Understanding Identity Changes in Psychosis: A Systematic Review and Narrative Synthesis

Abstract

Background and Objective Experiencing psychosis can be associated with changes in how people see themselves as individuals and in relation to others (ie, changes in their identity). However, identity changes receive little attention in treatment, possibly due to a lack of clarity or consensus around what identity change means in people with psychosis. We aimed to create a conceptual framework synthesizing how identity changes are understood in the psychosis literature. Methods Electronic databases were searched up to April 2020. Studies about identity changes among people with psychotic disorders were analyzed using narrative synthesis by a collaborative review team, including researchers from different disciplines, clinicians, and people who have experienced psychosis. Results Of 10 389 studies screened, 59 were eligible. Identity changes are understood in 5 ways as (1) characteristics of psychosis, (2) consequences of altered cognitive functioning, (3) consequences of internalized stigma, (4) consequences of lost roles and relationships, and (5) reflections of personal growth. These 5 understandings are not mutually exclusive. Across a heterogeneous literature, identity changes were mostly framed in terms of loss. Conclusions Our conceptual framework, comprising 5 understandings, highlights the complexity of studying identity changes and suggests important implications for practice and research. For clinicians, this framework can inform new therapeutic approaches where the experience and impact of identity changes are acknowledged and addressed as part of treatment. For researchers, the conceptual framework offers a way of locating their understandings of identity changes when undertaking research in this area.

Post-traumatic Growth in Psychosis: A Systematic Review and Narrative Synthesis

“…However, this raises the question of who is responsible for fostering a positive identity in people with psychosis? This may involve more focus on avoiding the imposition of a clinical explanatory model to support personal meaning-making (Conneely et al, 2020). Systemically, the integration of supportive models that exist outside of formal mental health services (e.g., Hearing Voices Movement network) can complement the work of mental health services and provide individuals with a choice in conceptualising their experiences.…”

“…However, despite arguments surrounding consideration of psychosis as a disorder of self-experience (Sass and Parnas, 2003), aetiological models have focused on symptomatology and cognitive de cits (Burke et al, 2016;Rusch et al, 2014). Five in uences on identity changes in psychosis have been identi ed from a systematic review:1) characteristics of psychosis, 2) altered cognitive functioning, 3) internalised stigma, 4) lost roles and relationships, and 5) personal growth (Conneely et al, 2020). Such in uences highlight the different ways people with psychosis may understand and make meaning from their experiences.…”

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

“…Extensive and converging evidence suggests that alterations in the ways persons diagnosed with psychosis understand and think about themselves and others significantly influences the course of their disorder [ 1 – 4 ]. This has fueled research on the processes that might undermine or enhance self-experience [ 5 ]. For example, interest has grown in describing and measuring aspects related to self-experience, which if compromised, may contribute to the loss of agency and self-coherence, and if recaptured, may enable recovery from psychosis [ 6 ].…”

Targeting Personal Recovery of People With Complex Mental Health Needs: The Development of a Psychosocial Intervention Through User-Centered Design

“…Several factors negatively affect self-identity in people in need of intensive and longer-term psychiatric services [see for a review (22)]. First, as a result of the difficulty to integrate the illness into a multidimensional self-identity, self-identity may be narrowed down to a more or less unidimensional self-identity of mental illness (14).…”