Why Are Familiar Faces Unfamiliar to People with Schizophrenia?

Some of the symptoms of schizophrenia include delusions, mood fluctuations, and impaired social functioning. One of the reasons social interactions are challenging for people with schizophrenia is the way in which facial expressions are processed. Specifically, it is theorized that schizophrenia deteriorates the recognition processes of individuals and makes it more difficult for them to distinguish between familiar and unfamiliar faces. This can cause significant social struggles because accurately perceiving the facial expressions of others is how people determine their reactions to them. It is also how people decide which faces are threatening and which are safe.

Fabrice Guillaume of the Laboratory of Cognitive Psychology at Aix-Marseille University in France recently led a study that explored facial recognition in individuals with schizophrenia in order to get a better idea of impairments that occurred and why. Guillaume assessed 20 individuals with schizophrenia and 20 without as they evaluated the familiarity of facial expressions. The electrophysiological (ERP) responses of the participants were monitored as a set of faces was presented with expression changes, without expression changes, and then, finally, new faces were presented. Guillaume discovered that when the expressions changed, the participants with schizophrenia did not recognize them as familiar, even though they had seen the faces before.

The participants with schizophrenia also had a hard time distinguishing between familiar faces with new expressions and unfamiliar faces. “This result suggests that patients with schizophrenia are more sensitive to the expression change and appears to be inconsistent with studies showing spared familiarity in schizophrenia,” Guillaume said. The findings could be interpreted to indicate a broader, more global perception of faces occurs in schizophrenia, and that individuals with schizophrenia have an impaired ability to retrieve the global perception when perceptual nuances, such as expressions, occur. In sum, the results of this study reveal that people with schizophrenia can experience facial recognition deficits, which can have a dramatic impact on social interactions, even when they try to identify faces familiar to them.

Guillaume, Fabrice, Francois Guillem, Guy Tiberghien, and Emmanuel Stip. Mismatched expressions decrease face recognition and corresponding ERP old/new effects in schizophrenia. Neuropsychology 26.5 (2012): 568-77. Print.

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  • zoe

    September 29th, 2012 at 5:03 AM

    This has to be very difficult for the families of patients with schizophrenia. Like with any other illness, it is always good to see a familiar face, but now they do not even have this consolation. They lose the ones who are closest to them, not due to actual loss but simply because the illness no longer allows them the comfort of having this remain in their lives.

  • nick

    September 29th, 2012 at 2:18 PM

    sounds horrible tbh.must be so hard to not be able to recognize the faces around you.that could well prep up the problem on hand as it is bound to increase anxiety.is there anything that could help this?

  • Jean

    September 29th, 2012 at 5:46 PM

    if facial expression is such an important aspect to recognition for people with schizophrenia,then should those around them not be trained to help the person recognize them?I think this can be done with a little bit of practice because just knowing that your family is around and with you should offer those people so much relief.

  • Ralph

    September 29th, 2012 at 11:08 PM

    So what exactly does familiar faces with new expressions mean in this context? Is it as simple as having a different facial expression will make it hard for someone with schizophrenia to recognize you? If it is,then what is this new facial expression ‘different’ from? Is there some sort of a default expression by sticking to which we can help such people recognize us if they know us already?

    I’m confused by use of this term and would really like some clarity on this.

  • lola

    September 30th, 2012 at 4:44 AM

    how can family members be more mindful of the expressions that they portray so as to help the patient feel safer and more confident that they know this person?


    September 30th, 2012 at 9:02 AM

    Must be so hard to lose the ability to recognize the faces around you.Can seem so threatening!And if this is something that is an effect of schizophrenia then I just hope these people have some techniques to help themselves. I think technology can come to the aid. Maybe they could have an app on their tablet that gives them pictures of people around them and their relationship? I think that would be a great help for these people.

  • Jennifer

    September 30th, 2012 at 11:59 AM

    So weird. . . would have thought that they would continue to recognize those they know regardless of the facial expressions

  • dale

    September 30th, 2012 at 3:45 PM

    although not being able to recognize even familiar faces seems like a horrible punishment for anybody,I think the level of suffering due to this would vary.If the person is someone who can connect with people easily I presume the effects of this disorder would be offset to a certain extent.Just another reason why being outgoing and good socializing skills are a great asset.

  • Cheves S

    October 1st, 2012 at 4:01 AM

    I am pretty sane and even I, when someone is out of the setting where I normally see them, have a hard time sometimes remembering who they are or how I should know them! It is like I know I should know who they are, but out of context it can be hard to pinpoint that person.
    Maybe this is somewhat what the schizophrennic patient is experiencing? The new expression could be out of the context of how they normally see this person, and with their illness it could make it more difficult for them to process and remember who this person is or how he or she fits into the puzzle of their lives.

  • Tate

    October 2nd, 2012 at 4:16 AM

    So what we should be looking at here is not the fact that the faces are unfamiliar, because that doesn’t really solve the problems. What we need to focus on are ways to remind the schizophrenic patients that these people should indeed be failiar to them and give them some tools for putting the two together even when there is that little blip that causes them to believe that this is not someone with whom they are familiar. I am not sure how the medications for this condition work, but hopefully there is something promising for them coming down the pipeline soon. Also teaching those people who they are around the most to maintain an even keel so that you don’t lose that connection that you could have been creating with the patient.

  • Laurie Kimmel

    October 9th, 2012 at 7:09 PM

    I once worked with a very bright and insightful 26 year old man diagnosed with schizophrenia. He told me that sometimes he doesn’t recognize his wife. And talking on the phone was difficult because he had no facial clues.

  • Unrecognized brother

    April 24th, 2023 at 8:38 PM

    My sister (undiagnosed drug induced schizophrenia ) recently spent 20 minutes telling me what happened to her older brother (ME!?!) and I should be careful because I might encounter similar difficulties.
    Shortly after that she walked into the common room and had a short conversation with myself and her father. No indication that she was disturbed. Returned to her room and called 911 telling them there were two strangers in her house and she was hiding in the closet afraid for her life. After the police confirmed this was a mental health episode and left, I asked her what had happened to trigger this delusion. She was extremely nonchalant and dismissive of the seriousness of the event. Finally after growing agitated as she repeatedly evaded my queries, she just kinda shrugged and replied “I don’t know, you just didn’t look like yourselves.” She refused to discuss the matter further.
    I miss talking to her, but these days any attempt to move beyond banal pleasantries is met with agitation, aggression and ultimately savage emotional assaults to drive away her inquisitor (whoever he is). Family. If you aren’t crazy they’ll drive you there. We are continuing to encourage her to seek treatment, but it’s usually a very short and intensely unpleasant conversation ending in doors slamming and bloodcurdling screams to be left alone. Her only solace is drug use which exacerbates and triggers her paranoia and delusional thinking.
    I hope she can one day find peace and I wish she’d allow me to help her do so. One day.

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