Manuel Sprung
Juliane Burghardt
Monica Mazza
Friedrich Riffer- 1Department of Psychology and Psychodynamics, Division of Clinical Psychology, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
- 2Waldviertel Psychosomatic Center, Eggenburg, Austria
- 3Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
Editorial on the Research Topic
Misunderstanding Others: Theory of Mind in Psychological Disorders
Theory of mind (ToM) or mentalizing is a fundamental component of human cognition. It is defined as the ability to ascribe mental states, such as desires, beliefs, intentions, and emotions, to oneself and others and to explain and predict behavior based on these mental states (Wimmer and Perner, 1983). ToM is also a part of current models of empathy, which include two ToM systems, a cognitive and an affective system, with separate but interacting brain networks (Shamay-Tsoory, 2011). The cognitive ToM system involves thinking about thoughts, intentions, or beliefs. The affective ToM involves thinking about feelings and is distinct from the affective empathy system, which involves sharing the emotional experiences of others (Shamay-Tsoory, 2011). Important developmental ToM milestones are in preschool, school-age, and early adolescence (Rakoczy, 2017; Meinhardt-Injac et al., 2020; Wellman, 2020; Devine and Lecce, 2021; Osterhaus and Koerber, 2021). Childhood adversity can disrupt ToM development (Benarous et al., 2015). There are also limits in healthy adults' ToM use (Apperly et al., 2010); ToM abilities typically declines in aging adults (Henry et al., 2013). ToM is also linked to social development and functioning. For instance, ToM is related to prosocial behavior, peer popularity and reciprocated friendship (Fink et al., 2015; Slaughter et al., 2015; Imuta et al., 2016). Moreover, superior ToM relates to less loneliness, less social rejection, and being rated as socially skilled by teachers (Banerjee et al., 2011; Devine et al., 2016; Koerber and Osterhaus, 2020).
In the last two decades ToM impairments have also been reported in over 30 different mental disorders, including autism spectrum disorder (ASD), schizophrenia, borderline personality disorder (BPD), post-traumatic stress disorder, depression, and eating disorders. Dysfunctional ToM has been proposed as a transdiagnostic clinical marker (Cotter et al., 2018) and has been included as a subconstruct in the Research Domain Criteria, a research framework for investigating mental disorders (Cuthbert, 2014). The underlying mechanisms and the precise role of ToM in the etiology, diagnosis, and treatment of these mental disorders are also still poorly understood. Some existing treatment programs, such as mentalization-based therapy or metacognitive training, emphasize ToM treatment as a core component (Moritz et al., 2014; Malda-Castillo et al., 2019). This Research Topic promotes our understanding on the specific nature of ToM in individuals with borderline personality disorder, autism spectrum disorder and schizophrenia.
The study by Lévay et al. investigated whether individuals with BPD exhibit an asymmetry between their own social behavior and their expectations of other people's social motivation. Compared with health control subjects, individuals with BPD expected significantly more selfishness in others. This finding suggests that ToM impairments in BPD are best characterized as mistrust and a negativity bias. This specific profile of ToM impairment may be linked to an abusive family environment, common in the history of many BPD patients, in which cooperation was met with selfishness.
A different profile of impaired ToM, indicated by difficulties in the spontaneous intuitive ascription of mental states, has been observed in individuals with ASD. Krämer et al. investigated the feasibility and efficacy of a treatment program specifically targeting spontaneous ToM in individuals with ASD, an adapted Mentalization-Based Treatment (MBT). The ToM abilities of a group of adult patients with Asperger's syndrome, a form of ASD with no general impairments in language or cognitive abilities, significantly improved over the course of the treatment. Despite the lack of a control group this is a very promising finding, showing that MBT can help AS patients to better understand and reflect on interpersonal situations.
Two further papers in this Research Topic address other aspects related to ToM, in patients with psychosis and schizophrenia. Lysaker et al. provide an interesting review of research on social cognition, intersubjectivity and metacognition in individuals with psychosis. This article points out that deficits in social cognition cannot fully explain the disturbed social functioning of individuals with psychosis. Instead Lysaker et al. suggest that deficits in metacognitive capacity, contributing to experiences of self and others as increasingly fragmented, provide a better account of social dysfunction in psychosis. Maaßen et al. address emotional awareness an important aspect of affective ToM. They examining the usability and convergent validity of the Levels of Emotional Awareness Scale (LEAS) in a large sample of outpatients with schizophrenia or schizoaffective disorders. The LEAS uses scenarios of social situations to evoke participants' emotions and assess both their own emotional reactions and their inferences about the emotions of interactions partners presented in the scenarios. Their findings suggest that although formal levels of EA may not differ significantly between patients and healthy controls there may be inadequacies in other-related mentalizing in the patient group.
Finally, Nonnemacher et al. offer a developmental perspective on ToM. In an impressive longitudinal design, this study investigated the relation of self-regulatory skills in infancy with later ToM abilities in pre-school age children of clinically depressed mothers and healthy controls. Contrary to the authors hypothesis maternal depression did not impair ToM developmental per se. However, an interaction was found between infants self-comforting behavior and later ToM abilities. This finding adds to the heterogeneous picture about the influence of parental mental illness on children's ToM development, suggesting that other factors such as self-regulatory abilities contribute to ToM development.
Author Contributions
MS wrote the first draft. JB reviewed and revised the manuscript. MM and FR reviewed the manuscript. All authors contributed to the article and approved the submitted version.
Funding
The Gesellschaft für Forschungsförderung Niederösterreich (GFF) [Society for Research Promotion Lower Austria] supported this work by financing the endowed professorship in clinical psychology held by MS. The VAMED Institute for Gender Medicine financed the position held by JB.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's Note
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References
Apperly, I. A., Carroll, D. J., Samson, D., Humphreys, G. W., Qureshi, A., and Moffitt, G. (2010). Why are there limits on theory of mind use? Evidence from adults' ability to follow instructions from an ignorant speaker. Quart. J. Exp. Psychol. 63, 1201–1217. doi: 10.1080/17470210903281582
Banerjee, R., Watling, D., and Caputi, M. (2011). Peer relations and the understanding of faux pas: longitudinal evidence for bidirectional associations. Child Dev. 82, 1887–1905. doi: 10.1111/j.1467-8624.2011.01669.x
Benarous, X., Guilé, J.-M., Consoli, A., and Cohen, D. (2015). A systematic review of the evidence for impaired cognitive theory of mind in maltreated children. Front. Psychiatry 6:108. doi: 10.3389/fpsyt.2015.00108
Cotter, J., Granger, K., Backx, R., Hobbs, M., Looi, C. Y., and Barnett, J. H. (2018). Social cognitive dysfunction as a clinical marker: a systematic review of meta-analyses across 30 clinical conditions. Neurosci. Biobeh. Rev. 84, 92–99. doi: 10.1016/j.neubiorev.2017.11.014
Cuthbert, B. N. (2014). The RDoC framework: facilitating transition from ICD/DSM to dimensional approaches that integrate neuroscience and psychopathology. World Psychiatry 13, 28–35. doi: 10.1002/wps.20087
Devine, R. T., and Lecce, S. (2021). Theory of Mind in Middle Childhood and Adolescence: Integrating Multiple Perspectives. London: Routledge. doi: 10.4324/9780429326899
Devine, R. T., White, N., Ensor, R., and Hughes, C. (2016). Theory of mind in middle childhood: longitudinal associations with executive function and social competence. Dev. Psychol. 52, 758–771. doi: 10.1037/dev0000105
Fink, E., Begeer, S., Peterson, C. C., Slaughter, V., and de Rosnay, M. (2015). Friendlessness and theory of mind: a prospective longitudinal study. Br. J. Dev. Psychol. 33, 1–17. doi: 10.1111/bjdp.12060
Henry, J. D., Phillips, L. H., Ruffman, T., and Bailey, P. E. (2013). A meta-analytic review of age differences in theory of mind. Psychol. Aging 28, 826–839. doi: 10.1037/a0030677
Imuta, K., Henry, J. D., Slaughter, V., Selcuk, B., and Ruffman, T. (2016). Theory of mind and prosocial behavior in childhood: a meta-analytic review. Dev. Psychol. 52, 1192–1205. doi: 10.1037/dev0000140
Koerber, S., and Osterhaus, C. (2020). Some but not all aspects of (advanced) theory of mind predict loneliness. Br. J. Dev. Psychol. 38, 144–148. doi: 10.1111/bjdp.12302
Malda-Castillo, J., Browne, C., and Perez-Algorta, G. (2019). Mentalization-based treatment and its evidence-base status: a systematic literature review. Psychol. Psychother. Theory Res. Pract. 92, 465–498. doi: 10.1111/papt.12195
Meinhardt-Injac, B., Daum, M. M., and Meinhardt, G. (2020). Theory of mind development from adolescence to adulthood: testing the two-component model. Br. J. Dev. Psychol. 38, 289–303. doi: 10.1111/bjdp.12320
Moritz, S., Andreou, C., Schneider, B. C., Wittekind, C. E., Menon, M., Balzan, R. P., et al. (2014). Sowing the seeds of doubt: a narrative review on metacognitive training in schizophrenia. Clin. Psychol. Rev. 34, 358–366. doi: 10.1016/j.cpr.2014.04.004
Osterhaus, C., and Koerber, S. (2021). The development of advanced theory of mind in middle childhood: a longitudinal study from age 5 to 10 years. Child Dev. 92, 1872–1888. doi: 10.1111/cdev.13627
Rakoczy, H. (2017). “Theory of mind,” in The Cambridge Encyclopedia of Child Development (Cambridge, Cambridge University Press), 505–512. doi: 10.1017/9781316216491.081
Shamay-Tsoory, S. G. (2011). The neural bases for empathy. Neuroscientist 17, 18–24. doi: 10.1177/1073858410379268
Slaughter, V., Imuta, K., Peterson, C. C., and Henry, J. D. (2015). Meta-analysis of theory of mind and peer popularity in the preschool and early school years. Child Dev. 86, 1159–1174. doi: 10.1111/cdev.12372
Wellman, H. M. (2020). Reading Minds: How Childhood Teaches Us to Understand People. New York, NY: Oxford University Press. doi: 10.1093/oso/9780190878672.001.0001
Keywords: theory of mind, social cognition, metacognition, mentalizing, borderline personality disorder, autism spectrum disorder, schizophrenia, maternal depression
Citation: Sprung M, Burghardt J, Mazza M and Riffer F (2022) Editorial: Misunderstanding Others: Theory of Mind in Psychological Disorders. Front. Psychol. 13:838853. doi: 10.3389/fpsyg.2022.838853
Received: 18 December 2021; Accepted: 14 January 2022;
Published: 07 February 2022.
Edited and reviewed by: Irene Ceccato, University of Studies G. d'Annunzio Chieti and Pescara, Italy
Copyright © 2022 Sprung, Burghardt, Mazza and Riffer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Manuel Sprung, manuel.sprung@kl.ac.at