Theory of mind deficits in bipolar disorder in remission



Bipolar Disorder, Remission phase, Theory of Mind, Social Cognition


Aims: Theory of Mind (ToM), a concept used to describe an individual's social cognitive abilities that play roles in social interaction, may have a significant role in explaining the clinical variables and social problems of affective disorders. This study aims to determine whether ToM functions are impaired in Bipolar Disorder (BD) compared to healthy controls as well as investigate the association between clinical variables of ToM deficit and social competence.
Methods: A total of 50 patients diagnosed with BD who were in remission and 50 healthy control subjects were included in this cross-sectional study. Demographic data and medical history of participants were assessed, and Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Eyes test, Hinting Task, Social Adaptation and Self-Evaluation Scale (SASS), Wechsler Adult Intelligence Scale-Revised (WAIS-R) tests were administered.
Results: There were no significant differences with regards to age, gender and BDI scores between patient and control groups. Hinting test (P=0.001), Eyes test (P=0.001), SASS (P=0.007) and WAIS-R (P=0.001) scores were higher in the control group. There was a significant correlation between Hinting Test and WAIS-R (r=0.430, P=0.001), and between Eyes Test and age (r.-0.590, P=0.001), duration of bipolar disorder (r=-0.554, P=0.001), number of manic attacks (r=0.590, P=0.001) and WAIS-R (r=0.343, P=0.050). Logistic regression analysis showed that compared to the patient group, control group was related to Eyes test by 1.2-fold for each point increase in Eyes test (P=0.001) and 1.3-fold for each point increase in Hinting test (P=0.003).
Conclusion: ToM deficit was an essential factor that separated BD patients in remission from healthy individuals. ToM deficit may play a role in the essential pathology or affect the presence, or even onset, of BD.


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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) 1995.

Harrington L, Siegert R, McClure JJCn. Theory of mind in schizophrenia: a critical review. Cog Neurosci. 2005;10(4):249-86.

Tager-Flusberg H, Sullivan KJC. A componential view of Theory of mind: evidence from Williams syndrome. Cognition. 2000;76(1):59-90.

Sabbagh MAJB, cognition. Understanding orbitofrontal contributions to theory-of-mind reasoning: implications for autism. Brain and Cognition. 2004;55(1):209-19.

Shamay-Tsoory SG, Shur S, Barcai-Goodman L, Medlovich S, Harari H, Levkovitz YJ. Dissociation of cognitive from affective components of Theory of mind in schizophrenia. Psychiatry Research. 2007;149(1-3):11-23.

Hisli N. A reliability and validity study of Beck Depression Inventory in a university student sample. Psikoloji Dergisi. 1989;7:3-13.

Beck AT, Epstein N, Brown G, Steer R. An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology. 1988;56(6):893.

Ulusoy M, Sahin NH, Erkmen HJ. The Beck anxiety inventory: psychometric properties. J Cogn Psychother. 1998;12(2):163-72.

Corcoran R, Mercer G, Frith C. Schizophrenia, symptomatology and social inference: investigating "theory of mind" in people with schizophrenia. Schizophrenia Research. 1995;17(1):5-13.

Bora E, Gökçen S, Kayahan B, Veznedaroglu B. Deficits of social-cognitive and social-perceptual aspects of Theory of mind in remitted patients with schizophrenia: effect of residual symptoms. The Journal of Nervous and Mental Disease. 2008;196(2):95-9.

Tas C, Danaci AE, Cubukcuoglu Z, Brüne M. Impact of family involvement on social cognition training in clinically stable outpatients with schizophrenia—a randomized pilot study. Psychiatry Research. 2012;195(1-2):32-8.

Yildirim EA, Kaşar M, Güdük M, Ateş E, Küçükparlak İ, Özalmete E. Reading the Mind in the Eyes Test Turkish Reliability Study. Turkish Journal of Psychiatry. 2011;22(3):1-8

Bosc M, Dubini A, Polin V. Development and validation of a social functioning scale, the Social Adaptation Self-evaluation Scale. European Neuropsychopharmacology. 1997;7(1):57-70.

Wechsler D. WAIS-R manual: Wechsler adult intelligence scale-revised: Psychological Corporation; 1981.

Savaşır I, Şahin N, Ankara. The Wechsler Intelligence Scale for Children manual. Turkish Psychology Association Publication, 1995.

Bora E, Vahip S, Gonul A, Akdeniz F, Alkan M, Ogut M, et al. Evidence for Theory of mind deficits in euthymic patients with bipolar disorder. Acta Psychiatrica. 2005;112(2):110-6.

Ma DL, Qu JQ, Goh EL, Tang F. Reorganization of basolateral amygdala-subiculum circuitry in mouse epilepsy model. Frontiers in Neuroanatomy. 2016;9:167.

Friedman L, Avallone J, Magrys B. Maturational effects of single and multiple early-life seizures on AMPA receptors in prepubescent hippocampus. Developmental Neuroscience. 2007;29(6):427-37.

Iori V, Maroso M, Rizzi M, Iyer AM, Vertemara R, Carli M, et al. Receptor for Advanced Glycation Endproducts is upregulated in temporal lobe epilepsy and contributes to experimental seizures. Neurobiology of Disease. 2013;58:102-14.

Kurnaz A, Barişik C. Relationship Between Gifted Students' Motivational Beliefs and Creative Thinking Skills In Science. Milli Eğitim Dergisi. 2018;47(220):59-78.

Senturk V, Goker C, Bilgic A, Olmez S, Tugcu H, Oncu B, et al. Impaired verbal memory and otherwise spared cognition in remitted bipolar patients on monotherapy with lithium or valproate. Bipolar Disorders. 2007;9:136-44.

Çalişir Ö, Atbaşoğlu E, Özgüven H, Ölmez Ş. Cognitive Functions in High Functioning Autism and High Functioning Schizophrenia. Türk Psikiyatri Dergisi. 2018;11:1-10

Yağci S. Neuropsychological Assessment Guide in Epilepsy Surgery. Journal of the Turkish Epilepsi Society. 2012;3:33-43

Wolkenstein L, Schönenberg M, Schirm E, Hautzinger M. I can see what you feel, but I can't deal with it: Impaired Theory of mind in depression. Journal of Affective Disorders. 2011;132(1-2):104-11.

Wang L, Zhong Z, Hu J, Rong X, Liu J, Xiao S, et al. Sertraline plus deanxit to treat patients with depression and anxiety in chronic somatic diseases: A randomized controlled trial. BMC Psychiatry. 2015;15(1):84.

Xiao T, Qiu H, Chen Y, Zhou X, Wu K, Ruan X, et al. Prevalence of anxiety and depression symptoms and their associated factors in mild COPD patients from community settings, Shanghai, China: a cross-sectional study. BMC Psychiatry. 2018;18(1):89.

Dunbar R. The social brain hypothesis. Anthropology. 1998;6(5):178-90.

Gallagher HL, Frith CD. Functional imaging of 'theory of mind'. Trends in Cognitive Sciences. 2003;7(2):77-83.

Inoue Y, Tonooka Y, Yamada K, Kanba S. Deficiency of Theory of mind in patients with remitted mood disorder. Journal of Affective Disorders. 2004;82(3):403-9.

Duman T. Theory of mind and executive functions in bipolar disorder patients and their first-degree relatives: Pamukkale University Faculty of Medicine; 2014.






Research Article

How to Cite

Kılınçel O, Eker S, Kılınçel Şenay. Theory of mind deficits in bipolar disorder in remission. J Surg Med [Internet]. 2020 Jul. 1 [cited 2022 Oct. 4];4(7):527-30. Available from: