Clinical Manifestations of Self-disorders in Schizophrenia Spectrum Conditions

Authors

  • Mads Henriksen Mental Health Center Glostrup, University Hospital of Copenhagen / Center for Subjectivity Research, University of Copenhagen / Department of Media, Cognition and Communication, Philosophy Section, University of Copenhagen Author
  • Josef Parnas Mental Health Center Glostrup, University Hospital of Copenhagen / Center for Subjectivity Research, University of Copenhagen / Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen Author

DOI:

https://doi.org/10.1515/cpp-2017-0014

Keywords:

EASE, anomalous self-experience, schizotypal disorder

Abstract

This article explores the phenomenologically informed, theoretical and empirical research direction on self-disorders in the schizophrenia spectrum conditions. First, we describe the concept of ‘self’ that is operative in the concept of ‘self-disorders’ and we discuss how this self may be disordered or fragile in the schizophrenia spectrum. Second, we offer a detailed psychopathological presentation and discussion of 3 patients with schizophrenia. The vignettes provide paradigmatic examples of self-disorders in schizophrenia. Third, we summarize the main findings in the current empirical research on self-disorders. These findings consistently indicate that self-disorders constitute a crucial, trait phenotype of the schizophrenia spectrum.

References

1. WHO: World Health Organization. The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines. Geneva; WHO: 1992.

2. APA: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Arlington; APA: 2013.

3. Bleuler E. Dementia Praecox or the Group of Schizophrenias, trans. by J. Zinkin. New York; International Universities: 1950.

4. Parnas J., Bovet P., Zahavi D. Schizophrenic autism: clinical phenomenology and pathogenetic implications. World Psychiatry, 2002; 1(3): 131-136.

5. APA: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington, DC; APA: 1994.

6. Andreasen N. DSM and the death of phenomenology in America: an example of unintended consequences. Schizophr Bull, 2007; 33: 108-112.

7. Parnas J., Bovet P. Psychiatry made easy: operation(al)ism and some of its consequences. In: Kendler K., Parnas J. (eds), Philosophical issues in psychiatry III: the nature and sources of historical science. Oxford; Oxford University Press: 2015, pp. 190-212.

8. Parnas J. Differential diagnosis and current polythetic classification. World Psychiatry, 2015; 14: 284-287.

9. Parnas J. Diagnostic epidemics and diagnostic disarray: the issue of differential diagnosis. In: Kendler K., Parnas J (eds), Philosophical Issues in Psychiatry IV. Oxford; Oxford University Press: 2017, 143-145.

10. Sass L.A., Parnas J.: Schizophrenia, consciousness, and the self. Schizophr Bull, 2003; 29: 427-444.

11. Parnas J., Møller P., Kircher T., Thalbitzer J., Jansson L., Handest P., et al. EASE: Examination of anomalous self-experience. Psychopathology, 2005; 38: 236-258.

12. Parnas J., Henriksen M.G. Disordered self in the schizophrenia spectrum: A clinical and research perspective. Harv Rev Psychiatry, 2014; 22: 251-265.

13. Hume D. A Treatise of Human Nature. New York; Oxford University Press: 2007.

14. Zahavi D. Thin, Thinner, Thinnest: Defining the Minimal Self. In Durt C., Fuchs T., Tewes C. (eds.), Embodiment, Enaction, and Culture. Investigating the Constitution of the Shared World. Cambridge, MA.; The MIT Press: 2017, pp. 193-199.

15. Zahavi D. Subjectivity and Selfhood. Investigating the First-Person Perspective. Cambridge, MA; MIT Press: 2005.

16. Zahavi D., Kriegel U. For-Me-Ness: What It Is and What It Is Not. In Dahlstrom D.O., Elpidorou A., Hopp W. (eds), Philosophy of Mind and Phenomenology: Conceptual and Empirical Approaches. New York; Routledge: 2016, pp. 36-53.

17. Zahavi D. Self and Other: Exploring Subjectivity, Empathy, and Shame. Oxford; Oxford University Press: 2014.

18. Sartre J.P. Being and Nothingness, trans. H. E. Barnes. London; Routledge: 2003.

19. Cermolacce M., Naudin J., Parnas J. The ‘minimal self’ in psychopathology: Reexamining the self-disorders in the schizophrenia spectrum. Conscious Cogn, 2007; 16: 703-714.

20. Nelson B., Parnas J., Sass L.A. Disturbance of minimal self (ipseity) in schizophrenia: Clarification and current status. Schizophr Bull, 2014; 40: 479-482.

21. Parnas J., Henriksen M.G. Schizophrenia and mysticism: A phenomenological exploration of the structure of consciousness in the schizophrenia spectrum disorders. Conscious Cogn, 2016; 43: 75-88.

22. Parnas J., Henriksen, M.G. Selfhood and its disorders. In: Stanghellini G., Broome M., Fusar-Poli P., Fernandez A., Rosfort R., Raballo A. (eds), The Oxford Handbook of Phenomenological Psychopa-thology. Oxford; Oxford University Press: in press.

23. Hart J.G. Who One Is. Book 1. Meontology of the ‘I’: A Transcendental Phenomenology. Berlin; Springer: 2009.

24. Henry M. The essence of manifestation, trans. Etzkorn G. The Hague; Martinus Nijhoff: 1973.

25. Saks E.R. The center cannot hold. New York; Hyperion: 2007.

26. Nagai M. The “schizophrenic” in the self-consciousness of schizophrenic patients. Hist Psychiatry, 2016; 27: 493-503.

27. Henriksen M.G., Parnas J. Self-disorders and schizophrenia: A phenomenological reappraisal of poor insight and noncompliance. Schizophr Bull, 2014; 40: 542-547.

28. Parnas J., Henriksen M.G. Disturbance of the experience of self – a phenomenologically based approach. In Waters F., Stephane M. (eds), The assessment of psychosis: a reference book and rating scales for research and practice. New York; Routledge: 2015, pp. 235-244.

29. Jansson L., Nordgaard J. The psychiatric interview for differential diagnosis. Switzerland; Springer: 2016.

30. Henriksen M.G. On incomprehensibility in schizophrenia. Phenom Cogn Sci, 2013; 12: 105-129.

31. Parnas J., Henriksen M.G. Subjectivity and schizophrenia: another look at incomprehensibility and treatment non-adherence. Psychopathology, 2013; 46 (5): 320-329.

32. Henriksen M.G., Parnas J. Clinical manifestations of self-disorders and the Gestalt of schizophrenia. Schizophr Bull, 2012; 38: 657-660.

33. Parnas J., Handest P. Phenomenology of Anomalous Experiences in Early Schizophrenia. Compr Psychiatry, 2003; 44: 121-134.

34. Henriksen M.G., Raballo A., Parnas J. The pathogenesis of auditory verbal hallucinations in schizophrenia: a clinical-phenomenological account. Philos Psychiatr Psychol, 2015; 22: 165-181.

35. Henriksen M.G., Nordgaard J. Self-disorders in Schizophrenia. In Stanghellini G., Aragona M. (eds), An Experiential Approach to Psychopathology. What is it like to suffer from mental disorders. New York; Springer: 2016, pp. 265-280.

36. Parnas J. A disappearing heritage: the clinical core of schizophrenia. Schizophr Bull, 2011; 37: 1121-30.

37. Parnas J. The core Gestalt of schizophrenia. World Psychiatry, 2012; 11(2): 67-69.

38. Bovet P., Parnas J. Schizophrenic delusions: a phenomenological approach. Schizophr Bull, 1993; 19: 579-597.

39. Parnas J., Handest P., Jansson L., Sæbye D. Anomalous subjective experi-ence among first-admitted schizophrenia spectrum patients: empirical investigation. Psychopathology, 2005b; 38: 259-267.

40. Raballo A., Sæbye D., Parnas J. Looking at the schizophrenia spectrum through the prism of self-disorders: an empirical study. Schizophr Bull, 2011; 37: 344-351.

41. Raballo A., Parnas J. Examination of anomalous self-experience: Initial study of the structure of self-disorders in schizophrenia spectrum. J Nerv Ment Dis, 2012; 200: 577-583.

42. Haug E., Lien L., Raballo A. Bratlien U., Øie M., Andreassen O.A., et al. Selective aggregation of self-disorders in first-treatment DSM-IV schizophrenia spectrum disorders. J Nerv Ment Dis, 2012; 200: 632-636.

43. Nordgaard J., Parnas J. Self-disorders and schizophrenia-spectrum: A study of 100 first hospital admissions. Schizophr Bull, 2014; 40: 1300-1307.

44. Parnas J., Handest P., Sæbye D., Jansson L. Anomalies of subjective experience in schizophrenia and psychotic bipolar illness. Acta Psychiatr Scand, 2003; 108: 126-133.

45. Raballo A., Parnas J. The silent side of the spectrum: schizotypy and the schizotaxic self. Schizophr Bull, 2011; 37: 1017-1026.

46. Koren D., Reznik N., Adres M., Scheyer R., Apter A., Steinberg T., et al. Disturbances of basic self and prodromal symptoms among nonpsychotic help-seeking adolescents. Psychol Med, 2013; 43: 1365-76.

47. Raballo A., Pappagallo E., Dell' Erba A., Lo Cascio N., Patane' M., Gebhardt E., et al. Self-disorders and clinical high risk for psychosis: an empirical study in help-seeking youth attending Community mental health facilities. Schizophr Bull, 2016; 42: 926-32.

48. Nelson B., Thompson A., Yung A.R. Basic self-disturbance predicts psychosis onset in the ultra high risk for psychosis ‘prodromal’ population. Schizophr Bull, 2012; 38: 1277-1287.

49. Parnas J., Raballo A., Handest P., Jansson L., Vollmer-Larsen A., Sæbye D. Self-experience in the early phases of schizophrenia: 5-year follow-up of the Copenhagen Prodromal Study. World Psychiatry, 2011; 10: 200-204.

50. Parnas J., Carter J., Nordgaard J. Premorbid self-disorders and lifetime diagnosis in the schizophrenia spectrum: a prospective high-risk study. Early Interv Psychiatry, 2016; 10: 45-53.

51. Haug E., Øie M., Andreassen O.A., Bratlien U., Raballo A., Nelson B., et al. Anomalous self-experiences contribute independently to social dysfunction in the early phases of schizophrenia and psychotic bipolar disorder. Compr Psychiatry, 2014; 55: 475-82.

52. Skodlar B., Parnas J. Self-disorder and subjective dimensions of suicidality in schizophrenia. Compr Psychiatry, 2010; 51: 363-6.

53. Haug E., Melle I., Andreassen O.A., Raballo A., Bratlien U., Øie M. et al. The association between anomalous self-experience and suicidality in first-episode schizophrenia seems mediated by depression. Compr Psychiatry, 2012; 53: 456-60.

54. Haug E., Øie M., Melle I., Andreassen O.A., Raballo A., Bratlien U., et al. The association between self-disorders and neurocognitive dysfunction in schizophrenia. Schizophr Res, 2012; 135: 79-83.

55. Nordgaard J., Revsbech R., Henriksen M.G. Self-disorders, neurocognition, and rationality in schizophrenia: A preliminary study. Psychopathology, 2015; 48: 310-316.

56. Nordgaard J., Handest P., Vollmer-Larsen A., Sæbye D., Thejlade Pedersen J., Parnas J. Temporal persistence of anomalous self-experience: A 5 years follow-up. Schizophr Res, 2017; 179: 36-40.

57. Maj M. The critique of DSM-IV operational criteria for schizophrenia. Brit J Psychiatry, 1998; 172: 458-460.

Downloads

Published

2017-09-06

How to Cite

Henriksen, M., & Parnas, J. (2017). Clinical Manifestations of Self-disorders in Schizophrenia Spectrum Conditions. Current Problems of Psychiatry, 18(3), 177-183. https://doi.org/10.1515/cpp-2017-0014