The Impact of Bipolar Disorder & Schizophrenia on Social Cognition

Social interactions are guided by myriad unwritten rules and procedures.

For most people, understanding these rules and internalizing these procedures is virtually instinctive. Observing others and subconsciously learning how to function within the context of a family, peer group, workplace, or community is a fundamental part of human development.

For some people, though, recognizing and adapting to cultural norms is extremely difficult or downright impossible. In many cases, the difficulty is related to a mental or behavioral health concern.

Recent research into social cognition suggests bipolar disorder and schizophrenia can significantly impair a person’s abilities in these important areas.

What Is Social Cognition?

Social cognition is a broad term that describes the many mental processes that allow people to perceive, understand, and communicate with others.

Core areas of social cognition include:

• Theory of mind: Awareness of one’s own mental state and the understanding that other people may have different thoughts, hopes, feelings, and beliefs
• Social perception: The ability to identify the nature of relationships between two or more people based on both verbal and nonverbal cues.
• Social knowledge: Understanding the rules that govern most social situations and the roles that guide most interactions between people
• Attributional bias: Judging whether a person’s behaviors are extension of their character or the result of circumstantial pressures or other external influences
• Emotional processing: Being able to use and understand emotional expressions

Healthy social cognition can enable a person to function successfully within a family, workplace, community, or other group. Conversely, diminished social cognition can undermine a person’s efforts to form healthy friendships, interact positively with other people, and pursue a full and satisfying life within a structured society.

In practice, people who have a healthy social cognition will be able to:

• Correctly interpret facial gestures and other nonverbal responses
• Remember and recall key details about other people
• Gain insights into the motivations, desires, and emotions of others by observing their actions
• Develop empathy for others and view the world from a non-egocentric perspective
• Adapt their behaviors to align with understood social norms.

A variety of factors can cause a person to struggle with poor social cognition. These influences include bipolar disorder, schizophrenia, and certain other mental health concerns.

Bipolar Disorder & Social Cognition

In May 2020, the Australian & New Zealand Journal of Psychiatry published an article on impaired social cognition among people with bipolar disorder.

This report was based on a meta-analysis of 30 studies involving 2,410 subjects, 1,294 of whom had euthymic bipolar disorder. (In the context of bipolar disorder, the term “euthymic” refers to periods of relative stability, when a person is not being affected by manic, hypomanic, or depressive symptoms.)

The studies that were analyzed in the May 2020 report evaluated subjects’ ability to perform the following three tasks, all of which are related to theory of mind:

• Recognize social missteps (or faux pas)
• Differentiate between the literal definition of a word and its intended meaning when used in conversation
• Evaluate another person’s mental state by observing their eyes

The team that conducted this meta-analysis reached the following conclusions:

• People with bipolar disorder exhibited “significant impairment” in all three abilities when compared to people who do not have this disorder.
• Bipolar disorder appears to impact the verbal aspects of theory of mind more than the nonverbal elements.
• People with bipolar II disorder may be affected more severely than people with bipolar I disorder.
• The intensity of a person’s struggles with social cognition can vary depending on the nature and severity of the episode (manic, hypomanic, depressive, or euthymic) they are currently experiencing.

“Impairment has been broadly observed during acute phases of the illness,” the research team reported, “while evidence of the presence of deficits in remission samples has been less conclusive.”

Schizophrenia & Social Cognition

The impact of schizophrenia on social cognition was explored in a study from the March 2017 edition of the journal Mental Illness.

This study, which was conducted at Thammasat University Hospital in Thailand, took a similar approach to the study on bipolar disorder and social cognition that we discussed in the previous section.

This study involved 72 subjects ages 20-60, including 36 people with schizophrenia and 36 people who had no history of schizophrenia or any other major mental health concerns. All the subjects who had schizophrenia were taking antipsychotic medication at the time of the study.

The research team assessed the subjects’ abilities in three areas:

• Determining a person’s emotional state based on full-face photographs
• Describing what a person is thinking or feeling based on photographs of their eyes
• Identifying features of common situations, such as getting a haircut or taking a test

All study participants also took Addenbrooke’s Cognitive Examination (ACE), which evaluated their capabilities in areas such as attention, verbal fluency, language, and memory.

This research yielded the following results:

• The people with schizophrenia demonstrated “obvious impairment” in all measured areas of social cognition.
• The social cognition deficits among the schizophrenia group remained consistent after controlling for age, gender, and level of education.
• The difference between the control group and the group with schizophrenia was largest in the areas of theory of mind and emotion processing.
• The members of the schizophrenia group scored “significantly lower” on the ACE test than the control group, but they were still within the normal range.

“The results of our study … suggest that social cognition impairment possibly represents one of the core symptoms and a trait characteristic of schizophrenia,” the research team wrote. “The impairments in social cognition detected may explain the deficits in social skills and social functions of people with schizophrenia.”

Treatment Options to Improve Social Cognition

As indicated by the studies mentioned in this post, people who have bipolar disorder and schizophrenia may have considerable difficulty with basic social cognition skills that most people take for granted. But if people who have these mental health disorders get the right type and level of care, they may be able to improve their capabilities in this vital area.

An April 2018 article on the Frontiers in Psychiatry website explored the connection between enhanced social cognition and improved functional outcomes among people who have schizophrenia. This study identified several interventions that may benefit people with this disorder:

• Social cognition and interaction training (SCIT)
• Metacognitive and social cognition training (MSCT)
• Social cognition training program
• Training of affect recognition (TAR)
• Emotion and ToM imitation training (ETIT)
• Emotion processing and ToM video-based training
• Video and audio emotion processing training

A July 2012 study in the Journal of Affective Disorders also identified social cognition and interaction training as a potentially beneficial treatment for people who have either bipolar disorder or schizophrenia.

Researchers have also studied the ability of medication to improve social cognition among people who have mental health concerns, but these efforts have had mixed results.

Hope for A Healthier Future

So, what does all this information mean to people who have bipolar disorder or schizophrenia?

Bipolar disorder and schizophrenia are complex challenges that can have profound negative impact on a person’s quality of life. Ongoing research continues to reveal more effective ways at helping people learn to manage their symptoms, exert greater control over their thoughts and behaviors, and function more successfully within the context of their families and communities.

If someone that you care about has one of these disorders, and they have also been showing signs of diminished social cognition, here’s what is most important for you to know today: With proper care, your loved one’s life can get better.

To learn more about comprehensive treatment options for adults who have severe symptoms of bipolar disorder, schizophrenia, and other complex mental health concerns, contact Crownview Co-Occurring Institute today.