A case–control study examining the relationship between social cognition and post-traumatic stress disorder

Background Difficulties with social cognition, particularly with mentalising, have been hypothesised to increase the risk of, and affect recovery from, trauma and post-traumatic stress disorder (PTSD). We lack a comprehensive picture of the nature of social cognitive impairments in people with PTSD. Aims To assess whether variation in social cognition is associated with trauma and PTSD. Method Ninety-eight participants with PTSD symptoms and 99 controls were recruited from tertiary PTSD services and the Prolific online platform. All participants completed a battery of social cognition tasks covering face emotion recognition, social attribution and mentalisation. They also completed a trauma measure, PTSD screening measure and verbal IQ task. Logistic regression analyses were used to examine the relationship between social cognition and PTSD, and were adjusted for age, gender, autism and verbal IQ. Results There was some evidence that hypomentalisation, measured via the Reflective Functioning Questionnaire, was associated with exposure to trauma (adjusted odds ratio 1.80, 95% CI 1.03–3.14, p = 0.040) and increased odds of PTSD symptoms (adjusted odds ratio 4.29, 95% CI 2.76–6.66, p < 0.001). Higher scores for use of mentalising language on a naturalistic video-based spontaneous mentalising task (Modified-STOMP; potentially reflecting hypermentalising) were also associated with increased odds of PTSD symptoms (adjusted odds ratio 1.65, 95% CI 1.17–2.33, p = 0.004) in the main analysis, but not in the sensitivity analysis restricted to the Prolific-only sample. Conclusions Our results show an association between mentalising difficulties and PTSD symptoms, indicating mentalising might be a target for future risk prediction.