Deficits in facial affect recognition – the ability to identify and discriminate emotion in the faces of others – might significantly contribute to aggressive behavior in psychotic illness, according to a literature review on the topic.
Reporting in the January-February 2012 issue of Aggression and Violent Behavior, researchers led by Aisling Malone used the General Aggression Model (GAM), to explore the theory that facial affect recognition (FAR) deficits may contribute to increased aggression in psychosis. The GAM "suggests that an aggressive response is determined by specific features of the person and the situation interacting with cognitions, affect and arousal to produce a particular outcome," wrote Ms. Malone of the School of Psychology and Psychiatry at Monash University, Clayton, Australia, and her colleagues. "In other words, it is not only what an individual brings to the situation but how they process social information that decides the likelihood of an aggressive response."
The GAM model was applied in the review because many published studies examining the relationship between FAR deficits in individuals with psychosis "have been inconclusive and hampered by small sample sizes and other methodological problems," the researchers explained (Aggress. Violent Behav. 2012;17:27-35). "They failed to consistently measure history of violence or to control for relevant confounding variables such as psychopathy, childhood trauma, and substance abuse." When these three potential confounding variables are taken into account, they continued, it spotlights socioemotional processing deficits such as impaired FAR as "a fruitful area for research aimed at understanding, and hence reducing the risk of violence in psychosis."
"It is not only what an individual brings to the situation but how they process social information that decides the likelihood of an aggressive response."
According to the review, any relationship between FAR deficits and aggression in psychosis might be attributable to a subgroup with comorbid psychopathy. For example, in one study, psychopathic inmates demonstrated difficulty in identifying emotions generally and less intense facial expressions, as well as deficits in identifying happy and sad expressions (Pers. Individ. Dif. 2008;44:1474-83). Another study found that males with schizophrenia and high psychopathy scores demonstrated deficits in recognizing sadness, with a marked impairment for lower intensity expressions (Psychiatry Res. 2006;141:29-37).
While the effects of childhood trauma on FAR deficits in psychosis remain unexplored, "what is known is that such childhood trauma is both a significant risk factor for later violence and highly prevalent in psychosis," the researchers wrote. "Child abuse appears to result in hypersensitivity to threat, which may facilitate the development of a hostile attribution bias that primes them to perceive threat in neutral social interactions. These biases may persist into adult life, increasing the likelihood of engaging in violence."
Substance abuse also might negatively affect FAR abilities. One study found that compared with controls, individuals with alcohol dependence tended to mislabel facial expressions as angry or disgusted (Psychiatry Res. 2002;113:161-71). However, the review notes, "it is unclear whether alcohol causes a hostile attrition bias or whether it is attributable to an aggressive response pattern learned early in life as all subjects had at least one alcoholic parent." Another study found that regular cocaine users had difficulty recognizing fearful facial expressions, compared with occasional users or nonusers (Psychopharmacol. 2007;194:151-9).
Socioemotional processing deficits and FAR deficits are a promising avenue to future research in this area, the researchers wrote.
Neither Ms. Malone nor her colleagues disclosed relevant financial conflicts of interest.
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