Theory of Mind and Empathic Responding in Patients with Mood Disorders

Abstract

<p>Theory of mind (ToM) and empathic responding are thought to rely on the joint contribution of cognitive and affective processes, and the corresponding complex neural networks involved in these diverse cognitive and affective functions. Individuals with mood disorders demonstrate deficits in many of the same cognitive and affective processes thought to mediate ToM and empathy, and demonstrate structural and functional changes in the neural regions that subserve these social cognitive domains. We examined ToM and empathic responding in patients with major depressive disorder (MDD) and bipolar disorder (BD) using standardized measures of social cognitive responding. Patients with BD and MDD with sub-syndromal depressive symptoms showed deficits on a cognitively challenging task that required them to integrate two perspectives simultaneously (second-order ToM stimuli). Sub-syndromal patients with BD also showed a trend toward poor performance on a less demanding first-order ToM task; no such deficit was observed for sub-syndromal MDD patients. Patients with BD were also impaired at discriminating mental states from pictures of eyes and in making complex social judgments. Both patient groups reported reduced levels of cognitive empathy, but differed in response on affective empathy domains. Specifically, whereas the BD group reported higher levels of distress in response to others' negative experiences, the MDD group reported less feelings of care and concern in response to another’s emotional experience. Across the BD studies, impaired ToM and empathic responding were found to be associated with poor social functioning and increased depressive symptoms, but the influence of illness burden variables on performance was variable. Across the MDD studies, the associations between social cognitive performance, illness variables, and social functioning were inconsistent. Taken together, our findings indicate that patients with mood disorders demonstrate altered ToM and empathic responding that may contribute to the difficulties in social communication observed in these patient populations.</p>