Profiles of theory of mind impairments and personality in clinical and community samples: integrating the alternative DSM-5 model for personality disorders

Mireille Lampron; Amélie M Achim; Dominick Gamache; Allyson Bernier; Stéphane Sabourin; Claudia Savard

doi:10.3389/fpsyt.2023.1292680

Profiles of theory of mind impairments and personality in clinical and community samples: integrating the alternative DSM-5 model for personality disorders

Front Psychiatry. 2024 Jan 11:14:1292680. doi: 10.3389/fpsyt.2023.1292680. eCollection 2023.

Authors

Mireille Lampron¹, Amélie M Achim^{2

3

4}, Dominick Gamache^{2

5}, Allyson Bernier¹, Stéphane Sabourin¹, Claudia Savard^{2

6}

Affiliations

¹ School of Psychology, Université Laval, Québec City, QC, Canada.
² CERVO Brain Research Centre, Québec City, QC, Canada.
³ Department of Psychiatry and Neurosciences, Université Laval, Québec City, QC, Canada.
⁴ VITAM - Centre de recherche en santé durable, Québec City, QC, Canada.
⁵ Department of Psychology, Université du Québec à Trois-Rivières, Québec City, QC, Canada.
⁶ Department of Educational Fundamentals and Practices, Université Laval, Québec City, QC, Canada.

Abstract

Introduction: Deficits in theory of mind (ToM)-the ability to infer the mental states of others-have been linked to antagonistic traits in community samples. ToM deficits have also been identified in people with personality disorders (PD), although with conflicting evidence, partly due to the use of categorical diagnoses. The DSM-5 Alternative Model for Personality Disorders (AMPD) provides an opportunity for a more precise understanding of the interplay between ToM abilities and personality pathology. Therefore, the study aims to determine whether and how individuals with diverse ToM profiles differ regarding personality impairment (AMPD Criterion A) and pathological facets (AMPD Criterion B).

Method: Adults with PD (n = 39) and from the community (n = 42) completed tests assessing ToM skills and self-reported questionnaires assessing AMPD Criteria A and B. Hierarchical agglomerative and TwoStep cluster analyses were consecutively computed using scores and subscores from ToM tests as clustering variables. Multivariate analyses of variance were subsequently performed to compare the clusters on both AMPD Criteria. Five clinically and conceptually meaningful clusters were found. The most notable differences across clusters were observed for Intimacy and Empathy dysfunctions (Criterion A), as well as for the Deceitfulness, Callousness, and Hostility facets from the Antagonism domain and the Restricted affectivity facet from the Detachment domain (Criterion B).

Discussion: The results support the association between antagonistic personality facets and ToM deficits. However, clusters showing impairments in ToM abilities did not necessarily exhibit high levels of personality dysfunction or pathological facets, emphasizing that both constructs are not isomorphic. Nevertheless, specific profiles can help refine existing interventions to make them more sensitive and specific to the nature of ToM dysfunctions while considering personality functioning and facets.

Keywords: DSM-5 alternative model for personality disorders; personality disorders; personality functioning; personality traits; theory of mind.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Fondation de l’Université Laval, Fonds Merck Sharpe & Dohme – Faculté de Médecine, the Fonds de Recherche du Québec – Santé, and the Social Sciences and Humanities Research Council of Canada.