World psychiatry : official journal of the World Psychiatric Association (WPA)
June 1, 2022
Paolo Fusar-Poli, Andrés Estradé, Giovanni Stanghellini et al.
225 citations
Psychosis unfolds through distinct stages, each with its own core existential experiences. Early phases (premorbid and prodromal) involve loss of common sense, perplexity, lack of immersion in the world, heightened salience, a feeling that something important is about to happen, perturbation of the sense of self, and a need to hide inner turmoil. The first episode brings transitory relief from delusions, intense self-referentiality, permeated self-world boundaries, internal noise, and dissolution of self with social withdrawal. Later stages (relapsing and chronic) involve grieving losses, feeling split, and struggling to accept inner chaos, a new self, diagnosis, and uncertain future. Treatment experiences include both positive and negative aspects, with recovery understood as reconstructing personhood and re-establishing bonds toward meaningful goals.
Consciousness and cognition
June 1, 2013
Louis Sass, Elizabeth Pienkos, Barnaby Nelson et al.
144 citations
Anomalous self-experiences are central to schizophrenia and other psychiatric disorders. This analysis compared such experiences in schizophrenia-spectrum disorders, as cataloged in the EASE, with those described in severe depersonalization. Numerous affinities were found, showing that pure forms of diminished self-affection (depersonalization) can involve experiences resembling those of schizophrenia. However, important discrepancies emerged, suggesting that more automatic or deficiency-like factors—probably involving self/world or self/other confusion and erosion of first-person perspective—are more distinctive of schizophrenia-spectrum disorders.
Consciousness and cognition
September 1, 2013
Louis Sass, Elizabeth Pienkos, Barnaby Nelson
42 citations
Comparing anomalous self-experiences common in schizophrenia with those of normal individuals in an intensely introspective orientation reveals significant similarities but also important differences. Affinities include feelings of passivity, fading of self or world, and alienation from thoughts, feelings, or the lived-body. Differences involve confusion between self and world and severe dislocation or erosion of first-person perspective, qualities unique to schizophrenia. The comparison places putatively schizophrenic self-disorders in a broader context, evaluates hypotheses about core processes in schizophrenia, and orients investigation of pathogenetic pathways and psychotherapeutic interventions.
Early intervention in psychiatry
June 1, 2019
Barnaby Nelson, Emily Li, David C Cicero et al.
39 citations
The Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE) shows strong construct validity as a self-report measure of minimal self-disturbance. In a sample of 46 participants including ultra-high risk and first-episode psychosis patients and healthy controls, the IPASE correlated very strongly (r = 0.92) with the gold-standard interview measure (EASE). It also correlated strongly with general psychopathology and positive psychotic symptoms, moderately with negative symptoms, and weakly with manic symptoms. The IPASE may serve as a screener but cannot replace the in-depth assessment of minimal self-disturbance, which requires clinical expertise.
Early intervention in psychiatry
March 1, 2023
Lachlan Kent, Barnaby Nelson, Georg Northoff
35 citations
Distortions in how time is experienced, perceived, and processed appear across many psychiatric disorders, including depression, mania, anxiety, autism, impulse-control, dissociative, and attention-deficit/hyperactivity disorders. A proposed Transdiagnostic Taxonomy of (disordered) Time (TTT) maps these temporal disturbances onto a 2 × 2 × 2 state space that combines psychological models of temporal processing with phenomenological models of subjective time experience. The taxonomy differentiates diagnoses primarily involving distorted macro-level phenomenal temporal experiences (anxiety, dissociation/PTSD, depression, mania) from those involving distorted micro-level temporal processing (psychotic, impulse-control, autistic, and attention-deficit/hyperactivity disorders). Temporal distortions may precede functional decline, suggesting potential for early detection and intervention in at-risk groups.
Consciousness and cognition
January 1, 2020
Abigail Wright, Barnaby Nelson, David Fowler et al.
26 citations
Auditory perceptual biases, such as a tendency to hear things differently, are linked to anomalous self-experiences, especially feeling alienated from one's surroundings and emotional numbing, in people with first episode psychosis and healthy controls. No link was found between metacognitive efficiency and anomalous experiences. The findings support the minimal self-disturbance model of schizophrenia spectrum vulnerability, particularly the idea of hyperreflexivity.
Psychopathology
January 1, 2008
Barnaby Nelson, Louis A. Sass
24 citations
The relationship between substance use and psychosis is usually studied as a cause-and-effect question, but the subjective experiences of both are often overlooked. This paper compares the phenomenology of psychosis onset, based on Sass's four components (Unreality, Fragmentation, Mere Being, Apophany), with the experience of hallucinogenic intoxication as described by Huxley. The analysis finds significant parallels, including a breakdown of the sign-referent relationship and disconnection from the practical world. However, in psychosis this breakdown feels like alienation from self and world, while in hallucinogenic states it is experienced as mystical union and revelation. The authors suggest a shared factor—psychotic-like experience—and propose further research on other drugs like cannabis.
The lancet. Psychiatry
February 1, 2026
Rosa Ritunnano, Jeannette Littlemore, Barnaby Nelson et al.
8 citations
Delusions in first-episode psychosis are not isolated symptoms but emerge from a global shift in how a person experiences self and world, shaped by early negative emotions like shame. In a qualitative study of ten adults, persecutory, reference, and grandiose or religious themes were common and overlapping. Narrative interviews revealed that recurrent shame, anger, and fear, along with efforts to avoid or immerse in these emotions, preceded delusions. Three emotional transformation patterns were identified: from embodied shame to invincibility, from meaninglessness to love and hope, and feeling cut off in a simulation. Delusions reflect an embodied, temporal process where bodily experiences link to extreme appraisals, such as being a bad person or connected to God. Interventions should target the lived body and social environments for emotional regulation.
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.
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.
The lancet. Psychiatry
March 1, 2026
Jasper Feyaerts, Pavan S Brar, Louis Sass et al.
1 citation
Psychiatric research has long sought to identify and treat people in the early stages of psychosis, but progress has been limited. This paper argues that combining dynamical systems theory with the phenomenological self-disturbance model of schizophrenia can improve understanding and prediction of psychosis. The integration specifies causal processes involving altered self-awareness and reality-awareness, whose dynamics can be modeled to anticipate the onset and recurrence of psychotic episodes. This approach may enable earlier, personalized therapeutic interventions. Empirical testing of the model requires intensive longitudinal studies and phenomenological assessment methods. The authors also discuss theoretical and methodological challenges to implementing their proposal.
Psychopathology
August 18, 2025
Evan J Kyzar, George H Denfield, Jasper Feyaerts et al.
1 citation
Integrating methods from phenomenology can strengthen the application of dynamical systems theory (DST) in psychopathology research. Phenomenological psychopathology improves DST-based investigations by specifying core symptoms more precisely through a focus on subjective experiences and by deepening theoretical understanding of how symptoms evolve in severity over time. Using clinical high risk for psychosis as a test case, the article demonstrates the utility of combining phenomenologically informed theory and DST, examining the ipseity-disturbance model of psychosis development. The authors offer a vision for broader integration of DST and phenomenological research methods to better understand and predict psychiatric disorders and transitions in mental health states.
January 18, 2024
Jasper Feyaerts, Barnaby Nelson, Louis A. Sass
1 citation
preprint
Phenomenological research on schizophrenia often views self-disorders as disturbances of the 'minimal self,' the most basic sense of self. This paper identifies challenges for that view, including problems with the minimal self being considered essential to conscious experience and the fact that some schizophrenia patients experience an exaggerated, not diminished, sense of self. The authors then explore an alternative 'transparency-view' of consciousness, which treats self-awareness as a transparent quality of experience rather than a separate entity. They argue this view can account for loss-of-self experiences, aligns with the concept of hyper-reflexivity (excessive self-awareness), and explains instances of increased selfhood. The paper suggests this alternative may offer advantages for research and clinical approaches.