Abstract
Studies have shown that elevated empathic abilities and impaired theory of mind (ToM) tasks may be associated with social anxiety disorder (SAD). Adolescence is a critical period for the onset of SAD which may cause impairment in various domains of functioning. We aimed to investigate the association of ToM and empathy characteristics in adolescents diagnosed as having SAD. Forty-one drug-naïve adolescents (between 12 and 18 years), who were diagnosed as having SAD without comorbidities were enrolled in the patient group. Forty adolescents in the same age range without any psychiatric disorders were matched as the healthy control group. The sample was evaluated via the Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version. The severity of the SAD symptoms was evaluated using the Social Anxiety Scale for Adolescents. ToM was evaluated with the Reading the Mind in the Eyes Test and emotion recognition was assessed by Faces Test. The KA-SI Empathic Tendency Scale was used to assess empathic abilities. The average age was 14.36 ± 1.41 years in the SAD group and 14.30 ± 1.04 years in the control group. Twenty-eight adolescents were female in the SAD and control groups. SAD and healthy controls did not differ in terms of sociodemographic data. There were higher scores in the KA-SI cognitive and affective empathic subscales (p < .001 in all scales) in the SAD group compared with the healthy controls. Adolescents with SAD have more difficulties both in Reading the Mind in the Eyes Test and Faces Test. The results of this study may indicate that although adolescents with SAD may be impaired in decoding aspects of ToM they may evaluate themselves as more empathic in self-report tests. The discrepancy between objective tests of ToM decoding and subjective reports of empathy may play an important role in the etiology and treatment of SAD in adolescents.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Psychiatry Association. (2013). Diagnostic and statistical manual of mental disorders (5th edition). Washington DC: APA.
Amir, N., & Foa, E. B. (2001). Cognitive biases in social phobia. In S. G. Hofmann & P. M. DiBartolo (Eds.), From social anxiety to social phobia: Multiple perspectives (pp. 254–267). Needham Heights: Allyn & Bacon.
Auyeung, K. W., & Alden, L. E. (2016). Social anxiety and empathy for social pain. Cognitive Therapy and Research, 40, 38–45. https://doi.org/10.1007/s10608-015-9718-0.
Aydin, A., & Tekinsav-Sütcü, S. T. (2007). Validity and reliability of social anxiety scale for adolescents (SAS-A). Turkish Journal of Child and Adolescent Mental Health, 14(2), 79–89.
Banerjee, R., & Henderson, L. (2001). Social-cognitive factors in childhood social anxiety: A preliminary investigation. Social Development, 10, 558–572. https://doi.org/10.1111/1467-9507.00180.
Baron-Cohen, S., Jolliffe, T., Mortimore, C., & Robertson, M. (1997). Another advanced test of theory of mind: Evidence from very high functioning adults with autism or Asperger syndrome. Child Psychology & Psychiatry & Allied Disciplines, 38(7), 813–822. https://doi.org/10.1111/j.1469-7610.1997.tb01599.x.
Baron-Cohen, S., Ring, H. A., Wheelwright, S., Bullmore, E. T., Brammer, M. J., Simmons, A., et al. (1999). Social intelligence in the normal and autistic brain:An fMRI study. European Journal of Neuroscience, 11, 1891–1898. https://doi.org/10.1046/j.1460-9568.1999.00621.x.
Baron-Cohen, S., Wheelwright, S., Spong, A., Scahill, V., & Lawson, J. (2001). Are intuitive physics and intuitive psychology independent? A test with children with Asperger syndrome. Journal of Developmental and Learning Disorders, 5(1), 47–78.
Bronfman, Z. Z., Brezis, N., Lazarov, A., Usher, M., & Bar-Haim, Y. (2018). Extraction of mean emotional tone from face arrays in social anxiety disorder. Depression and Anxiety, 35(3), 248–255. https://doi.org/10.1002/da.22713.
Campbell, D. W., Sareen, J., Stein, M. B., Kravetsky, L. B., Paulus, M. P., & Reiss, J. P. (2009). Happy but not so approachable: The social judgments of individuals with generalized social phobia. Depression and Anxiety, 26, 419–424. https://doi.org/10.1002/da.20474.
Carpendale, J. I., & Lewis, C. (2004). Constructing an understanding of mind: The development of children's social understanding within social interaction. Behavioral and Brain Sciences, 27, 79–96.
Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archive General Psychiatry, 60(8), 837–844. https://doi.org/10.1001/archpsyc.60.8.837.
Davis, M. H. (1980). A multidimensional approach to individual differences in empathy. Journal of Personality and Social Psychology, 10, 85. https://doi.org/10.1037/0022-3514.44.1.113.
DeWall, C. N., & Baumeister, R. F. (2006). Alone but feeling no pain: Effects of social exclusion on physical pain tolerance and pain threshold, affective forecasting, and interpersonal empathy. Attitudes and Social Cognition, 91, 1–15. https://doi.org/10.1037/0022-3514.91.1.1.
Dziobek, I., Fleck, S., Kalbe, E., Rogers, K., Hassenstab, J., Brand, M., Kessler, J., Woike, J. K., Wolf, O. T., & Convit, A. (2006). Introducing MASC: A movie for the assessment of social cognition. Journal of Autism and Developmental Disorders, 36, 623–636. https://doi.org/10.1007/s10803-006-0107-0.
Eisenberg, N., Shell, R., Pasternack, J., Lennon, R., Beller, R., & Mathy, R. M. (1987). Prosocial development in middle childhood: A longitudinal study. Developmental Psychology, 23, 712–718. https://doi.org/10.1037/0012-1649.23.5.712.
Ekman, P. (1992). Are there basic emotions? Psychological Review, 99(3), 550–553. https://doi.org/10.1037/0033-295X.99.3.550.
Ekman, P., & Keltner, D. (1997). Universal facial expressions of emotion: An old controversy and new findings. In U. C. Segerstråle & P. Molnár (Eds.), Nonverbal communication: Where nature meets culture (pp. 27–46). Hillsdale: Lawrence Erlbaum Associates, Inc..
Fehm, L., Beesdo, K., Jacobi, F., & Fiedler, A. (2008). Social phobia above and below the diagnostic threshold: Prevalence, comorbidity and impairment in the general population. Social Psychiatry and Psychiatric Epidemiology, 43(4), 257–265. https://doi.org/10.1007/s00127-007-0299-4.
Feshbach, N. D. (1978). Studies of empathic behavior in children (Vol. 8). New York: Academic Press.
Fichter, M. M., Kohlboeck, G., Quadflieg, N., Wyschkon, A., & Esser, G. (2009). From childhood to adult age: 18-year longitudinal results and prediction of the course of mental disorders in the community. Social Psychiatry and Psychiatric Epidemiology, 44(9), 792–803. https://doi.org/10.1007/s00127-009-0501-y.
Frith, C. D., & Corcoran, R. (1996). Exploring theory of mind in people with schizophrenia. Psychological Medicine, 26, 521–530. https://doi.org/10.1017/S0033291700035601.
Frith, C., & Frith, U. (2005). Theory of mind. Current Biology, 15, 644–645. https://doi.org/10.1016/j.cub.2005.08.041.
Gokler, B., Unal, F., Pehlivanturk, B., Kultur, E. C., Akdemir, D., & Taner, Y. (2004). Reliability and validity of schedule for affective disorders and schizophrenia for school age children present and lifetime version-Turkish version (K-SADS-PL-T). Turkish Journal of Child and Adolescent Mental Health, 11(3), 109–116.
Greco, L. A., & Morris, T. L. (2005). Factors influencing the link between social anxiety and peer acceptance. Contributions of social skills and close friendships during middle childhood. Behavior Therapy, 36, 197–205. https://doi.org/10.1016/S0005-7894(05)80068-1.
Hezel, D. M., & McNally, R. J. (2014). Theory of mind impairments in social anxiety disorder. Behavior Therapy, 45, 530–540. https://doi.org/10.1016/j.beth.2014.02.010.
Hughes, C., & Devine, R. T. (2015). A social perspective on theory of mind. In M. E. Lamb (Ed.), Handbook of child psychology and developmental science (volume III): Socioemotional processes (7th ed., pp. 564–609). Hoboken: Wiley.
Ickes, W. (1997). Empathic accuracy. New York: Guilford.
Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of American Academy of Child and Adolescent Psychiatry, 36, 980–988. https://doi.org/10.1097/00004583-199707000-00021.
Kaya, A. (2010). Child and adolescent KA-Sİ empathic tendency scale: Development, validity and reliability study. Education and Science, 35, 56.
Kessler, R. C. (2003). The impairments caused by social phobia in the general population: Implications for intervention. Acta Psychiatrica Scandinavica, 417, 19–27. https://doi.org/10.1034/j.1600-0447.108.s417.2.x.
Lee, L., Harkness, K. L., Sabbagh, M. A., & Jacobson, J. A. (2005). Mental stated coding abilities in clinical depression. Journal of Affective Disorders, 86, 247–258. https://doi.org/10.1016/j.jad.2005.02.007.
Lenton-Brym, A. P., Moscovitch, D. A., Vidovic, V., Nilsen, E. & Friedman, O. (2018). Theory of mind ability in high socially anxious individuals. Anxiety Stress & Coping, 31(5), 487–499. https://doi.org/10.1080/10615806.2018.1483021.
Masten, C. L., Gillen-O'Neel, C., & Brown, C. S. (2010). Children's intergroup empathic processing: The roles of novel ingroup identification, situational distress, and social anxiety. Journal of Experimental Child Psychology, 106(2–3), 115–128. https://doi.org/10.1016/j.jecp.2010.01.002.
Mathews, A., & MacLeod, C. (2005). Cognitive vulnerability to emotional disorders. Annual Review of Clinical Psychology, 1, 167–195. https://doi.org/10.1146/annurev.clinpsy.1.102803.143916.
Morrison, A. S., Mateen, M. A., Brozovich, F. A., Zaki, J., Goldin, P. R., Heimberg, R. G., & Gross, J. J. (2016). Empathy for positive and negative emotions in social anxiety disorder. Behaviour Research and Therapy, 87, 232–242. https://doi.org/10.1016/j.brat.2016.10.005.
Nikolić, M., van der Storm, L.,, Colonnesi, C., , Brummelman, E., Kan, K.J.,, & Bögels, S. (2019). Are socially anxious children poor or advanced Mindreaders? Child Development, 90(4), 1424–1441. https://doi.org/10.1111/cdev.13248.
O’Toole, M. S., Hougaard, E., & Mennin, D. (2013). Social anxiety and emotion knowledge: Ameta-analysis. Journal of Anxiety Disorders, 27, 98–108. https://doi.org/10.1016/j.janxdis.2012.09.005.
Pelphrey, K. A., Morris, J. P., & McCarthy, G. (2004). Grasping the intentions of others: The perceived intentionality of an action influences activity in the superior temporal sulcus during social perception. Journal of Cognitive Neuroscience, 16, 1706–1716. https://doi.org/10.1162/0898929042947900.
Roy-Byrne, P. P., Davidson, K. W., Kessler, R. C., Asmundson, G. J., Goodwin, R. D., Kubzansky, L., Lydiard, R. B., Massie, M. J., Katon, W., Laden, S. K., & Stein, M. B. (2008). Anxiety disorders and comorbid medical illness. General Hospital Psychiatry, 30(3), 208–225. https://doi.org/10.1016/j.genhosppsych.2007.12.006.
Ruscio, A. M., Brown, T. A., Chiu, W. T., Sareen, J., Stein, M. B., & Kessler, R. C. (2008). Social fears and social phobia in the USA: Results from the National Comorbidity Survey Replication. Psychological Medicine, 38(1), 15–28. https://doi.org/10.1017/S0033291707001699.
Russell, G., & Topham, P. (2012). The impact of social anxiety on student learning and wellbeing in higher education. Journal of Mental Health, 21, 375–385.
Sabbagh, M. A. (2004). Understanding orbitofrontal contributions to theory-of-mind reasoning: Implications for autism. Brain Cognition, 55, 209–219. https://doi.org/10.1016/j.bandc.2003.04.002.
Sabbagh, M. A., Moulson, M. C., & Harkness, K. L. (2004). Neural correlates of mental state decoding in human adults: An event-related potential study. Journal of Cognitive Neuroscience, 16(3), 415–426. https://doi.org/10.1162/089892904322926755.
Samson, A. C., Lackner, H. K., Weiss, E. M., & Papousek, I. (2012). Perception of otherpeople’s mental states affects humor in social anxiety. Journal of BehaviorTherapy and Experimental Psychiatry, 43, 625–631. https://doi.org/10.1016/j.jbtep.2011.08.007.
Sanna, L., Stuart, A. L., Pasco, J. A., Kotowicz, M. A., Berk, M., Girardi, P., et al. (2013). Physical comorbidities in men with mood and anxiety disorders: A population-based study. BMC Medicine, 11, 110.
Shamay-Tsoory, S. G., Tomer, R., Berger, B. D., & Aharon-Peretz, J. (2003). Characterization of empathy deficits following prefrontal brain damage: The role of the right entromedial prefrontal cortex. Journal of Cognitive Neuroscience, 15(3), 324–337. https://doi.org/10.1162/089892903321593063.
Simonian, S. J., Beidel, D. C., Turner, S. M., Berkes, J. L., & Long, J. H. (2001). Recognition of facial affect by children and adolescents diagnosed with social phobia. Child Psychiatry and Human Development, 32, 137–145. https://doi.org/10.1023/A:1012298707253.
Storch, E. A., Masia-Warner, C., Dent, H. C., Roberti, J. W., & Fisher, P. H. (2004). Psychometric evaluation of the social anxiety scale for adolescents and the social phobia and anxiety inventory for children: Construct validity and normative data. Journal of Anxiety Disorders, 18, 665–679. https://doi.org/10.1016/j.janxdis.2003.09.002.
Sturmer, S., Snyder, M., & Omoto, A. M. (2005). Prosocial emotions and helping: The moderating role of group membership. Journal of Personality and Social Psychology, 88, 532–546. https://doi.org/10.1037/0022-3514.88.3.532.
Tibi-Elhanany, Y., & Shamay-Tsoory, S. G. (2011). Social cognition in social anxiety: First evidence for increased empathic abilities. The Israel Journal of Psychiatry and Related Sciences, 48(2), 98–106.
Tseng, H. H., Huang, Y. L., Chen, J. T., Liang, K. Y., Lin, C. C., & Chen, S. H. (2017). Facial and prosodic emotion recognition in social anxiety disorder. Cognitive Neuropsychiatry, 22(4), 331–345. https://doi.org/10.1080/13546805.2017.1330190.
Washburn, D. (2012). Theory of mind decoding and reasoning abilities in depression, social phobia, and comorbid conditions. (Master's thesis). Retrieved from http://hdl.handle.net/1974/7406.
Washburn, D., Wilson, G., Roes, M., Rnic, K., & Harkness, K. L. (2016). Theory of mind in social anxiety disorder, depression, and comorbid conditions. Journal of Anxiety Disorders, 37, 71–77. https://doi.org/10.1016/j.janxdis.2015.
Wellman, H. M. (1990). The Child’s theory of mind. Cambridge: MIT Press.
Winton, E. C., Clark, D. M., & Edelmann, R. J. (1995). Social anxiety, fear of negative evaluation and the detection of negative emotion in others. Behaviour Research and Therapy, 33(2), 193–196. https://doi.org/10.1016/0005-7967(94)E0019-F.
Wittchen, H. U., Stein, M. B., & Kessler, R. C. (1999). Social fears and social phobia in a community sample of adolescents and young adults: Prevalence, risk factors and co-morbidity. Psychological Medicine, 29(2), 309–323. https://doi.org/10.1017/S0033291798008174.
Yildirim, E. A., Kaşar, M., Güdük, M., Ateş, E., Küçükparlak, İ., & Özalmete, E. O. (2011). Investigation of the reliability of the “Reading the mind in the eyes test” in a Turkish population. Turk Psikiyatri Dergisi, 22(3), 177–186.
Zaki, J., Bolger, N., & Ochsner, K. (2008). It takes two: The interpersonal nature of empathic accuracy. Psychological Science, 19, 399–404. https://doi.org/10.1111/j.1467-9280.2008.02099.x.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Öztürk, Y., Özyurt, G., Turan, S. et al. Association of theory of mind and empathy abilities in adolescents with social anxiety disorder. Curr Psychol 41, 1778–1787 (2022). https://doi.org/10.1007/s12144-020-00707-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12144-020-00707-2