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The ability to interpret courtship signals in patients with schizophrenia

Published online by Cambridge University Press:  26 August 2025

P. Biedkova*
Affiliation:
Charles University Centre for sexual health and interventions, National Institute of Mental Health, Prague, Czech Republic
O. Vaníček
Affiliation:
Charles University Centre for sexual health and interventions, National Institute of Mental Health, Prague, Czech Republic
K. Ständer
Affiliation:
Charles University Centre for sexual health and interventions, National Institute of Mental Health, Prague, Czech Republic
E. Kolářová
Affiliation:
Charles University Centre for sexual health and interventions, National Institute of Mental Health, Prague, Czech Republic
R. Androvičová
Affiliation:
Centre for sexual health and interventions, National Institute of Mental Health, Prague, Czech Republic Amsterdam Medical Centre, Amsterdam, Netherlands
*
*Corresponding author.

Abstract

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Introduction

Numerous studies have highlighted the unmet needs in intimate and sexual relationships among patients with schizophrenia. Although research shows that patients with schizophrenia express a desire for romantic and sexual connections, they encounter difficulties in forming and sustaining these relationships. However, the underlying causes of deficits in sexual and romantic functioning remain unknown and unexplored.

Objectives

The study aims to assess whether difficulties in forming intimate relationships could be connected to a decreased ability to interpret courtship signals.

Methods

49 male participants (36 patients, 13 controls) and 27 female participants (14 patients, 13 controls) were exposed to our experiment „Does she like me?” task. The task involves a video stimuli that depicts a woman/man displaying different nonverbal behaviors (rejection, courtship, and neutral attitude). Each participant evaluated the woman’s sexual interest/ man’s sexual interest on a nine-point scale. In addition, eye movements and pupil dilation were measured using the eye-tracking device Eyelink 1000plus. Patients and controls were compared on subjective report and psychophysiological eye tracking markers. For data analysis, we used Repeated measures ANOVA.

Results

There was no statistically significant difference between the control group and patients in their assessment of women´s interest (F (2, 94) = 1.28, p = 0.28, ηp2= 0.03) or men’s interest (F (2,50) = 0.24, p = 0.79, ηp2= 0.01). Also, there was no difference in average pupil size. However, while both groups correctly identified the nonverbal cues and responded accordingly (with the greatest assessments of interest for positive stimuli, lesser for neutral stimuli, and the least for negative stimuli), male patients on average tended to overestimate women’s interest in all conditions (positive, neutral, negative) compared to the control group.

Conclusions

According to our results, the ability to interpret courtship signals does not differ significantly between patients and controls. However, male patients tend to overestimate women’s sexual interest on average, which may be one of the reasons why they face challenges in intimate relationships. Further research is needed to explore this.

The study was supported by the Czech Health Research Council, no. NU21J-04-00024 and by the Charles University, Fac Med1, GAUK no. 56123.

Disclosure of Interest

None Declared

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Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of European Psychiatric Association
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