Health Trust, London, England, UK
| | - Simon Draycott
- University of Surrey, Guildford, England, UK.,West London NHS Trust, London, England, UK
| |
Collapse
|
9
|
Abstract
OBJECTIVE Disturbances in interpersonal functioning are prevalent in individuals with suicidality. Foundational for interpersonal functioning is theory of mind (ToM), a social-cognitive ability that allows individuals to understand the thoughts and feelings of others. Recent work has begun to investigate ToM performance in individuals with suicidality, though no review has quantitatively aggregated findings from these varied studies. The current study investigated the relations between ToM and suicidality with meta-analysis. METHOD We identified and meta-analyzed 15 studies that presented data for 2,895 participants (617 of whom had reported at least one suicide attempt). RESULTS Results indicated a significant, negative relation between ToM and suicidality with a medium overall effect size (g = -.475). Moderator analyses revealed that this effect was consistent across age, sex, ToM content, and suicidal outcome. CONCLUSION Deficits in ToM associated with suicidality hold promise for risk-identification, treatment, and prevention work.HighlightsTheory of mind (ToM) abilities are critical for effective interpersonal functioning.Meta-analytics results indicate that ToM deficits are associated with suicidality.Identifying such suicidality-related ToM deficits may inform risk-identification, treatment, and prevention work.
Collapse
|
10
|
Sahl AC, Rognlien HF, Andreassen OA, Melle I, Ueland T, Vaskinn A. Theory of mind in schizophrenia: a comparison of subgroups with low and high IQ. Nord J Psychiatry 2022; 77:329-335. [PMID: 35916656 DOI: 10.1080/08039488.2022.2106512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Social cognitive impairment is common in schizophrenia, but it is unclear if it is present in individuals with high IQ. This study compared theory of mind (ToM) in schizophrenia participants with low or high IQ to healthy controls. METHODS One hundred and nineteen participants (71 healthy controls, 17 high IQ (IQ ≥115), and 31 low IQ (IQ ≤95) schizophrenia participants) were assessed with the Movie for the Assessment of Social Cognition, providing scores for total, cognitive, and affective ToM, along with overmentalizing, undermentalizing, and no-mentalizing errors. IQ was measured with Wechsler Abbreviated Scale of Intelligence; clinical symptoms with the Positive and Negative Syndrome Scale. RESULTS Healthy controls performed better than the low IQ schizophrenia group for all ToM scores, and better than the high IQ schizophrenia group for the total score and under- and no-mentalizing errors. The high IQ group made fewer overmentalizing errors and had better total and cognitive ToM than the low IQ group. Their number of overmentalizing errors was indistinguishable from healthy controls. CONCLUSION Global ToM impairment was present in the low IQ schizophrenia group. Overmentalizing was not present in the high IQ group and appears related to lower IQ. Intact higher-level reasoning may prevent the high IQ group from making overmentalizing errors, through self-monitoring or inhibition. We propose that high IQ patients are chiefly impaired in lower-level ToM, whereas low IQ patients also have impaired higher-level ToM. Conceivably, this specific impairment could help explain the lower functioning reported in persons with intact IQ.
Collapse
Affiliation(s)
- André C Sahl
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Henning F Rognlien
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Anja Vaskinn
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
11
|
McLaren V, Gallagher M, Hopwood CJ, Sharp C. Hypermentalizing and Borderline Personality Disorder: A Meta-Analytic Review. Am J Psychother 2022; 75:21-31. [PMID: 35099264 DOI: 10.1176/appi.psychotherapy.20210018] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A hypermentalizing impairment, or tendency to overattribute mental states to others, has been identified among individuals with borderline personality disorder. However, associations between hypermentalizing and other disorders call into question the specificity of this impairment to borderline personality disorder. This study aimed to evaluate the relative strength of the association between hypermentalizing and borderline personality disorder compared with other disorders and to assess the impact of moderators on the relationship between hypermentalizing and psychopathology. METHODS The authors conducted a meta-analysis of 36 studies (N=4,188 people) to investigate the relative strength of the association between hypermentalizing and borderline personality disorder, compared with other disorders, and to assess the impact of moderators on this relationship. The Movie for the Assessment of Social Cognition, an ecologically valid experimental instrument, was used to measure hypermentalizing. RESULTS Results indicated support for an association between psychopathology and hypermentalizing (r=0.24, 95% confidence interval [CI]=0.17 to 0.31), but the association was not significantly stronger for borderline personality disorder (r=0.26, 95% CI=0.12 to 0.39) than for other disorders (r=0.24, 95% CI=0.14 to 0.33). Neither age nor gender significantly moderated the association between psychopathology and hypermentalizing. CONCLUSIONS Hypermentalizing may be related to psychopathology in general rather than borderline personality disorder in particular. The findings are discussed in view of the possibility that features of borderline personality disorder associated with other psychopathology may explain the overall association between psychopathology and hypermentalizing. Clinical implications for mentalization-based treatment and concerns that the measurement used for hypermentalization may be too narrow and not representative of variations in functioning across cultures and race-ethnicity also are discussed.
Collapse
Affiliation(s)
- Veronica McLaren
- Department of Psychology, University of Houston, Houston (McLaren, Gallagher, Sharp); Department of Psychology, University of California, Davis (Hopwood)
| | - Matthew Gallagher
- Department of Psychology, University of Houston, Houston (McLaren, Gallagher, Sharp); Department of Psychology, University of California, Davis (Hopwood)
| | - Chris J Hopwood
- Department of Psychology, University of Houston, Houston (McLaren, Gallagher, Sharp); Department of Psychology, University of California, Davis (Hopwood)
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston (McLaren, Gallagher, Sharp); Department of Psychology, University of California, Davis (Hopwood)
| |
Collapse
|
12
|
Woźniak-Prus M, Gambin M, Cudo A, Sharp C. Investigation of the Factor Structure of the Reflective Functioning Questionnaire (RFQ-8): One or Two Dimensions? J Pers Assess 2022; 104:736-746. [PMID: 35015610 DOI: 10.1080/00223891.2021.2014505] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a need to have reliable and accessible screening measures of mentalizing ability to investigate the role of this capacity in social functioning and its development, emergence of psychopathological conditions, as well as to understand its role in psychotherapeutic processes. The 8-itemed Reflective Functioning Questionnaire (RFQ-8) has been developed for this purpose, however its factor structure and psychometric properties are unclear. The aim of the current study was to further investigate the factor structure of the RFQ-8 and explore its psychometric properties in a Polish sample. 538 participants aged 17-50 (M = 21.44, SD = 2.92) took part in the study. They were asked to complete the RFQ-8, Difficulties in Emotion Regulation Scale (DERS), General Health Questionnaire (GHQ-28), the Relationship Structures (ECR-RS) questionnaire and the Borderline Personality Inventory (BPI). Results of both exploratory and confirmatory analysis indicated that the RFQ-8 may be regarded as a scale measuring a unidimensional construct. Our results confirmed good construct validity for the unidimensional RFQ-8, suggesting that the one-dimensional RFQ specifically assesses uncertainty concerning mental states. Our findings highlight the need for further studies investigating the factor structure and psychometric properties of the RFQ-8.
Collapse
Affiliation(s)
| | | | - Andrzej Cudo
- Institute of Psychology, The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas
| |
Collapse
|
13
|
Bora E. A meta-analysis of theory of mind and 'mentalization' in borderline personality disorder: a true neuro-social-cognitive or meta-social-cognitive impairment? Psychol Med 2021; 51:2541-2551. [PMID: 34530941 DOI: 10.1017/s0033291721003718] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND It is widely accepted that borderline personality disorder (BPD) is associated with significant impairments in mentalization and theory of mind (ToM) which are considered as closely related concepts by many authors particularly in psychoanalytical circles. However, for understanding interpersonal difficulties in personality disorders, it is important to distinguish neuro-social cognitive impairment from the abnormal meta-social-cognitive style of patients. METHODS The current systematic review aimed to conduct separate meta-analyses of 'mentalization' [reflective functioning (RF] and different aspects of ToM in BPD. A literature search was conducted to locate relevant articles published between January 1990 to July 2021. Random-effect meta-analyses were conducted in 34 studies involving 1448 individuals with BPD and 2006 healthy controls. RESULTS A very large impairment in RF was evident in BPD [d = 1.68, confidence interval (CI) = 1.17-2.19]. In contrast, ToM impairment was modest (d = 0.36, CI = 0.24-0.48). BPD patients underperformed healthy controls in ToM-reasoning (d = 0.44, CI = 0.32-0.56) but not ToM-decoding. Increased HyperToM (d = 0.60, CI = 0.41-0.79) and faux pas recognition (d = 0.62, CI = 0.35-0.90) errors in BPD compared to healthy controls were most robust ToM findings in this meta-analysis. CONCLUSIONS BPD is characterized by very severe deficits in RF and modest and selective abnormalities in ToM. Interpersonal problems and difficulties in processing social information in BPD can be best explained by patients' maldaptive meta-social cognitive style and top-down effects of these abnormalities rather than having a primary neuro-social cognitive deficit.
Collapse
Affiliation(s)
- Emre Bora
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir35340, Turkey
- Department of Neurosciences, Insitiute of Health, Dokuz Eylul University, Izmir, Turkey
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria3053, Australia
| |
Collapse
|
14
|
Lakhani S, Bhola P, Mehta UM. The conceptualization and assessment of social cognition in personality and common mental disorders. Asian J Psychiatr 2021; 65:102829. [PMID: 34537534 DOI: 10.1016/j.ajp.2021.102829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/06/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022]
Abstract
Social Cognition is a crucial transdiagnostic construct with clinical and functional relevance across a range of neuropsychiatric disorders. Most research has focused on schizophrenia and autism spectrum disorders and has informed frameworks for assessing social cognition in schizophrenia. The current review focuses on the more recent developments pertaining to personality and common mental disorders (PCMDs). Two main questions are addressed: 1. What are the important domains and patterns of social cognition impairments among the personality and common mental disorders? 2. What are the trends in the assessment of social cognition among personality and common mental disorders? We synthesize research findings on the conceptualization of SC and the application of these frameworks for assessment with PCMDs. We have outlined a typology of criteria and guidelines for selecting and developing measures of SC in the PCMDs. We conclude that there is a need for a reconceptualization of social cognition or PCMDs with a focus on higher-order processes and suggest that mentalization could be a suitable framework to understand and examine social cognition in the PCMDs. Future efforts to develop, adapt and use more complex, nuanced, sensitive, and culturally valid measures of social cognition in interpersonal contexts can aid the detection of subtle, context-dependent, and dynamic impairments across these disorders. Social cognition is a promising transdiagnostic construct and warrants more conceptual clarity and research on the varied patterns of impairments across disorders.
Collapse
Affiliation(s)
- Sheetal Lakhani
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Poornima Bhola
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India.
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| |
Collapse
|
15
|
Hillmann K, Neukel C, Krauch M, Spohn A, Schnell K, Herpertz SC, Bertsch K. Cognitive and Affective Theory of Mind in Female Patients With Borderline Personality Disorder. J Pers Disord 2021; 35:672-690. [PMID: 33107807 DOI: 10.1521/pedi_2020_34_490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Empirical studies have identified deficits in cognitive and affective theory of mind (ToM) in patients with borderline personality disorder (BPD), but results remain heterogeneous and not much is known about the role of childhood trauma. The current study assessed cognitive and affective ToM in 80 patients with BPD and 41 healthy controls in a false-belief cartoon task. Childhood trauma was measured with the Childhood Trauma Questionnaire (CTQ). Patients with BPD responded slower in all experimental conditions in false-belief situations, but not when false beliefs were resolved; made more errors in the cognitive ToM condition; and reported worse affective states more often in and after false-belief situations. No significant correlations between ToM and childhood trauma could be found. The current study revealed deficits in cognitive and affective ToM in patients with BPD that may be related to a more negative affective state raised by the false-belief stories.
Collapse
Affiliation(s)
- Karen Hillmann
- Department of General Psychiatry, Heidelberg University, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Heidelberg University, Germany
| | - Marlene Krauch
- Department of General Psychiatry, Heidelberg University, Germany.,Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Angelika Spohn
- Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Knut Schnell
- Asklepios Center for Psychiatry and Psychotherapy Göttingen, Göttingen, Germany
| | | | - Katja Bertsch
- Department of General Psychiatry, Heidelberg University, Germany
| |
Collapse
|
16
|
Wastler HM, Lenzenweger MF. Cognitive and Affective Theory of Mind in Positive Schizotypy: Relationship to Schizotypal Traits and Psychosocial Functioning. J Pers Disord 2021; 35:538-553. [PMID: 32163024 DOI: 10.1521/pedi_2020_34_473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Theory of mind (ToM) impairments are well documented in schizophrenia, although it remains unclear whether these deficits exist among individuals with schizotypy. The current study sought to shed light on mixed findings in schizotypy by differentiating between various aspects of ToM, (cognitive/affective ToM and overmentalization/undermentalization). A three-group design (positive schizotypy, negative affect, and healthy control) was used to assess ToM performance on the Movie for Assessment of Social Cognition. Results indicated that the positive schizotypy group made greater intent overmentalization errors than both control groups. The schizotypy and negative affect groups made greater emotion overmentalization errors relative to healthy controls. In addition, the authors explored the relationship between ToM, schizotypal traits, and psychosocial functioning. Results demonstrated a significant positive relationship between cognitive-perceptual schizotypal traits and intent overmentalization as well as a significant positive relationship between interpersonal traits and emotion overmentalization. Finally, intent and emotion overmentalization were both related to poorer psychosocial functioning.
Collapse
Affiliation(s)
- Heather M Wastler
- State University of New York at Binghamton.,The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mark F Lenzenweger
- State University of New York at Binghamton.,Weill Cornell Medical College, New York, New York
| |
Collapse
|
17
|
Friestad C, Vaskinn A. An exploration of theory of mind performance among men convicted of rape. Scand J Psychol 2021; 62:476-483. [PMID: 34085727 DOI: 10.1111/sjop.12732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/19/2021] [Indexed: 11/27/2022]
Abstract
Several of the known risk factors for sexual violence concern a lack of capacity for engaging in mutually satisfying interpersonal relationships. Socio-cognitive deficits may be approached from a theory of mind (ToM) perspective, where lack of ability to attribute mental states to others is seen as the core feature. This study focuses on imprisoned men (n = 26) convicted of rape against an adult. A video-based measure of ToM (MASC) was applied, depicting social interaction in a dynamic real-life setting. The results showed that the rape-convicted men have a markedly inferior ability to infer the mental states of others. Clinical as well as theoretical implications of the findings are discussed.
Collapse
Affiliation(s)
- Christine Friestad
- Department of Mental Health and Addiction, Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.,University College of Norwegian Correctional Service, Lillestrom, Norway
| | - Anja Vaskinn
- NORMENT Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
18
|
Hanegraaf L, van Baal S, Hohwy J, Verdejo-Garcia A. A systematic review and meta-analysis of 'Systems for Social Processes' in borderline personality and substance use disorders. Neurosci Biobehav Rev 2021; 127:572-592. [PMID: 33865874 DOI: 10.1016/j.neubiorev.2021.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 02/10/2021] [Accepted: 04/12/2021] [Indexed: 01/12/2023]
Abstract
Deficits in social processing (SP) have been proposed to underpin interpersonal dysfunction in both Borderline Personality Disorder (BPD) and Substance Use Disorders (SUD). This study aimed to explore potential transdiagnostic cognitive and behavioral phenotypes of these disorders utilizing the NIMH Research Domain Criteria 'Systems for Social Processes'. A systematic review and meta-analysis of the published research was conducted on 134 studies identified through our database searches. Four meta-analyses were conducted, which revealed significant overlapping deficits in the ability to identify facial emotions and infer the mental states of others in both BPD and SUD. Further, people with BPD displayed a higher ostracism effect following perceived social exclusion. Systematically reviewed studies also revealed significant dysfunction amongst individuals with BPD and SUD across both self and other SP constructs, which were broadly similar in magnitude. Taken together, these results support the proposition that SP dysfunction may be considered a core transdiagnostic phenotype of BPD and SUD.
Collapse
Affiliation(s)
- Lauren Hanegraaf
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia.
| | - Simon van Baal
- Cognition and Philosophy Lab, Philosophy Department, Monash University, Clayton, Australia
| | - Jakob Hohwy
- Cognition and Philosophy Lab, Philosophy Department, Monash University, Clayton, Australia
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| |
Collapse
|
19
|
Cyrkot T, Szczepanowski R, Jankowiak-Siuda K, Gawęda Ł, Cichoń E. Mindreading and metacognition patterns in patients with borderline personality disorder: experimental study. Eur Arch Psychiatry Clin Neurosci 2021; 271:1159-1168. [PMID: 33459868 PMCID: PMC8354944 DOI: 10.1007/s00406-020-01227-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022]
Abstract
Current psychopathology attempts to understand personality disorders in relation to deficits in higher cognition such as mindreading and metacognition. Deficits in mindreading are usually related to limitations in or a complete lack of the capacity to understand and attribute mental states to others, while impairments in metacognition concern dysfunctional control and monitoring of one's own processes. The present study investigated dysfunctional higher cognition in the population of patients with borderline personality disorder (BPD) by analyzing the accuracy of metacognitive judgments in a mindreading task [reading the mind in the eyes Test (RMET)] and a subsequent metacognitive task based on self-report scales: a confidence rating scale (CR) versus a post-decision wagering scale (PDW). It turned out that people from the BPD group scored lower in the RMET. However, both groups had the same levels of confidence on the PDW scale when giving incorrect answers in the RMET test. As initially hypothesized, individuals with BPD overestimated their confidence in incorrect answers, regardless of the type of metacognitive scales used. The present findings indicate that BPD individuals show dysfunctional patterns between instances of mindreading and metacognition.
Collapse
Affiliation(s)
- Tomasz Cyrkot
- College of Psychological Sciences, Faculty of Education, University of Lower Silesia, Wroclaw, Poland
| | - Remigiusz Szczepanowski
- College of Psychological Sciences, Faculty of Education, University of Lower Silesia, Wroclaw, Poland.
| | - Kamila Jankowiak-Siuda
- Behavioral Neuroscience Lab, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Ewelina Cichoń
- College of Psychological Sciences, Faculty of Education, University of Lower Silesia, Wroclaw, Poland ,WSB University in Toruń, Toruń, Poland
| |
Collapse
|
20
|
Vaskinn A, Melle I, Aas M, Berg AO. Sexual abuse and physical neglect in childhood are associated with affective theory of mind in adults with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2020; 23:100189. [PMID: 33134093 PMCID: PMC7586237 DOI: 10.1016/j.scog.2020.100189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/09/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
Whereas childhood trauma is associated with reduced nonsocial cognition in schizophrenia, research on the relationship between childhood trauma and social cognition is limited and mixed. The aim of this study was to examine the association between childhood trauma and theory of mind (ToM) in persons with schizophrenia (n = 68) compared to healthy control participants (n = 70). Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ), providing information on physical abuse, emotional abuse, sexual abuse, physical neglect and emotional neglect. ToM was indexed by the Movie for the Assessment of Social Cognition (MASC), which yields scores for total, cognitive and affective ToM, and for three error types (overmentalizing, undermentalizing, no mentalizing). Persons with schizophrenia had elevated rates of childhood trauma and lower ToM scores than healthy controls. In the schizophrenia group, associations between sexual abuse and affective ToM was statistically significant. In regression analyses, physical neglect was found to be the strongest predictor of affective ToM. In healthy controls, childhood trauma was not associated with ToM. Follow-up analyses comparing individuals with/without clinically significant childhood trauma, confirmed the findings for the schizophrenia group. No causal inferences can be made in this cross-sectional study, but the results suggest an illness-specific association between both sexual abuse and physical neglect in childhood, and adult affective ToM in individuals with schizophrenia.
Collapse
Affiliation(s)
- Anja Vaskinn
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Monica Aas
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway
| | - Akiah Ottesen Berg
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
21
|
Penner F, McLaren V, Leavitt J, Akca OF, Sharp C. Implicit and Explicit Mentalizing Deficits in Adolescent Inpatients: Specificity and Incremental Value of Borderline Pathology. J Pers Disord 2020; 34:64-83. [PMID: 31887101 DOI: 10.1521/pedi_2019_33_463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Research has demonstrated mentalizing impairment associated with borderline personality disorder (BPD) in adolescents. However, mentalizing performance in adolescents with BPD has never been compared to that of psychiatric control and healthy control adolescents simultaneously. The present study aimed to (a) compare implicit and explicit mentalizing, and hypermentalizing errors in implicit mentalizing, across youth with BPD and psychiatric and healthy controls, and (b) evaluate the association of borderline features with mentalizing deficits over and above internalizing and externalizing. Psychiatric inpatients with BPD (n = 139), inpatient psychiatric controls (n = 310), and healthy adolescents (n = 134) completed two mentalizing tasks, an interview assessing BPD, and measures of psychopathology. Results showed that BPD specificity could be demonstrated only for implicit mentalizing and hypermentalizing. Explicit mentalizing deficits did not differ between BPD and psychiatric control groups. Borderline features had unique associations to implicit mentalizing and hypermentalizing, over and above internalizing and externalizing.
Collapse
Affiliation(s)
| | | | - Jacob Leavitt
- Department of Psychology, University of Houston, Houston, Texas
| | - Omer Faruk Akca
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas.,Centre for Development Support, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
22
|
Diaconescu AO, Stecy M, Kasper L, Burke CJ, Nagy Z, Mathys C, Tobler PN. Neural arbitration between social and individual learning systems. eLife 2020; 9:54051. [PMID: 32779568 PMCID: PMC7476763 DOI: 10.7554/elife.54051] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 08/10/2020] [Indexed: 12/20/2022] Open
Abstract
Decision making requires integrating knowledge gathered from personal experiences with advice from others. The neural underpinnings of the process of arbitrating between information sources has not been fully elucidated. In this study, we formalized arbitration as the relative precision of predictions, afforded by each learning system, using hierarchical Bayesian modeling. In a probabilistic learning task, participants predicted the outcome of a lottery using recommendations from a more informed advisor and/or self-sampled outcomes. Decision confidence, as measured by the number of points participants wagered on their predictions, varied with our definition of arbitration as a ratio of precisions. Functional neuroimaging demonstrated that arbitration signals were independent of decision confidence and involved modality-specific brain regions. Arbitrating in favor of self-gathered information activated the dorsolateral prefrontal cortex and the midbrain, whereas arbitrating in favor of social information engaged the ventromedial prefrontal cortex and the amygdala. These findings indicate that relative precision captures arbitration between social and individual learning systems at both behavioral and neural levels.
Collapse
Affiliation(s)
- Andreea Oliviana Diaconescu
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland.,Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland.,University of Basel, Department of Psychiatry (UPK), Basel, Switzerland.,Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Canada
| | - Madeline Stecy
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland.,Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland.,Rutgers Robert Wood Johnson Medical School, New Brunswick, United States
| | - Lars Kasper
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland.,Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, MRI Technology Group, ETH Zürich & University of Zurich, Zurich, Switzerland
| | - Christopher J Burke
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Zoltan Nagy
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Christoph Mathys
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland.,Interacting Minds Centre, Aarhus University, Aarhus, Denmark.,Scuola Internazionale Superiore di Studi Avanzati (SISSA), Trieste, Italy
| | - Philippe N Tobler
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| |
Collapse
|
23
|
Sjølie C, Meyn EK, Raudeberg R, Andreassen OA, Vaskinn A. Nonsocial cognitive underpinnings of theory of mind in schizophrenia. Psychiatry Res 2020; 289:113055. [PMID: 32446008 DOI: 10.1016/j.psychres.2020.113055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/27/2020] [Accepted: 04/30/2020] [Indexed: 12/30/2022]
Abstract
Social cognition is a mediator between nonsocial cognition and functional outcome in schizophrenia. However, the relationship between specific nonsocial cognitive and social cognitive domains is less clear. The aim of this study was to investigate which specific nonsocial cognitive domains best predict theory of mind (ToM) performance in schizophrenia. We indexed ToM by a composite score of the video-based Movie for the Assessment of Social Cognition test (MASCtot) in a sample of 91 individuals with schizophrenia. Nonsocial cognition was measured with the nonsocial cognitive subtests of the MATRICS Consensus Cognitive Battery (MCCB) and the Wechsler Abbreviated Scale of Intelligence (WASI IQ). Bivariate and multiple regression analyses were applied. We found statistically significant bivariate associations between MASCtot and five nonsocial cognitive tests, measuring intelligence, speed of processing, verbal or visual memory, and non-verbal working memory. Together, they accounted for 17% of the variation in MASCtot, but none of the five tests made significant unique contributions to MASCtot in the regression analysis. Our results confirm that nonsocial cognition and ToM are associated, albeit distinct, constructs. The findings suggest that cognitive remediation must include social cognitive targets in order to achieve improved ToM and better functioning.
Collapse
Affiliation(s)
- Charlotte Sjølie
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway
| | - Emilie K Meyn
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway
| | - Rune Raudeberg
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anja Vaskinn
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| |
Collapse
|
24
|
Pizarro-Campagna E, Terrett G, Jovev M, Rendell PG, Henry JD, Chanen AM. Rapid facial mimicry responses are preserved in youth with first presentation borderline personality disorder. J Affect Disord 2020; 266:14-21. [PMID: 32056868 DOI: 10.1016/j.jad.2020.01.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/27/2019] [Accepted: 01/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Empathy is a complex and multifaceted construct comprising cognitive and affective components. Abnormal empathic responses are implicated in borderline personality disorder (BPD). Specifically, unconscious motor mimicry (a primitive component of affective empathy evident from infancy) is theorized to be heightened and to contribute to the heightened emotional contagion often seen in people with BPD. Yet, no study has directly tested whether abnormally heightened unconscious motor mimicry is associated with BPD features or whether this is present early in the course of BPD. METHODS In the present study, facial electromyography was used to assess the rapid facial mimicry responses (a form of unconscious motor mimetic responding) of 32 outpatient youths (aged 15-25 years) with early stage BPD features and 47 demographically matched healthy control participants (HC). RESULTS The results showed no group differences in rapid facial mimetic responses to either positive (happy) or negative (angry) facial emotions. LIMITATIONS Co-occurring psychopathology and the potential impact of state affect on rapid facial mimicry were considered and discussed. CONCLUSIONS These data indicate that there is no evidence for abnormally heightened rapid motor mimicry in youth early in the course of BPD, suggesting that rapid facial mimicry is preserved in this group. It is thus unlikely that abnormally heightened unconscious simulation contributes to heightened emotional contagion in youth with first presentation BPD. Future research should explore alternative mechanisms for this phenomenon and also whether abnormalities in motor mimetic responses are evident in later stages of the disorder.
Collapse
Affiliation(s)
- Elizabeth Pizarro-Campagna
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, Australia.
| | - Gill Terrett
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Martina Jovev
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Peter G Rendell
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Julie D Henry
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
25
|
Abstract
After participating in this activity, learners should be better able to:• Assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes• Evaluate the effects of empathy or related processes as factors contributing to abnormal social functioning in BPD ABSTRACT: We reviewed 45 original research studies, published between 2000 and 2019, to assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes (i.e., theory of mind, mentalizing, social cognition, and emotional intelligence). Thirty-six studies reported deficits of empathy or related processes in patients with BPD. Enhanced emotional empathy in BPD was also reported in eight studies, all of which revealed that patients had increased scores of personal distress on the Interpersonal Reactivity Index self-report questionnaire. Six studies did not find significant differences between patients with BPD and healthy control subjects in terms of empathy or related processes. No study reported enhanced cognitive empathy, social cognition, or emotional intelligence in patients with BPD. We postulate that deficits of empathy or related processes contribute to preempting the formation of stable interpersonal relationships, whereas enhanced emotional empathy might lead to personal (and interpersonal) distress, further contributing to abnormal social functioning in BPD.
Collapse
|
26
|
Urbańska D, Moritz S, Gawęda Ł. The impact of social and sensory stress on cognitive biases and delusions in schizophrenia. Cogn Neuropsychiatry 2019; 24:217-232. [PMID: 31043127 DOI: 10.1080/13546805.2019.1611551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Stress aggravates delusional symptoms, but the exact underlying mechanisms are still not fully understood. One of the routes may be via exacerbation of information processing distortions frequently observed in psychosis. The aim of the present study was thus to investigate the impact of social and sensory stress on specific cognitive processes along with different dimensions of delusional thinking. METHODS Nineteen individuals affected by schizophrenia and 15 healthy controls were assessed under 3 experimental conditions (social stress, neutral, noise stress), with counter-balanced presentation of stress conditions across participants of both groups. Under each condition participants performed parallel versions of experimental tasks and had to report their level of paranoid thinking and subjective distress. RESULTS Irrespective of condition, patients showed significant impairments in metacognitive accuracy compared with controls. When social stress was applied first, mentalising accuracy decreased significantly in the subsequent condition among patients only. Following exposure to either social or sensory stress, patients reported significantly higher conviction in their paranoid ideas in the subsequent condition. CONCLUSIONS Only limited evidence was found for the negative impact of stress on cognitive processes in schizophrenia patients. However, this may not be true for those with more severe information processing abnormalities and/or delusions.
Collapse
Affiliation(s)
- Dorota Urbańska
- a Faculty of Psychology , University of Warsaw , Warsaw , Poland
| | - Steffen Moritz
- b Department of Psychiatry and Psychotherapy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Łukasz Gawęda
- c Psychopathology and Early Interventions Lab, II Department of Psychiatry , The Medical University of Warsaw , Warsaw , Poland
| |
Collapse
|
27
|
Quek J, Melvin GA, Bennett C, Gordon MS, Saeedi N, Newman LK. Mentalization in Adolescents With Borderline Personality Disorder: A Comparison With Healthy Controls. J Pers Disord 2019; 33:145-163. [PMID: 29469664 DOI: 10.1521/pedi_2018_32_336] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mentalization is proposed to underlie the disturbed interpersonal relatedness that is a hallmark of borderline personality disorder (BPD). Despite growing evidence of BPD in adolescents, studies examining mentalization in relation to adolescent BPD have remained limited. Given contradictory findings of this relationship, particularly with adults, further research of mentalization in adolescents with BPD is warranted. The current study further clarifies the nature of mentalizing impairments, related to BPD, by examining different aspects of mentalization between adolescents with BPD (n = 26) and a group of healthy controls (n = 25). Findings support studies that suggest that mentalization may be an important treatment target, influencing BPD symptoms and interpersonal functioning in adolescents with BPD. They also support the importance of examining mentalizing abilities in relation to varying levels of complexity, interpersonal contexts, and levels of arousal. Limitations and further research are discussed.
Collapse
Affiliation(s)
- Jeremy Quek
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Glenn A Melvin
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Clair Bennett
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Michael S Gordon
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia.,Early in Life Mental Health Service, Monash Health, Australia
| | - Naysun Saeedi
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia.,Early in Life Mental Health Service, Monash Health, Australia
| | - Louise K Newman
- Department of Psychiatry, University of Melbourne, Australia
| |
Collapse
|
28
|
Quadflieg S, Westmoreland K. Making Sense of Other People’s Encounters: Towards an Integrative Model of Relational Impression Formation. JOURNAL OF NONVERBAL BEHAVIOR 2019. [DOI: 10.1007/s10919-019-00295-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
29
|
Németh N, Mátrai P, Hegyi P, Czéh B, Czopf L, Hussain A, Pammer J, Szabó I, Solymár M, Kiss L, Hartmann P, Szilágyi ÁL, Kiss Z, Simon M. Theory of mind disturbances in borderline personality disorder: A meta-analysis. Psychiatry Res 2018; 270:143-153. [PMID: 30248485 DOI: 10.1016/j.psychres.2018.08.049] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/30/2018] [Accepted: 08/13/2018] [Indexed: 02/07/2023]
Abstract
Impairments of theory of mind (ToM) are widely accepted underlying factors of disturbed relatedness in borderline personality disorder (BPD). The aim of this meta-analysis a was to assess the weighted mean effect sizes of ToM performances in BPD compared to healthy controls (HC), and to investigate the effect of demographic variables and comorbidities on the variability of effect sizes across the studies. Seventeen studies involving 585 BPD patients and 501 HC were selected after literature search. Effect sizes for overall ToM, mental state decoding and reasoning, cognitive and affective ToM, and for task types were calculated. BPD patients significantly underperformed HC in overall ToM, mental state reasoning, and cognitive ToM, but had no deficits in mental state decoding. Affective ToM performance was largely task dependent in BPD. Comorbid anxiety disorders had a positive moderating effect on overall and affective ToM in BPD. Our results support the notion that BPD patients' have specific ToM impairments. Further research is necessary to evaluate the role of confounding factors, especially those of clinical comorbidities, neurocognitive functions, and adverse childhood life events. Complex ToM tasks with high contextual demands seem to be the most appropriate tests to assess ToM in patients with BPD.
Collapse
Affiliation(s)
- Nándor Németh
- Neurobiology of Stress Research Group, Szentágothai János Research Centre, University of Pécs, Pécs, Hungary
| | - Péter Mátrai
- Institute of Bioanalysis, University of Pécs, Medical School, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine and 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary; Momentum Translational Gastroenterology Research Group, Hungarian Academy of Sciences University of Szeged, Szeged, Hungary
| | - Boldizsár Czéh
- Neurobiology of Stress Research Group, Szentágothai János Research Centre, University of Pécs, Pécs, Hungary; Department of Laboratory Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - László Czopf
- Department of Cardiology, 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Alizadeh Hussain
- Department of Haematology, 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Judith Pammer
- Department of Haematology, 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Imre Szabó
- Department of Gastroenterology, 1st Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Margit Solymár
- Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Loránt Kiss
- Department of Pathophysiology, University of Szeged, Medical School, Szeged, Hungary
| | - Petra Hartmann
- Institute of Surgical Research, University of Szeged, Hungary
| | | | - Zoltán Kiss
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Maria Simon
- Neurobiology of Stress Research Group, Szentágothai János Research Centre, University of Pécs, Pécs, Hungary; Department of Psychiatry and Psychotherapy, University of Pécs, Medical School, Pécs, Hungary.
| |
Collapse
|
30
|
Emotion perception, non-social cognition and symptoms as predictors of theory of mind in schizophrenia. Compr Psychiatry 2018; 85:1-7. [PMID: 29906670 DOI: 10.1016/j.comppsych.2018.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/28/2018] [Accepted: 05/31/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Theory of mind (ToM) can be divided into cognitive and affective ToM, and a distinction can be made between overmentalizing and undermentalizing errors. Research has shown that ToM in schizophrenia is associated with non-social and social cognition, and with clinical symptoms. In this study, we investigate cognitive and clinical predictors of different ToM processes. METHODS Ninety-one individuals with schizophrenia participated. ToM was measured with the Movie for the Assessment of Social Cognition (MASC) yielding six scores (total ToM, cognitive ToM, affective ToM, overmentalizing errors, undermentalizing errors and no mentalizing errors). Neurocognition was indexed by a composite score based on the non-social cognitive tests in the MATRICS Consensus Cognitive Battery (MCCB). Emotion perception was measured with Emotion in Biological Motion (EmoBio), a point-light walker task. Clinical symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Seventy-one healthy control (HC) participants completed the MASC. RESULTS Individuals with schizophrenia showed large impairments compared to HC for all MASC scores, except overmentalizing errors. Hierarchical regression analyses with the six different MASC scores as dependent variables revealed that MCCB was a significant predictor of all MASC scores, explaining 8-18% of the variance. EmoBio increased the explained variance significantly, to 17-28%, except for overmentalizing errors. PANSS excited symptoms increased explained variance for total ToM, affective ToM and no mentalizing errors. DISCUSSION Both social and non-social cognition were significant predictors of ToM. Overmentalizing was only predicted by non-social cognition. Excited symptoms contributed to overall and affective ToM, and to no mentalizing errors.
Collapse
|
31
|
An investigation of the mentalization-based model of borderline pathology in adolescents. Compr Psychiatry 2018; 84:87-94. [PMID: 29727808 DOI: 10.1016/j.comppsych.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/16/2018] [Accepted: 04/12/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE According to mentalization-based theory, transgenerational transmission of mentalization from caregiver to offspring is implicated in the pathogenesis of borderline personality disorder (BPD). Recent research has demonstrated an association between hypermentalizing (excessive, inaccurate mental state reasoning) and BPD, indicating the particular relevance of this form of mentalizing dysfunction to the transgenerational mentalization-based model. As yet, no study has empirically assessed a transgenerational mentalization-based model of BPD. The current study sought firstly to test the mentalization-based model, and additionally, to determine the form of mentalizing dysfunction in caregivers (e.g., hypo- or hypermentalizing) most relevant to a hypermentalizing model of BPD. METHOD Participants were a mixed sample of adolescents with BPD and a sample of non-clinical adolescents, and their respective primary caregivers (n = 102; 51 dyads). Using an ecologically valid measure of mentalization, mediational analyses were conducted to examine the relationships between caregiver mentalizing, adolescent mentalizing, and adolescent borderline features. RESULTS Findings demonstrated that adolescent mentalization mediated the effect of caregiver mentalization on adolescent borderline personality pathology. Furthermore, results indicated that hypomentalizing in caregivers was related to adolescent borderline personality pathology via an effect on adolescent hypermentalizing. CONCLUSIONS Results provide empirical support for the mentalization-based model of BPD, and suggest the indirect influence of caregiver mentalization on adolescent borderline psychopathology. Results further indicate the relevance of caregiver hypomentalizing to a hypermentalizing model of BPD.
Collapse
|
32
|
Lysaker PH, George S, Chaudoin-Patzoldt KA, Pec O, Bob P, Leonhardt BL, Vohs JL, James AV, Wickett A, Buck KD, Dimaggio G. Contrasting metacognitive, social cognitive and alexithymia profiles in adults with borderline personality disorder, schizophrenia and substance use disorder. Psychiatry Res 2017; 257:393-399. [PMID: 28826064 DOI: 10.1016/j.psychres.2017.08.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/21/2017] [Accepted: 08/01/2017] [Indexed: 01/28/2023]
Abstract
Deficits in the ability to recognize and think about mental states are broadly understood to be a root cause of dysfunction in Borderline Personality Disorder (PD). This study compared the magnitude of those deficits relative to other forms of serious mental illness or psychiatric conditions. Assessments were performed using the metacognition assessment scale-abbreviated (MAS-A), emotion recognition using the Bell Lysaker Emotion Recognition Test and alexithymia using the Toronto Alexithymia Scale among adults with schizophrenia (n = 65), Borderline PD (n = 34) and Substance Use disorder without psychosis or significant Borderline traits (n = 32). ANCOVA controlling for age revealed the Borderline PD group had significantly greater levels of metacognitive capacity on the MAS-A than the schizophrenia group and significantly lower levels of metacognitive capacity than the Substance Use group. Multiple comparisons revealed the Borderline PD group had significantly higher self-reflectivity and awareness of the other's mind than the schizophrenia group but lesser mastery and decentration on the MAS-A than substance use group, after controlling for self-report of psychopathology and overall number of PD traits. The Borderline PD and Schizophrenia group had significantly higher levels of alexithymia than the substance use group. No differences were found for emotion recognition. Results suggest metacognitive functioning is differentially affected in different mental disorders.
Collapse
Affiliation(s)
- Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Day Hospital 116H, 1481 W. 10th Street, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA.
| | - Sunita George
- School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, GH109, Indianapolis, IN 46227, USA
| | - Kelly A Chaudoin-Patzoldt
- School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, GH109, Indianapolis, IN 46227, USA
| | - Ondrej Pec
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry, First Faculty of Medicine, Charles University, Ovocný trh 3-5, 116 36 Praha 1-Staré Město, Prague, Czech Republic; Psychotherapeutic and Psychosomatic Clinic ESET, Prague, Czech Republic
| | - Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry, First Faculty of Medicine, Charles University, Ovocný trh 3-5, 116 36 Praha 1-Staré Město, Prague, Czech Republic
| | - Bethany L Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA
| | - Jenifer L Vohs
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA
| | - Alison V James
- Department of Psychology, Indiana State University, B-207 Root Hall, 200 N. Seventh Street, Terre Haute, IN 47809, USA
| | - Amanda Wickett
- Richard L. Roudebush VA Medical Center, Day Hospital 116H, 1481 W. 10th Street, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA
| | - Kelly D Buck
- Richard L. Roudebush VA Medical Center, Day Hospital 116H, 1481 W. 10th Street, Indianapolis, IN 46202, USA
| | - Giancarlo Dimaggio
- Center for Metacognitive Psychotherapy, Piazza dei Martiri di Belfiore 4, 00195 Rome, Italy
| |
Collapse
|
33
|
Tay SA, Hulbert CA, Jackson HJ, Chanen AM. Affective and cognitive theory of mind abilities in youth with borderline personality disorder or major depressive disorder. Psychiatry Res 2017; 255:405-411. [PMID: 28667928 DOI: 10.1016/j.psychres.2017.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/01/2017] [Accepted: 06/04/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Theory of mind (ToM) is an important social cognitive ability that has been investigated in BPD, with inconsistent findings indicating impaired, comparable, and enhanced ToM in BPD. This study aimed to clarify and extend previous findings by investigating affective and cognitive ToM abilities in youth early in the course of BPD, by including a clinical comparison group of youth with major depressive disorder (MDD). METHODS Female participants aged 15-24 years diagnosed with BPD (n = 41) or MDD (n = 37) completed the Reading the Mind in the Eyes Test (RMET) and Happé's Cartoon Task, measures of affective and cognitive dimensions of ToM, respectively. RESULTS The BPD group performed significantly worse than the MDD group on the affective ToM task, even after controlling for age, intelligence and depressive symptoms. Results for cognitive ToM were not significantly different. CONCLUSIONS Finding of poorer performance on a measure of affective ToM, in BPD youth, relative to youth with MDD early in the course of BPD suggest a developmental failure of sociocognitive abilities needed for mentalising and which are theorised as giving rise to core features of BPD. Future research should employ more naturalistic paradigms to study social cognition and should assess individuals even earlier in the course of BPD.
Collapse
Affiliation(s)
- Sarah-Ann Tay
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Carol A Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.
| | - Henry J Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Andrew M Chanen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| |
Collapse
|
34
|
Trujillo SP, Valencia S, Trujillo N, Ugarriza JE, Rodríguez MV, Rendón J, Pineda DA, López JD, Ibañez A, Parra MA. Atypical Modulations of N170 Component during Emotional Processing and Their Links to Social Behaviors in Ex-combatants. Front Hum Neurosci 2017; 11:244. [PMID: 28588462 PMCID: PMC5440593 DOI: 10.3389/fnhum.2017.00244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/25/2017] [Indexed: 11/13/2022] Open
Abstract
Emotional processing (EP) is crucial for the elaboration and implementation of adaptive social strategies. EP is also necessary for the expression of social cognition and behavior (SCB) patterns. It is well-known that war contexts induce socio-emotional atypical functioning, in particular for those who participate in combats. Thus, ex-combatants represent an ideal non-clinical population to explore EP modulation and to evaluate its relation with SCB. The aim of this study was to explore EP and its relation with SCB dimensions such as empathy, theory of mind and social skills in a sample of 50 subjects, of which 30 were ex-combatants from illegally armed groups in Colombia, and 20 controls without combat experience. We adapted an Emotional Recognition Task for faces and words and synchronized it with electroencephalographic recording. Ex-combatants presented with higher assertion skills and showed more pronounced brain responses to faces than Controls. They did not show the bias toward anger observed in control participants whereby the latter group was more likely to misclassify neutral faces as angry. However, ex-combatants showed an atypical word valence processing. That is, words with different emotions yielded no differences in N170 modulations. SCB variables were successfully predicted by neurocognitive variables. Our results suggest that in ex-combatants the links between EP and SCB functions are reorganized. This may reflect neurocognitive modulations associated to chronic exposure to war experiences.
Collapse
Affiliation(s)
- Sandra P Trujillo
- Doctoral Program in Psychology, Department of Experimental Psychology, Universidad de GranadaGranada, Spain.,GISAME, Facultad Nacional de Salud Pública, Universidad de Antioquia (UdeA),Medellín, Colombia
| | - Stella Valencia
- GISAME, Facultad Nacional de Salud Pública, Universidad de Antioquia (UdeA),Medellín, Colombia
| | - Natalia Trujillo
- GISAME, Facultad Nacional de Salud Pública, Universidad de Antioquia (UdeA),Medellín, Colombia.,Neuroscience Group, Universidad de Antioquia (UdeA),Medellín, Colombia
| | - Juan E Ugarriza
- Facultad de Jurisprudencia, Universidad del RosarioBogotá, Colombia
| | - Mónica V Rodríguez
- SISTEMIC, Facultad de Ingeniería, Universidad de Antioquia (UdeA),Medellín, Colombia
| | - Jorge Rendón
- Neuroscience Group, Universidad de Antioquia (UdeA),Medellín, Colombia.,Neuropsychology and Behavior Group, Universidad de Antioquia (UdeA),Medellín, Colombia.,Department of Cognitive Neuroscience, Maastricht UniversityMaastricht, Netherlands
| | - David A Pineda
- Neuropsychology and Behavior Group, Universidad de Antioquia (UdeA),Medellín, Colombia
| | - José D López
- SISTEMIC, Facultad de Ingeniería, Universidad de Antioquia (UdeA),Medellín, Colombia
| | - Agustín Ibañez
- Facultad de Psicología, Universidad Autónoma del CaribeBarranquilla, Colombia.,Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo IbañezSantiago, Chile.,National Scientific and Technical Research CouncilBuenos Aires, Argentina.,Laboratory of Experimental Psychology and Neuroscience, Institute of Translational and Cognitive Neuroscience, INECO Foundation, Favaloro UniversityBuenos Aires, Argentina.,ACR Centre of Excellence in Cognition and its Disorders, SydneyNSW, Australia
| | - Mario A Parra
- Facultad de Psicología, Universidad Autónoma del CaribeBarranquilla, Colombia.,Psychology, School of Social Sciences, Heriot-Watt UniversityEdinburgh, United Kingdom
| |
Collapse
|
35
|
Kocsis-Bogár K, Kotulla S, Maier S, Voracek M, Hennig-Fast K. Cognitive Correlates of Different Mentalizing Abilities in Individuals with High and Low Trait Schizotypy: Findings from an Extreme-Group Design. Front Psychol 2017. [PMID: 28634459 PMCID: PMC5460341 DOI: 10.3389/fpsyg.2017.00922] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Mentalizing or Theory of Mind (ToM) deficits in schizophrenia have been studied to great extent, but studies involving samples of trait schizotypy yield ambiguous results. Executive functions like cognitive inhibition, cognitive flexibility, and agency are all prerequisites of mentalizing, and it is assumed that the impairment of these functions contributes to ToM deficits in schizophrenia. Whether these impairments influence the ToM performance of people with high trait schizotypy remains unclear. Although impaired self-agency has repeatedly been identified in people with schizotypy, its role in mentalizing is yet to be investigated. The main aim of this study was to explore whether deficits in cognitive and affective ToM can be found in high trait schizotypy, and to identify in what way these deficits are related to the positive and negative dimensions of schizotypy. The secondary aim was to examine whether these deficits correlate with executive functions. Based on the dimensional view of the schizophrenia spectrum, an extreme-group design was applied to non-clinical volunteers demonstrating high (N = 39) and low (N = 47) trait schizotypy. Affective and cognitive ToM were investigated using the Movie for Assessment of Social Cognition, a sensitive and video-based measurement. Cognitive inhibition was assessed using the Stroop Test, and cognitive flexibility was analyzed using the Trail-Making Test. Agency was measured using a computerized self-agency paradigm. Participants in the high-schizotypy group performed significantly worse in the affective ToM task (d = 0.79), and their overall ToM performance was significantly impaired (d = 0.60). No between-group differences were found with regards to cognitive ToM, executive functions, and self-agency. Cognitive flexibility correlated negatively with positive schizotypy, and contributed to a worse overall and affective ToM. Impaired cognitive inhibition contributed to undermentalizing-type errors. It was found that non-clinical participants with high trait (positive) schizotypy - especially those with slight executive-function deficits - may have difficulties in understanding the emotional state of others and consequently in functioning in social situations.
Collapse
Affiliation(s)
- Krisztina Kocsis-Bogár
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of ViennaVienna, Austria
| | - Simone Kotulla
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of ViennaVienna, Austria
| | - Susanne Maier
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of ViennaVienna, Austria
| | - Martin Voracek
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of ViennaVienna, Austria
| | - Kristina Hennig-Fast
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of ViennaVienna, Austria.,Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus BielefeldBielefeld, Germany
| |
Collapse
|
36
|
Brockmeyer T, Pellegrino J, Münch H, Herzog W, Dziobek I, Friederich HC. Social cognition in anorexia nervosa: Specific difficulties in decoding emotional but not nonemotional mental states. Int J Eat Disord 2016; 49:883-90. [PMID: 27315544 DOI: 10.1002/eat.22574] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Building on recent models of anorexia nervosa (AN) that emphasize the importance of impaired social cognition in the development and maintenance of the disorder, the present study aimed at examining whether women with AN have more difficulties with inferring other people's emotional and nonemotional mental states than healthy women. METHOD Social cognition was assessed in 25 adult women with AN and 25 age-matched healthy women. To overcome limitations of previous research on social cognition in AN, the processing of social information was examined in a more complex and ecologically valid manner. The Movie for the Assessment of Social Cognition (MASC) reflects complex real-life social interaction and allows for disentangling emotional and non-emotional mental state inference as well as different types of errors in mentalizing. RESULTS Women with AN showed poorer emotional mental state inference, whereas non-emotional mental state inference was largely intact. Groups did not differ in undermentalizing (overly simplistic theory of mind) and overmentalizing (overly complex or over-interpretative mental state reasoning). Performance in the MASC was independent of levels of eating disorder psychopathology and symptoms of depression and anxiety. DISCUSSION The findings suggest that AN is associated with specific difficulties in emotional mental state inference despite largely intact nonemotional mental state inference. Upon replication in larger samples, these findings advocate a stronger emphasis on socio-emotional processing in AN treatment. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:883-890).
Collapse
Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Center for Psychosocial Medicine, Heidelberg, Germany. .,Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Judith Pellegrino
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Hannah Münch
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Isabell Dziobek
- Berlin School of Mind and Brain and Institute of Psychology, Humboldt-University, Berlin, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Center for Psychosocial Medicine, Heidelberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| |
Collapse
|
37
|
|