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You looking at me?: Interpreting social cues in schizophrenia

Published online by Cambridge University Press:  04 September 2015

T. P. White
Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
F. Borgan
Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
O. Ralley
Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
S. S. Shergill*
Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
*Address for correspondence: Professor S. S. Shergill, Cognition, Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK. (Email:



Deficits in the perception of social cues are common in schizophrenia and predict functional outcome. While effective communication depends on deciphering both verbal and non-verbal features, work on non-verbal communication in the disorder is scarce.


This behavioural study of 29 individuals with schizophrenia and 25 demographically matched controls used silent video-clips to examine gestural identification, its contextual modulation and related metacognitive representations.


In accord with our principal hypothesis, we observed that individuals with schizophrenia exhibited a preserved ability to identify archetypal gestures and did not differentially infer communicative intent from incidental movements. However, patients were more likely than controls to perceive gestures as self-referential when confirmatory evidence was ambiguous. Furthermore, the severity of their current hallucinatory experience inversely predicted their confidence ratings associated with these self-referential judgements.


These findings suggest a deficit in the contextual refinement of social-cue processing in schizophrenia that is potentially attributable to impaired monitoring of a mirror mechanism underlying intentional judgements, or to an incomplete semantic representation of gestural actions. Non-verbal communication may be improved in patients through psychotherapeutic interventions that include performance and perception of gestures in group interactions.

Original Articles
Copyright © Cambridge University Press 2015 

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Abu-Akel, A, Bailey, AL (2000). The possibility of different forms of theory of mind impairment in psychiatric and developmental disorders. Psychological Medicine 30, 735738.CrossRefGoogle ScholarPubMed
Adams, RA, Stephan, KE, Brown, HR, Frith, CD, Friston, KJ (2013). The computational anatomy of psychosis. Frontiers in Psychiatry 4, 47.CrossRefGoogle Scholar
Allen, PP, Johns, LC, Fu, CH, Broome, MR, Vythelingum, GN, McGuire, PK (2004). Misattribution of external speech in patients with hallucinations and delusions. Schizophrenia Research 69, 277287.CrossRefGoogle ScholarPubMed
Annen, S, Roser, P, Brune, M (2012). Nonverbal behavior during clinical interviews: similarities and dissimilarities among schizophrenia, mania, and depression. Journal of Nervous and Mental Disease 200, 2632.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th edn. American Psychiatric Association: Washington, DC.Google ScholarPubMed
Averbeck, BB, Evans, S, Chouhan, V, Bristow, E, Shergill, SS (2011). Probabilistic learning and inference in schizophrenia. Schizophrenia Research 127, 115122.CrossRefGoogle Scholar
Backasch, B, Straube, B, Pyka, M, Klohn-Saghatolislam, F, Muller, MJ, Kircher, TT, Leube, DT (2013). Hyperintentionality during automatic perception of naturalistic cooperative behavior in patients with schizophrenia. Social Neuroscience 8, 489504.CrossRefGoogle ScholarPubMed
Bedford, NJ, David, AS (2014). Denial of illness in schizophrenia as a disturbance of self-reflection, self-perception and insight. Schizophrenia Research 152, 8996.CrossRefGoogle ScholarPubMed
Blakemore, SJ, Boyer, P, Pachot-Clouard, M, Meltzoff, A, Segebarth, C, Decety, J (2003). The detection of contingency and animacy from simple animations in the human brain. Cerebral Cortex 13, 837844.CrossRefGoogle ScholarPubMed
Bucci, S, Startup, M, Wynn, P, Baker, A, Lewin, TJ (2008 a). Referential delusions of communication and interpretations of gestures. Psychiatry Research 158, 2734.CrossRefGoogle ScholarPubMed
Bucci, S, Startup, M, Wynn, P, Heathcote, A, Baker, A, Lewin, TJ (2008 b). Referential delusions of communication and reality discrimination deficits in psychosis. British Journal of Clinical Psychology 47, 323334.CrossRefGoogle ScholarPubMed
Burgoon, JK, Buller, DB & Woodall, WG (1989). Nonverbal Communication: The Unspoken Dialogue. Harper & Row Publishers Inc.: New York.Google Scholar
Buxbaum, LJ, Kalenine, S (2010). Action knowledge, visuomotor activation, and embodiment in the two action systems. Annals of the New York Academy of Science 1191, 201218.CrossRefGoogle ScholarPubMed
Corcoran, R, Cahill, C, Frith, CD (1997). The appreciation of visual jokes in people with schizophrenia: a study of ‘mentalizing’ ability. Schizophrenia Research 24, 319327.CrossRefGoogle ScholarPubMed
Crais, E, Douglas, DD, Campbell, CC (2004). The intersection of the development of gestures and intentionality. Journal of Speech Language and Hearing Research 47, 678694.CrossRefGoogle ScholarPubMed
Dakin, S, Carlin, P, Hemsley, D (2005). Weak suppression of visual context in chronic schizophrenia. Current Biology 15, R822R824.CrossRefGoogle ScholarPubMed
Damasio, AR (1996). The somatic marker hypothesis and the possible functions of the prefrontal cortex. Philosophical Transactions of the Royal Society of London B: Biological Sciences 351, 14131420.CrossRefGoogle ScholarPubMed
Daprati, E, Franck, N, Georgieff, N, Proust, J, Pacherie, E, Dalery, J, Jeannerod, M (1997). Looking for the agent: an investigation into consciousness of action and self-consciousness in schizophrenic patients. Cognition 65, 7186.CrossRefGoogle ScholarPubMed
DeLisi, LE (2001). Speech disorder in schizophrenia: review of the literature and exploration of its relation to the uniquely human capacity for language. Schizophrenia Bulletin 27, 481496.CrossRefGoogle ScholarPubMed
Elahipanah, A, Christensen, BK, Reingold, EM (2011). Controlling the spotlight of attention: visual span size and flexibility in schizophrenia. Neuropsychologia 49, 33703376.CrossRefGoogle Scholar
Ellgring, H (1986). Nonverbal expression of psychological states in psychiatric patients. European Archives of Psychiatry and Neurological Sciences 236, 3134.CrossRefGoogle ScholarPubMed
Erickson, DH, Beiser, M, Iacono, WG, Fleming, JA, Lin, TY (1989). The role of social relationships in the course of first-episode schizophrenia and affective psychosis. American Journal of Psychiatry 146, 14561461.Google ScholarPubMed
Evans, S, Almahdi, B, Sultan, P, Sohanpal, I, Brandner, B, Collier, T, Shergill, SS, Cregg, R, Averbeck, BB (2012). Performance on a probabilistic inference task in healthy subjects receiving ketamine compared with patients with schizophrenia. Journal of Psychopharmacology 26, 12111217.CrossRefGoogle ScholarPubMed
Fett, AK, Shergill, SS, Krabbendam, L (2014). Social neuroscience in psychiatry: unravelling the neural mechanisms of social dysfunction. Psychological Medicine 45, 11451165.CrossRefGoogle ScholarPubMed
Fossati, P, Hevenor, SJ, Graham, SJ, Grady, C, Keightley, ML, Craik, F, Mayberg, H (2003). In search of the emotional self: an fMRI study using positive and negative emotional words. American Journal of Psychiatry 160, 19381945.CrossRefGoogle ScholarPubMed
Frith, CD (2004). Schizophrenia and theory of mind. Psychological Medicine 34, 385389.CrossRefGoogle ScholarPubMed
Frith, CD, Done, DJ (1988). Towards a neuropsychology of schizophrenia. British Journal of Psychiatry 153, 437443.CrossRefGoogle ScholarPubMed
Frith, CD, Frith, U (1999). Interacting minds – a biological basis. Science 286, 16921695.CrossRefGoogle ScholarPubMed
Gallagher, S (2000). Self-reference and schizophrenia: A cognitive model of immunity to error through misidentification. In Exploring the Self: Philosophical and Psychopathological Perspectives on Self-Experience (ed. Zahavi, D.), pp. 203–236. John Benjamins: Amsterdam.Google Scholar
Gray, JA (1995). Dopamine release in the nucleus accumbens: the perspective from aberrations of consciousness in schizophrenia. Neuropsychologia 33, 11431153.CrossRefGoogle Scholar
Gusnard, DA, Akbudak, E, Shulman, GL, Raichle, ME (2001). Medial prefrontal cortex and self-referential mental activity: relation to a default mode of brain function. Proceedings of the National Academy of Science USA 98, 42594264.CrossRefGoogle ScholarPubMed
Hemsley, DR (2005). The schizophrenic experience: taken out of context? Schizophrenia Bulletin 31, 4353.CrossRefGoogle ScholarPubMed
Horan, WP, Nuechterlein, KH, Wynn, JK, Lee, J, Castelli, F, Green, MF (2009). Disturbances in the spontaneous attribution of social meaning in schizophrenia. Psychological Medicine 39, 635643.CrossRefGoogle Scholar
Huq, SF, Garety, PA, Hemsley, DR (1988). Probabilistic judgements in deluded and non-deluded subjects. Quarterly Journal of Experimental Psychology A 40, 801812.CrossRefGoogle ScholarPubMed
Joyce, DW, Averbeck, BB, Frith, CD, Shergill, SS (2013). Examining belief and confidence in schizophrenia. Psychological Medicine 43, 23272338.CrossRefGoogle Scholar
Kapur, S (2003). Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry 160, 1323.CrossRefGoogle Scholar
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.CrossRefGoogle Scholar
Kim, J, Norton, D, McBain, R, Ongur, D, Chen, Y (2013). Deficient biological motion perception in schizophrenia: results from a motion noise paradigm. Frontiers in Psychology 4, 391.CrossRefGoogle ScholarPubMed
King, JP, Christensen, BK, Westwood, DA (2008). Grasping behavior in schizophrenia suggests selective impairment in the dorsal visual pathway. Journal of Abnormal Psychology 117, 799811.CrossRefGoogle ScholarPubMed
Knoblich, G, Stottmeister, F, Kircher, T (2004). Self-monitoring in patients with schizophrenia. Psychological Medicine 34, 15611569.CrossRefGoogle ScholarPubMed
Li, X, Branch, CA, DeLisi, LE (2009). Language pathway abnormalities in schizophrenia: a review of fMRI and other imaging studies. Current Opinions in Psychiatry 22, 131139.CrossRefGoogle ScholarPubMed
Loughland, CM, Williams, LM, Gordon, E (2002). Schizophrenia and affective disorder show different visual scanning behavior for faces: a trait versus state-based distinction? Biological Psychiatry 52, 338348.CrossRefGoogle ScholarPubMed
Mareschal, I, Calder, AJ, Clifford, CW (2013). Humans have an expectation that gaze is directed toward them. Current Biology 23, 717721.CrossRefGoogle Scholar
Marwaha, S, Johnson, S (2004). Schizophrenia and employment – a review. Social Psychiatry and Psychiatric Epidemiology 39, 337349.CrossRefGoogle ScholarPubMed
Matthews, NL, Collins, KP, Thakkar, KN, Park, S (2014). Visuospatial imagery and working memory in schizophrenia. Cognitive Neuropsychiatry 19, 1735.CrossRefGoogle Scholar
Monte, RC, Goulding, SM, Compton, MT (2008). Premorbid functioning of patients with first-episode nonaffective psychosis: a comparison of deterioration in academic and social performance, and clinical correlates of Premorbid Adjustment Scale scores. Schizophrenia Research 104, 206213.CrossRefGoogle ScholarPubMed
Moore, JW, Pope, A (2014). The intentionality bias and schizotypy. Quarterly Journal of Experimental Psychology 67, 22182224.CrossRefGoogle ScholarPubMed
Moritz, S, Woodward, TS (2005). Jumping to conclusions in delusional and non-delusional schizophrenic patients. British Journal of Clinical Psychology 44, 193207.CrossRefGoogle ScholarPubMed
Must, A, Janka, Z, Benedek, G, Keri, S (2004). Reduced facilitation effect of collinear flankers on contrast detection reveals impaired lateral connectivity in the visual cortex of schizophrenia patients. Neuroscience Letters 357, 131134.CrossRefGoogle ScholarPubMed
Ortigue, S, Sinigaglia, C, Rizzolatti, G, Grafton, ST (2010). Understanding actions of others: the electrodynamics of the left and right hemispheres. A high-density EEG neuroimaging study. PLoS ONE 5, e12160.CrossRefGoogle ScholarPubMed
Otsuka, Y, Mareschal, I, Calder, AJ, Clifford, CW (2014). Dual-route model of the effect of head orientation on perceived gaze direction. Journal of Experimental Psychology: Human Perception and Performance 40, 14251439.Google ScholarPubMed
Peyroux, E, Strickland, B, Tapiero, I, Franck, N (2014). The intentionality bias in schizophrenia. Psychiatry Research 219, 426430.CrossRefGoogle Scholar
Phillips, WA, Silverstein, SM (2013). The coherent organization of mental life depends on mechanisms for context-sensitive gain-control that are impaired in schizophrenia. Frontiers in Psychology 4, 307.CrossRefGoogle Scholar
Rizzolatti, G, Sinigaglia, C (2010). The functional role of the parieto-frontal mirror circuit: interpretations and misinterpretations. Nature Reviews Neuroscience 11, 264274.CrossRefGoogle ScholarPubMed
Roiser, JP, Stephan, KE, den Ouden, HE, Barnes, TR, Friston, KJ, Joyce, EM (2009). Do patients with schizophrenia exhibit aberrant salience? Psychological Medicine 39, 199209.CrossRefGoogle ScholarPubMed
Rose, D, Pevalin, DJ (2001). The national statistics socio-economic classification: unifying official and sociological approaches. ISER Working Papers. Paper 2001-4. Colchester: University of Essex.Google Scholar
Schilbach, L, Timmermans, B, Reddy, V, Costall, A, Bente, G, Schlicht, T, Vogeley, K (2013). Toward a second-person neuroscience. Behavioral and Brain Sciences 36, 393414.CrossRefGoogle Scholar
Schilbach, L, Wohlschlaeger, AM, Kraemer, NC, Newen, A, Shah, NJ, Fink, GR, Vogeley, K (2006). Being with virtual others: Neural correlates of social interaction. Neuropsychologia 44, 718730.CrossRefGoogle ScholarPubMed
Schmidt, SJ, Mueller, DR, Roder, V (2011). Social cognition as a mediator variable between neurocognition and functional outcome in schizophrenia: empirical review and new results by structural equation modeling. Schizophrenia Bulletin 37 (Suppl. 2), S41S54.CrossRefGoogle ScholarPubMed
Shad, MU, Keshavan, MS, Steinberg, JL, Mihalakos, P, Thomas, BP, Motes, MA, Soares, JC, Tamminga, CA (2012). Neurobiology of self-awareness in schizophrenia: an fMRI study. Schizophrenia Research 138, 113119.CrossRefGoogle Scholar
Shergill, SS, Samson, G, Bays, PM, Frith, CD, Wolpert, DM (2005). Evidence for sensory prediction deficits in schizophrenia. American Journal of Psychiatry 162, 23842386.CrossRefGoogle Scholar
Shergill, SS, White, TP, Joyce, DW, Bays, PM, Wolpert, DM, Frith, CD (2014). Functional magnetic resonance imaging of impaired sensory prediction in schizophrenia. Journal of American Medical Association: Psychiatry 71, 2835.Google Scholar
Simons, CJ, Tracy, DK, Sanghera, KK, O'Daly, O, Gilleen, J, Dominguez, MD, Krabbendam, L, Shergill, SS (2010). Functional magnetic resonance imaging of inner speech in schizophrenia. Biological Psychiatry 67, 232237.CrossRefGoogle Scholar
Slaghuis, WL (1998). Contrast sensitivity for stationary and drifting spatial frequency gratings in positive- and negative-symptom schizophrenia. Journal of Abnormal Psychology 107, 4962.CrossRefGoogle ScholarPubMed
Timmermans, B, Schilbach, L, Pasquali, A, Cleeremans, A (2012). Higher order thoughts in action: consciousness as an unconscious re-description process. Philosophical Transactions of the Royal Society of London B: Biological Sciences 367, 14121423.CrossRefGoogle ScholarPubMed
Troisi, A, Pompili, E, Binello, L, Sterpone, A (2007). Facial expressivity during the clinical interview as a predictor functional disability in schizophrenia. A pilot study. Progress in Neuropsychopharmacology and Biological Psychiatry 31, 475481.CrossRefGoogle ScholarPubMed
Uhlhaas, PJ, Silverstein, SM (2005). Perceptual organization in schizophrenia spectrum disorders: empirical research and theoretical implications. Psychological Bulletin 131, 618632.CrossRefGoogle ScholarPubMed
Walther, S, Stegmayer, K, Sulzbacher, J, Vanbellingen, T, Muri, R, Strik, W, Bohlhalter, S (2015). Nonverbal social communication and gesture control in schizophrenia. Schizophrenia Bulletin 41, 338345.CrossRefGoogle Scholar
Wechsler, D (1999). Wechsler Abbreviated Scale of Intelligence. The Psychological Corporation: Harcourt Brace & Company: New York.Google Scholar
Wells, A, Cartwright-Hatton, S (2004). A short form of the metacognitions questionnaire: properties of the MCQ-30. Behaviour Research and Therapy 42, 385396.CrossRefGoogle Scholar
Werner, JD, Trapp, K, Wustenberg, T, Voss, M (2014). Self-attribution bias during continuous action-effect monitoring in patients with schizophrenia. Schizophrenia Research 152, 3340.CrossRefGoogle ScholarPubMed
White, TP, Gilleen, J, Shergill, SS (2013). Dysregulated but not decreased salience network activity in schizophrenia. Froniers in Human Neuroscience 7, 65.Google ScholarPubMed
Woods, SW (2003). Chlorpromazine equivalent doses for the newer atypical antipsychotics. Journal of Clinical Psychiatry 64, 663667.CrossRefGoogle ScholarPubMed
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