Consciousness and cognition
July 1, 2016
Josef Parnas, Mads Gram Henriksen
128 citations
Mysticism and schizophrenia, though distinct categories, share important phenomenological similarities that have been largely overlooked. This paper explores structural analogies between key features of mysticism and major clinical-phenomenological aspects of schizophrenia spectrum disorders, including attitudes, the nature of experience, and the experience of an 'other' reality. These features revolve around basic dimensions of consciousness and appear to involve a specific alteration of the structure of consciousness itself. This finding has implications for understanding consciousness and its psychopathological distortions.
Consciousness and cognition
September 1, 2019
Mads Gram Henriksen, Josef Parnas, Dan Zahavi
82 citations
In consciousness research, the authors defend experiential minimalism, the view that for-me-ness (or minimal selfhood) is a necessary, universal feature of all conscious experience. They refute claims that thought insertion in schizophrenia is a counterexample showing experiences without for-me-ness. Instead, they argue that thought insertion involves a disturbed, not absent, for-me-ness. The authors highlight unaddressed methodological and psychopathological problems in philosophical discussions of thought insertion and offer a novel account of how for-me-ness is disturbed in schizophrenia spectrum disorders, potentially contributing to the formation of thought insertion.
European archives of psychiatry and clinical neuroscience
December 1, 2021
Josef Parnas, Annick Urfer-Parnas, Helene Stephensen
59 citations
People with schizophrenia can live in two separate worlds at once: the shared social world and a private delusional world. Eugen Bleuler called this "double bookkeeping" but never explained it. This article shows that double bookkeeping appears across many psychotic symptoms and can be observed before psychosis starts and in schizotypal disorder. The authors propose that double bookkeeping arises from instability in how the self feels itself from within, a process called auto-affection. They discuss four implications for diagnosis, understanding, treatment, and research into causes.
Psychopathology
January 1, 2021
Julie Nordgaard, Mads Gram Henriksen, Lennart Jansson et al.
52 citations
The concept of disordered selfhood in schizophrenia reemerged around the year 2000. In 2005, the Examination of Anomalous Self-Experience (EASE) was published as a psychometric tool. This article traces the historical background of the EASE, explains the idea of a disorder of the basic or minimal self using phenomenological philosophy, and describes the clinical signs the EASE targets. The authors share their own experience using and teaching the EASE and review the empirical evidence gathered so far. They argue that basic self-disorder is a key phenotype of schizophrenia spectrum disorders, offering a path for empirical research into causes and for psychotherapeutic treatment.
Schizophrenia research
April 1, 2020
Karl Erik Sandsten, Julie Nordgaard, Troels Wesenberg Kjaer et al.
45 citations
Patients with schizophrenia often report not recognizing themselves in the mirror, a form of self-alienation. Using the Enfacement Illusion, a multisensory paradigm that manipulates self-other facial recognition through visuo-tactile stimulation, this study compared 35 patients with schizophrenia and 35 healthy matched controls. At baseline, patients showed a significant skew toward perceiving another person's face as their own. After both synchronous and asynchronous visuo-tactile stimulation, patients' self-recognition was significantly altered compared to baseline. In contrast, healthy controls only showed altered self-recognition after synchronous stimulation, consistent with prior research. The findings suggest that temporal factors in multisensory integration may contribute to altered self-recognition in schizophrenia.
European archives of psychiatry and clinical neuroscience
September 1, 2024
Helene Stephensen, Annick Urfer-Parnas, Josef Parnas
28 citations
In schizophrenia, many patients experience a second, private reality alongside everyday shared reality, a phenomenon called double bookkeeping. In a qualitative study of 25 patients, most felt in contact with another dimension of reality that they considered more profound and real than the shared world. Hallucinations and delusions belonged to this separate reality, which patients usually kept distinct from ordinary life. This double reality persisted even during remission, and patients did not view their condition as an illness like a physical disease. Many described a vague sense of duality that began in childhood or early adolescence, tied to a fundamental alienation from self, world, and others.
Schizophrenia research
March 1, 2024
Josef Parnas, Janne-Elin Yttri, Annick Urfer-Parnas
28 citations
Auditory verbal hallucinations in schizophrenia differ from ordinary perception in several ways, and only a minority of patients experience them as localized externally. The official definition of hallucinations as a perception without object does not fit the lived experience of these voices. Auditory verbal hallucinations are associated with anomalies of subjective experience known as self-disorders, and they should be understood as a product of self-fragmentation. This has implications for how hallucinations are defined, how clinical interviews are conducted, how psychotic states are conceptualized, and what targets are pursued in pathogenetic research.
Psychopathology
January 1, 2015
Andreas Rosén Rasmussen, Josef Parnas
22 citations
In schizophrenia spectrum disorders, mental imagery can become unusually vivid and take on quasi-perceptual qualities—acquiring spatialization, constancy, and autonomy—while the normal sense of unreality is weakened. This perceptualized imagery often triggers strong emotional responses. The authors argue that these anomalies stem from a core disturbance in the minimal self (unstable first-person perspective) and propose that such pathology of imagination is key for early and differential diagnosis, distinguishing schizophrenia from other disorders where similar phenomena like obsessions occur.
Frontiers in psychiatry
January 1, 2021
Andreas Rosén Rasmussen, Andrea Raballo, Antonio Preti et al.
21 citations
Anomalies of imagination—disturbances in the basic structure of fantasies and imagery—are highly characteristic of schizophrenia-spectrum disorders and closely related to self-disorders. In a study of 81 participants, including patients with schizophrenia or other non-affective psychosis, schizotypal personality disorder, other mental illness, and healthy controls, these anomalies aggregated significantly in the schizophrenia-spectrum group compared to other mental illness and healthy controls, with no difference between schizophrenia and schizotypal disorder. Network analysis showed anomalies of imagination were closely interconnected with self-disorders, while correlations with perceptual disturbances and positive, negative, and general symptoms were moderate but separated in the network.
Schizophrenia research
August 1, 2024
Josef Parnas, Karl Erik Sandsten
17 citations
Schizophrenia's resistance to understanding its causes may stem from neglecting its characteristic overall pattern (Gestalt) of psychopathological structure. Disorders of selfhood play a crucial role in forming this Gestalt. A phenomenological account of the self is presented, followed by basic complaints in schizophrenia that reflect a disordered selfhood, often dating back to childhood. Characteristic features of schizophrenic psychosis include "double bookkeeping," where hallucinations, delusions, and double bookkeeping are all linked to instability of the self. Self-disorders play an important diagnostic role in encounters with patients. The article emphasizes the role of phenomenology in psychiatric research.
Schizophrenia bulletin
May 25, 2025
Andrea Raballo, Mads Gram Henriksen, Michele Poletti et al.
9 citations
Self-disorders—non-psychotic anomalous self-experiences—cluster specifically in schizophrenia spectrum disorders, including familial high-risk groups. Over three decades, the concept has matured from clinical observations into a defined research domain. Self-disorders serve as a quantifiable trait phenotype for genetic liability and as a risk phenotype that precedes overt symptoms like schizotypal features and positive, negative, and disorganized symptoms. This framework offers insights into the nature of these conditions and holds promise for improving diagnostic accuracy, prognostic assessments, and intervention targets.
Psychopathology
June 30, 2025
Stephan Lechner, Karl Erik Sandsten, Dusan Hirjak et al.
7 citations
Altered experiences of time and space are linked to general symptoms and basic self-disorders in people with schizophrenia spectrum disorder. Self-disturbance acts as a key mediator through which fundamental time-space disruptions influence perceptual changes as well as negative, positive, and general symptoms. Data were collected at three medical expert centers using semi-structured phenomenological interviews and analyzed with network and mediation methods.
Early Intervention in Psychiatry
July 2, 2023
Marija Krcmar, Cassandra Wannan, Suzie Lavoie et al.
6 citations
Basic self-disturbance is a potential core vulnerability marker for schizophrenia spectrum disorders. The Self, Neuroscience and Psychosis (SNAP) study tests a neurophenomenological model of psychosis by examining clinical, neurocognitive, and neurophysiological variables in individuals at ultra-high risk (UHR) for psychosis. It includes 400 UHR individuals, 100 clinical controls without attenuated psychotic symptoms, and 50 healthy controls. Participants complete baseline assessments and electroencephalography; UHR participants are followed for 24 months with clinical assessments every 6 months. The protocol aims to develop a prediction model for persistence or worsening of UHR symptoms at 12 months and to determine how specific these disturbances are to attenuated psychotic symptoms.
European archives of psychiatry and clinical neuroscience
April 1, 2026
Lars Siersbæk Nilsson, Julie Nordgaard, Mads Gram Henriksen et al.
5 citations
Poor insight in schizophrenia is linked to fundamental alterations in the structure of subjective experience, known as self-disorders, rather than to other symptoms or general intelligence. In a study of 67 patients with schizophrenia or non-affective psychosis in a non-acute phase, those with impaired insight had significantly higher levels of self-disorders than those with good insight, while positive, negative, and depressive symptoms did not differ between groups. Regression analyses showed that only self-disorders were significantly associated with impaired insight. These findings support the idea that self-disorders contribute to poor insight, which may inform early intervention and treatment.
Psychopathology
January 1, 2024
Helene Stephensen, Annick Urfer-Parnas, Josef Parnas
4 citations
Feeling fundamentally different from others (Anderssein) is a core but underexplored experience in schizophrenia spectrum disorders. Based on interviews with 25 patients, most reported having felt this way since childhood, often describing it as existing outside shared reality. Intersubjective reality felt unreal or inauthentic, while their inner world was invaded by alien thoughts, emotions, or social rules. The onset of psychosis involved a gradual extension of these altered structures of subjectivity. The authors conceptualize Anderssein as a halted dynamic movement between particularity and intersubjectivity, with critical implications for understanding schizophrenia's onset.
Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists
August 1, 2025
Vera A Barata, Suzie Lavoie, Łukasz Gawęda et al.
3 citations
Among 43 individuals at ultra-high risk for psychosis, those who later remitted had lower baseline levels of basic self-disturbance than those whose symptoms persisted or who transitioned to psychosis. Basic self-disturbance scores predicted worse clinical outcomes at 12 months. Source monitoring deficits were greater in first-episode psychosis patients than in those at ultra-high risk whose symptoms persisted or transitioned. The findings suggest that high levels of basic self-disturbance may serve as a predictor of poor prognosis in ultra-high risk patients.
L'Encephale
August 1, 2025
Andreas Rosén Rasmussen, Helene Stephensen, Julie Nordgaard et al.
A French translation of the Examination of Anomalous Fantasy and Imagination (EAFI) is presented, along with an introduction to the phenomenology of imagination and its experiential alterations. The EAFI's interrater reliability was tested in a diagnostically heterogeneous sample of 20 inpatients, yielding agreement from 0.6 to 1.0 with an average κ of 0.84, and internal consistency (Cronbach's α) above 0.88. The anomalies of imagination explored by the EAFI are suggested to reflect an alteration of the structure of consciousness and belong to a fundamental, generative layer of psychopathology, with potential relevance for differential diagnosis, especially in first-contact patients.
Schizophrenia research
May 1, 2022
Andreas Rosén Rasmussen, Josef Parnas
Obsessive-compulsive symptoms are common in schizophrenia-spectrum disorders and can complicate diagnosis, especially in first-contact patients. Classic psychopathology defines true obsessions in obsessive-compulsive disorder (OCD) as intrusions with intact resistance and insight, while in schizophrenia, pseudo-obsessive-compulsive phenomena lack resistance and align with thought disorder or catatonia. Current diagnostic systems use broader, vaguer definitions, causing overlap with delusions and other anomalies. The authors examine links between obsessive-compulsive phenomena and disturbances of basic experience in schizophrenia-spectrum disorders, suggesting these experiential alterations aid differential diagnosis and early detection.