Article Type: Original Articles
Theory of Mind Skills in Adolescents with Obsessive-Compulsive Disorder
Fatih Dagdelen, Ayse Pinar Vural

Objective: The aim of study is to examine whether there is a deficit about Theory of Mind (ToM) skills of adolescents with obsessive-compulsive disorder (OCD) compared to ythe psychiatrically healthy controls and to examine the association between ToM deficit and variables such as OCD severity.

Methods: The study included 30 adolescents between 12 to 16 years old who were diagnosed with OCD according to the Diagnostic and Statistical Manual of Mental Disorders Fifth edition (DSM-5) and 30 adolescents without any psychiatric diagnoses. Sociodemographic characteristics of the participants were collected with a form; in addition, neuropsychological tests were administered to examine development of ıntelligence and ToM skills. Turkish version of Schedule for Affective Disorders and Schizophrenia for School-Age-Children Present and lifetime version, Children's Yale-Brown Obsessive Compulsive Scale, Children’s Depression Inventory, and Childhood Anxiety Screening Scale were administered. Intelligence level of patients were assessed with Wechsler Intelligence Scale for Children-Revised; while ToM skills were evaluated with Hinting Task Reading the Mind in the Eyes Task and false belief tasks such as Sally-Anne, Smarties, Chocolate Bar cand Ice-Cream Truck tests.

Results: It was determined those adolescents with OCD tended to fail in false belief tests and that the increase in OCD symptom severity did not affect ToM test performance.

Conclusions: Due to limited number of patients, our findings couldn’t be generalized to all adolescents diagnosed OCD; therefore there is a need for more studies in this area.


1.Tirapu-Ustárroz J, Pérez-Sayes G, Erekatxo-Bilbao M, Pelegrín-Valero C. What is theory of mind Rev Neurol 2007;44(8):479-89.

2.Harrington L, Sieger RJ, McClure J. Theory of mind in schizophrenia: a critical review. Cogn Neuropsychiatry 2005;10(4):249–86.

3.Leslie AM. Pretense and representation: the origins of “theory of mind”. Psychological Review 1987;94(4):412–26.

4.Gallase V, Keysers C, Rizzolatti G. A unifying view of social cognition. Trends Cog Sci 2004; 8(9):396-403.

5.Baron-Cohen S, Leslie A, Frith U. Mechanical, behavioural and intentional understanding of Picture stories in autistic children. Br J Dev Psychol 1986;4(2):113–25.

6.Baron-Cohen S. Theory of mind and autism: a review. Int Rev Ment Retardation 2001;23:169–84.

7.Wolf F, Brüne M, Assion HJ. Theory of mind and neurocognitive functioning in patients with bipolar disorder. Bipolar Disord 2010;12(6):657- 66.

8.Martino DJ, Strejilevich SA, Fassi G, et al. Theory of mind and facial emotion recognition in euthymic bipolar I and bipolar II disorders. Psychiatry Res 2011;189(3):379-84.

9.Shamay-Tsoory S, Harari H, Szepsenwol O, Levkovitz Y. Neuropsychological evidence of impaired cognitive empathy in euthymic bipolar disorder. J Neuropsychiatry Clin Neurosci 2009;21(1):59- 67.

10.Bora E, Yucel M, Pantelis C. Theory of mind impairment in schizophrenia: meta-analysis, Schizophr Res 2009;109(1-3):1–9.

11.Bora E, Sehitoglu G, Aslier M, Atabay I, Veznedaroglu B. Theory of mind and unawareness of illness in schizophrenia Is poor insight a mentalizing deficit? Eur Arch Psychiatry Clin Neurosci 2007;257(2):104–11.

12.Murphy D, Theory of mind in a sample of men with schizophrenia detained in aspecial hospital: its relationship to symptom profiles and neuropsychological tests. Crim Behav Ment Health 1998;8(51):13-26.

13.Chamberlain SR, Fineberg NA, Menzies LA, Blackwell AD, Bulmore ET, Robbins TW, et al. Impaired cognitive flexibility and motor inhibition in unaffected first degree relatives of patients with obsessive-compulsive disorder. Am J Psychiatry 2007;164(2):335-8.

14.Andres S, Lazaro R, Salamero M, Boget T, Penades R, Castro-Fornieles J. Changes in cognitive disfunction in children and adolescent with obsessive-compulsive disorder after treatment. J Psychiatric Research 2008;42(6):507-14.

15.Kuelz AK, Hohagen F, Voderholzer U. Neuropsychological performance in obsessive-compulsive disorder: a critical review. Biol Psychol 2004;65;185-236.

16.Gladstone M,Carter AS, Schultz RT, et al. Neuropsychological functioning of children affected with Tourette syndrome and obsessive-compulsive disorder. J Clin Exp Neuropsychol 1993;15:70.

17.Cox CS, Fedio P, Rapoport JL Neuropsychological testing of obsessive-compulsive adolescents. In: Rapoport JL, editor. Obsessive-compulsive disorder in children and adolescents. Washington (DC): American Psychiatric Press, 1989; p.73-85.

18.Kaufman J, Birmaher B, et al. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997;36(7):980-8.

19.Gokler B, Unal F, Pehlivanturk B, Kultur EC, Akdemir D, Taner Y. 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 2004; 11(3):109- 16. [Turkish]

20.Oy B. Çocuklar için depresyon ölçeği geçerlik güvenlik çalışması; Turkish Journal of Psychiatry 1991;2(2):132-6. [Turkish]

21.Cakmakci FK. Cocuklarda Anksiyete Bozukluklarını Tarama Ölçeği geçerlik ve güvenirlik çalışması. Yayınlanmamış Uzmanlık Tezi, Kocaeli Üniversitesi, Tıp Fakültesi, Çocuk Psikiyatrisi Anabilim Dalı, Kocaeli, 2004. [Turkish]

22.Kovacs M. Rating scale to assess depression in school aged children. Acta Paedopsyhiatr 1981;46(5-6):305- 15.

23.Yucelen AG, Rodopman AA, Topcuoglu V, Yazgan MY, Fisek G. Interrater reliability and clinical efficacy of Children's Yale-Brown Obsessive-Compulsive Scale in an outpatient setting. Comprehensive Psychiatry 2006;47(1):48-53. [Turkish]

24.Salah AA. Insan ve Bilgisayarda Yuz Tanima. Uluslararası Kognitif Nörobilim Sempozyumu. Türkiye; 2006. [Turkish]

25.Perner J, Lang B. Development of theory of mind and executive control. Trends Cogn Sci 1999;3:337-344.

26.Wimmer H, Perner J. Beliefs about beliefs: Representation and constraining function of wrong beliefs in young children’s understanding of deception. Cognition 1983;13(1):103-128.

27.Stone VE, Baron-Cohen S, Knight RT. Frontal lobe contributions to theory of mind. J Cogn Neurosci 1998;10(5):640-56.

28.Flobbe L, Verbrugge R, Hendriks P, Kramer I. Children’s application of theory of mind in reasoning and language. J Logic Lang Inform 2008;17(4):417-42.

29.Girli A, Tekin D. Investigating false belief levels of typically developed children and children with autism. Procedia Soc Behav Sci 2010;2(2):1944-50.

30.Corcoran R, Mercer G, Frith CD. Schizophrenia, symptomatology and social inference: investigating “theory of mind” in people with schizophrenia. Schizophr Res 1995;17(1):5-13.

31.Jolliffe T, Baron-Cohen S. The strange stories test: a replication with high-functioning adults with autism or Asperger syndrome. J Autism Dev Disord 1999;29(5):395-406.

32.Baron Cohen S, Jolliffe T, Mortimore C, Robertson M. Another advanced test of theory of mind: Evidence from very high functioning adults with autism or Asperger syndrome. J Child Psychol Psychiatry 1997;38(7):813-22.

33.Baron-Cohen S, Wheelwright S, Spong A, Scahill V, Lawson J. Are intuitive physics and intuitive psychology independent? A test with children with Asperger Syndrome. J Dev Learn Disord 2001;5:47-78.

34.Girli A. Psychometric properties of the Turkish child and adult form of “reading the mind in the eyes test”. Psychology 2014;5(11):1321-37.

35.Hughes C. Theory of mind grows up: reflections on new research on theory of mind in middle childhood and adolescence. J Exp Child Psychol 2016;149:1-5.

36.Mavrogiorgou P, Bethge M, Luksnat S, Nalato F, Juckel G, Brüne M. Social cognition and metacognition in obsessive-compulsive disorder: an explorative pilot study. Eur Arch Psychiatry Clin Neurosci 2016;266(3);209-16.

37.Sayin A, Oral N, Utku C, Baysak E, Candansayar S. Theory of mind in obsessive-compulsive disorder: comparison with healthy controls. Eur Psychiatry 2010;25(2)116-22.

38.Carluer L, Mondou A, Buhour MS, Laisney M, Pélerin, A, Eustache F, et al. Neural substrate of cognitive theory of mind impairment in amyotrophic lateral sclerosis. Cortex 2015;65:19-30.

39.Laisney M, Bon L, Guiziou C, Daluzeau N, Eustache F, Desgranges B. Cognitive and affective Theory of Mind in mild to moderate Alzheimer's disease. J Neuropsychol 2013;7(1)107-20.

40.Pellicano E. Links between theory of mind and executive function in young children with autism: clues to developmental primacy. Dev Psychol 2007;43(4):974-90.

41. Saltzman J, Strauss E, Hunter M, Archibald S. Theory of mind and executive functions in normal human aging and parkinson's disease. J Int Neuropsychol Soc 2000;6(7):781-8.

42.Channon S, Sinclair E, Waller D, Healey L, Robertson MM. Social cognition in tourette's syndrome: intact theory of mind and impaired inhibitory functioning. J Autism Dev Disord 2004;34(6)669-77.

43.Fine C, Lumsden J, Blair RJ. Dissociation between theory of mind and executive functions in a person with early left amygdala damage. Brain 2001;124(Pt 2)287-98.

44.Vivan Ade S, Rodrigues L, Wendt G, Bicca MG, Cordioli AV. Quality of life in adolescents with obsessive-compulsive disorder. Braz J Psychiatry 2013;35(4):369-74.

45.Whiteside SP, Abramowitz JS. The expression of anger and its relationship to symptoms and cognitions in obsessive-compulsive disorder. Depress Anxiety 2005;21(3):106-11.

Key words: False belief, obsessive-compulsive disorder, theory of mind
Psychiatry and Behavioral Sciences 2019;9(4):172-178
Online ISSN: 2636-834X
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