Affective theory of the mind and suicide in women with borderline personality disorder and schizophrenia: a comparative study

Abstract

Background Theory of mind (ToM) is one of the essential components of social cognition. Affective ToM enables us to interpret other’s feelings and behaviors. Borderline personality disorder (BPD) and schizophrenia are two distinct mental disorders, yet they have a mutual deficit in interpreting emotions, thoughts, and intentions which may lead to a higher incidence of suicidality. Studies that involved social cognition, particularly ToM in schizophrenia, or BPD have controversial results. Therefore, this study aimed at comparing affective ToM functioning in female patients with BPD, schizophrenia, and healthy controls. In addition, identifying the possible impact and any correlation exists between the affective ToM and liability for suicide in those patients. Sixty individuals were recruited from the Institute of Psychiatry, Ain Shams University, Cairo, Egypt, and assigned into 3 groups where group A involved 20 BPD patients, group B involved 20 schizophrenic patients, and group C were healthy persons as a control. Assessment of affective ToM was done using Reading the Mind in the Eyes Test (RMET), and probability of suicide was measured using Suicide Probability Scale (SPS). Results Regarding ToM, the three groups were assessed using RMET and the results revealed a significantly higher mean score (hypermentalization) in BPD patients than both schizophrenic patients and controls. While schizophrenic patients had significantly lower mean scores than the control group (hypomentalization). As well, BPD patients had a significantly higher suicide probability total score than Schizophrenic patients and in all subdomains except for the hostility subdomain that was significantly higher in schizophrenic patients. Interestingly, in BPD, the suicide probability total score was positively correlated with RMET. Conclusions BPD patients have enhanced affective ToM and hypermentalization that is significantly associated with increased suicide probability in those patients, while in schizophrenia, hypomentalization could not be linked to increased suicide probability. Rehabilitation and proper management of ToM abnormalities might be a crucial tool in suicide prevention in mental illnesses, particularly, BPD.

Systematic Review of the Link Between Social Cognition and Suicidal Ideation and Behavior in People With Serious Mental Illness

“…The 16 studies varied in their objectives. The primary objective of 10 of the studies examined the relationship between some aspect of social cognition and SI or behavior, 40–45 , 50–54 whereas 5 of the studies did not have a primary objective of examining this relationship and reported statistics examining the relationship. 33 , 39 , 46 , 47 , 55 Nine studies included purely cross-sectional analysis of social cognitive variables, 33 , 43–47 , 53–55 5 studies were longitudinal with follow-up intervals ranging from 2 weeks to 20 years, 39–41 , 51 , 52 and 2 studies were cross-sectional case-control designs.…”

“… 33 , 39 , 46 , 47 , 55 Nine studies included purely cross-sectional analysis of social cognitive variables, 33 , 43–47 , 53–55 5 studies were longitudinal with follow-up intervals ranging from 2 weeks to 20 years, 39–41 , 51 , 52 and 2 studies were cross-sectional case-control designs. 42 , 50 One included study is a Letter to the Editor that contains empirical data not published elsewhere, but is not a peer-reviewed journal article. 53 …”

“…Mean ages of the samples ranged from 23.06 to 49.4, and samples varied greatly in their gender distribution, with 1 study only including men 42 and another study only including women. 50 Gender distributions of the other included studies were more balanced between men and women. Samples were racially and ethnically diverse, though 8 studies did not report the racial and ethnic makeup of their sample.…”

“…Samples were racially and ethnically diverse, though 8 studies did not report the racial and ethnic makeup of their sample. 39 , 41 , 43–45 , 47 , 50 , 54 Studies came from a diverse range of countries, including the United States ( N = 5), Spain ( N = 5), China ( N = 3), Egypt ( N = 1), Italy ( N = 1), and the Netherlands ( N = 1). Four articles examined a sample of individuals with an FEP, 46 , 47 , 51 , 52 and 1 study recruited individuals who had experienced an FEP and examined the link between social cognition and suicide 20 years later.…”

“…Nine studies included a measure of SI. 33 , 40 , 41 , 43 , 46 , 47 , 50 , 53 , 55 Twelve studies collected data relating to SB, specifically suicide attempts. 33 , 39 , 41 , 42 , 44–47 , 51 , 52 , 54 , 55 For SI and behavior, studies varied in the method of assessment (interviewer-rated vs self- or informant-report) and depth (scale vs single item) in characterizing this construct.…”