In the past three decades, psychiatric research has increasingly focused on the early subthreshold stages of psychosis, with the aim of improving the early identification and treatment of individuals at increased risk of psychotic disorder. Yet, despite considerable research effort, current early psychosis research faces several limitations. In this Personal View, we consider how integrating...
Dynamical systems theory (DST) has recently gained traction as a framework to describe and predict the progression of psychopathology. However, a number of challenges to the application of DST to psychopathology have arisen, including the heterogeneity of symptom measures and the lack of theoretical underpinnings to describe the temporal unfolding of psychiatric illnesses. In this article, we...
IntroductionWe previously proposed a neurophenomenological model of schizophrenia, linking basic self-disturbance with neural deficits of source monitoring and aberrant salience. Baseline comparisons in ultra-high risk (UHR) and first-episode psychosis (FEP) samples indicated a relationship between basic self-disturbance and source monitoring deficits, but not aberrant salience. The current...
Autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SSD) overlap in behavioral signs, particularly in social functioning; consequently, SSD patients are frequently misdiagnosed with ASD and vice versa. The neurodevelopmental and spectrum nature of both disorders, including milder variants, further complicates differential diagnosis, which calls for a better differentiation by...
Understanding alterations of selfhood (termed self-disorders or self-disturbances) that are considered typical of the schizophrenia-spectrum is a central focus of phenomenological research. The currently most influential way of phenomenologically conceiving self-disorders in schizophrenia is as disorders of the so-called most basic or ‘minimal self’. In this paper, we first highlight some...
AIM: Basic self disturbance is a putative core vulnerability marker of schizophrenia spectrum disorders. The primary aims of the Self, Neuroscience and Psychosis (SNAP) study are to: (1) empirically test a previously described neurophenomenological self-disturbance model of psychosis by examining the relationship between specific clinical, neurocognitive, and neurophysiological variables in UHR...
The significance for psychiatry of a patient's subjective or "lived" experience seems obvious even on casual reflection, especially in cases of severe mental illness. It is likely that curiosity and concern about what a patient is experiencing is a prerequisite for building trust or a therapeutic alliance, particularly when the experiences seem highly unsettling and unusual. Few would deny that...
BackgroundThe integration of various domains or levels of analysis (clinical, neurobiological, genetic, etc.) has been a challenge in schizophrenia research. A promising approach is to use the core phenomenological features of the disorder as an organising principle for other levels of analysis. Minimal self-disturbance (fragility in implicit first-person perspective, presence and agency) is...
A disturbance of "minimal self," - of the immediate sense of mine-ness inherent in experience-is hypothesized to be the core disturbance in schizophrenia. Research with the Examination of Anomalous Self Experience (EASE) has demonstrated the selective aggregation of anomalous self-experiences in the schizophrenia spectrum. Conceptual research suggests that anomalous world experiences, including...
This paper offers a hermeneutic-phenomenological perspective on three dangers relevant to the psychotherapy of an underserved and often poorly understood population: persons with schizophrenia and other psychotic conditions. The discussion offered relies on analyses offered by Heidegger (on the "forgetting of the ontological difference"), Husserl (on the nature and importance of...
The self-disorder model offers a unifying way of conceptualizing schizophrenia's highly diverse symptoms (positive, negative, disorganized), of capturing their distinctive bizarreness, and of conceiving their longitudinal development. These symptoms are viewed as differing manifestations of an underlying disorder of ipseity or core-self: hyper-reflexivity/diminished-self-presence with...
Anomalous self-experiences (ASEs), presumably involving alterations in "core" or "minimal self," have been studied as manifest in schizophrenia and its spectrum, in contrast with mood disorder and personality disorder samples. This is the first study to examine ASEs in panic disorder (PD), beginning the exploration of these disturbances of subjectivity in anxiety disorders. We aimed to clarify...
"Atmospheric" alterations are key aspects of altered subjectivity in mental disorder. Karl Jaspers famously described the "delusional mood": a sense of uncanny salience and ominousness that often precedes the onset of schizophrenic psychosis or of delusions. Such experiences, he writes, involve "a transformation in our total awareness of reality" that often verges on ineffability. In...
Schizophrenia is a diverse and varying syndrome that defies most attempts at classification and pathogenetic explanation. This is the second of two articles offering a comprehensive model meant to integrate an understanding of schizophrenia-related forms of subjectivity, especially anomalous core-self experience (disturbed ipseity), with neurocognitive and neurodevelopmental findings....
Schizophrenia is a heterogeneous syndrome, varying between persons and over course of illness. In this and a companion article, we argue that comprehension of this condition or set of conditions may require combining a phenomenological perspective emphasizing disorders of basic-self experience ("ipseity disturbance") with a multidimensional appreciation of possible neurobiological...
There is considerable overlap between phenomenological and neurocognitive perspectives on delusions. In this paper, we first review major phenomenological accounts of delusions, beginning with Jaspers' ideas regarding incomprehensibility, delusional mood, and disturbed "cogito" (basic, minimal, or core self-experience) in what he termed "delusion proper" in schizophrenia. Then we discuss later...
This paper offers an overview and clarification of the ipseity-disturbance or self-disorder hypothesis regarding schizophrenia, with focus on some recent and recommended research and theoretical refinements. There is need to expand research and theorizing in several directions-in order to: 1, specify more precisely what is truly distinctive in the schizophrenia spectrum, 2, explore internal...
Phenomenological research indicates that disturbance of the basic sense of self may be a core phenotypic marker of schizophrenia spectrum disorders. Basic self-disturbance refers to disruption of the sense of ownership of experience and agency of action and is associated with a variety of anomalous subjective experiences. Little is known about the neurocognitive underpinnings of basic...
Phenomenological research indicates that disturbance of the basic sense of self may be a core phenotypic marker of schizophrenia spectrum disorders. Basic self-disturbance refers to disruption of the sense of ownership of experience and agency of action and is associated with a variety of anomalous subjective experiences. Little is known about the neurocognitive underpinnings of basic...
This paper offers a comparative investigation of anomalous self-experiences common in schizophrenia (defined in Examination of Anomalous Self Experiences (EASE) instrument) and those of normal individuals in an intensely introspective orientation (early 20th-century "introspectionist" psychology). The latter represent a relatively pure manifestation of certain forms of exaggerated...
Various forms of anomalous self-experience can be seen as central to schizophrenia and other psychiatric disorders. We examined similarities and differences between anomalous self-experiences common in schizophrenia-spectrum disorders, as listed in the EASE (Examination of Anomalous Self Experiences), and those described in published accounts of severe depersonalization. Our aims were to...
Questions concerning both the ontology and epistemology of the "psychiatric object" (symptoms and signs) should be at the forefront of current concerns of psychiatry as a clinical neuroscience. We argue that neglect of these issues is a crucial source of the stagnation of psychiatric research. In honor of the centenary of Karl Jaspers' book, General Psychopathology, we offer a critique of the...
There is a glaring gap in the psychiatric literature concerning the nature of psychiatric symptoms and signs, and a corresponding lack of epistemological discussion of psycho-diagnostic interviewing. Contemporary clinical neuroscience heavily relies on the use of fully structured interviews that are historically rooted in logical positivism and behaviorism. These theoretical approaches marked...
Background: Autistic traits and perplexity are considered core features of schizophrenia in phenomenological psychiatry. They express a fundamental disturbance of the self-world relation (including disturbances of self and intersubjectivity). The aim of our study was to examine this disturbance by exploring in detail how autism and perplexity are experienced subjectively. Methods: It is a...