Abstract
While individuals with schizophrenia (SZ) exhibit deficits in social cognition, the specific profile of these deficits across multiple domains and their relationship with clinical symptoms warrants further characterization. This study aimed to systematically assess key social-cognitive domains—theory of mind (ToM), emotion recognition, attributional style, and social perception—and examine their associations with psychopathology in SZ. Sixty-eight individuals with SZ and 68 matched healthy controls (HC) completed a comprehensive battery of social-cognitive measures, including the false-belief task (assessing first- and second-order ToM), the Faux Pas task, the emotional recognition task, the attributional style questionnaire, and the social perception scale. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Compared to HC, individuals with SZ showed significant deficits across all social-cognitive measures. Specifically, the SZ group exhibited deficits in emotion recognition for all negative emotions (fear, anger, sadness, disgust) but not for happiness, and in attributional style for positive but not negative events. Correlation analyses identified a statistically significant inverse relationship between attributional stability for negative events (i.e., the tendency to attribute the causes of negative events to factors that are persistent over time) and PANSS general psychopathology scores (τ = −0.25, P < 0.043). Furthermore, no other social-cognitive domains (ToM, emotion recognition, social perception) showed significant correlations with any PANSS symptom dimensions. Network analysis further characterized second-order ToM as the core deficit, exhibiting the highest strength and centrality within the social-cognitive network, with mediation effects most pronounced for sadness and happiness recognition. These findings highlight second-order ToM as a core deficit in individuals with schizophrenia and suggest that a stable attributional style may be associated with a lower overall burden of general psychopathology. These social-cognitive domains may represent promising targets for future cognitive remediation interventions for people living with schizophrenia.
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The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of research participants.
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Acknowledgements
The authors gratefully acknowledge all contributors to this cross-sectional study. We extend our deepest appreciation to the individuals diagnosed with schizophrenia and their families for their essential participation. Special thanks are accorded to the clinical teams, particularly the psychiatrists and nurses who conducted standardized diagnostic evaluations and psychometric assessments. This study was supported by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (grant number ZLRK202335).
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Danni He, Douyu Zhang, and Qijing Bo wrote the paper. Tian Li, Zhen Mao, Yimeng Wang, Fuchun Zhou, Fang Dong, and Chuanyue Wang designed the study. Yujie Xing, Zhiqi Liu, Chenyu Zhou, Lei Zhao, and Feng Li collected the data. Yushen Ding and Xiaoyao Wang performed all analyses. All authors reviewed the paper.
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He, D., Zhang, D., Ding, Y. et al. Social cognitive deficits and their relationship with clinical symptoms in schizophrenia. Schizophr (2026). https://doi.org/10.1038/s41537-025-00723-w
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DOI: https://doi.org/10.1038/s41537-025-00723-w
