Theory of mind abilities in patients with borderline personality disorder and
major depression: a meta-analysis
1,2
1
Mara J. Richman
& Zsolt Unoka , MD, PhD
1. Department of Psychotherapy and Psychiatry, Semmelweis University 2. Department of C ognitive Science, Central European University
ABSTRACT
Patients with borderline personality disorder (BPD) and major
depression (MD) are characterized by distorted perception of other's
intentions. Deficits in mental state decoding (MSD) are thought to
underlie this clinical feature, although studies examining MSD
abilities assessed by the Reading in the Mind of the Eyes Test
(RMET) in MD and in BPD with or without MD have yielded
inconsistent findings. A meta-analysis assessing differences in the
disorders was conducted among accuracy and valence scores.
RESULTS
Large significant deficits were seen for RMET accuracy among MD (d=
-0.751). In positive RMET valence, patients with MD significantly
performed the worst (d= -0.523); in neutral valence, patients with BPD
exhibited similar deficits (d= -0.230). Moderator analysis revealed no
demographic (age, sex) or co-morbidity differences (anxiety, eating,
substance abuse, or cluster A personality disorders); however, comorbidity of BPD with MD performed better than BPD alone on
accuracy and positive valence. Co-morbid clusters A, B, or C
personality disorders performed worse than BPD alone.
INTRODUCTION
Major depression and borderline personality disorder are
both characterized by distorted perception of intentions of
others leading to impaired social functioning (Csukly et al.,
2011). This leads to issues with mental state decoding
(MSD). The Reading Eyes in the Mind Test (RMET; BaronCohen et.al, 2001) is a test matching semantic definitions of
mental states to pictures of the eye-region with emotionally
valenced positive, negative, or neutral expressions. In the
current study, a quantitative meta-analysis on RMET
performance of adults clinically diagnosed with BPD and MD
was conducted. RMET performance was analyzed in total
score and on negative, neutral, and positive valences to
assess mental state decoding differences.
METHODS
The current study included a review of 13 cross-sectional
articles (13 effects) comparing RMET accuracy performance of
patients with MD or BPD and healthy controls (N=976).
Potential moderator variables including co-morbidity with BPD
(MD, anxiety, substance abuse, eating, and any personality
disorders) and demographic characteristics (age and sex) were
also assessed. In addition to overall performance, 7 of the 13
articles provided valence scores (21 effects) of patients with
MD or BPD and healthy age matched controls (N= 1525).
CONCLUSIONS
Findings highlight the relevance of RMET performance in
patients with BPD and MD. Accuracy deficits in MD could be
explained by an emphasized impairment in mental state
decoding. Positive valence outcomes in MD are a result of the
disorder's clinical features. BPD deficits in neutral valence
suggest patients emotionalized facial cues. Results also reveal
the importance of considering co-morbidity in future
assessment.
Selected References
• Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., Plumb, I., 2001. The “Reading the Mind in the Eyes” test revised version: a study with normal adults, and adults with Asperger syndrome or
high-functioning autism. J. Child Psychol. Psychiatry 42, 241–251.
• Borenstein, H., Higgins, Rothstein. (2005). Comprehensive meta-analysis version 3.0, Englewood, NJ: Biostat.
• Csukly, G., Telek, R., Filipovits, D., Takacs, B., Unoka, Z., & Simon, L. (2011). What is the relationship between the recognition of emotions and core beliefs: Associations between the recognition
of emotions in facial expressions and the maladaptive schemas in depressed patients. J.Behav.Ther.Exp.Psychiatry, 42, 129-137.
• Frick, C., Lang, S., Kotchoubey, B., Sieswerda, S., Dinu-Biringer, R., Berger, M., ... & Barnow, S. (2012). Hypersensitivity in Borderline Personality Disorder during Mindreading. PloS one, 7(8),
e41650.
• Fertuck, E. A., Jekal, A., Song, I., Wyman, B., Morris, M. C., Wilson, S. T. Brodsky BS, Stanley B. (2009). Enhanced 'Reading the Mind in the Eyes' in borderline personality disorder compared to
healthy controls. Psychol.Med., 39, 1979-1988.
• Lee, L., Harkness, K.L., Sabbagh, M.A., Jacobson, J.A., 2005. Mental state decoding abilities in clinical depression. J. Affect. Disord. 86, 247–258.
• Nejati, V., Zabihzadeh, A., Maleki, G., & Tehranchi, A. (2012). Mind reading and mindfulness deficits in patients with major depression disorder. Procedia-Social and Behavioral Sciences, 32, 431437.
• Kettle, J.W.L., O'Brien-Simpson, L., Allen, N.B., (2008). Impaired theory of mind in first-episode schizophrenia: comparison with community, university, and depressed controls. Schizophr. Res.
99, 96–102.
• Harkness, K. L., Washburn, D., Theriault, J., Lee, L., & Sabbagh, M. A. (2011).Maternal history of depression is associated with enhanced theory of mind ability in depressed and non-depressed
women. Psychiatry Research, 189, 91-96.
• Szanto K, Dombrovski AY, Sahakian BJ, Mulsant BH, Houck PR, et al. (2012) Social emotion recognition, social functioning, and attempted suicide in late-life depression. Am J Geriatr
Psychiatry 20: 257–265.
• Schilling, L., Wingenfeld, K., Lowe, B., Moritz, S., Terfehr, K., Kother, U. et al. (2012). Normal mind- reading capacity but higher response confidence in borderline personality disorder patients.
Psychiatry Clin.Neurosci., 66, 322-327.
• Wolkenstein, L., Schönenberg, M., Schirm, E., & Hautzinger, M. (2011). I can see what you feel, but I can't deal with it: Impaired theory of mind in depression. Journal of affective
disorders, 132(1), 104-111.
• Wang, Y., Wang, Y., Chen, S., Zhu, C., Wang, K., 2008. Theory of mind disability in major depression with or without psychotic symptoms: a compo- nential view. Psychiatry Res. 161, 153–161.