How psychosis shapes the impact of childhood trauma on social cognition in bipolar disorder: the role of Theory of Mind.
Abstract
Objective
Childhood trauma and psychotic symptoms are prevalent in bipolar disorder (BD) and independently linked to social cognition impairments, particularly Theory of Mind (ToM). However, it remains unclear whether trauma and psychosis exert cumulative effects on ToM performance in BD.
Methods
We conducted a cross-sectional study involving 54 euthymic individuals with BD reporting at least moderate childhood trauma (Childhood Trauma Questionnaire; CTQ). Participants completed the Reading the Mind in the Eyes Test (RMET) to assess ToM. Clinical and sociodemographic data were collected. Participants were stratified by lifetime psychotic symptoms for between-group comparisons.
Results
Individuals with a history of psychotic symptoms (n=18) reported significantly higher total CTQ scores (Mean=61.0, SD=15.7) than those without psychotic symptoms (Mean=44.5, SD=13.1; p=0.028) and exhibited significantly lower ToM accuracy (Mean RMET=23.0, SD=4.5 vs. 25.4, SD=3.4; p<0.001, d=0.58).
Conclusions
In BD, the co-occurrence of childhood trauma and lifetime psychosis is associated with more pronounced ToM deficits. These results highlight the need for trauma-informed approaches and early cognitive interventions targeting social cognition in individuals with BD and psychosis history.