Abstract
BackgroundAn emerging body of research has begun to elucidate disturbances to social cognition in specific personality disorders (PDs). No research has been conducted on patients with Mixed Personality Disorder (MPD), however, who meet multiple diagnostic criteria. Further, very few studies have compared social cognition between patients with PD and those presenting with symptomatic diagnoses that co-occur with personality pathologies, such as anxiety disorder (AD). The aim of this study was to provide a detailed characterization of deficits to various aspects of social cognition in MPD and dissociate impairments specific to MPD from those exhibited by patients with AD who differ in the severity of personality pathology.MethodBuilding on our previous research, we administered a large battery of self-report and performance-based measures of social cognition to age-, sex- and education-matched groups of patients with MPD or AD, and healthy control participants (HCs; n = 29, 23, and 54, respectively). This permitted a detailed profiling of these clinical groups according to impairments in emotion recognition and regulation, imitative control, low-level visual perspective taking, and empathic awareness and expression.ResultsThe MPD group demonstrated poorer emotion recognition for negative facial expressions relative to both HCs and AD. Compared with HCs, both clinical groups also performed significantly worse in visual perspective taking and interference resolution, and reported higher personal distress when empathizing and more state-oriented emotion regulation.ConclusionWe interpret our results to reflect dysfunctional cognitive control that is common to patients with both MPD and AD. Given the patterns of affective dispositions that characterize these two diagnostic groups, we suggest that prolonged negative affectivity is associated with inflexible styles of emotion regulation and attribution. This might potentiate the interpersonal dysfunction exhibited in MPD, particularly in negatively valenced and challenging social situations.
Highlights
Disturbances to interpersonal functioning are recognized increasingly as a characteristic symptom of many psychiatric conditions, personality disorders (PD; Schilbach, 2016; Cotter et al, 2018)
These distinct facets of social cognition are assumed to be organized in a hierarchical manner, whereby complex abilities build on more elementary mechanisms – efficient emotion recognition and imitative control are suggested to be necessary for affective empathy, for example, and lowlevel perspective taking is considered a prerequisite for cognitive empathy (Decety, 2011; Happé et al, 2017; Shaw et al, 2018)
In a previous investigation conducted on a large healthy sample we revealed associations between individual differences in the flexible deployment of personality styles and various components of social cognition: Relative to individuals reporting a broader repertoire of personality styles, those showing a strong preference for avoidant, borderline, depressive, and dependent styles exhibited less control over imitative tendencies, maladaptive styles of emotion regulation, and greater distress when empathizing with others (Shaw et al, 2018)
Summary
Disturbances to interpersonal functioning are recognized increasingly as a characteristic symptom of many psychiatric conditions, personality disorders (PD; Schilbach, 2016; Cotter et al, 2018). Despite a lack of agreement concerning the structure of cognitive skills subsumed within this psychological construct, and considerable variability among existing taxonomies (Happé et al, 2017), several facets have been investigated in both healthy and clinical populations: (1) Emotion recognition – our ability to recognize emotional expressions in others; (2) imitative control – the capacity to inhibit our automatic tendency to imitate the actions of others; (3) visual perspective taking – the process through which we infer what others can see; (4) empathy – our ability to understand and share in the emotions of others (cognitive and affective empathy, respectively), whilst recognizing that they are the source of one’s own emotional state (Cuff et al, 2014); and (5) emotion regulation – the capacity to self-regulate our emotional responses in order to behave appropriately in the face of changing environmental demands (Aldao, 2013) These distinct facets of social cognition are assumed to be organized in a hierarchical manner, whereby complex abilities build on more elementary mechanisms – efficient emotion recognition and imitative control are suggested to be necessary for affective empathy, for example, and lowlevel perspective taking is considered a prerequisite for cognitive empathy (Decety, 2011; Happé et al, 2017; Shaw et al, 2018). The aim of this study was to provide a detailed characterization of deficits to various aspects of social cognition in MPD and dissociate impairments specific to MPD from those exhibited by patients with AD who differ in the severity of personality pathology
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