Social Cognition and Interpersonal Problems in Persistent Depressive Disorder vs. Episodic Depression: The Role of Childhood Maltreatment

Abstract

Objective: Little is known about the specific psychological features that differentiate persistent depressive disorder (PDD) and episodic depression (ED). Thus, the present study aimed to investigate differences in social cognition and interpersonal problems between these two forms of depression and healthy controls. In addition, we aimed to examine childhood maltreatment (CM) as a possible origin of these alterations.Methods: In a cross-sectional study, adult patients with a current PDD (n = 34) or in a current episode of ED (n = 38), and healthy controls (n = 39) completed questionnaires about depression severity, empathy, interpersonal problems, and CM, as well as tests of affective theory of mind and facial emotion recognition.Results: Patients with PDD reported higher empathic distress than patients with ED and healthy controls. Both depressive groups recognized angry faces with higher accuracy and reported more interpersonal problems, with no differences between PDD and ED. Empathic distress and interpersonal problems mediated the link between CM and depression in the combined sample.Limitations: Patient groups were not drug-naïve and antidepressant intake might have influenced social-cognitive functions. Self-report measures of empathy and interpersonal problems are vulnerable to bias. The cross-sectional design does not allow causal conclusions.Conclusion: Depressed patients may not show deficits in decoding the affective states of others and in feeling with others. However, depressed individuals—in particular patients with PDD—may feel easily overwhelmed by emotionally tense situations, resulting in empathic distress and avoidant/submissive interpersonal behavior. Exposure to CM might be an origin of alterations in social cognition and interpersonal problems.

Theory of Mind in Somatization and Depression

“…Various studies have reported that individuals with MDD are unsuccessful in the Eyes Test compared with the healthy controls (Durmaz and Baykan, 2020; Lee et al, 2005; Nejati et al, 2012; Wang et al, 2008). However, there are also many studies that have concluded that the reading the mind in the eyes skills of patients with depression are not different from those of the healthy controls, which is similar to the findings of the present study (Struck et al, 2021; Szanto et al, 2012; Tekin et al, 2020; Wolkenstein et al, 2011). These contradicting results were emphasized in a review study in the literature related with the ToM in MDD indicating that depressive patients display disruptions in their social-cognitive and social-perceptual ToM functions during the acute period.…”

“…Different and conflicting results are observed in ToM studies for major depressive disorder (MDD). There are studies reporting that the affective ToM capabilities of depressed patients are normal (Struck et al, 2021; Wolkenstein et al, 2011). On the other hand, it has also been put forward that there are impairments in the affective part of ToM in depressed patients (Durmaz and Baykan, 2020; Lee et al, 2005) and that the disruption is more extensive in patients with psychotic symptoms (Wang et al, 2008).…”

Reduced Social Connectedness and Compassion Toward Close Others in Patients With Chronic Depression Compared to a Non-clinical Sample

“…Distress tolerance, the "ability to tolerate difficult emotions in oneself when confronted with someone else's suffering" is considered an aspect of compassion (41) and may reflect low trait personal distress, another facet of empathy. Considering previous findings of increased personal distress (49,50) and our present findings of reduced compassion in patients with PDD, it could be hypothesized that patients with PDD experience other people's negative experiences as distressing rather than responding to them compassionately (i.e., with emotional concern). However, the assumption of reduced empathic concern would be in contrast to findings that suggest that empathic concern is either not reduced (49,51) or is even increased (50) in patients with PDD.…”

“…Considering previous findings of increased personal distress (49,50) and our present findings of reduced compassion in patients with PDD, it could be hypothesized that patients with PDD experience other people's negative experiences as distressing rather than responding to them compassionately (i.e., with emotional concern). However, the assumption of reduced empathic concern would be in contrast to findings that suggest that empathic concern is either not reduced (49,51) or is even increased (50) in patients with PDD. Moreover, our findings of reduced compassion in PDD cannot be validly reconciled with other studies' findings of increased personal distress (as a correlate of reduced compassion) because the CLS contains few items regarding distress tolerance (41) and correlates only weakly with personal distress (48).…”

Trauma History and Course of Therapy in a Naturalistic Cognitive Behavior Therapy Outpatient Sample: An Archive Data Study

“…Elements of schema therapy (Young, Klosko, & Weishaar, 2006), developed specifically for patients with challenging interpersonal behavior and a history of childhood maltreatment, might be applied to overcome problems in the therapeutic relationship and even modify dysfunctional attachment styles. Regarding persistent depressive disorder, deficits in social cognition, more specifically the phenomenon of preoperational thinking (McCullough, 2000(McCullough, , 2006, has been proposed as a mediator between childhood trauma and chronic, treatment-resistant depression (McCullough Jr., 2003;Struck, Gärtner, Kircher, & Brakemeier, 2021). Following McCullough (2006), maltreated and early-onset chronically depressed patients have difficulties in recognizing the effects they have on their interaction partners.…”