Psychological Medicine

Original Articles

Theory of mind deficits for processing counterfactual information in persons with chronic schizophrenia

R. S. Kerna1a2 c1, M. F. Greena1a2, A. P. Fiskea3, K. S. Keea1a2a4, J. Leea1a2, M. J. Sergia1a2a5, W. P. Horana1a2, K. L. Subotnika1, C. A. Sugara6 and K. H. Nuechterleina1a7

a1 Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at UCLA, Los Angeles, CA, USA

a2 Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA

a3 Department of Anthropology; Center for Culture, Brain, and Development; and Center for Behavior, Evolution, and Culture, University of California, Los Angeles, CA, USA

a4 California State University, Channel Islands, CA, USA

a5 California State University, Northridge, CA, USA

a6 Department of Biostatistics, UCLA School of Public Health, Los Angeles, CA, USA

a7 Department of Psychology, University of California, Los Angeles, CA, USA


Background Interpersonal communication problems are common among persons with schizophrenia and may be linked, in part, to deficits in theory of mind (ToM), the ability to accurately perceive the attitudes, beliefs and intentions of others. Particular difficulties might be expected in the processing of counterfactual information such as sarcasm or lies.

Method The present study included 50 schizophrenia or schizo-affective out-patients and 44 demographically comparable healthy adults who were administered Part III of The Awareness of Social Inference Test (TASIT; a measure assessing comprehension of sarcasm versus lies) as well as measures of positive and negative symptoms and community functioning.

Results TASIT data were analyzed using a 2 (group: patients versus healthy adults)×2 (condition: sarcasm versus lie) repeated-measures ANOVA. The results show significant effects for group, condition, and the group×condition interaction. Compared to controls, patients performed significantly worse on sarcasm but not lie scenes. Within-group contrasts showed that patients performed significantly worse on sarcasm versus lie scenes; controls performed comparably on both. In patients, performance on TASIT showed a significant correlation with positive, but not negative, symptoms. The group and interaction effects remained significant when rerun with a subset of patients with low-level positive symptoms. The findings for a relationship between TASIT performance and community functioning were essentially negative.

Conclusions The findings replicate a prior demonstration of difficulty in the comprehension of sarcasm using a different test, but are not consistent with previous studies showing global ToM deficits in schizophrenia.

(Received January 29 2008)

(Revised May 27 2008)

(Accepted May 31 2008)

(Online publication August 12 2008)


c1 Address for correspondence: R. S. Kern, Ph.D., VA Greater Los Angeles Healthcare System (MIRECC 210 A), Building 210, Room 116, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA. (Email: