BACKGROUND: An 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. METHOD: Building 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. RESULTS: The 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. CONCLUSION: We 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.

Behavioral and Social Neuroscience Research Group CEITEC Masaryk University Brno Czechia

Department of Psychiatry Faculty of Medicine Masaryk University Brno and University Hospital Brno Czechia

Department of Psychology School of Life and Health Sciences Aston University Birmingham United Kingdom

Institute of Psychology Czech Academy of Sciences Brno Czechia

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Aldao A. (2013). The future of emotion regulation research: capturing context. Perspect. Psychol. Sci. 8 155–172. 10.1177/1745691612459518 PubMed DOI

Baskin-Sommers A., Krusemark E., Ronningstam E. (2014). Empathy in narcissistic personality disorder: from clinical and empirical perspectives. Personal. Disord. 5 323–333. 10.1037/per0000061 PubMed DOI PMC

Beeney J. E., Hallquist M. N., Ellison W. D., Levy K. N. (2016). Self-other disturbance in borderline personality disorder: neural, self-report and performance-based evidence. Personal. Disord. 7 28–39. 10.1002/cncr.27633 PubMed DOI PMC

Benjamini Y., Hochberg Y. (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. J. R. Stat. Soc. Series B Methodol. 57 289–300. 10.1111/j.2517-6161.1995.tb02031.x DOI

Berenson K. R., Dochat C., Martin C. G., Yang X., Rafaeli E., Downey G. (2018). Identification of mental states and interpersonal functioning in borderline personality disorder. Personal. Disord. 9 172–181. 10.1037/per0000228 PubMed DOI PMC

Bilotta E., Carcione A., Fera T., Moroni F., Nicolò G., Pedone R., et al. (2018). Symptom severity and mindreading in narcissistic personality disorder. PLoS One 13:e0201216. 10.1371/journal.pone.0201216 PubMed DOI PMC

Binney R. J., Ramsey R. (2019). Social semantics: the role of conceptual knowledge and cognitive control in a neurobiological model of the social brain. Neurosci. Biobehav. Rev. 112 28–38. 10.1016/j.neubiorev.2020.01.030 PubMed DOI

Borges L. M., Naugle A. E. (2017). The role of emotion regulation in predicting personality dimensions. Personal. Ment. Health 11 314–334. 10.1002/pmh.1390 PubMed DOI

Brass M., Bekkering H., Prinz W. (2001). Movement observation affects movement execution: evidence from a simple response task paradigm. Acta Psychologica 106 3–22. 10.1007/s00221-011-2583-5 PubMed DOI

Bukowski H. (2018). The neural correlates of visual perspective taking: a critical review. Curr. Behav. Neurosci. Rep. 5 189–197. 10.1007/s40473-018-0157-6 DOI

Cain N. M., Ansell E. B., Simpson H. B., Pinto A. (2015). Interpersonal functioning in obsessive-compulsive personality disorder. J. Pers. Assess. 97 90–99. 10.1080/00223891.2014.934376 PubMed DOI PMC

Clark L. A., Vanderbleek E. N., Shapiro J. L., Nuzum H., Allen X., Daly E., et al. (2015). The brave new world of personality disorder-trait specified: effects of additional definitions on coverage, prevalence, and comorbidity. Psychopathol. Rev. 2 52–82. 10.5127/pr.036314 PubMed DOI PMC

Coifman K. G., Summers C. B. (2019). Understanding emotion inflexibility in risk for affective disease: integrating current research and finding a path forward. Front. Psychol. 10:392. 10.3389/fpsyg.2019.00392 PubMed DOI PMC

Coolidge F. L., Thede L. L., Jang K. L. (2004). Are personality disorders psychological manifestations of executive function deficits? Bivariate heritability evidence from a twin study. Behav. Genet. 34 75–84. 10.1023/B:BEGE.0000009486.97375.53 PubMed DOI

Cotter J., Granger K., Backx R., Hobbs M., Looi C. Y., Barnett J. H. (2018). Social cognitive dysfunction as a clinical marker: a systematic review of meta-analyses across 30 clinical conditions. Neurosci. Biobehav. Rev. 84 92–99. 10.1016/j.neubiorev.2017.11.014 PubMed DOI

Cracco E., Bardi L., Desmet C., Genschow O., Rigoni D., Coster L., et al. (2018). Automatic imitation: a meta-analysis. Psychol. Bull. 144 453–500. 10.1037/bul0000143 PubMed DOI

Cuff B. M. P., Brown S. J., Taylor L., Howat D. J. (2014). Empathy: a review of the concept. Emot. Rev. 8 144–153. 10.1177/1754073914558466 DOI

Czekóová K., Shaw D. J., Saxunová K., Dufek M., Mareček R., Vaníček J., et al. (2019). Impaired self-other distinction and subcortical gray-matter alterations characterize socio-cognitive disturbances in multiple sclerosis. Front. Neurol. 10:525. 10.3389/fneur.2019.00525 PubMed DOI PMC

Darda K. M., Butler E. E., Ramsey R. (2019). Individual Differences in Social and Non-Social Cognitive Control. Available online at: https://psyarxiv.com/8b4cz/ (accessed May 23, 2019). PubMed

Davis M. H. (1983). Measuring individual differences in empathy: evidence for a multidimensional approach. J. Pers. Soc. Psychol. 44 113–126. 10.1037/0022-3514.44.1.113 DOI

De Corte K., Buysse A., Verhofstadt L. L., Roeyers H., Ponnet K., Davis M. H. (2007). Measuring empathic tendencies: reliability and validity of the Dutch version of the interpersonal reactivity index. Psychol. Belg. 47 235–260. 10.5334/pb-47-4-235 DOI

Decety J. (2011). Dissecting the neural mechanisms mediating empathy. Emotion Review 3 92–108. 10.1177/1754073910374662 DOI

Deschrijver E., Wiersema J. R., Brass M. (2017). Disentangling neural sources of the motor interference effect in high functioning autism: an EEG-study. J. Autism Dev. Disord. 47 690–700. 10.1007/s10803-016-2991-2 PubMed DOI

Diamond A. (2013). Executive functions. Annu. Rev. Psychol. 64 135–168. 10.1146/annurev-psych-113011-143750 PubMed DOI PMC

Dimaggio G., Carcione A., Nicolò G., Conti L., Fiore D., Pedone R., et al. (2009). Impaired decentration in personality disorder: a series of single cases analysed with the metacognition assessment scale. Clin. Psychol. Psychother. 16 450–462. 10.1002/cpp.619 PubMed DOI

Dumontheil I., Apperly I. A., Blakemore S. J. (2010). Online usage of theory of mind continues to develop in late adolescence. Dev. Sci. 13 331–338. 10.1111/j.1467-7687.2009.00888.x PubMed DOI

Dziobek I., Rogers K., Fleck S., Bahnemann M., Heekeren H. R., Wolf O. T., et al. (2008). Dissociation of cognitive and emotional empathy in adults with Asperger syndrome using the multifaceted empathy test (MET). J. Autism Dev. Disord. 38 464–473. 10.1007/s10803-007-0486-x PubMed DOI

Ferguson H. J., Cane J. (2017). Tracking the impact of depression in a perspective-taking task. Sci. Rep. 7:14821. 10.1038/s41598-017-13922-y PubMed DOI PMC

Friborg O., Martinussen M., Kaiser S., Øvergård K. T., Rosenvinge J. H. (2013). Comorbidity of personality disorders in anxiety disorders: a meta-analysis of 30 years of research. J. Affect. Disord. 145 143–155. 10.1016/j.jad.2012.07.004 PubMed DOI

Genschow O., Van Den Bossche S., Cracco E., Bardi L., Rigoni D., Brass M. (2017). Mimicry and automatic imitation are not correlated. PLoS One 12:e0183784. 10.1371/journal.pone.0183784 PubMed DOI PMC

Gilet A. L., Mella N., Studer J., Griihn D., Labouvie-Vief G. (2013). Assessing dispositional empathy in Adults: a french validation of the interpersonal reactivity index (IRI). Can. J. Behav. Sci. 45 42–48. 10.1037/a0030425 DOI

Grunewald M., Stadelmann S., Brandeis D., Jaeger S., Matuschek T., Weis S., et al. (2015). Early processing of emotional faces in a Go/NoGo task: lack of N170 right-hemispheric specialisation in children with major depression. J. Neural Transm. 122 1339–1352. 10.1007/s00702-015-1411-7 PubMed DOI

Happé F., Cook J. L., Bird G. (2017). The structure of social cognition: in(ter)dependence of sociocognitive processes. Annu. Rev. Psychol. 68 243–267. 10.1146/annurev-psych-010416-044046 PubMed DOI

Hauschild S., Winter D., Thome J., Liebke L., Schmahl C., Bohus M., et al. (2018). Behavioural mimicry and loneliness in borderline personality disorder. Compr. Psychiatry 82 30–36. 10.1016/j.comppsych.2018.01.005 PubMed DOI

Herpertz S. C., Bertsch K. (2014). The social-cognitive basis of personality disorders. Curr. Opin. Psychiatry 27 73–77. 10.1097/YCO.0000000000000026 PubMed DOI

Heyes C. (2011). Automatic imitation. Psychol. Bull. 137 463–483. 10.1037/a0022288 PubMed DOI

Hopwood C. J., Malone J. C., Ansell E. B., Sanislow C. A., Grilo C. M., McGlashan T. H., et al. (2011). Personality assessment in DSM-5: empirical support for rating severity, style, and traits. J. Pers. Disord. 25 305–320. 10.1521/pedi.2011.25.3.305 PubMed DOI

Hopwood C. J., Wright A. G. C., Ansell E. B., Pincus A. L. (2013). The interpersonal core of personality pathology. J. Pers. Disord. 27 270–295. 10.1521/pedi.2013.27.3.270 PubMed DOI PMC

Keysar B., Barr D. J., Balin J. A., Brauner J. S. (2000). Taking perspective in conversation: the role of mutual knowledge in comprehension. Psychol. Sci. 11 32–38. 10.1111/1467-9280.00211 PubMed DOI

Koole S. L., Kuhl J., Jostmann N. B., Finkenauer C. (2006). “Self-regulation in interpersonal relationships: the case of action versus state orientation,” in Self and Relationships: Connecting Intrapersonal and Interpersonal Processes, eds Vohs K. D., Finkel E. J. (New York, NY: Guilford; ), 360–383.

Kret M. E., Ploeger A. (2015). Neuroscience and biobehavioral reviews emotion processing deficits: a liability spectrum providing insight into comorbidity of mental disorders. Neurosci. Biobehav. Rev. 52 153–171. 10.1016/j.neubiorev.2015.02.011 PubMed DOI

Kuhl J. (2000). “A theory of self-development: affective fixation and the STAR model of personality disorders and related styles,” in Advances in Psychology, 131. Motivational Psychology of Human Development: Developing Motivation and Motivating Development, ed. Heckhausen J. (New York, NY: Elsevier Science; ), 187–211. 10.1016/S0166-4115(00)80012-6 DOI

Kuhl J., Beckmann J. (eds). (1994). “Action versus state orientation: psychometric properties of the action control scale (ACS-90),” in Volition and Personality: Action Versus State Orientation (Seattle, WA: Hogrefe Huber; ), 47–59.

Lamm C., Bukowski H., Silani G. (2016). From shared to distinct self–other representations in empathy: evidence from neurotypical function and socio-cognitive disorders. Philos. Transact. R. Soc. B Biol. Sci. 371:20150083. 10.1098/rstb.2015.0083 PubMed DOI PMC

Langdon R., Coltheart M., Ward P. B., Catts S. V. (2001). Visual and cognitive perspective-taking impairments in schizophrenia: a failure of allocentric simulation? Cogn. Neuropsychiatry 6 241–269. 10.1080/13546800143000005 DOI

Langner O., Dotsch R., Bijlstra G., Wigboldus D. H. J., Hawk S. T., van Knippenberg A. (2010). Presentation and validation of the radboud faces database. Cogn. Emot. 24 1377–1388. 10.1080/02699930903485076 DOI

Loranger A. W., Janca A., Sartorius N. (1997). Assessment and Diagnosis of Personality Disorders: The ICD-10 International Personality Disorder Examination (IPDE), eds Loranger A. W., Janca A., Sartorius N. (Cambridge: Cambridge University Press; ).

Marissen M. A. E., Deen M. L., Franken I. H. A. (2012). Disturbed emotion recognition in patients with narcissistic personality disorder. Psychiatry Res. 198 269–273. 10.1016/j.psychres.2011.12.042 PubMed DOI

Mitchell A. E., Dickens G. L., Picchioni M. M. (2014). Facial emotion processing in borderline personality disorder: a systematic review and meta-analysis. Neuropsychol. Rev. 24 166–184. 10.1007/s11065-014-9254-9 PubMed DOI

Miyake A., Friedman N. P., Emerson M. J., Witzki A. H., Howerter A., Wager T. D. (2000). The unity and diversity of executive functions and their contributions to complex “Frontal Lobe” tasks: a latent variable analysis. Cogn. Psychol. 41 49–100. 10.1006/cogp.1999.0734 PubMed DOI

Morey L. C., Hopwood C. J. (2019). Expert preferences for categorical, dimensional, and mixed/hybrid approaches to personality disorder diagnosis. J. Pers. Disord. 10.1521/pedi_2019_33_398 PubMed DOI

Moroni F., Procacci M., Pellecchia G., Semerari A., Nicolò G., Carcione A., et al. (2016). Mindreading dysfunction in avoidant personality disorder compared with other personality disorders. J. Nerv. Ment. Dis. 204 752–757. 10.1097/NMD.0000000000000536 PubMed DOI

Nilsen E. S., Duong D. (2013). Depressive symptoms and use of perspective taking within a communicative context. Cogn. Emot. 27 335–344. 10.1080/02699931.2012.708648 PubMed DOI

Pellecchia G., Moroni F., Colle L., Semerari A., Carcione A., Fera T., et al. (2018). Avoidant personality disorder and social phobia: does mindreading make the difference? Compr. Psychiatry 80 163–169. 10.1016/j.comppsych.2017.09.011 PubMed DOI

Plana I., Lavoie M. A., Battaglia M., Achim A. M. (2014). A meta-analysis and scoping review of social cognition performance in social phobia, posttraumatic stress disorder and other anxiety disorders. J. Anxiety Disord. 28 169–177. 10.1016/j.janxdis.2013.09.005 PubMed DOI

Quirin M., Bode R. C. (2014). An alternative to self-reports of trait and state affect: the implicit positive and negative affect test (IPANAT). Eur. J. Psychol. Assess. 30 231–237. 10.1027/1015-5759/a000190 DOI

Quirin M., Kazén M., Kuhl J. (2009). When nonsense sounds happy or helpless: the implicit positive and negative affect test (IPANAT). J. Pers. Soc. Psychol. 97 500–516. 10.1037/a0016063 PubMed DOI

Qureshi A. W., Monk R. L. (2018). Executive function underlies both perspective selection and calculation in Level-1 visual perspective taking. Psycho. Bull. Rev. 25 1526–1534. 10.3758/s13423-018-1496-8 PubMed DOI PMC

Ritter K., Dziobek I., Preißler S., Rüter A., Vater A., Fydrich T., et al. (2011). Lack of empathy in patients with narcissistic personality disorder. Psychiatry Res. 187 241–247. 10.1016/j.psychres.2010.09.013 PubMed DOI

Rosenthal M. Z., Kim K., Herr N. R., Smoski M. J., Cheavens J. S., Lynch T. R., et al. (2011). Speed and accuracy of facial expression classification in avoidant personality disorder: a preliminary study. Personal. Disord. 2 327–334. 10.1037/a0023672 PubMed DOI

Schilbach L. (2016). Towards a second-person neuropsychiatry. Philos. Transact. R. Soc. B Biol. Sci. 371:20150081. 10.1098/rstb.2015.0081 PubMed DOI PMC

Semerari A., Colle L., Pellecchia G., Buccione I., Carcione A., Dimaggio G., et al. (2014). Metacognitive dysfunctions in personality disorders: correlations with disorder severity and personality styles. J. Pers. Disord. 28 751–766. 10.1521/pedi_2014_28_137 PubMed DOI

Semerari A., Colle L., Pellecchia G., Carcione A., Conti L., Fiore D., et al. (2015). Personality disorders and mindreading: specific impairments in patients with borderline personality disorder compared to other PDs. J. Nerv. Ment. Dis. 203 626–631. 10.1097/NMD.0000000000000339 PubMed DOI

Shaw D. J., Czekóová K., Pennington C. R., Qureshi A. W., Špiláková B., Salazar M., et al. (2018). You ≠ Me: individual differences in the structure of social cognition. Psychol. Res. 10.1007/s00426-018-1107-3 PubMed DOI PMC

Shaw D. J., Czekóová K., Porubanová M. (2017). Orthogonal-compatibility effects confound automatic imitation: implications for measuring self–other distinction. Psychol. Res. 81 1152–1165. 10.1007/s00426-016-0814-x PubMed DOI

Sowden S., Koehne S., Catmur C., Dziobek I., Bird G. (2016). Intact automatic imitation and typical spatial compatibility in autism spectrum disorder: challenging the broken mirror theory. Autism Res. 9 292–300. 10.1002/aur.1511 PubMed DOI

Steinbeis N. (2016). The role of self–other distinction in understanding others’ mental and emotional states: neurocognitive mechanisms in children and adults. Philos. Transact. R. Soc. B Biol. Sci. 371:20150074. 10.1098/rstb.2015.0074 PubMed DOI PMC

Todd A. R., Forstmann M., Burgmer P., Brooks A. W., Galinsky A. D. (2015). Anxious and egocentric: how specific emotions influence perspective taking. J. Exp. Psychol. Gen. 144 374–391. 10.1037/xge0000048 PubMed DOI

Tottenham N., Hare T. A., Casey B. J. (2011). Behavioral assessment of emotion discrimination, emotion regulation, and cognitive control in childhood, adolescence, and adulthood. Front. Psychol. 2:39. 10.3389/fpsyg.2011.00039 PubMed DOI PMC

Tyrer P., Reed G. M., Crawford M. J. (2015). Classification, assessment, prevalence, and effect of personality disorder. Lancet 385 717–726. 10.1016/S0140-6736(14)61995-4 PubMed DOI

Vrijen C., Hartman C. A., Lodder G. M. A., Verhagen M., De Jonge P., Oldehinkel A. J. (2016). Lower sensitivity to happy and angry facial emotions in young adults with psychiatric problems. Front. Psychol. 7:1797. 10.3389/fpsyg.2016.01797 PubMed DOI PMC

Weightman M. J., Air T. M., Baune B. T. (2014). A review of the role of social cognition in major depressive disorder. Front. Psychiatry 5:179. 10.3389/fpsyt.2014.00179 PubMed DOI PMC

World Health Organization (2004). ICD-10: International Statistical Classification of Diseases and Related Health Problems. Geneva: World Health Organization.

Zhang B., Shen C., Zhu Q., Ma G., Wang W. (2016). Processing of facial expressions of emotions in antisocial, narcissistic, and schizotypal personality disorders: an event-related potential study. Pers. Individ. Dif. 99 1–6. 10.1016/j.paid.2016.04.066 DOI

Zimmerman M., Rothschild L., Chelminski I. (2005). Psychiatric outpatients. Am. J. Psychiatry 162 1911–1918. PubMed