Poor premorbid social functioning and theory of mind deficit in schizophrenia: evidence of reduced context processing? Lindsay S. Schenkel a,b , William D. Spaulding a , Steven M. Silverstein b, * a Department of Psychology, University of Nebraska-Lincoln, 325 Burnett Hall, Lincoln, NE 68588, USA b Department of Psychiatry, Center for Cognitive Medicine, University of Illinois at Chicago, 912 South Wood Street, Suite 235, Chicago, IL 60612, USA Received 31 August 2004; received in revised form 24 November 2004; accepted 4 January 2005 Abstract Investigations have demonstrated deficits in theory of mind (ToM) ability in schizophrenia. Yet, the development of, and mech- anisms associated with these deficits are not well understood. The present investigation examined the hypothesis that, among chronic schizophrenia patients, impaired ToM is associated with failures in context processing, greater disorganized symptoms, and poor premorbid functioning. Forty-two inpatients with schizophrenia spectrum disorders were assessed on tests of ToM, visual and linguistic context processing, executive functioning, and verbal IQ. Symptomatology and premorbid functioning were also assessed. Results revealed that more impaired ToM was associated with poorer performance on both visual and linguistic context processing measures and higher ratings of disorganization on the BRRS. ToM was also associated with poorer childhood social functioning and an earlier age of illness onset. ToM was not associated with verbal processing speed, verbal fluency, response inhi- bition, sequence learning, or estimated verbal IQ. A significant regression model including measures of childhood peer problems and visual and language context processing significantly predicted ToM performance and accounted for 43% of the variance. These find- ings suggest that, among chronic schizophrenia patients, deficits in ToM ability may be the result of context processing impairments. These impairments may be a factor in both poor social functioning during childhood and greater disorganized symptoms after ill- ness onset. Ó 2005 Elsevier Ltd. All rights reserved. Keywords: Theory of mind; Schizophrenia; Context processing; Premorbid functioning; Disorganization 1. Introduction An important aspect of social cognition is the ability to infer what another individual is thinking or feeling, or the ability to have a theory of mind (ToM). The ability to understand the behavior and intentions of others forms the basis for making causal explanations involving the interconnections among events, thinking, and behav- ior (Flavell, 1999; Tager-Flusberg and Sullivan, 2000). Over the past ten years, there has been an increased interest in ToM ability in schizophrenia with a number of investigations showing impairments in ToM perfor- mance (Corcoran et al., 1995; Corcoran and Frith, 1996; Frith and Corcoran, 1996; Greig et al., 2004). Corcoran and Frith (Corcoran, 2000; Corcoran and Frith, 1996; Corcoran and Frith, 2003; Frith, 1992) sug- gested that different symptom clusters in schizophrenia are related to different developmental courses of ToM impairment. Specifically, they hypothesized that individ- uals with negative features of schizophrenia never fully develop ToM ability and likely begin showing social impairments related to ToM deficits in childhood. In contrast, patients with positive symptoms, and more specifically those with paranoid delusions, are thought to have once had adequate ToM abilities, which then 0022-3956/$ - see front matter Ó 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.jpsychires.2005.01.001 * Corresponding author. Tel.: +1 312 996 9515. E-mail address: ssilverstein@psych.uic.edu (S.M. Silverstein). www.elsevier.com/locate/jpsychires Journal of Psychiatric Research 39 (2005) 499–508 J OURNAL OF P SYCHIATRIC RESEARCH