Affective and cognitive theory of mind in posttraumatic stress, major depressive, and somatic symptom disorders: Association with childhood trauma

Abstract

Objectives Childhood trauma constitutes a major risk factor for adult psychopathology, including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and somatic symptom disorder (SSD). One potential mechanism linking childhood trauma to adult psychopathology may be alterations in theory of mind (ToM). Given the lack of transdiagnostic studies on the association between childhood trauma and ToM, further research is needed to elucidate whether and how childhood trauma relates to ToM impairments across and within diagnostic boundaries. Design A cross‐sectional study design was applied. Methods A total of 137 individuals with varying levels of childhood trauma took part in this study, encompassing individuals with PTSD (n = 33), MDD (n = 33), SSD (n = 36), and healthy volunteers (HVs; n = 35). To assess ToM performance and childhood trauma, the Movie for the Assessment of Social Cognition was administered along with the Childhood Trauma Questionnaire. Results Only individuals with PTSD, but not individuals with MDD or SSD, showed a worse ToM performance compared to HVs. In the whole sample, childhood trauma correlated negatively with ToM performance. Exploratory group‐specific analyses revealed higher levels of childhood trauma to be associated with more excessive ToM errors in individuals with SSD, and notably with an enhanced ToM performance in individuals with MDD. Conclusions Our results indicate associations between childhood trauma and ToM impairments in a large, transdiagnostic sample. Provided replication in future studies, our findings suggest ToM capacities as a promising treatment target for individuals exposed to severe childhood trauma, at least or particularly with a diagnosis of PTSD. Practitioner points Our results suggest that individuals with a history of severe childhood trauma, at least or particularly with a clinical diagnosis of posttraumatic stress disorder, may benefit from therapeutic approaches targeting theory of mind capacities. Our findings indicate that higher levels of childhood trauma may be linked to a specific ‘hypermentalizing’ bias in somatic symptom disorder. Our findings further point towards an association between higher levels of childhood trauma and a heightened – rather than a diminished – sensitivity towards interpersonal cues in major depressive disorder. Provided further confirmatory evidence, our findings may support diagnosis‐specific approaches in ameliorating theory of mind abilities in individuals with different mental disorders and a history of severe childhood trauma.

Association between childhood maltreatment and social functioning in individuals with affective disorders: A systematic review and meta‐analysis

“…Twelve studies controlled for confounders in their analysis with a wide range of confounders being considered, including sex, 31,44,107–109 gender, 41,105,106 age, 41,44,83,106,110 ethnicity, 41,108 years and level of education, 31,41,109 IQ, processing speed, and verbal intelligence, 83 severity of CM, severity of (subclinical) depressive and anxiety symptoms, 82,83,111 duration of illness, 106 recent stressful events, 83 impulsivity and borderline personality disorder, 108 and psychotropic medication use 106,110 …”

“…Twelve studies controlled for confounders in their analysis with a wide range of confounders being considered, including sex, 31,44,[107][108][109] gender, 41,105,106 age, 41,44,83,106,110 ethnicity, 41,108 years and level of education, 31,41,109 IQ, processing speed, and verbal intelligence, 83 severity of CM, severity of (subclinical) depressive and anxiety symptoms, 82,83,111 duration of illness, 106 recent stressful events, 83 impulsivity and borderline personality disorder, 108 and psychotropic medication use. 106,110 The SCID-Structured Clinical Interview for DSM 112 was the most used diagnostic instrument (n = 18), three studies used the Mini International Psychiatric Interview, 42,103,107 one study used the Major Depression Inventory, 105 one study used clinical reports, 113 and five studies used an unstructured clinical interview based on DSM 97,[114][115][116]80 or ICD 44 criteria.…”

Scoping review update on somatic symptom disorder that includes additional Chinese data

“… 18 Moreover, higher levels of childhood trauma appeared to be associated with more excessive mentalisation deficits in patients with SSD. 19 …”

Beliefs about emotions predict psychological stress related to somatic symptoms

“…holding beliefs about) one's emotions relate to somatic symptoms is not new to psychosomatic research: Starting with Freud's idea that there might be an “enigmatic leap from the psychic into the physical” (1916/1917, p. 265), many scholars have noted the negative relation between a person's ability to experience and express emotions as controllable and useful on the one hand, and somatic symptoms and psychological distress thereof on the other hand in aetiological models, cross‐sectional or quasi‐experimental research‐designs (e.g. Henningsen, 2020; Henningsen et al, 2018; Löwe et al, 2022; Seitz et al, 2022; Subic‐Wrana et al, 2010; for a systematic review of studies showing that beliefs about emotions relate to psychological distress in somatic symptoms: Okur Güney et al, 2019, p. 17). Successful intervention‐studies explicitly focus on the link between emotions and bodily sensations (Abbass et al, 2020; Arbeitskreis PISO, 2012; Kleinstäuber et al, 2019; Sattel et al, 2012) and might therefore be effective.…”