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Investigating the Social Costs of Schizophrenia: Facial Expressions in Dyadic Interactions of People With and Without Schizophrenia

People with schizophrenia show marked reductions in their emotional expressiveness, generally known as blunted affect. In this study, we tested whether interaction partners would evaluate community-dwelling participants with schizophrenia less favorably than healthy controls and whether this difference would be explained by reduced smiling behavior related to schizophrenia. We also tested whether deficient affect recognition would predict reduced smiling. We created 3 study groups, consisting of 28 participants each, participants with schizophrenia (SZ), healthy controls (HC), and naive healthy interaction partners (IP). IP engaged in 2 separate same-sex dyadic interactions with matched members of each of the other 2 groups, SZ and HC, in a repeated-measures study design. During the interactions, we assessed the amount of smiling and mimicry of smiling via electromyography. After the interactions, IP rated their willingness for future interactions with SZ and HC, respectively. IP indicated less willingness for future interactions with SZ than with HC participants (d = −0.72) but SZ and HC did not differ with respect to smiling or affect recognition. Better affect recognition predicted more smiling; more smiling predicted more favorable social evaluations. Within SZ participants, disorganization symptoms but no other symptom dimensions were associated with the social evaluations. In conclusion, community-dwelling people with schizophrenia face social challenges that go beyond the adverse effects of stigmatization. Future work needs to clarify the role of different symptom dimensions and behavioral aspects contributing to the interpersonal costs of schizophrenia to derive interventions targeted at social reintegration.