Schizophrenia attributional style disputed

May 7 2014

By Eleanor McDermid, Senior medwireNews Reporter

Patients with schizophrenia tend to have a self-blaming attributional style in response to negative events, show findings from a multicentre study.

This contrasts with the belief that the attributional style of schizophrenia patients has a personalising bias, in other words, a tendency to blame external factors – specifically other people – for negative events. This, in theory, would lead to the development and maintenance of positive symptoms, in particular of persecutory delusions.

In this study of 258 schizophrenia patients, neither the group as a whole nor the subgroup of 142 patients who had persecutory delusions had an externalising or personalising bias to their attributional style, when compared with 51 mentally healthy controls.

Indeed, the patients were significantly more likely than controls to attribute negative events to themselves, contributing to a significantly reduced externalising bias.

The study participants completed a revised version of the Internal, Personal and Situational Attributions Questionnaire, which required them to rate the likelihood of an event being due to internal, personal and/or situational causes (ie, self, other people or circumstances), rather than attributing an event solely to one of these causes.

The researchers, led by Stephanie Mehl (Philipps–University, Marburg, Germany), believe that the revised questionnaire activates a rational, rather than intuitive, process of causal attribution. They suggest that their study cohort of willing trial participants may represent “a population of psychological help seekers who might present a pronounced level of insight that is often linked to depression and self-stigmatization.”

These patients may therefore genuinely blame themselves for negative life events, says the team.

However, cluster analysis of the questionnaire responses identified two subgroups: one large subgroup of 188 patients with a reduced personalising bias relative to the attributional style of the controls and a second, smaller subgroup of 70 patients with a significantly increased personalising bias.

Of note, the only significant difference between these two subgroups was that the smaller group with the increased personalising bias had more severe persecutory delusions.

This could be because some patients used a intuitive process for causal attribution, despite the use of rating scales, say the researchers in Schizophrenia Bulletin.

But noting that the combination of a personalising bias and depression has previously been linked to persecutory delusions, they suggest that “these patients might correctly assume that other persons are often responsible for negative events in their life and feel depressed as a consequence.”

They add: “Given the less supportive social network of patients with schizophrenia, this assumption might be plausible.”

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