Comparison of facial expression in patients with obsessive-compulsive disorder and schizophrenia using the Facial Action Coding System: a preliminary study

Giuseppe Bersani,¹ Francesco Saverio Bersani,^1,2 Giuseppe Valeriani,¹ Maddalena Robiony,¹ Annalisa Anastasia,¹ Chiara Colletti,^1,3 Damien Liberati,¹ Enrico Capra,² Adele Quartini,¹ Elisa Polli<sup>1

1</sup>Department of Medical-Surgical Sciences and Biotechnologies, ²Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, ³Department of Neuroscience and Behaviour, Section of Psychiatry, Federico II University of Naples, Naples, Italy

Background: Research shows that impairment in the expression and recognition of emotion exists in multiple psychiatric disorders. The objective of the current study was to evaluate the way that patients with schizophrenia and those with obsessive-compulsive disorder experience and display emotions in relation to specific emotional stimuli using the Facial Action Coding System (FACS).
Methods: Thirty individuals participated in the study, comprising 10 patients with schizophrenia, 10 with obsessive-compulsive disorder, and 10 healthy controls. All participants underwent clinical sessions to evaluate their symptoms and watched emotion-eliciting video clips while facial activity was videotaped. Congruent/incongruent feeling of emotions and facial expression in reaction to emotions were evaluated.
Results: Patients with schizophrenia and obsessive-compulsive disorder presented similarly incongruent emotive feelings and facial expressions (significantly worse than healthy participants). Correlations between the severity of psychopathological condition (in particular the severity of affective flattening) and impairment in recognition and expression of emotions were found.
Discussion: Patients with obsessive-compulsive disorder and schizophrenia seem to present a similarly relevant impairment in both experiencing and displaying of emotions; this impairment may be seen as a chronic consequence of the same neurodevelopmental origin of the two diseases. Mimic expression could be seen as a behavioral indicator of affective flattening. The FACS could be used as an objective way to evaluate clinical evolution in patients.

Keywords: schizophrenia, obsessive-compulsive disorder, facial expression, Facial Action Coding System