Emotion recognition misclassification patterns in individuals with psychotic spectrum disorders and history of interpersonal aggression

Research suggests a need for more ecologically valid assessments of emotion recognition in aggressive individuals with psychotic spectrum disorder (PSD). We employed a task featuring dynamic, multimodal (visual and auditory) expressions of a broad range of positive and negative emotions. Emotion recognition accuracy and misclassification patterns were compared between individuals with PSD and a history of interpersonal aggression (PSD+AGG; n = 79), individuals with PSD without such a history (PSD-AGG; n = 72), and healthy controls (HC; n = 86). Analyses of variance investigated effects of presentation modality (visual, auditory, multimodal), emotion category (12 emotions), valence (positive, negative), and arousal (high, low). Across analyses, the PSD+AGG group showed significantly lower accuracy than the PSD-AGG group, which in turn showed significantly lower accuracy than the HC group. Misclassification patterns revealed that the PSD+AGG group was more likely to misclassify negative emotions as positive emotions compared to the PSD-AGG group. Multiple regression analyses indicated that accuracy was most strongly predicted by fluid intelligence and semantic understanding of emotion words in individuals with PSD, with significant additional effects of gender, history of substance use disorders in remission, and educational attainment. PSD group remained a significant predictor of accuracy after controlling for these factors. In summary, individuals with PSD and a history of interpersonal aggression exhibit more pronounced deficits in emotion recognition than those with PSD alone. This underscores the potential value of incorporating emotion recognition assessment and training into clinical interventions to reduce aggression risk and improve social functioning in individuals with PSD.