Basic Self-Disturbance in the Schizophrenia Spectrum: Taking Stock and Moving Forward

Abstract

The concept of basic self-disturbance offers a renewed, phenomenologically oriented framework to approach both the cross-sectional and longitudinal complexity of schizophrenia spectrum psychopathology. According to this approach, schizophrenia is characterized by instability in the most foundational and irreducible dimension of selfhood, i.e. the basic sense of self. Whereas normal basic self-experience is characterized by being a self-present, single, temporally persistent, bodily and demarcated (bounded) subject of experience and action, vulnerability to schizophrenia is marked by several structural shifts in such a basic selfhood (e.g. unstable first-person perspective, diminished sense of presence, and loss of vital contact with reality). This provides the ground for the emergence of the varied symptoms of schizophrenia, such as positive, negative and disorganization symptoms. Recent empirical research confirms that basic self-disturbance is specific to the schizophrenia spectrum and might be of value in the prospective identification of prodromal patients. The concept has implications for both aetiopathogenetic research and clinical-psychotherapeutic intervention. Furthermore, it may offer an integrative framework across ‘levels' of inquiry in schizophrenia research (i.e. across psychopathological, neurocognitive and neurobiological domains).

The Self in the Spectrum: A Closer Look at the Temporal Stability of Self-Disorders in Schizophrenia

“…Far from being just a mere psychometric add-on with respect to the properties of the EASE or a predictable redundancy on a subdomain level of general properties of the scale (i.e., temporal persistence of SD), the results corroborate important aspects of the SD model [16, 23, 24]. Concretely, they show that SD dimensions (i.e., stream of consciousness, presence, corporeality, demarcation, and solipsism) are intimately associated with each other both at baseline and at follow-up.…”

Anomalous Self-Experiences: Markers of Schizophrenia Vulnerability or Symptoms of Depersonalization Disorder? A Phenomenological Investigation of Two Cases

“…The descriptions of ASEs from the two cases were scrutinized, analyzed, and categorized according to the EASE manual. Based on this first analysis, descriptions of ASEs were again analyzed and this time categorized as examples of one of the two dimensions of BSD: diminished self-affection and hyperreflexivity [2, 30], as well as the four symptom groups constituting the depersonalization syndrome [38]. This second analysis was done on an ad hoc theoretical basis, comparing verbatim statements from the two cases with paradigmatic descriptions of the core dimensions of BSD and the prototypical depersonalization syndrome symptom groups [2, 38, 50].…”

“…They are also prominent in non-psychotic family members of SSD patients and in CHR for psychosis conditions, and they predict SSDs in CHR and in non-psychotic conditions [22-29]. Consequently, ASEs are increasingly considered as strong phenotypic markers of schizophrenia vulnerability, and the identification of ASEs has been suggested as a close-in strategy for identifying subjects with the highest risk for psychosis, particularly with respect to SSDs [25, 30]. …”

“…However, the description of prototypical symptoms in DPD does include several aspects of disturbances in the sense of mineness of experience, as described with respect to feelings of disembodiment, although not including frank first-rank symptoms [37, 38]. Such similarities seem to question a clear distinction between SSD and other mental disorders, including DPD, as made by Schneider [40], Klosterkötter [16], Bürgy [39], and proponents of the BSD model [30]. …”

Conceptualization of the terms of self and the sense of identity and their disorders in the course of schizophrenia in the works of Polish authors

“…Problematyka ta była omawiana w odniesieniu do genezy takich zaburzeń jak zaburzenia osobowości, nerwice czy zespoły depresyjne [4,7,8,9], jednak szczególnie ciekawe wydaje się być przeanalizowanie zaburzeń Ja występujących w przebiegu schizofrenii, które to według niektórych autorów [6,10,11,12] stanowią jej istotę.…”