Empathetic perspective-taking is impaired in schizophrenia: Evidence from a study of emotion attribution and theory of mind

Introduction. Schizophrenia and autism are clinically distinct yet both disorders are characterised by theory of mind (ToM) deficits. Autistic individuals fail to appreciate false beliefs, yet understand the causal connections between behavioural events and simple emotions. Findings of this type have promoted the view that ToM deficits in autism reflect a domain-specific difficulty with appreciating the representational nature of epistemic mental states (i.e., beliefs and intentions and not emotions). This study examines whether the same holds true for schizophrenia. Methods. A picture-sequencing task assessed capacity to infer false beliefs in patients with schizophrenia and healthy controls. To assess emotion attribution, participants were shown cartoon strips of events likely to elicit strong emotional reactions in story characters. Characters' faces were blanked out. Participants were instructed to think about how the characters would be feeling in order to match up the cards depicting facial affect appropriately. Participants later named emotions depicted in facial affect cards. Results. Patients were as capable as controls of identifying cartoon facial expressions, yet had greater difficulties with: (a) attributing emotions based on circumstances; and (b) inferring false beliefs. Conclusions. Schizophrenia patients, unlike autistic individuals, suffer a domain-general difficulty with empathetic perspective-taking that affects equally their appreciation of other people's beliefs, percepts, and emotions.