Facial expression in male and female schizophrenia patients

  • Gwenda Simons
  • Johann Heinrich Ellgring
  • Katja Beck-Dossler
  • Wolfgang Gaebel
  • Wolfgang Wölwer
Original Paper


This study investigated gender differences in facial expression as a reaction to various emotional stimuli in two groups of schizophrenia patients. The first group consisted of hospitalized patients (22 men and 13 women) who were tested at three points in time. The second group consisted of outpatients (21 men, 8 women) who were tested at two points in time. In addition, the facial behaviour of two control groups was investigated (17 men and 12 women; 18 men and 14 women, respectively). Facial activity was videotaped, whilst participants watched emotion-eliciting video clips and participated in an emotion-inducing interview, and measured using the Facial Action Coding System. In agreement with our expectations, schizophrenia patients showed significantly less facial activity overall than healthy control participants. Contrary to expectations, however, female patients did not display more facial activity compared to male schizophrenia patients. This finding contrasts with those of healthy participants in previous studies where women tended to show more facial activity than men. It was further expected that in non-psychotic patients (i.e. outpatients), gender differences would be more clearly apparent and female schizophrenia patients would show considerably more facial activity than male patients, with findings more or less comparable to the gender differences found in healthy controls. However, no significant interaction was found between patient group (in- vs. outpatients) and gender. The different explanations for these findings are considered in this study.


Facial expression Flat affect Gender differences Schizophrenia 


  1. 1.
    Aghevli MA, Blanchard JJ, Horan WP (2003) The expression and experience of emotion in schizophrenia: a study of social interactions. Psychiatry Res 119:261–270CrossRefPubMedGoogle Scholar
  2. 2.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn, text revision. American Psychiatric Association, Washington, DCGoogle Scholar
  3. 3.
    Andia AM, Zisoor S, Heaton RK, Hesselink J, Jerigan T, Kuck J, Moranville J, Braff DI (1995) Gender differences in schizophrenia. J Nerv Ment Dis 183:522–528PubMedCrossRefGoogle Scholar
  4. 4.
    Berenbaum H (1992) Posed facial expression of emotion in schizophrenia and depression. Psychol Med 22:929–937CrossRefPubMedGoogle Scholar
  5. 5.
    Brody LR, Hall JA (2008) Gender and emotion in context. In: Lewis M, Haviland-Jones JM, Barrett LF (eds) Handbook of emotions, 3rd edn. Guilford press, New York, pp 395–409Google Scholar
  6. 6.
    Brüne M, Sonntag C, Abdel-Hamid M, Lehnkaemper C, Juckel G, Troisi A (2008) Nonverbal behavior during standardized interviews in patients with schizophrenia spectrum disorders. J Nerv Ment Dis 196(4):282–288CrossRefPubMedGoogle Scholar
  7. 7.
    Cole PM (1986) Children’s spontaneous control of facial expression. Child Development 57:1309–1321CrossRefGoogle Scholar
  8. 8.
    Dworkin R, Clark S, Amador X, Gorman J (1996) Does affective blunting in schizophrenia reflect affective deficit or neuromotor dysfunction. Schizophr Res 20:301–306CrossRefPubMedGoogle Scholar
  9. 9.
    Ekman P, Friesen WV (1969) The repertoire of non-verbal behaviour: categories, origins and coding. Semiotica 1:49–98Google Scholar
  10. 10.
    Ekman P, Friesen WV (1978) The facial action coding system. Consulting Psychologists Press, Palo AltoGoogle Scholar
  11. 11.
    Ekman P, Friesen WV, Ancoli S (1980) Facial signs of emotional experience. J Pers Soc Psychol 54:414–420Google Scholar
  12. 12.
    Ekman P, Friesen WV, Hager JC (2002) The facial action coding system on CD. A Human Face, Salt Lake CityGoogle Scholar
  13. 13.
    Ellgring H, Gaebel W (1995) Facial expression in schizophrenic patients. In: Beigel A, Lopez Ibor JJ, Costa e Silva JA (eds) Past, present, and future of psychiatry, vol 1. World Scientific Publisher, London, pp 435–439Google Scholar
  14. 14.
    Ellgring H, Smith M (1998) Affect regulation during psychosis. In: Flack WF Jr, Laird JD (eds) Emotions in psychopathology: theory and research. Oxford University Press, New YorkGoogle Scholar
  15. 15.
    Falkenberg I, Bartels M, Wild B (2008) Keep smiling! Facial reactions to emotional stimuli and their relationship to emotional contagion in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 258:245–253CrossRefPubMedGoogle Scholar
  16. 16.
    Friesen WV, Ekman P (1984) EMFACS-7: emotional facial action coding system. University of California, San Francisco (Unpublished manuscript)Google Scholar
  17. 17.
    Frisch I (1997) Eine Frage des Geschlechts? Mimischer Ausdruck und Affekterleben in Gesprächen [A question of gender? Facial expression and experienced affect in conversations]. Röhrig Universitätsverlag, St IngbertGoogle Scholar
  18. 18.
    Gaebel W, Wölwer W (2004) Facial expressivity in the course of schizophrenia and depression. Eur Arch Psychiatry Clin Neurosci 254:335–342CrossRefPubMedGoogle Scholar
  19. 19.
    Gottheil E, Thorton CC, Exline RV (1976) Appropriate and background affect in facial displays of emotion (comparisons of normal and schizophrenic males). Arch Gen Psychiatry 33:565–568PubMedGoogle Scholar
  20. 20.
    Hinsz VB, Tomhave JA (1991) Smile and (half) the world smiles with you, frown and you frown alone. Pers Soc Psychol Bull 17:586–592CrossRefGoogle Scholar
  21. 21.
    Krause R, Steimer E, Sänger-Alt C, Wagner G (1989) Facial expression of schizophrenic patients and their interaction partners. Psychiatry 52:1–12PubMedGoogle Scholar
  22. 22.
    Kring AM, Alpert M, Neale JM, Harvey PD (1994) A multimethod, multichannel assessment of affective flattening in schizophrenia. Psychiatry Res 54:211–222CrossRefPubMedGoogle Scholar
  23. 23.
    Kring AM, Moran EK (2008) Emotional response deficits in schizophrenia: insights from affective science. Schizophr Bull 34:819–834CrossRefPubMedGoogle Scholar
  24. 24.
    Lang PJ, Greenwald MK, Bradley MM, Hamm AO (1993) Looking at pictures: affective, facial, visceral, and behavioural reactions. Psychophysiology 30:261–273CrossRefPubMedGoogle Scholar
  25. 25.
    Manstead ASR (1991) Expressiveness as an individual difference. In: Fieldname RS, Rime B (eds) Fundamentals of non-verbal behaviour. Cambridge University Press, Cambridge, pp 285–323Google Scholar
  26. 26.
    Myin-Germeys I, Delespaul PAEG, de Vries MW (2000) Schizophrenia patients are more emotionally active than is assumed based on their behaviour. Schizophr Bull 26:847–854PubMedGoogle Scholar
  27. 27.
    Saarni C (1984) An observational study of children’s attempts to monitor their expressive behaviour. Child Dev 55:1504–1513CrossRefGoogle Scholar
  28. 28.
    Schneider F, Ellgring H, Friedrich J, Fus I, Beyer I, Heimann H, Himer W (1992) The effects of neuroleptics on facial action in schizophrenic patients. Pharmacopsychiatry 25:233–239CrossRefPubMedGoogle Scholar
  29. 29.
    Schneider F, Fus I, Friedrich J, Heimann H, Himer W (1992) Mimische Beweglichkeit unmedizierte schizophrener Patienten. [Mobility of mimic in unmedicated schizophrenic patients]. Zeitschrift fuer Klinische Psychologie 21:352–360Google Scholar
  30. 30.
    Steimer E, Krause R, Sänger-alt C, Wagner G (1988) Mimische Verhalten schizophrener Patienten und ihrer Gesprächspartner [Facial behaviour of schizophrenia patients and their conversation partners]. Zeitschrift fuer Klinischen Psychologie 17:132–147Google Scholar
  31. 31.
    Steimer Krause E, Krause R, Wagner G (1997) Interaction regulations used by schizophrenic and psychosomatic patients: studies on facial behaviour in dyadic interactions. In: Ekman P, Rosenberg E (eds) What the face reveals: basic and applied studies of spontaneous expression using the facial action coding system (FACS). Oxford University Press, Oxford, pp 361–380Google Scholar
  32. 32.
    Trémeau F, Malaspina D, Duval F, Corrêa H, Hager-Budny M, Coin-Bariou L, Macher J, Gorman JM (2005) Facial expressiveness in patients with schizophrenia compared to depressed patients and nonpatient comparison subjects. Am J Psychiatry 162:92–101CrossRefPubMedGoogle Scholar
  33. 33.
    Usall J, Araya S, Ochoa S, Busquets E, Gost A, Márquez M et al (2001) Gender differences in a sample of schizophrenic outpatients. Compr Psychiatry 42:301–305CrossRefPubMedGoogle Scholar
  34. 34.
    Wirth NBA, Letsch C, Gaebel W, Beck-Dossler K, Ellgring H (1997) Veränderung von Affektleistungen bei Schizophrenen. [Change in emotional performance in schizophrenics]. In: Peters U, Schifferdecker M, Krahl A (eds) 150 Jahre Psychiatrie—Das Jubiläumswerk der Deutschen Gesellschaft für Psychiatrie und Nervenheilkunde, Bd. 2. Martini, Köln, pp 231–238Google Scholar
  35. 35.
    Wolf K, Mass R, Kiefer F, Eckert K, Weinhold N, Wiederman K, Naber D (2004) The influence of olanzapine on facial expression of emotions in schizophrenia: an improved facial EMG study. Ger J Psychiatry 7:14–19Google Scholar
  36. 36.
    World Health Organisation (1978) ICD-9 mental disorders: glossary and guide to their classification of mental and behavioral disorders. World Health Organisation, GenevaGoogle Scholar
  37. 37.
    World Health Organisation (1994) Pocket guide to the ICD-10 classification of mental and behavioral disorders. Churchill Livingstone, EdinburghGoogle Scholar
  38. 38.
    World Health Organisation (2007) International statistical classification of diseases and related health problems, 10th revision online version. http://www.who.int/classifications/apps/icd/icd10online/

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Gwenda Simons
    • 1
  • Johann Heinrich Ellgring
    • 2
  • Katja Beck-Dossler
    • 3
  • Wolfgang Gaebel
    • 4
  • Wolfgang Wölwer
    • 4
  1. 1.Department of Experimental PsychologyUniversity of OxfordOxfordUK
  2. 2.Department of PsychologyUniversity of WürzburgWürzburgGermany
  3. 3.University of WürzburgWürzburgGermany
  4. 4.Department of Psychiatry and PsychotherapyHeinrich-Heine-University DüsseldorfDüsseldorfGermany

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