Deficits in social cognition, especially in Theory of Mind (ToM) and empathy, may contribute in poor social functioning of patients with bipolar disorder (BD).

Previous studies have found impaired empathy in euthymic patients with bipolar disorder using self-report measures of empathy. However, evidence on the neuropsychological processes that underlie empathic abilities in BD is scarce.

The aim of the study was to assess empathy and ToM abilities in euthymic BD using both self-report and neuropsychological measures.

Fifty-seven euthymic BD patients and 53 healthy control subjects completed the Empathy Quotient, a self-report measure of empathy. A multi-level battery of ToM tasks was applied in all study participants, including First order false beliefs stories, Hinting task and Faux Pas Recognition Test (FP). Besides the ability to recognize Faux Pas, three specific components of ToM were assessed with FP: the affective ToM, the cognitive ToM, and the emotional perspective taking. The two groups were matched for gender, age and education.

Patients with BD reported significantly lower levels of empathy than healthy controls. There was no significant difference between the two groups in the First order false beliefs and Hinting task scores. Patients had significantly lower score than healthy controls in FP recognition and cognitive ToM. However, there was no significant difference between the two groups in affective ToM and emotional perspective taking.

Deficits in higher order ToM were found in the euthymic BD. These deficits might have important contribution to empathy impairments found, using self-report scales.