---
title: "Theory of Mind fMRI Activation Linked to Dimensional Symptoms More than Categorical Diagnoses"
id: "biorxiv-4-dimensional-and-categorical-predictors-of-theory-of-mind-network-activation-a"
canonical_url: "https://medichelpline.com/clinical-feed/biorxiv-4-dimensional-and-categorical-predictors-of-theory-of-mind-network-activation-a"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "bioRxiv (Biomedical Preprints)"
source_url: "https://www.biorxiv.org/content/10.64898/2026.09.21.753139v1?rss=1"
published_at: "2026-09-22T12:00:00.000Z"
evidence_level: "Verified Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Theory of Mind fMRI Activation Linked to Dimensional Symptoms More than Categorical Diagnoses
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/biorxiv-4-dimensional-and-categorical-predictors-of-theory-of-mind-network-activation-a
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** bioRxiv (Biomedical Preprints)
- **Source URL:** [Original Journal Publication](https://www.biorxiv.org/content/10.64898/2026.09.21.753139v1?rss=1)
- **Published At:** 2026-09-22T12:00:00.000Z
- **Evidence Rating:** Verified Feed
## Executive GIST (TL;DR)
- This preprint reports a transdiagnostic fMRI study of **Theory of Mind** (ToM) network activation in 313 participants: 91 healthy controls and 222 psychiatric inpatients distributed across five diagnostic clusters (substance use, schizophrenia spectrum, affective, anxiety, and personality disorders). - The authors used a naturalistic movie-based fMRI paradigm to probe ToM-selective regional activation across predefined ROIs. - Frequentist analyses showed reduced ToM-selective activity in psychiatric inpatients compared with healthy controls across all ToM ROIs; no significant differences emerged between the diagnostic clusters. - Activation in ToM ROIs correlated negatively with dimensional psychopathology measures from the **Adult Self-Report (ASR)**: Total Problems, Internalising, and Externalising scales. - Bayesian ANCOVAs consistently favored models that excluded traditional categorical diagnoses and instead supported models including dimensional symptom measures, particularly **Total Problems** and **Internalising**, as better predictors of ToM regional activation. - The authors interpret results as evidence that atypical mentalising may reflect a shared transdiagnostic vulnerability rather than disorder-specific neurobiological signatures. - The study challenges reliance on categorical diagnostic labels in neurobiological research and highlights the predictive utility of dimensional symptom measures for social-cognitive neural function. - The article is a preprint and has not been peer reviewed; funding was declared from Paracelsus Medical University. Details beyond the abstract (specific ROI names, exact statistical values, preprocessing and scanning parameters) were not reported in the source abstract.
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Pauline Maria Nagel 1 Department for Psychiatry, Psychotherapy and Psychosomatics, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; * [Find this author on Google Scholar](https://www.biorxiv.org/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Pauline%2BMaria%2BNagel%2B "Open in new tab") * [Find this author on PubMed](https://www.biorxiv.org/lookup/external-ref?access_num=Nagel%20PM&link_type=AUTHORSEARCH "Open in new tab") * [Search for this author on this site](https://www.biorxiv.org/search/author1%3APauline%2BMaria%2BNagel%2B) * [ORCID record for Pauline Maria Nagel](http://orcid.org/0009-0005-9015-1834 "Open in new tab") Simon Hefner 1 Department for Psychiatry, Psychotherapy and Psychosomatics, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; * [Find this author on Google Scholar](https://www.biorxiv.org/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Simon%2BHefner%2B "Open in new tab") * [Find this author on PubMed](https://www.biorxiv.org/lookup/external-ref?access_num=Hefner%20S&link_type=AUTHORSEARCH "Open in new tab") * [Search for this author on this site](https://www.biorxiv.org/search/author1%3ASimon%2BHefner%2B) Sarah Said-Yuerekli 2 Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria; * [Find this author on Google Scholar](https://www.biorxiv.org/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Sarah%2BSaid-Yuerekli%2B "Open in new tab") * [Find this author on PubMed](https://www.biorxiv.org/lookup/external-ref?access_num=Said-Yuerekli%20S&link_type=AUTHORSEARCH "Open in new tab") * [Search for this author on this site](https://www.biorxiv.org/search/author1%3ASarah%2BSaid-Yuerekli%2B) * [ORCID record for Sarah Said-Yuerekli](http://orcid.org/0000-0002-3286-1249 "Open in new tab") Daniel Freinhofer 2 Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria; * [Find this author on Google Scholar](https://www.biorxiv.org/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Daniel%2BFreinhofer%2B "Open in new tab") * [Find this author on PubMed](https://www.biorxiv.org/lookup/external-ref?access_num=Freinhofer%20D&link_type=AUTHORSEARCH "Open in new tab") * [Search for this author on this site](https://www.biorxiv.org/search/author1%3ADaniel%2BFreinhofer%2B) Kornelius Winds 3 Department for Child and Adolescent Psychiatry, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria * [Find this author on Google Scholar](https://www.biorxiv.org/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Kornelius%2BWinds%2B "Open in new tab") * [Find this author on PubMed](https://www.biorxiv.org/lookup/external-ref?access_num=Winds%20K&link_type=AUTHORSEARCH "Open in new tab") * [Search for this author on this site](https://www.biorxiv.org/search/author1%3AKornelius%2BWinds%2B) Daniel Freinhofer 2 Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria; * [Find this author on Google Scholar](https://www.biorxiv.org/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Daniel%2BFreinhofer%2B "Open in new tab") * [Find this author on PubMed](https://www.biorxiv.org/lookup/external-ref?access_num=Freinhofer%20D&link_type=AUTHORSEARCH "Open in new tab") * [Search for this author on this site](https://www.biorxiv.org/search/author1%3ADaniel%2BFreinhofer%2B) Martin Kronbichler 2 Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria; * [Find this author on Google Scholar](https://www.biorxiv.org/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Martin%2BKronbichler%2B "Open in new tab") * [Find this author on PubMed](https://www.biorxiv.org/lookup/external-ref?access_num=Kronbichler%20M&link_type=AUTHORSEARCH "Open in new tab") * [Search for this author on this site](https://www.biorxiv.org/search/author1%3AMartin%2BKronbichler%2B) Lisa Kronbichler 1 Department for Psychiatry, Psychotherapy and Psychosomatics, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; * [Find this author on Google Scholar](https://www.biorxiv.org/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Lisa%2BKronbichler%2B "Open in new tab") * [Find this author on PubMed](https://www.biorxiv.org/lookup/external-ref?access_num=Kronbichler%20L&link_type=AUTHORSEARCH "Open in new tab") * [Search for this author on this site](https://www.biorxiv.org/search/author1%3ALisa%2BKronbichler%2B) * [ORCID record for Lisa Kronbichler](http://orcid.org/0000-0003-1659-706X "Open in new tab") * For correspondence: li.kronbichler@salk.at * [Abstract](https://www.biorxiv.org/content/10.64898/2026.09.21.753139v1)[](https://www.biorxiv.org/panels_ajax_tab/biorxiv_tab_art/node:5800875/1) * [Info/History](https://www.biorxiv.org/content/10.64898/2026.09.21.753139v1.article-info)[](https://www.biorxiv.org/panels_ajax_tab/biorxiv_tab_info/node:5800875/1) * [Metrics](https://www.biorxiv.org/content/10.64898/2026.09.21.753139v1.article-metrics)[](https://www.biorxiv.org/panels_ajax_tab/article_tab_metrics/node:5800875/1) * [Supplementary material](https://www.biorxiv.org/content/10.64898/2026.09.21.753139v1.supplementary-material)[](https://www.biorxiv.org/panels_ajax_tab/biorxiv_tab_data/node:5800875/1) * [ Preview PDF](https://www.biorxiv.org/content/10.64898/2026.09.21.753139v1.full.pdf+html)[](https://www.biorxiv.org/panels_ajax_tab/biorxiv_tab_pdf/node:5800875/1) ![Loading](https://www.biorxiv.org/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif) ## Abstract Socio-cognitive alterations are widely observed across different psychiatric conditions, yet it remains unclear whether these deficits map onto distinct diagnostic categories or represent a shared transdiagnostic phenotype, driven by dimensional psychopathological symptom severity.This study evaluates Theory of Mind (ToM) network activation during a naturalistic functional magnetic resonance imaging (fMRI) movie paradigm in 313 participants, including 91 healthy controls and 222 psychiatric inpatients across five distinct diagnostic clusters (substance use, schizophrenia spectrum, affective, anxiety, and personality disorders). Frequentist analyses revealed decreased ToM-selective activity in psychiatric patients, compared to controls across all ToM regions of interest (ROIs). No significant difference emerged between diagnostic groups, but ROI activation correlated negatively with Adult Self-Report (ASR) scales (Total Problems, Internalising, Externalising). Subsequent Bayesian analysis of covariance (ANCOVAs) consistently favoured models that excluded traditional categorical diagnoses, suggesting that dimensional measures, especially Total Problems and Internalising, provided substantially greater predictive utility for ToM-related regional brain activation. Our findings challenge traditional categorical classifications in neurobiological research as they suggest that atypical mentalising might reflect a shared transdiagnostic vulnerability. ### Competing Interest Statement The authors have declared no competing interest. ## Funder Information Declared Paracelsus Medical University, https://ror.org/03z3mg085, 2023-SEED-047-Kronbichler Copyright The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a [CC-BY-NC-ND 4.0 International license](http://creativecommons.org/licenses/by-nc-nd/4.0/). bioRxiv and medRxiv thank the following for their generous financial support: > The Chan Zuckerberg Initiative, Cold Spring Harbor Laboratory, the Sergey Brin Family Foundation, California Institute of Technology, Centre National de la Recherche Scientifique, Fred Hutchinson Cancer Center, Imperial College London, Massachusetts Institute of Technology, Stanford University, The University of Edinburgh, University of Washington, and Vrije Universiteit Amsterdam. [Donate to openRxiv ](https://www.zeffy.com/en-US/donation-form/donate-to-make-a-difference-10981) [ Back to top](https://www.biorxiv.org/content/10.64898/2026.09.21.753139v1?rss=1#page) [ Previous](https://www.biorxiv.org/content/10.64898/2026.09.18.752627v1 "Saturated fatty acid chain length shapes B cell lymphoma metabolism and progression") Posted September 22, 2026. [ Download PDF](https://www.biorxiv.org/content/10.64898/2026.09.21.753139v1.full.pdf) Print/Save Options [Download PDF](https://www.biorxiv.org/content/biorxiv/early/2026/09/22/2026.09.21.753139.full.pdf)Full Text & In-line FiguresXML [More Info](https://www.biorxiv.org/about/FAQ#PrintOptions "More Information on Print/Save Options") [Supplementary Material ](https://www.biorxiv.org/content/10.64898/2026.09.21.753139v1.supplementary-material) [ Email](https://www.biorxiv.org/ "Email this Article") [ Share](https://www.biorxiv.org/) Dimensional and Categorical Predictors of Theory of Mind Network Activation: A transdiagnostic fMRI Study in Psychiatric Inpatients Pauline Maria Nagel, Simon Hefner, Sarah Said-Yuerekli, Daniel Freinhofer, Kornelius Winds, Daniel Freinhofer, Martin Kronbichler, Lisa Kronbichler bioRxiv 2026.09.21.753139; doi: https://doi.org/10.64898/2026.09.21.753139 This article is a preprint and has not been certified by peer review [[what does this mean?](https://www.biorxiv.org/about/FAQ#unrefereed)]. 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