Revisiting the relationship between impaired social functioning and psychopathology in schizophrenia

Impaired social functioning is a common and well-known feature of schizophrenia. The relationship between psychopathology and social functioning is poorly understood, but substance use disorder is often suspected to negatively impact social functioning. In this empirical study, we explored the relationship between psychopathology and social functioning in two groups of patients with schizophrenia spectrum disorders with impaired social functioning: homeless and domiciled patients. The patients were thoroughly examined for psychopathology, social functioning, and substance use disorder. The results showed that all domains of psychopathology correlated significantly and negatively with social functioning. The homeless group was worse off than the domiciled group on social functioning scales, but this difference was not reflected in differences in psychopathology or substance use disorder among the two groups. Moreover, the homeless group had more disturbed and aggressive behavior, less contact with relatives, and experienced more childhood trauma and imprisonment compared with the domiciled patients. Our findings seemingly challenge the prevailing explanatory models of impaired social functioning in schizophrenia as being a result of negative symptoms or substance use disorder. Finally, the intertwinement of psychopathology and social functioning in assessment measures should be considered before concluding how specific psychopathological domains affect social functioning in schizophrenia.