Theory of mind deficits in chronically depressed patients

ArticleinDepression and Anxiety 27(9):821-8 · September 2010with57 Reads
DOI: 10.1002/da.20713 · Source: PubMed
Abstract
Poor theory of mind (ToM) performance has been found in patients with mood disorders, but it has not been examined in the subgroup of chronic depression where ToM deficits may be even more persistent than in acute depressive episodes. The aim of this study was to compare the ToM performance of chronically depressed patients with a healthy control group and to clarify the relation of ToM to other cognitive functions. ToM performance was assessed in 30 chronically depressed patients and 30 matched healthy controls by two cartoon picture story tests. In addition, logical memory, alertness, and executive functioning were evaluated. Chronically depressed patients were markedly impaired in all ToM- and neuropsychological tasks compared to healthy controls. Performance in the different ToM tests was significantly correlated with at least one other cognitive variable. After controlling for logical memory and working memory, no ToM tasks predicted being a patient. Patients with chronic depression present significant deficits in "reading" social interactions, which may be associated with general cognitive impairments.
    • "In contrast to low mood and mild depression, major depression, like many other severe psychiatric conditions, is associated with highly impaired executive function, reduced motivation and attention, and working memory deficits (Burt, Zembar, & Niederehe, 1995; Fossati, Ergis, & Allilaire, 2002; Gałecki, Talarowska, Anderson, Berk, & Maes, 2015; Hasler, Drevets, Manji, & Charney, 2004 ). Empathizing performance in depression (as well as relatively-severe cases of BPD) is expected to be confounded by the presence of these deficits (Lee, Harkness, Sabbagh, & Jacobson, 2005); for example, Zobel et al. (2010) found that chronic depression predicted poor theory of mind performance on a cartoon-picture story task, but after controlling for logical memory and working memory, depressive status no longer predicted theory of mind ability. Studies that evaluate aspects of empathy along a continuum from very low to high levels of depression are suggested as especially useful for future work, by our results. "
    [Show abstract] [Hide abstract] ABSTRACT: Baron-Cohen's 'extreme male brain' theory postulates that autism involves exaggerated male-typical psychology, with reduced empathizing (considered here as social-emotional interest, motivation and abilities) and increased systemizing (non-social, physical-world and rule-based interest, motivation and abilities), in association with its male-biased sex ratio. The concept of an 'extreme female brain', involving some combination of increased empathizing and reduced systemizing, and its possible role in psychiatric conditions, has been considerably less well investigated. Female-biased sex ratios have been described in two conditions, depression and borderline personality disorder (BPD), that also show evidence of increases in aspects of empathy in some studies. We evaluated the hypothesis that BPD and depression can be conceptualized in the context of the 'extreme female brain' by: (1) describing previous conceptualizations of the extreme female brain model, (2) reviewing evidence of female-biased sex ratios in BPD and depression, (3) conducting meta-analyses of performance on the Reading the Mind in the Eyes test (RMET) among individuals with BPD, clinical or subclinical depression, and other psychiatric conditions involving altered social cognition and mood (schizophrenia, bipolar disorder, eating disorders, and autism), in relation to disorder sex ratios, and (4) evaluating previous evidence of increased empathic performance in these, and related, psychiatric conditions, and (5) synthesizing these lines of evidence into models for causes and effects of an 'extreme female brain'. Our primary empirical results are that RMET performance is enhanced in subclinical depression, preserved in borderline personality disorder, and reduced in other disorders (by meta-analyses), and that across disorders, more male-biased patient sex ratios are strongly associated with worse RMET performance of patients relative to controls. Our findings, in conjunction with previous work, suggest that increased cognitive empathizing mediates risk and expression of some psychiatric conditions with evidence of female biases, especially non-clinical depression and borderline personality disorder, in association with increased attention to social stimuli, higher levels of social and emotional sensitivity, negative emotion biases, and over-developed mentalist thought. These results link evolved human sex differences with psychiatric vulnerabilities and symptoms, and lead to specific suggestions for future work.
    Full-text · Article · Feb 2016
    • "For example, major depressive disorder in adults is associated with lower RF, both generally (Fischer-Kern et al., 2013) and specifically regarding experiences of rejection and loss (Staun, Kessler, Buchheim, Kächele, & Taubner, 2010). There is also evidence of ToM deficits in adults with chronic (Zobel et al., 2010), unipolar (Lee, Harkness, Sabbagh, & Jacobson, 2005;Wang, Wang, Chen, Zhu, & Wang 2008), and remitted (Bora et al., 2005;Inoue, Tonooka, Yamada, & Kanba, 2004;Montag et al., 2010) depression. There is also a dearth of literature regarding RF and externalising behaviour difficulties. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Sexual abuse is a well-recognised risk factor for child psychopathology. Little is known regarding whether child and maternal mentalization can be considered a potential resource or protective factor in this context, respectively, mediating or moderating the relationship between sexual abuse and psychopathology. Objective: The aims of this study were (1) to explore the relationships between child and maternal mentalizing, measured as reflective functioning (RF), and child depressive symptoms and externalising difficulties; and (2) to examine whether child mentalizing mediates the relationship between child sexual abuse (CSA) and psychopathology. Method: A total of 168 children aged 7-12 years and their mothers participated in the study. The sample included 74 dyads where children had experienced sexual abuse. The Child Attachment Interview was rated by using the Child Reflective Functioning Scale to assess children's mentalization, and the Child Depression Inventory was used to assess depressive symptoms. Mothers completed the Parent Development Interview to assess maternal RF and the Child Behavior Checklist to assess their child's externalising difficulties. A model involving direct and indirect paths from CSA, child and maternal RF to child psychopathology was examined using Mplus software. Results: Child mentalization partially mediated the relationships between CSA and depressive symptoms, as well as the relationship between CSA and externalising difficulties. Maternal mentalization was an independent predictor of child externalising difficulties, with higher maternal RF associated with less externalising difficulties. Discussion: The findings indicate that by ages 7-12, child mentalization is an important inner resource associated with lower depression and externalising. In addition, this study provides new evidence of the importance of the parent's mentalizing stance for the development of self-regulation and externalising difficulties in both abused and non-abused children. The clinical implications are discussed.
    Full-text · Article · Jan 2016
    • "For example, major depressive disorder in adults is associated with lower RF, both generally (Fischer-Kern et al., 2013) and specifically regarding experiences of rejection and loss (Staun, Kessler, Buchheim, Kächele, & Taubner, 2010). There is also evidence of ToM deficits in adults with chronic (Zobel et al., 2010), unipolar (Lee, Harkness, Sabbagh, & Jacobson, 2005;Wang, Wang, Chen, Zhu, & Wang 2008), and remitted (Bora et al., 2005;Inoue, Tonooka, Yamada, & Kanba, 2004;Montag et al., 2010) depression. There is also a dearth of literature regarding RF and externalising behaviour difficulties. "
    Full-text · Article · Jan 2016
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