Deciding to Be Left Alone After Being Left Out: Behavioral Responses to Social Exclusion in Schizophrenia.

Background And Hypotheses: People with schizophrenia are at risk for social exclusion, yet we know little about their responses. We hypothesized (1) people with schizophrenia would be more likely to withdraw following social exclusion compared to controls; (2) withdrawal intentions would be greater following exclusion compared to disappointment; (3) withdrawal behavior would be predicted by rejection sensitivity, alternative sources of acceptance, chronicity of exclusion, and perceived fairness; and (4) withdrawal following exclusion would be associated with more negative symptoms and poorer functioning.

Study Design: People with (n = 43) and without (n = 43) schizophrenia or schizoaffective disorder played Cyberball - Behavioral Response, a novel version of the exclusion task. Participants responded to social exclusion with affiliative, retaliatory, and withdrawal behaviors within a 2 (Group: Schizophrenia vs. Control) × 3 (Game Type: Exclusion vs. Disappointment vs. Inclusion) mixed design. Participants reported their social experiences, affective and psychological responses following exclusion, negative symptoms, and functioning.

Study Results: People with schizophrenia reported heightened rejection sensitivity, fewer alternative sources of acceptance, and more chronic exclusion in daily life compared to controls. They responded to exclusion with more withdrawal behavior than controls, with social exclusion eliciting more of these responses than disappointment. Withdrawal responses were associated with chronicity of exclusion, and withdrawal and exclusion in daily life were linked to functional outcomes.

Conclusions: People with schizophrenia experience frequent social exclusion in daily life, and this predicts withdrawal responses to social exclusion. Findings provide initial evidence of vulnerability to a cycle of exclusion and withdrawal.