The Association Between Theory of Mind, Psychopathic Traits, Borderline Personality Traits, and Severity of Substance Use Disorder in Women: A Comparative Analysis.

Objective: Studies investigating social cognition impairments in substance use disorders (SUD) emerged from attempts to understand the influence of social interactions on substance use. This study aimed to measure Theory of Mind (ToM) performance and possible interactions between ToM performance, personality traits, and substance use severity.

Methods: Participants (n = 153) were assessed using the Reading the Mind in the Eyes, Dokuz Eylul Theory of Mind Index, Addiction Profile Index (API), Borderline Personality Questionnaire (BPQ), Basic Empathy Scale (BES), and Levenson Self-Report Psychopathy scale (LSRP).

Results: Cluster analysis identified two groups: a 'high ToM' (n = 59, 41.2%) and a 'low ToM' (n = 84, 58.8%) group. Comparative analysis showed that the API effect of substance use on life subscale scores (p = 0.033), BES total (p = 0.003), and affective empathy subscale scores (p = 0.001) were higher in the high ToM group compared with the low ToM group. Conversely, BPQ impulsivity subscale scores (p = 0.011), LSRP total (p = 0.026), and primary psychopathy subscale scores (p = 0.007) were lower in the high ToM group compared with the low ToM groups. Binary logistic regression analysis showed that lower affective empathy scores (odds ratio (OR) = 0.896, 95% confidence interval (CI) (0.818-0.982), p = 0.019) and higher primary psychopathy scores (OR = 1.099, 95% CI (1.011-1.195), p = 0.027) predicted ToM abilities in women with SUD.

Conclusions: This study provides novel evidence that in women with SUD, affective psychopathic traits and lack of affective empathy predict lower ToM abilities. These findings suggest that intervention targeting affect-related psychopathy dimensions may be effective in alleviating ToM disabilities.