Can SZ/SZA mess with empathy?

My partner was a very empathic person. Over the years, though, and he became more ill, I noticed sometimes he would seem “infected” by a strong lack of empathy.

I’m not talkig about merely not seeing things from my point of view, but being totally uncaring for his children or pets, not hurting them but being annoyed and angry if they were ill or hurt.

I have a hard time with this because his empathy was the thing that was important to me. I never would have chosen a partner who yelled at someone who was ill. It seems utterly not okay to me.

But it’s not always like that. He is three different people now, and who knows who he will be when he wakes up any given day.

Most common - totally checked out. Absorbed in his own world. Not actively unempathic but just lost.

Sometimes - angry, everyone is out to get him, if a child needs to go to the ER he feels like it was something done to him and he will be very cold to the child and yell at them. Absolutely unacceptable. Doesn’t seem aware of his behavior later, either, no shame and never thinks about it again.

Sometimes - something like his old self but with zero happiness. But at least calm, thoughtful.

Is any of this similar to SZ/SZA?

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People with SZ are dealing with the symptoms of their brain disease and that has to take their attention off of trying to put themselves in others’ shoes.

Yes this happens with my partner. You eluded to them being in their own world when they aren’t well, which can definitely make my partner unconcerned, but also it happens for me when they are experiencing a lot of symptoms, because of the paranoia and they don’t see things as they actually are. For me that may mean he is treating me without care because he has paranoia connected to me. So where he may care in a better place, he thinks something is going on and is more worried about himself in the face of his delusions, and is suspicious instead of empathetic towards me. Sometimes these situations can be shockingly cold feeling, and baffling they aren’t empathic like you’re used to. It has been something ive felt a lot of hurt in certain situations. Especially when it’s someone you’re especially close to like your partner/ or their father. Delusions very commonly, ive seen for a lot involve those closest to them, like you and your children sound involved in/ or he at least thinks at times are messing up things he’s trying to protect himself from. That results in not thinking about you empathetically, because he doesn’t see it the same. Also worth noting for them, dealing with SZ; they are in such a stressful and paranoid state things do mostly revolve around concerns for their wellbeing; its a hypervigilant survival mode.

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Thank you so much for that thoughtful response. It really helps.

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As someone diagnosed with SZA, I relate to some of these observations and have thoughts on underlying dynamics and causes. First, if caregivers are honest with themselves, everyone’s capacity for empathy and expressions of empathy varies by situation. And a diagnosed person’s situation is changed forever by illness. They may improve or decline with treatment, but will never be quite the same. Caregivers tend to forget that SZ affects thought AND emotion, and since empathy is strongly tied to both these functions, it follows that perception and expression of empathy changes as a direct result of the illness.

Let’s examine the three states you’ve identified: Checked out? In this state he’s likely too distracted by the chaos of this own thoughts, “voices”, delusions, medication side effects, hallucinations, background noise chatter etc, to perceive what he’s “supposed” to be empathetic towards. Angry? Reached the end of his ability to cope, because in addition to this internal chaos, he’s further overstimulated by information or sounds of a child or animal, screaming, barking, meowing, and otherwise expressing emotions he can’t handle, and asked to perform cognitive and emotional labor while he’s struggling to keep himself together as it is. Old self, minus happiness? A good day. Minimal symptoms, but he still has an illness that affects his thoughts and emotions. He may also have a number of underappreciated “negative” symptoms like avolition (lack of motivation), anhedonia (lack of pleasure in formerly enjoyable activities), anasognosia (lack of insight into his disease), and flat affect (lack of expression of emotion) that may foster an underlying depression.

I find it a touch ironic you’re focused on his lack of empathy, yet seem to struggle at accepting and understanding his challenges with a new mental and emotional state. Consider approaching his illness and recovery as you would someone who’s suffered a stroke. Medication may help with the more onerous “positive” symptoms like hallucinations and delusions, but it’s unlikely to completely suppress them or help significantly with negative symptoms. As a stroke sufferer might regain movement or speech, he may be able to adapt and recover from changes to his brain, but that progress may be slow, difficult or seemingly impossible and you may need to reduce your expectations and help with supportive adaptations.

People with SZ and autism can suffer from social-emotional agnosia where they have difficulty reading emotional content from faces, tone of voice or social cues. And as a result their behavior may be perceived as lacking empathy. I’ve had some struggles with this which were compounded by misattributing other’s emotions as directed at me and/or my underlying delusional systems, when the person’s emotions were a result of something or someone else entirely. The resulting embarrassment of reading others emotions wrong, can lead to a “once bitten, twice shy” approach where you’re either hesitant to act on perceptions and attributions without additional confirmation, or you avoid social situations and people altogether, because emotional content can be confusing or confounding.

With support from a therapist and sympathetic workmates, I settled on a mix of the two approaches—venturing out into society as much as I could handle, retreating as necessary to safe-spaces like therapy, acting and voice classes until I built up a circle of friends who I felt comfortable enough with to inquire if I was reading social-emotional situations correctly. Things got much easier then, and I gradually gained confidence to navigate social-emotional situations. I still struggle with processing emotions in-the-moment, as actors say, and I’d turned this into a benefit in the workplace. I’m known to be calm and focused in a crisis, so long as people speak with me clearly, calmly and quietly, avoid reporting the same information or asking for updates repeatedly, and shield me from extraneous information or emotional outbursts that don’t help the situation. When that fails, as with your partner, the pressure exceeds my coping mechanisms and I can get angry and lash out. It doesn’t happen very often, but when it does— it isn’t pretty.

My recovery isn’t typical and the result of over 10 years of individual psychotherapy, psychosocial therapy, and better than average insight and medication compliance. From what you’ve shared about his symptoms and his treatment plan, my impression is your expectations of his level of recovery and functioning are unrealistic as it takes a level of communication about and acceptance of his condition that seems absent. If as before you’re asking these questions to confirm a diagnosis of SZ/SZA, it’s plausible, but an observed lack of empathy intersects with other disorders and neurodivergencies. If a definitive diagnosis is still important to you and you’re unable to obtain that information from your partner or his doctor, we may be able to work backwards from a list of his medications and dosages.

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Thank you so much, that was very helpful.

I may not have been clear - he is not diagnosed with anything, I am on the forum reading and posting a little bit in hopes of seeing if there might be a possible match. I need to decide if he’s just a run of the mill abuser or if there is more going on.

I’m quite empathic and patient with him, but abusive behavior toward children doesn’t magically disappear because he may or may not have an illness. I could care about him yet remive my children from a home that is causing trauma. If they have genetic predisposition to SZ, it is also important to reduce their risk of developing symptoms themselves due to trauma, a risk factor. My husband witnessed the abuse of his mother and blames her for not removing them from the trauma sooner.

I do find myself caught in a full bind where society blames me for not leaving and also blames me for not being empathic enough. I can’t please society so I will have to make my own decisions for the good of my family, and accept that noone will be pleased no matter what I do.


Hi ficus,

I am curious as to why you are thinking he is possibly neurodiverse- schizophrenia scz or sza? Lack of empathy and being abusive towards children aren’t usually among the reasons people end up here asking questions.

First, I want to let you know you are a great mom! My husband either has bipolar or schizoaffective disorder (it’s leaning towards the latter). I know he has an illness that causes much suffering for him, but he is an adult. Our son is a child. I’ve had to set a lot of tough love boundaries with him to keep the house safe and functioning.

My advice is to be firm about boundaries. For example, I don’t allow my husband to have angry tirades towards me. I remove myself from the situation and temporarily block his calls. I support him when he’s sad, tired, and numerous other ways, but the aggressiveness is not going to help anyone.

When dad is having a rough time, and it starts feeling like we’re walking on egg shells, my son and I take a vacation to a nice hotel. Our mental health and needs are just as important. Dad chilling at the house alone is a much better situation for him than the police getting called or him being involuntarily submitted to a clinic or hospital.

Remember there’s support, but there’s also enabling.
The reality is that if he gets involuntarily submitted or jailed, those places are going to have way more rules and boundaries than what you’re capable of setting at the house. Rules and boundaries have a purpose.

You’re a good mommy. My advice is to prioritize a safe and stable household. He’s also responsible for his children and needs to be managing his illness to do his share for the household.

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