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. 2025 Jul 8:55:e186.
doi: 10.1017/S0033291725100822.

The shadow of trauma: impaired mentalization in clinical populations - a systematic review

Marianna Gorgellino  1 , Geetanjali Kumar  2 , Yusra Parkar  2 , Ana Catalan  3   4   5   6 , Natalia Fares-Otero  7 , Martin Debbané  8   9 , Marco Armando  10 , Luis Alameda  1   2   11
Affiliations

The shadow of trauma: impaired mentalization in clinical populations - a systematic review

Marianna Gorgellino et al. Psychol Med. .

Abstract

Background: Mentalizing defines the set of social cognitive imaginative activities that enable interpretation of behaviors as arising from intentional mental states. Mentalization impairments have been related to childhood trauma (CT) and are widely present in people suffering from mental disorders. Nevertheless, the link between CT exposure, mentalization abilities, and related psychopathology remains unclear. This study aims to systematically review the evidence in this domain.

Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-compliant systematic review of literature published until December 2022 was conducted through an Ovid search (Medline, Embase, and PsycINFO). The review was registered in the Prospective Register of Systematic Reviews (PROSPERO) (CRD42023455602).

Results: Twenty-nine studies were included in the qualitative synthesis. Twenty studies (69%) showed a significant negative correlation between CT and mentalization. There was solid evidence for this association in patients with psychotic disorders, as almost half the studies focused on this population. The few studies focusing on unipolar depression, personality disorders, and opioid addiction also reported a negative impact of CT on mentalization. In contrast, evidence for post-traumatic stress disorder was inconsistent, and no evidence was found for bipolar disorder. When stratifying for subtypes of CT, there was solid evidence that neglect (physical and emotional) decreased mentalization capacity, while abuse (physical, emotional, or sexual) was not associated with mentalization impairments.

Conclusions: Although causality cannot be established, there was substantial evidence that CT negatively affects mentalization across various psychiatric disorders, particularly psychotic disorders. These findings highlight the potential of targeting mentalization impairments in prevention and treatment strategies aiming to reduce the incidence and the social functioning burden of mental illness.

Keywords: childhood maltreatment; mental disorders; metacognition; neglect; psychosis; social cognition; theory of mind.

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Conflict of interest statement

The authors declare none.

Figures

Figure 1.
Figure 1.
PRISMA 2020 flowchart of studies selected for systematic review.
Figure 2.
Figure 2.
Clinical populations represented in the selected studies.
Figure 3.
Figure 3.
Association between CT and mentalization by subtypes of CT.
See this image and copyright information in PMC

References

    1. Addington, J., Penn, D., Woods, S. W., Addington, D., & Perkins, D. O. (2008). Social functioning in individuals at clinical high risk for psychosis. Schizophrenia Research, 99(1–3), 119–124. 10.1016/j.schres.2007.10.001. - DOI - PMC - PubMed
    1. Addington, J., Shakeel, M. K., Braun, A., Bonneville, D., & Stowkowy, J. (2019). Metacognition in youth at-risk for psychosis. Schizophrenia Research, 210, 303–305. 10.1016/j.schres.2019.07.005. - DOI - PubMed
    1. Alameda, L., Rodriguez, V., Carr, E., Aas, M., Trotta, G., Marino, P., Vorontsova, N., Herane-Vives, A., Gadelrab, R., Spinazzola, E., Di Forti, M., Morgan, C., & Murray, R. M. (2020). A systematic review on mediators between adversity and psychosis: Potential targets for treatment. Psychological Medicine, 50(12), 1966–1976. 10.1017/S0033291720002421. - DOI - PubMed
    1. Altman, D. G., Simera, I., Hoey, J., Moher, D., & Schulz, K. (2008). EQUATOR: Reporting guidelines for health research. Lancet, 371(9619), 1149–1150. 10.1016/S0140-6736(08)60505-X. - DOI - PubMed
    1. Andreou, C., Kelm, L., Bierbrodt, J., Braun, V., Lipp, M., Yassari, A. H., & Moritz, S. (2015). Factors contributing to social cognition impairment in borderline personality disorder and schizophrenia. Psychiatry Research, 229(3), 872–879. 10.1016/j.psychres.2015.07.057. - DOI - PubMed

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