Appearance-based trust processing in schizophrenia

Clare A. M. Sutherland* (Corresponding Author), Gillian Rhodes, Nikolas Williams, Emily Connaughton, Louise Ewing, Nathan Caruana, Robyn Langdon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
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Objectives. Schizophrenia is characterised by impaired social interactions and altered trust. In the general population, trust is often based on facial appearance, with limited validity but enormous social consequences. The aim was to examine trust processing in schizophrenia, and specifically to examine how people with schizophrenia use facial appearance as well as actual partner fairness to guide trusting decisions.
Design. An experimental economic game study.
Methods. Here we tested how schizophrenia patients and control participants (each N = 24) use facial trustworthiness appearance and partner fairness behaviour to guide decisions in a multi-round Trust Game. In the Trust Game, participants lent money to ‘partners’ whose facial appearance was either untrustworthy or trustworthy, and who either played fairly or unfairly. Clinical symptoms were measured as well as explicit trustworthiness impressions.
Results. Overall, the schizophrenia patients showed unimpaired explicit facial trustworthiness impressions and unimpaired facial appearance biases in the Trust Game. Crucially, patients and controls significantly differed so that the schizophrenia patients did not learn to discriminate in the Trust Game based on actual partner fairness, unlike control participants.
Conclusion. A failure to discriminate trust has important implications for everyday functioning in schizophrenia, as forming accurate trustworthiness beliefs is an essential social skill. Critically, without relying on more valid trust cues, people with schizophrenia may be especially susceptible to the misleading effect of appearance when making trusting decisions.
Original languageEnglish
Pages (from-to)139-153
Number of pages15
JournalBritish Journal of Clinical Psychology
Issue number2
Early online date6 Sept 2019
Publication statusPublished - Jun 2020

Bibliographical note

This research was supported by the Australian Research Council (ARC) Discovery Early Career Researcher Award to CS (DE190101043), the Centre of Excellence in Cognition and its Disorders (CE110001021), a 2017 ARC Cross-Program Award, and an ARC Discovery Grant (DP170104602). Funding sources had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank Todd Woodward for the BADE task materials. There are no conflicts of interest to disclose.


  • schizophrenia
  • psychosis
  • facial impressions
  • trust behaviour
  • facial trustworthiness


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