Journal of Genetic Disorders & Genetic Reports ISSN: 2327-5790

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Research Article, J Genet Disor Genet Rep Vol: 3 Issue: 2

Cross-Sectional Cohort Ukrainian Megapolice Sample Study of People�s Reactions to Faces of Patients with Different Mental Conditions

Filiptsova OV1* and Atramentova LA2
1Biology Department, National University of Pharmacy, Kharkov, Ukraine
2Genetics and Cytology Department, V.N. Karazin Kharkiv National University, Kharkov, Ukraine
Corresponding author : Dr. Olga Filiptsova
Biology Department, National University of Pharmacy, Pushkinska Street, 53, Kharkov, 61002, Ukraine
Tel: +380984099100;
E-mail: [email protected]
Received: February 21, 2014 Accepted: May 09, 2014 Published: May 15, 2014
Citation: Filiptsova and Atramentova LA (2014) Cross-Sectional Cohort Ukrainian Megapolice Sample Study of People’s Reactions to Faces of Patients with Different Mental Conditions. J Genet Disor Genet Rep 3:2. doi:10.4172/2327-5790.1000116


Cross-Sectional Cohort Ukrainian Megapolice Sample Study of People’s Reactions to Faces of Patients with Different Mental Conditions

Differences in human preferences including choice of faces are widely recognized across world populations by specialists in many research fields. These preferences may depend on both genetic and environmental factors and have an evolutionary basis like other ones do (food preferences, choice of marital partners, etc.). Human preferences to faces of patients with mental conditions need to be investigated for fundamental knowledge contribution in this area and for further potential practical applications. Population and genetic research of human behavior traits are limited.



The Szondi Test; Reaction to faces; Ukraine; Population distribution; Mental conditions


The study of people’s reactions to different types of human faces is of a significant interest to psychologists, psychiatrists, criminologists, anthropologists, ethnologists, socio-biologists, image-makers, personnel of marriage agencies, etc. Based on faces with different behavior disorders, a lot of diagnostic procedures are developed. Some of them are based on picture response evaluations. Leopold Szondi is a Hungarian psychiatrist who suggested one of such methods known as the Szondi test. It is based on portraits of people with some mental conditions [1]. Szondi approach is applied in the current paper.
A face plays a critical role in a subject’s acceptance by other people, because it is the most significant approach to identify external characteristics of a person. Humans remember the faces of individuals from their own race better than with people of another race [2]. Facial features are under genetic control and some scientists relate to them as secondary sex traits. It is demonstrated that even 3-months old infants keep an eye on beautiful faces longer [3]. In all of these, Aristotle was interested to know whether there is a link between a human behavior and his facial features. Usually, coarse facial features are associated with a predisposition to antisocial and aggressive behavior. A famous Italian anthropologist, Cesare Lombroso, even deduced that criminals who are considered as separate species, Homo Delinquens, did not evolve from a “normal” human, Homo sapiens. According to Lombroso’s view, these individuals had some common features like flat face, full lips, massive lower jaw, and protruded cheekbones. Individuals with somatic and mental health have less fluctuating asymmetry of faces and bodies [4]. A positive assortative mating in facial features was found [5]. Moreover, it was shown that the same Szondi portraits of males and females who were in relationships for at least one year were more frequently selected [6].
Initially, the Szondi test was used in clinical practice. Szondi considered that people could be diagnosed by prevalent “attraction” to the portraits of individuals with specific disorders. It was suggested that the prognosis of a disease progression could be estimated in such a way. Currently, these speculations are considered to be scientifically not proven, and that the diagnostic value of the procedure is doubtful. The data is controversial, in that, some latest studies confirm the correlation of results between the Szondi test and neurologic pathology conditions which was detected with modern exploration tools like MRI, CTscan, computed EEG, etc. [7]. Some scientists recommend to apply the Szondi test for description and analysis of the most important personality features in specific populations, for example, in different drug user groups; opiate users, cannabis users, and alcoholics) [8], as well as in civil aviation to check pilots with a history of attempted suicide [9].
Application of the Szondi test for other non-diagnostic purposes are not rejected if specific types of individuals will be concentrated in groups of certain behavior disorders.
The Szondi test was always considered to be complex to validate and to relate to other psychiatric and psychological diagnostic tools [10]. Recent attempts to assess some links between the Szondi test scales and non-projective techniques were made by Hungarian scientists. They evaluated Szondi-profile and dimensions of ECR-R questionnaire with Collins and Read’s questionnaire classification regarding attachment style in 80 individuals [11].
The Szondi test was rarely used for a general population study. Recently, Hungarian and Portuguese community samples were analyzed for their reactions to Szondi’s portraits [12]. The aim of the current study was to receive distribution characteristics of reactions to faces of people with different medical conditions and peculiarities in a population sample (schoolchildren and college/university students) of Ukrainian megapolice Kharkov (eastern Ukraine). Ukraine is a population with a unique history and culture background and with a specific multiethnic composition. Until 1991, Ukraine was part of the former Soviet Union, where population and genetic research of human behavior traits were strictly limited. This first cohort and cross-sectional study will fill some gaps on the “behavioral map’ of Ukraine.

Subjects and Methods

355 volunteers (90 males and 265 females) participated in the research. All participants lived in Ukraine and were Slavs (predominantly Ukrainians and Russians). Most of them were Kharkiv city residents (Kharkov is the second city in Ukraine by its population size after Kiev city, and Kharkov region includes about 1730000 inhabitants). The volunteers were enrolled randomly in different schools, colleges and universities of Kharkov city and Kharkov region. They were schoolchildren of the 10th and 11th classes (schools of Kharkov city Nos. 22, 23, 24, 27, 56, 91, 95, 148 and 156, and the Pesochin Collegium of Kharkov region) or college (Kharkov Building Secondary Technical School) and university (V.N. Karazin Kharkiv National University, National University of Pharmacy, National Technic University “Kharkov Polytechnic Institute” and Kharkov National Medical University) students of different courses (1st to 5th), so the age of participants varied from 16 to 23. Participants who were engaged were not relatives or marriage partners. All participants received the interpretation of their results as a reward for an experiment inclusion. The study design was cohort and crosssectional.
Psychological tools
The Szondi test of portrait choices was used as a major instrument for the research. According to the Szondi test, participants were supplied with 6 series of 8 portraits (total of 48 pictures). Participants were instructed to make a choice of four portraits in each series – two they liked and two they disliked respectively. Each series included portraits of people with some mental disorders and peculiarities such as homosexuality (h), sadism (s), epilepsy (е), hysteria (hy), catatonic schizophrenia (k), paranoid schizophrenia (p), depressive (d), and maniac (m) disorders. A fragment of the Szondi test is presented in Figure 1. The participants were not informed about the mental conditions of individuals presented on portraits. Groups were formed according to their reactions to a patient’s type depicted in portraits, thus, positive (+), negative (–), ambivalent, and null reactions. A positive reaction (in other words, tolerance) was considered as a predominant choice of patients’ faces with specific disorder. A negative reaction was considered as a rejection of an individual face. Ambivalent reaction was considered as a simultaneous attraction and rejection of two or more times. Null reaction was considered to be absence of any reaction or single attraction and/or rejection. Each portrait type was evaluated by 6-point scale (from –6 to +6 points). Characteristics under analysis (attitudes to pictures of people faces) can be viewed both as qualitative (predominant reaction type – positive, negative, ambivalent, and null) and quantitative (scale measurements in points). On a population sample level, a reaction was considered to be positive (negative), if an individual has made at least two attractions (rejections) to a specific type of portrait (without rejections/attractions respectively). A quantitative evaluation of a positive/negative type of reaction was assessed as well on a population sample level and was calculated as a ratio of total positive/negative points sum (regardless being in a specific preference group) to a total number of participants.
Figure 1: A fragment of the Szondi portrait choice test.
Statistical analysis
A fraction, p of individuals was calculated as a ratio of cases numbered (m) with a certain reaction type to the total number of observations (n):
Fractions were converted to φ angles (Fisher φ-transformation) according to the following formulae:
A statistical table was used [13], where р stands for unit fractions.
A statistical error mφ of φ angle was found by the formula:
, where, n stands for a sample size.
95% of confident interval of φ angle (95% CI) was found as follows:
, (t = 1, 96).
Confident limits of φ were transformed to fractions by counter motion by the formula:
A statistical error of an arithmetic mean was found by the formula , where n and s stand for a number of observations and a standard deviation respectively. Limits of 95% of confident interval of an arithmetic mean (95% CI) were found as follows: at t = 1.96.
A statistical significance of arithmetic means difference was assessed by t-test (Student’s test), which was calculated by the formula , where and stand for statistical errors of arithmetic means to be compared [13].

Results and Discussion

The following results were obtained from the population distribution of different types of portrait reactions from participants and their analysis. Both males and females found pictures of subjects with some behavior peculiarities more or less attractive. Nevertheless, out of the eight disorders, there was no difference in reactions among different sex groups for four types of portraits. Similar male and female face reactions were described as well for Hungarian and Portuguese community samples [12]. These findings served as a base to combine males and females to one group for further analysis. Population distributions for different types of portrait reactions are presented in Table 1.
Table 1: Population distribution of different portrait type reactions.
It is obvious from the results of Table 1 that volunteers responded in the most tolerant way to faces of individuals with mania disorders. 54% of participants concluded that faces of patients with these mental disorders are less unpleasant, as compared to the faces of other subjects in portraits. For comparison, it should be mentioned that respondents from a general population in Hungary and Portugal had very similar rate of positive response to faces of maniacs [12]. The second place on tolerability in Ukraine belongs to faces of patients with homosexuality disorder. Positive reactions to faces of patients with homosexual disorder were found in 41% of cases. About 1/3 of participants responded positively to faces of patients with epilepsy and paranoid schizophrenia disorders, about ¼ of participants responded positively to faces of patients with hysteria and sadists disorders. The faces of patients with depressive and catatonic schizophrenia disorders were less pleasant to participants.
The results which were obtained some decades ago have shown that some pictures were more readily identified than others by English participants working with the Szondi test. The findings demonstrated that homosexual and maniac disorders were the highest identified subjects by participants, while epileptic disorder was the least to be identified by participants. It was suggested that facial clues may be important in the determination of responses [14].
It should be noted that participants highly expressed more positive or negative reactions to the pictures of subjects with behavior disorders and peculiarities. According to Szondi views, marital partners are chosen by each other based on a term known as ‘Genotropism’. Genotropism means “attraction” to similar individuals by appearance. Moreover, it describes the similarities of humans and their pet faces [15]. As for the application of the test in clinical diagnosis, Szondi thought that participants who will have the same disorder(s) in future as that of a patient in the portrait are attracted to each other, or at least if participants are predisposed to some medical conditions which are controlled by “latent’ genes. Based on latest discoveries in modern genetics, one can state that such speculations do not stand, and that the diagnostic value of the Szondi test is doubtful. But, one can apply any procedure in picture selections for specific purposes to understand individual’s attractions, attitudes, and concentration. The results obtained, herein, may help to explain famous criminology and psychology phenomena. For example, many maniacs and serial killers are able to attract a potential victim. It is easily explained by the data obtained that participants’ dislike to faces of subjects with mania disorders was rarely observed. Among the Ukrainian sample under examination, only 12% of participants disliked the faces of people with mania disorders.
33% of participants expressed null reaction to faces of sadist disorder. These people can potentially form a group of risk on face, differentiating difficulty of normal individuals from those who are predisposed to violence. But this will be true only if associations between specific phenotypic face features and personality traits are proved.
About 4/5 of participants did not express attraction or did not react at all to faces of patients with depressive disorders. This may partially explain why these subjects are lonely. In such a situation of lack of attention and support from other people, this may result in their relative isolation and may facilitate suicide attempts completely.
In some papers, it was shown that Szondi choice of portraits may be influenced by some factors including learned reactions to facial expressions. This implies that some faces look friendly and are chosen more often while other faces look cruel and are not selected from the presented set of pictures [16].
For an explanation to the high prevalence of positive reactions to faces of people with different personality peculiarities, a genetic evolutionary hypothesis of mental disorders was appealed to. In accordance to this hypothesis, these human disorders evolved from animals’ defense reactions. A reaction threshold was decreased and these reactions lost their adaptive role and became abnormal. For example, it is considered that an epileptic seizure demonstrates extra readiness of a nervous system for defensive activities like strong movement of reflexes or running. The significance of these reactions are important because it is considered that in these moments, the nervous system can be “discharged” in tense areas or “released” from accumulated toxins. Catatonic reactions (a phenomenon known as “animal hypnosis”) are as well normal adaptive reactions. Usually, predators are attracted to moving objects but freezing postures make a victim to be hidden. The importance of depressive mood is similar to physical pain. Both conditions signal an organism of potential problems to prevent their further influence [17]. High prevalence of behavior deviations are explained by the fact that genes responsible for them in small doses are useful. So such genes are preserved in the populations and give some advantages to their carries [18].
It is interesting to know that in most cases, there were no relationships between a participant’s age and his expression degree of positive (+) or negative (–) reactions to portraits presented. It was found out that age was only slightly associated with three reactions to faces of individuals in portraits. Older people had less positive reactions to faces of sadist disorder and more negative reactions to faces of patients with catatonic schizophrenia and depressive disorders. But these links were very weak.
Besides qualitative population distribution of reactions to different types of faces, a quantitative analysis of positive and negative reactions and expression were performed. The results are presented in Table 2. The strongest positive reactions were observed for faces of individuals with homosexuality and maniac disorders. Qualitative and quantitative characteristics of negative reactions to faces of individuals with catatonic schizophrenia disorder were similar. The lowest dislike was traced in relationship to faces of subjects with paranoid schizophrenia and maniac disorders.
Table 2: Population profile of quantitative expression of positive and negative reactions to faces of different portrait types.
Analysis of world literature in relationship to the Szondi test showed that generally, this projective technique was used for an individual diagnosis and only in some cases in a general population [12]. Very different populations were selected including students, inmates of mental institutions, prisoners, subjects with diabetes and breast cancer etc. The studies were conducted in different countries (USA, Hungary, France, Germany, Brazil, Japan, Spain etc.). In the middle of ХХth century, Bushmen from equatorial Africa were studied [19]. It appeared that different ethnicities demonstrated similarities in a positive reaction to faces of people with homosexuality disorder. Perhaps, anthropologists and ethnic psychologists will be able to explain this fact soon. Moreover, race and ethnic differences in face evaluating are known. For example, in Japan, squinty eyes are perceived as attractive, but in Europe, there is another criterion for beauty. Some structural characteristics of eyes in people from different races and ethnicities are perceived to be clinically significant traits. In the Szondi test portraits, there are faces of individuals who lived in Hungary, Sweden, Austria and Germany. Certainly, cultural factors of these European populations are more relevant to individuals living in Ukraine, but not in African populations. It is logical to presume that more adequate results can be obtained in populations from a similar cultural background like with any psychological tests. For example, in some African tribes, comparatively with Caucasian people, homosexuality is perceived as a more acceptable and normal condition. So some people practice homosexuality and males have almost two hundred days per year forbidden for sex contacts with females. Some cultural phenomena may be partially explained by behavior disorders like shamanism spread among native north populations and possibly related to affected disorders, and like harakiri traditions among the Japanese people which may be viewed as extreme expression of masochism [18].
The current study of the Szondi test was not applied for diagnostic purposes. It was found out that there were no sex and age differences among individual reactions to portraits presented. The results obtained can contribute to facts described by other scientists such as reactions to faces with different mental conditions and hence, can serve as a control for studies conducted with a diagnostic aim.


The research demonstrated that healthy Ukrainian volunteers preferred faces (portraits) of maniac and homosexual disorders to that of other subjects with different mental conditions. Non-psychiatric volunteers in other industrial European populations (Hungarians and Portuguese) showed a similar pattern of choice of portraits as reported here. These findings lay the ground for putative heritability estimates using face preferences in Ukrainian populations as part of future behavior genetics project in Ukraine.


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