Transdiagnostic conceptualization of schizophrenia and autism spectrum disorder. An integrative framework of minimal self disturbance

Abstract

Autism spectrum disorder (ASD) and schizophrenia (SCZ) are diagnostically demarcated disorders, yet overlapping pathological functioning is reported at several levels of organisation starting from brain circuitry to behaviour, complicating diagnostic differentiation. In particular, what the two disorders seem to share is anomalous minimal self experience, which is a trait-like, phenomenological distortion. We propose a framework that unites multiple levels from neural substrates to neurocognitive and phenomenological correlates for the conceptualisation of minimal self disturbance across diagnostic boundaries. As it is increasingly important to uncover biomarkers of psychopathological functioning, we also propose a new paradigm for identifying the neural correlates of minimal selfhood. We argue that they can be more reliably subtracted during meditation rather than during a simple resting state as meditation increases the present-focused inward attention, while simultaneously decreasing reflective mind-wandering that spontaneously happens during rest. Our endeavours are in line with the broader movement in psychiatry to identify biomarkers of pathological functioning and shift from operationalized nosology towards approaches that are not agnostic about self-experience in ASD and SCZ.