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Protective factor associated with comorbid schizophrenia and autism

Research suggests that schizophrenia and autism may be highly comorbid conditions. Gholipour (2018) reports on a meta-analysis by Zheng and Zheng that schizophrenia has a more than three times higher prevalence in individuals with autism than controls. Still, science has yet to understand the linkage between the two conditions. Altschuler et al. (2021) identify deficits in social cognition and functioning as a common characteristic of both disorders. The central impairment in both disorders seems to be in the capacity for theory of mind (ToM), which refers to a person's ability to infer the mental states of others. Yet, while impaired ToM ability is common to both disorders, the mechanism by which it occurs seems to differ. Altschuler et al. (2021) assert that the difficulty in recognizing emotional facial expressions is the specific mechanism by which affective ToM processing is impaired in individuals with autism but not in schizophrenia. Vaskinn and Abu-Akel (2019) explain that ToM difficulties in individuals with

schizophrenia are due to overmentalizing, while those with autism undermentalize. Their research shows that individuals with comorbid schizophrenia (with positive symptoms) and autism demonstrate better social functioning than those with a single diagnosis. The authors theorize that the opposite mentalization tendencies normalize to confer improved abilities in social-emotional processing in those with a dual diagnosis. A practical limitation in understanding this phenomenon from a clinical perspective is that, while symptoms of schizophrenia may be present in a child, the likelihood of correctly identifying and diagnosing the disorder is low.


Altschuler, M. R., Trevisan, D. A., Wolf, J. M., Naples, A. J., Foss-Feig, J. H., Srihari, V. H., & McPartland, J. C. (2021). Face perception predicts affective theory of mind in autism spectrum disorder but not schizophrenia or typical development. Journal of Abnormal Psychology, 130(4), 413–422. (Supplemental)

Vaskinn, A., & Abu-Akel, A. (2019). The interactive effect of autism and psychosis severity on theory of mind and functioning in schizophrenia. Neuropsychology, 33(2), 195–202. (Supplemental)

Gholipour, B. (2018). Schizophrenia prevalence may be threefold higher in people with autism.

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