Exploring the Relationship Between Childhood Maltreatment, Alexithymia, and Facial Emotional Recognition in Schizophrenia

Abstract

Background: Childhood maltreatment is a significant factor affecting social cognition in schizophrenia (SCZ) patients. However, the relationship between childhood maltreatment, alexithymia, and facial emotional recognition in SCZ remains unclear.

Methods: SCZ patients in stable phase (n = 90) and healthy controls (n = 47) were included according to the DSM-5 criteria. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), childhood maltreatment was evaluated using the Childhood Trauma Questionnaire (CTQ), and alexithymia was assessed using the Toronto Alexithymia Scale-20 (TAS-20) to evaluate the ability to identify, describe, and express emotions. Social cognition was assessed using the Facial Emotion Recognition Test.

Results: Our findings indicate significant differences in CTQ, TAS-20, and facial emotional recognition between the two groups, with the SCZ group showing more severe impairments. Pearson correlation analysis showed that correct facial emotion recognition was negatively correlated with childhood maltreatment and alexithymia (p < 0.05). Stepwise regression analysis further revealed that the total PANSS score, positive symptom, CTQ total score, and difficulty describing feelings negatively affected the accuracy of facial emotional recognition (p < 0.05). Patients who find it difficult to describe feelings may also have greater difficulty in recognizing facial expressions of anger.

Conclusion: Good psychosocial functioning can mitigate the negative impact of childhood maltreatment on the severity of illness in SCZ patients. Therefore, psychotherapy that promotes personal expression is useful in the treatment of SCZ.

Keywords: alexithymia; childhood maltreatment; facial emotional recognition; schizophrenia.

FIGURE 1

Flowchart.

FIGURE 2

Mediation analysis of the role of difficulty describing feelings in mediating the relationship between childhood trauma and emotion recognition. CTQ, Childhood Trauma Questionnaire; ^* p ≤ 0.05; ^** p ≤ 0.01.