Meta-analysis of Theory of Mind (ToM) impairment in bipolar disorder
Open accessAbstract
BACKGROUND: Theory of mind (ToM) dysfunction is prominent in a number of psychiatric disorders, in particular, autism and schizophrenia, and can play a significant role in poor functioning. There is now emerging evidence suggesting that ToM abilities are also impaired in bipolar disorder (BP); however, the relationship between ToM deficits and mood state is not clear. METHOD: We conducted a meta-analysis of ToM studies in BP. Thirty-four studies comparing 1214 patients with BP and 1097 healthy controls were included. BP groups included remitted (18 samples, 545 BP patients), subsyndromal (12 samples, 510 BP patients), and acute (manic and/or depressed) (10 samples, 159 BP patients) patients. RESULTS: ToM performance was significantly impaired in BP compared to controls. This impairment was evident across different types of ToM tasks (including affective/cognitive and verbal/visual) and was also evident in strictly euthymic patients with BP (d = 0.50). There were no significant differences between remitted and subsyndromal samples. However, ToM deficit was significantly more severe during acute episodes (d = 1.23). ToM impairment was significantly associated with neurocognitive and particularly with manic symptoms. CONCLUSION: Significant but modest sized ToM dysfunction is evident in remitted and subsyndromal BP. Acute episodes are associated with more robust ToM deficits. Exacerbation of ToM deficits may contribute to the more significant interpersonal problems observed in patients with acute or subsyndromal manic symptoms. There is a need for longitudinal studies comparing the developmental trajectory of ToM deficits across the course of the illness.
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The reduced performance in social predictive tasks in BD is consistent with previous literature on theory of mind deficits in individuals with BD.
“is consistent with previous literature on the theory of mind deficits in individuals with BD (Bora et al., 2016; Olivito et al., 2022).”
From Predictive coding in neuropsychiatric disorders: a systematic transdiagnostic review. (2025) · cites this paper as Bora et al., 2016
Social cognitive disturbances are present in autism, schizophrenia, bipolar disorder, and depression.
“While scant systematic direct comparisons have been conducted between bvFTD and the most relevant PPD, it is known that social cognitive disturbances are present in autism, schizophrenia, bipolar disorder, and depression (APA, 2013; Ladegaard et al. , 2014; Bora et al. , 2016; Bonfils et al. , 2017).”
From Recommendations to distinguish behavioural variant frontotemporal dementia from psychiatric disorders (2020) · cites this paper as Bora et al. , 2016
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“The reduced performance in social predictive tasks shown by individuals with BD is consistent with previous literature on the theory of mind deficits in individuals with BD (Bora et al., 2016; Olivito et al., 2022).”
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- Authors
- Bora, E., Bartholomeusz, C., & Pantelis, C.
- Affiliations
- The University of Melbourne (AU)
- Corresponding author
- Bora, E.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2015-10-12
- Volume
- 46
- Issue
- 2
- Pages
- 253-264
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2271671804
- Cited by
- 216
- References
- 69
- Citations by year
- 2026: 10 · 2025: 20 · 2024: 13 · 2023: 18 · 2022: 11 · 2021: 24 · 2020: 29 · 2019: 37 · 2018: 21 · 2017: 20 · 2016: 11 · 2015: 2
- FWCI
- 2.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Health and Medical Research Council (628386)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Keywords
- theory of mind, bipolar disorder, social cognition, manic episodes, remitted bipolar disorder, mood states, interpersonal problems, neurocognitive impairment
- MeSH terms
- Bipolar Disorder, Humans, Theory of Mind
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