Attribution biases in schizophrenia: relationship to clinical and functional impairments

Patients with schizophrenia exhibit impairment in their ability to accurately recognize facial emotions in others, and the severity of this emotion perception deficit has been associated with poorer functioning. However, the mechanisms underlying facial emotion perception deficits are poorly understood. There is evidence to suggest that patients, particularly those with certain positive symptoms, may misinterpret other people's facial expressions as having an overly negative valence. The present study examined the degree to which attribution biases in facial emotion perception are associated with psychiatric symptomatology and social and occupational impairments.

The error profiles from a facial emotion perception test were analyzed and compared for 67 schizophrenic state hospital inpatients and 21 nonpsychiatric controls. Attribution bias scores were separately computed for each of six types of emotion.

The error profiles were remarkably similar for patients as a group and controls. Within the patient group, severity of positive symptoms was associated with more 'fear' misperceptions. Patients with relatively high levels of 'anger' misperceptions tended to have more severe disorganization and negative symptoms and more pronounced functional impairments. Interestingly, patients who erroneously reported seeing relatively high levels of 'shame' and 'happiness' showed better functioning and less severe symptoms.

Attribution biases appear to play a role in contributing to functional impairments in patients with schizophrenia. The lack of an isomorphic attribution bias across patients highlights the importance of considering schizophrenia heterogeneity when attempting to understand and treat social cognitive deficits.