Mapping the network of theory of mind in paranoid schizophrenia: Preliminary investigation of the role of attachment, emotional empathy and emotion recognition

OBJECTIVES: This study aimed to examine the underlying dynamics between theory of mind (ToM), attachment, emotional empathy and facial emotion recognition (FER) in individuals with paranoid schizophrenia (PaSch) and healthy controls. METHODS: Using network analysis, we investigated patterns of associations and compared the structural organization of these constructs across two matched samples (N = 60). RESULTS: Results indicated that unresolved family traumatization emerged as the most central node in both networks, suggesting its key role in linking attachment-related vulnerabilities with socio-cognitive functioning. Network comparison analyses revealed no significant differences between the PaSch and control groups in global structure and overall connectivity, suggesting potentially isomorphic relationships among the constructs studied across clinical and non-clinical populations. However, exploratory graph analysis identified meaningful differences in the organization of constructs. In healthy controls, attachment variables were relatively distinct from ToM and empathy. In contrast, in the PaSch group, these domains were more intertwined, particularly with negative self-representation clustering alongside ToM measures. Additionally, in the extended network including persecutory ideation, the most central nodes were unresolved family traumatization, negative model of others and persecutory ideation, supporting theoretical accounts linking insecure attachment and early adverse experiences with positive psychotic symptoms. CONCLUSION: These findings suggest that, although the overall structure of relationships may be similar, the functional integration of attachment and socio-cognitive processes differs in schizophrenia. The study highlights the importance of early relational experiences in understanding socio-cognitive impairments and psychotic symptomatology. Limitations include a small sample size and limited generalizability, warranting further research.