Theory of Mind in Social Anxiety Disorder and Avoidant Personality Disorder Comorbidity

The aim of this study was to examine Theory of Mind (ToM) abilities in patients with Social Anxiety Disorder (SAD) with and without Avoidant Personality Disorder (AvPD) comorbidity.

A total of 55 patients with SAD, 25 patients with AvPD and SAD, who presented to the Diskapi Teaching and Research Hospital Psychiatry Outpatient Unit and were diagnosed with SAD according to the Structured Clinical Interview Diagnostic Criteria for DSM-5 and 30 healthy controls were included in the study. Sociodemographic data form for SAD, Autism Spectrum Quotient (ASQ), Liebowitz Social Anxiety Scale (LSAS), Reading the Mind in the Eyes Test (RMET), and Dokuz Eylül Theory of Mind Index (DEToMI) were used.

The ToM positive-emotion scores measured by the RMET were higher in the control group than in the SAD and SAD+AvPD groups. The ToM negative-emotion scores were lower in the SAD+AvPD group than in the SAD and control groups. The ToM neutral-emotion scores were similar in all three groups. There were statistically significant differences in favor of the control group in the total score of DEToMI and its subtests among the three groups. There was no difference among the three groups in the faux pas comprehension test.

Our findings suggest that AvPD comorbidity is associated with a decrease in many ToM skills, both in decoding and reasoning, and that this decrease is mainly related to the perception of mental states with an emotional load. More specific methods are needed for ToM problems observed in patients with SAD and AvPD.