Everyday social encounters present people with schizophrenia a considerable amount of difficulty. They show significant impairment in both “instrumental relationships” and social-emotional relationships. This impairment is demonstrated by “downward social drift” and, perhaps more importantly, the fact that the majority of people with schizophrenia never marry. Of note is that interpersonal adjustment issues are much more prevalent in the male portion of the schizophrenia population that in the female portion.
Social competence is a global or “macro” measurement of social role performance. Global social competence issues continue to be a marker not only for people who have schizophrenia, but for people who are considered “high risk.” I still don’t quite understand the etiology of these social deficits however… which came first, the social deficits or the disorder?
Social skills are less global and more molecular, thereby representing skills that enable a person to competently perform a social task. They include “specific verbal, non-verbal and paralinguistic (e.g., voice tone) behavioral components that together form the basis for effective communication.” (Blaney & Millon, 2009, p. 335) To my own personal delight, I really enjoy any opportunity to utilize role-play… and this is one of them. Typically, people with schizophrenia will show weaker verbal and nonverbal skill development, they tend to be less assertive, and they tend to deny making errors or lie as opposed to apologize or explain. I am really looking forward to utilizing role-play with this population, I believe it to be one of my strong suits (and one of the pieces I really enjoy).
People with schizophrenia can have remarkably impaired ability to solve social problems. This might manifest in difficulty recognizing interpersonal problems, formulating solutions to that problem, or perhaps most importantly implementing a solution that has a probably degree of success. They are generally less able to recognize poor problem solutions (e.g., solutions that are unlikely to work).
Gender is an often neglected variable when studying schizophrenia. Female patients typically have later onset, shorter and less frequent psychotic episodes, and show better response to treatment when compared to make counterparts. They are more likely to be marked, to live independently, and to be employed (despite having similar symptoms to men). Women often require less antipsychotic medication to stabilize them. This leads some authors to speculate about the neuroprotective properties of estrogen… interesting concept to say the least. This might be off-base, but could this possibly explain the late life crisis that women often experience around menopause?
Positive and negative symptoms should not be viewed in the context of “good and bad.” Positive symptoms are “added,” like delusions or hallucinations for example. Negative symptoms are typically features that are removed, reduced, or blunted. This typically manifests as emotional withdrawal or anhedonia. Negative effects have been shown to predict both unemployment and reduced social network size. In total, positive symptoms, negative symptoms, and “disorders of relating” represent three distinct dimensions of schizophrenia. (Blaney & Millon, 2009, p. 340)
Of particular interest to me is the discussion on interpersonal stress, relapse, and the apparent foundation of the above in family systems theory. Specifically, “the social environment into which schizophrenia patients were discharged after they left the hospital was significantly associated with how well patients fared psychiatrically over the next several months.” (Blaney & Millon, 2009, p. 349) Expressed emotion (EE) reflects the extent to which the relatives of a psychiatric patient talk about that patient in a critical, hostile, or emotionally over-involved way. EE has been found to be a reliable predictor of relapse, and as a result, family therapy focused on dealing with living with a schizophrenic patient is definitely in order. This can assist family members in overcoming their apparent difficulty in accepting, and understanding, the disorder.
Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.