Basic Self-Disturbances beyond Schizophrenia: Discrepancies and Affinities in Panic Disorder - An Empirical Clinical Study.
Luís Madeira, Sergio Carmenates, Cristina Costa, Ludgero Linhares, Giovanni Stanghellini, Maria Luísa Figueira, Louis Sass
Psychopathology January 1, 2017 Peer reviewed DOI: 10.1159/000457803 via PubMed
Summary
People with panic disorder report anomalous self-experiences at levels similar to those seen in schizophrenia, though the types of experiences differ. In a study of 47 panic disorder patients and 47 healthy controls, patients scored much higher on measures of self-disturbance, with an average score of 17.94 compared to 1.00 in controls.
Study at a glance
| Design | cross-sectional study |
|---|---|
| Sample size | 94 |
| Population | hospital outpatients with panic disorder and healthy control subjects |
| Key finding | Panic disorder patients showed elevated anomalous self-experiences compared to healthy controls, approaching levels found in schizophrenia spectrum samples, but the pattern of experiences differed, suggesting more superficial disturbances related to depersonalization and derealization rather than profound ipseity disturbance. |
Abstract
Anomalous self-experiences (ASEs), presumably involving alterations in "core" or "minimal self," have been studied as manifest in schizophrenia and its spectrum, in contrast with mood disorder and personality disorder samples. This is the first study to examine ASEs in panic disorder (PD), beginning the exploration of these disturbances of subjectivity in anxiety disorders. We aimed to clarify what might, or might not, be specific to the schizophrenia spectrum domain - which, in turn, could be useful for developing pathogenetic models for various disorders. 47 hospital outpatients with PD and no other medical and psychiatric comorbidity and 47 healthy control (HC) subjects were assessed with the Examination of Anomalous Self Experiences (EASE) and Cambridge Depersonalization Scale (CDS). All our PD patients had overall ASE and EASE scores significantly higher than our HCs (mean ± SD 17.94 ± 11.88 vs. HC 1.00 ± 1.81), approaching levels found in previous schizophrenia spectrum samples. The distribution of particular EASE items and subitems in the PD sample was heterogeneous, varying from rare (<10%) or absent (termed "discrepancies" with schizophrenia spectrum: 29 items) to being present in >50% of subjects ("affinities" with schizophrenia spectrum: 7 items). EASE and CDS scores were highly correlated (r = 0.756, 95% CI 0.665-0.840). PD patients scored higher on items suggesting common forms of derealization and depersonalization, perhaps suggesting "secondary" and defensive psychological processes, while lacking indicators of more profound ipseity disturbance. Our study supports the basic-self-disturbance model of schizophrenia, while suggesting the possibility of transnosological "schizophrenia-like phenomena," which might require careful phenomenological exploration to be distinguished from those of true psychotic or schizophrenic conditions.