Autism and perplexity: a qualitative and theoretical study of basic subjective experiences in schizophrenia.

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 qualitative single-case study. In order to fully examine our patient's experiences within the context of his experiential world and not only as isolated or decontextualized symptoms, we applied a heideggerian framework, i.e. Heidegger's exhaustive account of the self-world relation (care).

Results: Through the framework of care, we discovered a profound disturbance of the self-world relation in our patient, characterized by subtle experiences of estrangement, anxiety and exposure. We found these experiences to be enduring, pervasive and generative for the development of other symptoms.

Conclusions: We argue that these experiences can be seen as experiential correlates of schizotypy and of vulnerability to schizophrenia, and furthermore that an understanding of these experiences can play a role in diagnostic and differential diagnostic procedures, e.g. in early detection or in the search for high-risk individuals, as well as in the psychotherapy of schizophrenia.