Self-disturbance and schizophrenia: structure, specificity, pathogenesis (Current issues, New directions).

The ipseity-disturbance or self-disorder hypothesis proposes that a disruption of minimal or core self-experience is central to schizophrenia. This paper reviews and refines that model, recommending research into what is distinctive about the schizophrenia spectrum, the internal structure of self-disturbance, and testable pathways for pathogenesis and therapy. Exploratory comparisons of self-anomalies in mania, psychotic depression, depersonalization disorder, and intense introspection found similarities—such as alienation of thoughts and bodily experiences, fading of self and world—but also key differences: outside schizophrenia, severe erosion of minimal self-experience or confusion of self and other was absent. These findings support and refine the model. Future work should treat self-experience as an independent variable to study its links with cognition, affect, expression, and neural functioning.

Study at a glance

Abstract

This paper offers an overview and clarification of the ipseity-disturbance or self-disorder hypothesis regarding schizophrenia, with focus on some recent and recommended research and theoretical refinements. There is need to expand research and theorizing in several directions-in order to: 1, specify more precisely what is truly distinctive in the schizophrenia spectrum, 2, explore internal structure and explanatory potential of this purported disturbance of minimal- or core-self experience, 3, generate testable hypotheses concerning pathogenetic pathways and psychotherapeutic interventions. Comparative studies can make a crucial scientific contribution. Some recent, exploratory studies are described: published reports were examined for alterations of self-experience in conditions outside the schizophrenia spectrum-mania, psychotic depression, and depersonalization disorder-and in one unusual attitudinal stance: intense introspection (as refined in early 20th century psychological research). Remarkable similarities (e.g., alienation/reification of thoughts and bodily experiences, fading of self and world) as well as some important differences (e.g., absence, outside schizophrenia, of severe erosion of minimal self-experience or real confusion of self and other) in types of self-anomalies were found. These support but also refine the ipseity-disturbance model. Future research should treat self-experience as an independent variable, manipulating and measuring this dimension (in both schizophrenic and non-schizophrenic populations) to study its associations with anomalies of cognition, affect, expression, and neural functioning already identified in schizophrenia. The self-disorder model offers an integrative and dynamic view of schizophrenia congruent with recent trends in cognitive neuroscience and consistent with the heterogeneous, varying, and holistic nature of this enigmatic illness.