Social disability in schizophrenia: the controlled prospective Burghölzli study II. Premorbid living situation and social adjustment--comparison with a normal control sample.

The assessment of premorbid adjustment in schizophrenia has gained increasing interest in psychiatric research. Numerous studies have provided evidence on the predictive power of premorbid adjustment in the course and outcome of schizophrenic psychoses, but only little systematic research has been done on this topic comparing schizophrenics and healthy persons. In this study we have analyzed the premorbid life situation and social adjustment of 69 first onset schizophrenics in contrast to 60 healthy subjects. The comparisons between these samples showed significant differences for nearly all areas assessed, indicating a premorbid disablement of the schizophrenics both for quantitative and qualitative aspects of social functioning. Compared to that of healthy people, the size of the schizophrenics' social network is markedly reduced and often characterized by a strong link to their family of origin. In general, the schizophrenics fail to establish close relationships or engage in social contact. Moreover, they tend to withdraw from existing relationships, especially heterosexual ones. Even when the schizophrenics appear quite normal on formal criteria (such as partnership or employment situation), further analyses often reveal problems, e.g., conflicts at work or reticence with partners. The results of this study clearly demonstrate the necessity of assessing not only formal criteria but also behavioral patterns and emotions of the persons concerned.