Sexual Dysfunctions and Problematic Sexuality in Personality Disorders and Pathological Personality Traits: A Systematic Review.

PURPOSE OF REVIEW: This aim of the present systematic literature review is to critically analyze problematic sexuality and sexual dysfunctions in personality disorders (PDs) and pathological personality traits. RECENT FINDINGS: An initial pool of 123 studies was found, out of which 17 met the selection criteria and were therefore included. Traumatic experiences as childhood sexual abuse and adverse childhood experiences characterize the relationship between sexual behavior and PDs. From this point of view, sexual compulsivity and sexual risk behaviors, typical of BPD and ASPD, respectively, are among the pathognomonic aspects of PDs and of pathological personality traits. A maladaptive personality functioning may manifest through a problematic sexuality and a sexual impairment. In this regard, traumatic life experiences may structure personality together with sexual functioning. Therefore, it would be useful to consider the relationship between trauma, sexuality, and personality in research and in the clinical setting.

Validation of a brief version of the Resilience Scale for Adults on an Italian non-clinical sample.

AIM: The Resilience Scale for Adults (RSA) is a self-administered 7-point Likert scale of 33 items, structured in 6 factors measuring personal and interpersonal resources. We aimed to develop and validate a brief form of the RSA, in order to produce a short, fast and handy tool for assessing resilience. MATERIALS AND METHODS: A non-clinical sample of 500 university students was recruited using a research website. Reduction of the RSA-33 was performed using an item response theory (IRT) analysis by means of a Graded Response Model (GRM) protocol on the 6 RSA factors separately. After the IRT reduction process, a Pearson's correlation matrix of the original RSA-33 and the reduced version was estimated. Finally, a CFA was estimated to assess factorial validity. The estimation of item discrimination from the GRM ranged from 0.69 and 5.94 and allowed to retain 11 items. RESULTS: For both the original RSA-33 and the brief RSA-11, the strongest correlations were between Family Cohesion and Social Resources factors. CFA was estimated to assess factorial validity in a simplified model with two latent first-order factors, i.e., Personal and Contextual resources. CONCLUSIONS: The availability of short and psychometrically robust measures is needed to improve evaluation and monitoring in mental health programs. For this reason, we provided a brief and effective tool to assess resilience resources in both research and clinical settings.

Personal and contextual components of resilience mediate risky family environment's effect on psychotic-like experiences.

BACKGROUND: Psychotic-like experiences (PLEs) index an increased risk for subsequent psychotic disorders. A risky family environment is a well-established risk factor for PLEs; however, different contextual and personal resiliency factors may differentially mediate its effect on PLEs. OBJECTIVE: In this study, we propose a two-dimensional model of resilience. Our aim is to address separately the mediational role of personal and contextual resiliency factors between a risky family environment and PLEs in a community sample. METHODS AND MATERIALS: Five-hundred University students completed an on-line questionnaire, including the Resilience Scale for Adults (RSA), the 16-item version of the Prodromal Questionnaire (iPQ-16) and the Risky Family Questionnaire (RFQ). Mediation was assessed using Structural Equation Modelling with bootstrapping estimation of indirect effect. RESULTS: The direct effects of personal and contextual resilience on PLEs were respectively -0.69 [-0.97, -0.41] (P < .001) and - 0.19 [-0.58, 0.20] (ns); the indirect effect through personal resilience was 0.03[0.01, 0.04] (P < .001). Personal resilience mediated 27.4% of the total effect of risky family environment on PLEs. DISCUSSION: Personal resilience, as opposite to contextual resilience, mediates the effect of a risky family environment on PLEs. Low personal resilience may represent an individual risk factor that transmits the effect of risky family environment on PLEs and could represent a central aspect of individualized prevention and treatment strategies.

The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis.

INTRODUCTION: Insecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation. METHODS: One-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome. RESULTS: Fearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress. CONCLUSIONS: The results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.

Personal resilience factors protect against distressing auditory hallucinations: A study comparing psychotic patients with auditory hallucinations, non-patients with auditory hallucinations, and healthy controls.

Although studies have identified several risk factors for the development of psychotic disorders, potential protective factors - such as resilience - have rarely been examined. Studies suggest that the negative beliefs people hold about their Auditory Hallucinations (AH) may be an indicator of a need for care. However, the reason why certain people do not develop negative beliefs is unclear but may be related to resilience. The present study aimed to examine the role of resilience in AH by comparing psychotic patients with AH, non-patients with AH, and healthy controls without AH. Another aim was to explore whether resilience is related to the beliefs people hold about their AH. Results revealed that patients with AH and non-patients with AH had similarly weak interpersonal resilience factors compared to healthy controls without AH. In contrast, patients with AH showed weak personal factors of resilience compared to both non-patients with AH and healthy controls without AH. Patients with AH had more negative and fewer positive beliefs about their AH than non-patients with AH. Finally, the personal factors of resilience were related to the beliefs about AH. These results showed that personal factors of resilience are decisive variables influencing the need for care in people experiencing AH and thus represent an important treatment target.

Cues for different diagnostic patterns of interpersonal violence in a psychiatric sample: an observational study.

BACKGROUND: Interpersonal violence has increased as a health concern, especially in psychiatry practice, over the last decades. Nevertheless, most patients with stable mental disorders do not present an increased risk of violence, and mental disorder is not a necessary or sufficient cause of violent behaviours. People with mental disorders endorse more often a number of risk factors for violence that could confound this association, such as young age and male gender. The aim of this study was to investigate the effect of age, gender, and diagnosis on reported levels of interpersonal violence in a sample of people with severe mental illness. METHODS: The sample was composed of 160 inpatients: 73 with a psychosis within the schizophrenia spectrum, 53 with a mood disorder and 34 with a personality disorder. All patients enrolled in the study were assessed for experiences of victimization and perpetration of interpersonal violence using the Karolinska Interpersonal Violence Scale interview. Demographic variables were also collected. RESULTS: Both violence perpetration and victimization negatively correlated with age. Compared to males, females were exposed to higher degree of victimization in childhood and adulthood, whereas males were more involved in the perpetration of violence in childhood. Personality disorders were associated with higher levels of interpersonal violence, both perpetration and victimization; an interaction effect of gender and diagnosis was also observed for violence perpetration in adulthood. Distinct patterns of interpersonal violence did emerge for the diagnostic groups with mood disorder showing a victimization pattern, personality disorders a perpetration pattern and psychoses less defined patterns. CONCLUSIONS: The main finding is that psychotic disorders, mood disorders and personality disorders have different patterns of violent experiences interacting with age and gender. This study offers a better understanding of how gender and age could affect violent behaviours. Moreover, study findings may increase the comprehension of the reason why some mental disorders, compared to others, are more associated with the risk of victimization or perpetration of violence. These patterns could have pathophysiological or pathoplastic meaning addressing clinical and diagnostic trajectories and they could interact with other intervening risk factors.

Resilience as a Mediator Between Interpersonal Risk Factors and Hopelessness in Depression.

Several studies investigated the role of resilience as a mediating factor for psychopathological phenotypes. The aim of the current study is to explore the putative role of resilience as a mediator between different vulnerability factors and depressive symptoms. One hundred and fifty patients with a major depressive disorder diagnosis have been evaluated on the basis of humiliation (Humiliation Inventory), adverse past family experiences (Risky Family Questionnaire), hopelessness (Beck Hopelessness Scale), and resilience (Resilience Scale for Adult) scores. A multiple regression analysis and a bootstrapping method were carried out to assess the hypothesis that resilience could mediate the relationships between these risk factors as predictors and hopelessness as a dependent variable. Our results show that resilience has a mediating role in the relationship between several risk factors that are specifically involved in interpersonal functioning and hopelessness. The main limitations of the study are the cross-sectional nature of the study, the use of self-report instruments, the lack of personality assessment, and the consideration of the resilience as a unique construct. The understanding of the mechanisms through which resilience mediates the effects of different interpersonal risk factors is crucial in the study of depression. In fact, future prevention-oriented studies can also be carried out considering the mediating role of resilience between interpersonal risk factors and depressive symptoms.

ResilienCity: Resilience and Psychotic-Like Experiences 10 Years After L'Aquila Earthquake.

An earthquake hit the city of L'Aquila in central Italy in 2009, leaving the city completely destroyed and 309 casualties. Unexpectedly, lower rates of psychotic experiences in persons affected by the earthquake compared to non-affected persons were found 10 months after the earthquake. The very long-term impact of a natural disaster on the prevalence of psychotic experiences deserves more in-depth detailing. The Authors examined resilience and psychotic experiences in a university student sample of 494. No effect of direct exposure to the earthquake (odds ratio = 0.64, 95%CI [0.37, 1.11]), material damages (odds ratio = 0.86, 95%CI [0.60, 1.23]), psychological suffering (odds ratio = 1.06, 95% CI [0.83, 1.36]), or global impact severity (odds ratio = 0.92, 95%CI [0.76, 1.12]) on psychotic experiences was detected. Resilience levels did not differ between affected and non-affected persons. Resilience showed a strong protective effect on psychotic experiences (odds ratio=0.38, 95% CI [0.28, 0.51]. The protective effect of the RSA factor "Perception of Self" was significantly stronger in individuals affected by the earthquake compared to non-affected subjects. Being affected by an earthquake is not a risk factor for psychotic experiences in a university student sample, as no direct effect of the earthquake was detected after 10 years after the event. Resilience is confirmed as a strong protective factor for psychotic experiences irrespectively of large collective traumatic events. Extension of these results to a general population sample could provide interesting insights into recovery from natural disasters.

Could the severity of symptoms of schizophrenia affect ability of self-appraisal of cognitive deficits in patients with schizophrenia? Lack of insight as a mediator between the two domains.

The relationship between subjective appraisal of cognitive deficits and symptom severity in schizophrenia is unclear. Insight reportedly affects both factors. Our aim is to further asses the relationship between subjective perception of cognitive deficits, symptom severity and lack of insight as a mediator variable. 109 subjects with schizophrenia were evaluated. Positive and Negative Syndrome Scale (PANSS) was modelled as independent variable, Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) as dependent and "Lack of Insight" (LoI) PANSS Item as mediator one. Mediation was assessed using bootstrap estimation approach. LoI acts as a suppressor variable (i.e., it enhances the relation between the independent and dependent variable) between Negative Symptoms and SSTICS, while showing a mediation effect between Depressive symptoms and SSTICS. LoI has a central role in mediating the relationship between negative and depressed symptoms on the one hand and self-appraisals of cognitive deficits (SACD) assessed with SSTICS on the other. Its suppressor role between negative symptoms and STICSS favour a direct effect of negative symptoms on SACD. On the other hand, its mediator role between depression and SSTICS is consistent with several reports of the 'insight paradox' of an enhanced severity of depression in patients with higher awareness of their disability.

Further Exploration of Personal and Social Functioning: The Role of Interpersonal Violence, Service Engagement, and Social Network.

Social functioning (SF) has mainly been studied in major psychoses in relation to symptom severity, but other factors may interfere with the achievement of a functional remission. The aim of this study is to explore interpersonal violence (IV), service engagement (SE), and social network (SN), together with demographics, as predictors of SF in a sample of subjects with severe mental illness (SMI). Consecutive adult inpatients were evaluated using self-report and clinician-rated questionnaires. Findings suggest that IV, SE, SN, male sex, and illness duration explained 39.1% of SF variance in people affected by SMI. IV was the strongest predictor, followed by sex and duration of illness. Lifetime expression of violence is a stronger predictor than lifetime exposure to violence. Positive SE and SN were found to predict SF, whereas age was not associated. This study underlines the need of other non-symptom-related variables for the comprehension of SF in mental disorders.

Paranoia, depression and lack of insight in schizophrenia: a suggestion for a mediation effect.

INTRODUCTION: Delusional symptoms are heterogeneous and differentially related to insight, depression and another psychological construct, such as deservedness. In this study we explore models of relationships among these constructs, by hypothesizing that lack of insight could predict depression or paranoia, representing these variables outcome or mediator variables alternatively. MATERIALS: We evaluated positive psychotic symptoms, depression, persecution, deservedness and insight in a clinical sample of 81 people with schizophrenia or other psychotic spectrum disorders. Using multiple regression analyses we found 2 significant models. In the first one the lack of insight is negatively associated with depression and negatively related to persecution that, as mediator, is positively associated with depression. In the second model, lack of insight is negatively associated with persecution and negatively related to depression that, as mediator, is positively associated with persecution. CONCLUSIONS: Persecution and depression could be not only predicted by insight but this prediction could also be mediated by the same variables. In both clinical models found in this study, insight does have a relevant role because the awareness about symptom/illness is crucial to the symptoms change. However, having good insight into schizophrenia can also be paradoxically associated with negative subjective states related to depression (the so-called "insight paradox").

Deontological morality can be experimentally enhanced by increasing disgust: A transcranial direct current stimulation study.

Previous studies empirically support the existence of a distinctive association between deontological (but not altruistic) guilt and both disgust and obsessive-compulsive (OC) symptoms. Given that the neural substrate underlying deontological guilt comprises brain regions strictly implicated in the emotion of disgust (i.e. the insula), the present study aimed to test the hypothesis that indirect stimulation of the insula via transcranial direct current stimulation (tDCS) would enhance disgust and morality in the deontological domain. A randomized, sham-controlled, within-subject design was used. Thirty-seven healthy individuals (25 women) underwent 15-min anodal and sham tDCS over T3 in two different days, while their heart rate (HR) was recorded to derive measures of parasympathetic nervous system activity (HR variability; HRV). After the first 10-min of sham or active tDCS stimulation, participants were asked to 1) complete a series of 6-item words that could be completed with either a disgust-related word (cleaning/dirtiness) or neutral alternatives; 2) rate how much a series of vignettes, each depicting a behavior that violated a specific moral foundation, were morally wrong. Levels of trait anxiety, depression, disgust sensitivity, scrupulosity, and altruism as well as pre- and post- stimulation momentary emotional states were assessed. Compared to the sham condition, after active stimulation of T3 a) HRV significantly increased and participants b) completed more words in terms of cleaning/dirtiness and c) reported greater subjective levels of disgust, all suggesting the elicitation of the emotion of disgust. Although the results are only marginally significant, they point to the absence of difference between the two experimental conditions for moral vignettes in the altruistic domain (i.e., animal care, emotional and physical human care), but not in the deontological domain (i.e., authority, fairness, liberty, and sacrality), where vignettes were judged as more morally wrong in the active compared to the sham condition. Moreover, scores on the OCI-R correlated with how much vignettes were evaluated as morally wrong in the deontological domain only. Results preliminarily support the association between disgust and morality in the deontological domain, with important implications for OC disorder (OCD). Future studies should explore the possibility of decreasing both disgust and morality in patients with OCD by the use of non-invasive brain stimulation techniques.

Interpersonal violence: identification of associated features in a clinical sample.

Violence is a burdensome problem in daily psychiatric practice, even though the diagnosisof a mental disorder is not sufficient to determine a violent behavior; therefore, other factors are involved. We predicted that the participants could be distributed in two groups (e.g. high versus low violence-maltreatment groups) because this grouping would better describe specific patterns of associations in a clinical sample. We aimed to investigate the relation between interpersonal violence and maltreating experiences in childhood. Affective states and personal functioning were also explored as meaningful outcomes. Consecutive patients (N = 101) admitted to a psychiatric unit were evaluated with the Risky Families Questionnaire, the Psychological Maltreatment Review, the Karolinska Interpersonal Violence Scale (KIVS), the Positive and Negative Affect Schedule and the Personal and Social Performance Scale. Single, with average education and unemployed individuals showed significantly higher KIVS scores. High levels of interpersonal violence (IV) in childhood correlated with a harsh family climate in early life. Moreover, IV correlated with perceived parental maltreatment and did not with parental support. The cluster analysis identified two clusters of patients. The first (n = 41) showed negative dysfunctional experiences; the second (n = 60) showed a more positive perception of parental support.The impairment of social functioning and emotions regulation are both involved in this complex relation. The study supports the hypothesis of a clustering of patients that needs tailored management of violence causes and consequences.

Bisexuality among a cohort of university students: prevalence and psychological distress.

Sociocultural prejudices and pressures may impair the mental health of bisexual people. We aim to evaluate psychological status according to sexual orientation in a sample of Italian university students, with specific attention to bisexuality and its frequency. Among a recruited sample of 551 university students, we found the following percentages for sexual orientation: heterosexuals 96.9% (n = 534), homosexuals 1.1% (n = 6), bisexuals 2% (n = 11). The cross-sectional analysis for psychological symptoms, with the Symptoms Check List-90 Revised (SCL-90-R), revealed that bisexual subjects have statistically significant higher scores on some symptomatic scales compared to heterosexuals. In particular, obsession-compulsion, paranoid ideation, hostility were significantly higher in bisexuals. Therefore, if heterosexual or homosexual orientation are not specified by particular psychological symptoms, bisexuality is characterized by a strong link with some facets of psychological distress, which are likely caused by a peculiar double stigma. In conclusion, through a specific psychometric tool, we found an association between bisexuality and various forms of psychological suffering. This evidence should further encourage clinicians to accurately assess the psychological health in young bisexual people.

Different roles of resilience in depressive patients with history of suicide attempt and no history of suicide attempt

Objective: Suicidal ideation is modulated by several risk and protective factors. The aim of this study was to evaluate differences between patients with a history of suicide attempt and those with no such history, with special attention to depression, interpersonal sensitivity, humiliation, and resilience. Methods: One hundred consecutively admitted patients with an index depressive episode were recruited. The Brief Symptom Inventory, Humiliation Inventory, and Resilience Scale for Adult were administered. Results: Scores for humiliation, interpersonal sensitivity, and depression were higher in subjects with history of suicide attempt, while higher scores for resilience were observed in the group with no such history. Different patterns of relationships among the variables of interest were found in the two groups. Resilience dimensions such as social resources and familial cohesion were strongly and negatively correlated with humiliation, interpersonal sensitivity, and depression in subjects with a past suicide attempt. Conclusions: Resilience factors can modulate and reduce the impact of suicide risk. Assessing risk and protective factors could enhance the ability to intervene appropriately.

Defence mechanisms and attachment styles in paranoid ideation evaluated in a sample of non-clinical young adults.

Objective: The aim of this investigation was to evaluate defence mechanisms and attachment styles in paranoid ideation through a cross-sectional design with sequential recruitment of subjects. Methods: Five hundred and fifty non-clinical subjects were recruited from university students. A psychometric protocol comprising paranoid ideation scale of Symptoms Check List (SCL-90-R-Par) to identify paranoid ideation, Defence Style Questionnaire (DSQ-40) to evaluate defence mechanisms, and Relationship Questionnaire (RQ) to measure attachment styles was then administered. Results: We found a significant predictive value of immature defence mechanisms (ß=0.48; p<0.0001) and preoccupied attachment style (ß=0.25; p<0.0001) in the paranoid ideation. Moreover, subjects reporting a preoccupied or fearful attachment style showed higher levels of paranoia. Conclusions: This study revealed that paranoid ideation is mainly characterised by immature defence mechanisms. A clear insecure attachment style associated with paranoia was also found. The assessment of paranoid ideation should therefore consider the role of attachment style and defence mechanisms as an integral part during the diagnostic and therapeutic processes.

Examination of humiliation and past maladaptive family context in persecutory ideation: An exploratory study.

INTRODUCTION: Previous studies have demonstrated that early interpersonal trauma is involved in the development of persecutory ideation. However, the specific influence of past and current social and familial variables has never been previously explored. Thus, the aim of the present study was to examine the potential role of current and past interpersonal humiliation events (e.g. to be cruelly criticized, submitted, bullied, insulted, scorned) and a negative family context on the development of persecutory ideation. METHODS: Current and past interpersonal humiliation events (Humiliation Inventory), a negative family context (Risky Family Questionnaire) and degree of persecutory ideation (Peters et al. Delusions Inventory) were assessed in a sample of 175 non-clinical participants (range=18-62years, 81% women and 19% men) with the help of an online survey. RESULTS: A pattern of significant correlations emerged, in particular, between persecutory ideation, the past and present interpersonal humiliation, and negative primary family context. Moreover, hierarchical multiple regression analysis revealed that, among the various variables, past interpersonal humiliation events and a negative family context significantly predicted higher levels of persecutory ideation. CONCLUSIONS: For the first time in the literature, this study provides preliminary evidence that past interpersonal humiliation events and a negative family context are related to the development of persecutory ideation. In addition, we showed that past interpersonal humiliation events, but not the fear of current events, have an impact on the development of persecutory ideation. These results suggest that the amelioration of early familial and social contexts may help to prevent the development of persecutory ideation.

Mating Strategies and Sexual Functioning in Personality Disorders: A Comprehensive Review of Literature.

INTRODUCTION: Personality disorders impair several aspects of intrapsychic and interpersonal life. In particular, mating strategies and sexual functioning could manifest in different and/or dysfunctional ways in people with personality disorders. AIM: To describe, through a comprehensive review of the literature, the mating strategies and sexual functioning in patients with personality disorders. METHODS: We listed and discussed the principal studies on the relation between mating strategies and sexual functioning in personality disorders. The search strategy used search terms in PubMed for the main studies published from January 2000 to December 2016. MAIN OUTCOME MEASURES: We considered two main sections for our selection according to the aim of the present review: mating and sexuality. RESULTS: Interesting evidence on mating strategies in personality disorders was found. In particular, the major items were found in the dramatic-unpredictable cluster, with borderline personality disorder being the most studied. In contrast, the bizarre-eccentric cluster had fewer items, with the schizoid personality disorder being the least studied. For sexual behavior, borderline personality seems to be the unique disorder sufficiently studied, with evidence of major histories of child sexual abuse, the presence of sexual dysfunctions, and paraphilic interests. CONCLUSION: A large spectrum of mating strategies characterizes different personality disorders, although an inconsistent knowledge about the relation between sexual function and personality disorders emerged from our analysis of the literature. Hence, we invite clinicians and researchers to integrate psychodiagnostic and sexual assessments in psychiatric disciplines for people with personality disorders. Collazzoni A, Ciocca G, Limoncin E, et al. Mating Strategies and Sexual Functioning in Personality Disorders: A Comprehensive Review of Literature. Sex Med Rev 2017;5:414-428.

Different roles of resilience in depressive patients with history of suicide attempt and no history of suicide attempt.

OBJECTIVE:: Suicidal ideation is modulated by several risk and protective factors. The aim of this study was to evaluate differences between patients with a history of suicide attempt and those with no such history, with special attention to depression, interpersonal sensitivity, humiliation, and resilience. METHODS:: One hundred consecutively admitted patients with an index depressive episode were recruited. The Brief Symptom Inventory, Humiliation Inventory, and Resilience Scale for Adult were administered. RESULTS:: Scores for humiliation, interpersonal sensitivity, and depression were higher in subjects with history of suicide attempt, while higher scores for resilience were observed in the group with no such history. Different patterns of relationships among the variables of interest were found in the two groups. Resilience dimensions such as social resources and familial cohesion were strongly and negatively correlated with humiliation, interpersonal sensitivity, and depression in subjects with a past suicide attempt. CONCLUSIONS:: Resilience factors can modulate and reduce the impact of suicide risk. Assessing risk and protective factors could enhance the ability to intervene appropriately.

Exploring the association between the Iowa Gambling Task and community functioning in people with schizophrenia.

BACKGROUND: Decision making (DM) consists of a number of complex processes involving higher-order cognitive functions involved in outcome evaluation. Problems in DM may have significant negative repercussions on community functioning. We hypothesise in individuals with schizophrenia difficulties in community functioning will be associated with DM problems. SUBJECTS AND METHODS: DM performance was assessed using the Iowa Gambling Task (IGT) in 30 individuals with schizophrenia and 32 healthy controls. Participants' choices on the IGT were grouped as: Ambiguous Decisions, where the outcome is uncertain and cannot be predicted (i.e. IGT initial phase), and Risky Decisions, where the outcome can be predicted with an error margin (i.e. IGT final phase). People with schizophrenia were also assessed with measures of community functioning and symptoms. RESULTS: Controls outperformed individuals with schizophrenia in risky decisions. In patients, levels of community functioning positively correlated with DM performance. Symptomatology was not associated with DM proficiency or functioning. CONCLUSIONS: DM impairment may represent an important contributor to poor functional outcomes in people with schizophrenia. Interventions targeting decision making and higher order cognitive problems in people with schizophrenia may have a greater impact on functional difficulties.