Characterization and interrelationships of theory of mind, socially competitive emotions and affective empathy in bipolar disorder

Cecilie K Lemvigh, James A Karantonis, Lisa S Furlong, Sean P Carruthers, Christos Pantelis, Susan L Rossell, Tamsyn E Van Rheenen

1 Citation (Scopus)


OBJECTIVE: Evidence shows impaired theory of mind (ToM) in patients with bipolar disorder (BD), yet research examining its cognitive and affective components simultaneously is sparse. Moreover, recognition of socially competitive 'fortune of others' emotions (e.g. envy/gloat) may be related to ToM, but has not been assessed in BD. Finally, if and how ToM and 'fortune of others' emotions relate to affective empathy in BD is currently unclear. This study aimed to address these points.

METHODS: 64 BD patients and 34 healthy controls completed the Yoni task, a visual task assessing first- and second-order cognitive and affective ToM as well as 'fortune of others' emotions. The Toronto Empathy Questionnaire was used to assess self-reported affective empathy.

RESULTS: Patients with BD showed no deficits in cognitive and affective ToM or recognition of 'fortune of others' emotions. The ability to infer 'fortune of others' emotions correlated with several ToM measures, indicating that these functions are part of the same system. Patients with BD reported similar levels of affective empathy to healthy controls, and this was not related to ToM or 'fortune of others' emotions, suggesting that affective empathy represents a separate social domain.

CONCLUSIONS: These findings highlight areas of spared social functioning in BD, which may be utilized in therapeutic strategies.

PRACTITIONER POINTS: Our results suggest theory of mind and empathy may represent areas of potentially spared cognitive functioning in BD. As many BD patients have experienced adversity during developmental periods in which theory of mind and empathy develop, our findings suggest that these abilities may be markers of resilience in the disorder. Our findings are important for the formulation of therapeutic interventions for BD, which may include considering practical ways that a patients' knowledge of intact ToM and empathy could be utilized to reduce self-stigma and promote self-efficacy, improved well-being and functioning.

Original languageEnglish
Article number61(1)
JournalIn Session - Psychotherapy in Practice
Issue number1
Pages (from-to)76-92
Number of pages17
Publication statusPublished - Mar 2022


  • Bipolar Disorder
  • Emotions
  • Empathy
  • Humans
  • Neuropsychological Tests
  • Theory of Mind


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