Aesthetic Response and Aesthetic Inference in Patients with Schizophrenia

Aesthetic experience integrates affective and cognitive components and may be altered inschizophrenia. We examined aesthetic responses to paintings, and the ability to infer others’aesthetic reactions in individuals with schizophrenia (SZ) and healthy controls (HC). Further, weexplored the relationship between aesthetic inference and empathy, as well as symptom severity.Participants rated positive attraction (beauty), emotional valence, and cognitive stimulation foreach painting, and provided self- and other-assessments. Compared with HC, SZ reported highercognitive stimulation, whereas group differences in positive attraction and emotional valenceself-ratings were small. Across groups, positive attraction was similarly predicted by emotionalvalence and cognitive stimulation, indicating comparable aesthetic evaluation. SZ showed higheraesthetic inference accuracy than HC, operationalized as closer alignment between other-attributionsand a normative reference pattern. Empathy measures were positively associatedwith inference performance, with domain-specific differences across groups, and positivepathology was negatively associated with positive attraction. These findings argue against asimple deficit account in which reduced Theory of Mind necessarily impairs aesthetic inferencein schizophrenia. Instead, they suggest that under certain task demands, individuals withschizophrenia may rely on strategies that improve normative prediction of others’ aestheticexperiences. Future work should distinguish normative, rule-based prediction from target-specificempathic accuracy and control for procedural differences across groups.