Identity Disturbance, Feelings of Emptiness, and the Boundaries of the Schizophrenia Spectrum

Abstract

Historical and current research on borderline personality disorder reveal certain affinities with schizophrenia spectrum psychopathology. This is also the case for the borderline criteria of "identity disturbance" and "feelings of emptiness," which reflect symptomatology frequently found in schizophrenia and schizotypal personality disorder. Unfortunately, the diagnostic manuals offer limited insight into the nature of these criteria, including possible deviations and similarities with schizophrenia spectrum symptomatology. In this article, we attempt to clarify the concepts of identity disturbance and feelings of emptiness with an emphasis on the criteria's differential diagnostic significance. Drawing on contemporary philosophy, we distinguish between a "narrative" self and a "core" self, suggesting that this distinction may assist differential diagnostic efforts and contribute to mark the psychopathological boundaries of these disorders.

Exploring schizophrenia spectrum psychopathology in borderline personality disorder

“…It is worth emphasizing that both manuals involved a fundamental epistemological shift from a diagnosis based on narrative descriptions with prototypical and conceptual considerations to the so-called a-theoretical, polythetic categories defined by a sufficient number of specific criteria. These categories are insufficiently articulated in terms of their phenomenological quiddity (i.e., their "whatness"), and the criteria are typically poorly defined [9].…”

“…Based on our previous work, we argue that since 1980, the founding prototypes and the original psychopathological insights that imbued the creation of single polythetic criteria have gone into oblivion [4,9]. Criteria have been modified and have undergone unnoted semantic drifts [4], and a ninth BPD criterion was added to the DSM-IV [60], i.e., "transient, stress-related paranoid ideation or severe dissociative symptoms".…”

“…In a detailed historical, conceptual, and empirical review [4], we have argued that the division of the borderline group into BPD and SPD was not entirely justified, and that the BPD category today is over-inclusive and both clinically and conceptually difficult to differentiate from the schizophrenia spectrum disorders. In a separate study [9], we have argued that the BPD criteria of "identity disturbance" and "chronic feelings of emptiness" are multi-layered phenomena which in their basic aspects of structural change of experience were both originally ascribed to the schizophrenia spectrum [10].…”

Self and schizophrenia: current status and diagnostic implications

“…This diagnostic confusion is multidetermined, but mostly due to a very tolerant use of the ninth borderline disorder criterion (“transient, stress‐related paranoid ideation or severe dissociative symptoms”) and the unclarity of the borderline disorder criteria of “identity disturbance” and “feelings of emptiness”. “Feelings of emptiness” are undefined, and the identity disturbance criterion, although apparently referring to the narrative level of selfhood, is not sufficiently differentiated from disturbances of core self. We find it crucial to sharpen the distinction between schizophrenia spectrum psychopathology (involving disturbances of both core and narrative self) and disorders of personality (which do not involve structural disturbances of the core self).…”

Study of validity, reliability in accordance with Turkey conditions in ego functions assessment scale

“…The healthy development of a basic sense of trust is an important step for the formation of a strong ego. 7 According to the psychoanalytic view on schizophrenics, it is argued that when the basic sense of trust does not develop, the person does not feel self-confident, and the ego remains weak due to the broken continuity and consistency in mother-child communication, 8 and with the effect of distressing factors, the interest and investment directed toward the object is redirected towards the body. 9-11 The effects of developmental and interpersonal issues have a crucial role in the symptom development of schizophrenia and in the etiology of thought disorders.…”